AN ENCYCLOPEDIA OF THE PRACTICE OF MEDICINE, BASED OX BflCTEKIOLOQT, J. BUCHANAN, ^I. D. .^ ',^,^' FIRST EDITION. NEW YORK : Published by R. R. Russell. 1890. COPYRIGHTED By J. Rttchanax, M. D., XKW YORK. Press of Avil Printing Co., rHILADKLPHl^. PUBLISHER'S PREFACE. From various considerations it is evident that Good Health in a great measure rests upon abundance of pure air and light, good food and drink, proper clothing and housing, the daily removing by bathing and otherwise the waste matter of our bodies, which to each of us is a poison. Successive epidemics of preventable and unpreventable disease have taught us that if we wish to maintain the highest possible standard of health as a nation, wdth a people vigorous and sound, we must secure to them the necessaries of life in due proportion and of proper purity ; that if we are to prevent disease and degra- dation of elementary living matter, there must be no overwork, )L0 exhaustion, no mental strain, and all insanitary states, together with ^nimal and vegetable waste, must be got rid of as speedily and c Tectually as possible. The statistics of our country show that the greatest mortality, immense waste of human life, is due to the presence of microbial diseases. The aim and scope ot the present work is to aid in the elucidation of the Germ Theory of Disease ; to the introduction of Bacte.'icides in treatment, so as to give all scientific physicians the means of grappling with maladies which baffled his pre- decessors. It 13 therefore a Practice of Medicine based upon Bacteriology, bringing the science and art of medicine forward as a great na- tional prophylactic, not only to prevent the evolution of disease germs, but the best means of preventing their dissemination and securing their destruction and extinction. It is intended as an introduction to the science of Bacteriology, and has been written more especially for those who have neither the time nor opportunity to pursue a thorough investigation ot 12 PUBLISHER'S I'KKKACE. the subject, our sole aim being to render the work as practical as possible. Theoretical discussions have been avoided, and as far as possi- ble accepted opinions and definite facts have been given. The introduction of a New Materia Medica, consisting of Bac- tericides or Microbicides, for sterilizing and destroying disease germs in and on the body, is an important feature of the work. The stamping out of disease germs, the creation of a higher type of manhood, the mitigation of human suffering and prolong- ing life, are themes which pervade the entire volume. The preventing of the dissemination of microbes, and their complete extinction, are briefly hinted at by opening up a new field of therapeutic success. The illustrations of the various Disease Germs are a marvel of art, being all microscopic, then photographed, and subsequently reduced to ordinary cuts. These are the work of two of the most celebrated artists in New York city, namely, Adolph Kleminger and Rudy Ortmayer. They have faithfully portrayed from pathological specimens, by original microscopic views, every microbe found in morbid states of the human body. The profession at large can attest their ac- curacy. The various specimens of morbid anatomy are also the pro- duction of those eminent artists. The photographing of the entire Eight Hundred Illustrations is the work of the Franklin Photo- Electro-Type Company, No. 305 Pearl street, New York city, the superior excellency of whose work is readily demonstrated by any one. We owe a deep debt of gratitude to the entire Medical Profes- sion of Great Britain and America for specimens of microbes, with the results of their culture and sterilization. The press-work and binding are the product of the famous AviE Printing Company, Nos. 3941-43-45 Market street, Phila- delphia, Pa., who are celebrated throughout the world for medical work. To Mr. John Avil we are specially indebted for his un- swerving, persevering solicitude in passing the work through the press. INDEX TO ILLUSTRATIONS. Abdomen, showing the viscera, 17. Acarus foUlculorum, highly magnified, 21. Actinomyces, a fungus, micro-parasite, 23,401. A group from human liver, 24. The fungus, 24. Human liver, 24. From the tongue of an ox, 25. Alcoholic vapor bath, 588. Adipose tissue, highly magnified, 30. Amceba of nasal catarrh 168, 389. Actively at work, 169. Animalcules in drinking water, 237. Anthrax in the blood and also in pustule, 59>39- -Vnus imperforate, four varieties, 493. Aorta, 733. Apoplexy cerebral, clot in base of brain, 65. Spinal clot in cord, 67. Aquatic saprophytus, 947. Asperillus albus, 934. Asperillus niger, three stages of growth. 755- Aural fungus, in three stages of growth, 755- Aural polypus, difterent varieties, 811. Bacteria, 390. Bacteria pneumonia, 391. Gastric fever, 321. Rhinoscleroma, 421, 917. Pemphigus, 793. Magnified, 947. Dental caries, 1015. Bacillus anthrax in human blood, 59. In pustule, 59. Alvei in honey, three diagrams, 258, 943 Alvei in intestines, 258. Amylobacta, 391, 573, 906. Comma cholera infanturn, 181, 257. Epidemic cholera, 403. Cancer, 394. Figurans in garden earth, 257, 949. Foot sweat, 1013. Leprosy, 676, Loevis, 935. Bacillus Mallei, (glanders) 396,425. Megatherium sauer krautj 257. Boilied cabbage. 258, 94S, 949. Malaria, 323, 405. Attacking red discs, 324. In pink marrow, 325. In oysters, sewage flats, 942. Putrid fish, 258. Saprogenes, (caries and necro.sisi 152, 397. Scarlatina, 359, 408. Large colony, 362. Stagnant water, 944. Subtilis, (microbe of hay fever) 351 399- 935- Syphilis, 400, 1184. Tuberculosis in blood, 397. Eye, 571, 1043, 1044, 1046. In rectum, 1049. On skin, 1053. 1054, 1069. Barber's itch, 792. Bladder diagram, 871, 977. Bladder and Seminal Vesicles, 978. Blood corpuscles, 45. Brain, 546. Breast, (female) 561. Calculi gall, vertical section, 108. Calculi renal, 112. Cartilages in gout, 429. Cancer on abdominal wall, 120. Of the lip in a woman, 122. Breast before removal, 124. After removal, 124. Scalps, 125. Brow, 126. Tongue, 126. Temporal region, 127. Antrum, 127. Outer canthus of eye, 128. Arm, 129. Lung, 130. Head of penis, 137. Tongue, l^o, 141, 142, 143. Neck of uterus, 146. Microbe entering os uteri, 147. , .. Infiltrating neck of uterus, 147, 14S, 149- 14 INDEX TO ILLUSTRA'lIONS. Cancer tilling up its cavity, 150, Extehial labia, 151. Cholera Bacilli, 403. Cocci found in the mouth in Quinsy, 645. Comma-bacillus in stools, 257. At work in bowels, 184. In sewers, 937, 946. Concretion, section intestinal, 235. Conferva in bronchitis, 99, 406. Crenothriiis kuhniana, 946. Crystals of cholesterin from gallstone, 108. Cysts in the kidney, 24(). Liver, 246. Lung, 247. Mesentery, 247. Cysticercus in the eye, 464. Fat of the hog, 778. Diphtheric Membrane, 271. Diphtheria Pasture Field evolution of Germ, 272. Embryo Trichinia, 782. Human, 832, 833. Emphysema of the Lungs, 299. Enteritis, Different stages, 557. l-'rysipelas, Microbe in skin, 308. Fatly Globules in cardiac degeneration, I'atty Liver. 312. Filaria Sanguinis Hominis, 368. Fissure of the Rectum, 370. 371. Fistula Rectal, 372. Gail-Bladder, filled with calculi, 102. Gastritis, Section of stomach walls, 636. Chronic, 637. Glucose fungus in diabetes, 250. Gonococcus in the eye, 571. Hair-lip, five different forms, 531. Hemorrhage in the kidney, 441. Hemorrhoids, internal and external, 447, 448, 453- Hydatids, 462, 463. In walls of uterus, 463. Voung brw^ds in eye, 464. ^ In lung, 466. Hydrocele, 467. Hydrocei)halus, 469. Hymen imperforate, 7 different varieties, 494. Hypersemia of the liver, 595, 597. Hypertrophy of the prostate gland, 478; 2 cuts, 479; 2 cuts, 480; 2 cuts, 481 ; 2 cuts, 482 ; 2 cuts, 483 ; 1 cut, 484. Human ova, 6 and 8 weeks, 832. Imperforate Anus, four different forms 493- Imperforate Hymen, seven different forms, 494. Inflammation of the bowels, enteritis, (3^ 557- Influenza, Infusorial Catarrh, 652. Itch-mite, 785. Kidney, vertical section of a human kid- ney, 26. Cysts, 246. Contracted, 582. Three different forms of degenera- tion, 583. Labor, 841, 842, 843, 844,848, 849. Labor Complex, 856, 857, 858, 859, 860. Laryngitis, vertical section membrane, 592. Liver, Congestion, 595. Fatty, 1 197. Lupus on the cheek, 682. Nose, 683. Mesentery, engorged with Typhoid Germ, .334. 335- Microbe of l)oils, 404. Actinomyces, 401. Cancer, 114. Catarrh Uterine, 176. Caries, 397. Cutaneous, 423. Cholera, 185. Diabetes, 250. Diarrhea, adults, 255,401. " infants, 252, 402. Diphtheria, 268, 274, 276, 278. Dysentery, 280, 281, 282, 403. Dengue, 342, 416. Dental caries. 397. Ecchymosis, 239. Glanders, 396. Gonorrhea, 407, (3) 1175. Hooping-cough. 410, 459. Hay Fever, 351, 399. Indican, 395. Influenza, 404. Leprosy, 241, 676. Lupus, 681. Malaria, 326, 325, 678. Measles, 356. 408. Molluscum, 693. Neurasthenia, 704. Puerperal, 348. Pneumonia, 391. 402, 403. Pemphigus, 790. Small-pox. 363, 409. |rV|)t;X. TO ILLUSTRATI01\S. Microbe of Sj'philis, 1 187. Tetanus, 396, 1008. Tetragonas, 409. Typhus Fever, 401. Typhoid Fever, 332, 333, 334. Venereal, 1187. Micrococci Urea, 39, 157. In chains, 348. Microsporon Missitissimum, 310. Moulds, 948. Mouth, 611. Nest of Lupus Germs. 681. Trichina in muscle, 781. Nipple, (oidium albicans) 562, Oidium albicans, (aphth;?e) 64, 270, 411, 562, 612. Omentum filled with cholera germs, 691. Ophidium Sanguinis in stagnant water, 946. Organisms in the mouth, 1013, 1022. Othoematoma in primary stage, 753. More aggravated, 753. Ova filiaria sanguinis hominis, 368. Oxaluria, 267. Pericarditis and iis microbe, 616. Penis, illustrating three discharges from urethra, 979. Pigment liver, 592. Piles, 447, 448, 453. Phlebitis, 651. Phosphates and chlorides in urine, 265. Placenta prgevia, 850. Pleurisy and its microbe, 622. Pneumococcus, (pathogenic microbe) 391. Pneumonia, 601. Prune juice sputum, 602, 604, 605, 606. Pneumothorax, 806. Polypoid growths, 808, 809, 823. Polypus of the ear, 81 1. Rectum, 818, 819. Umbilical, 820. Uterus, 822. Pelvis, (female). 828. Presentations in labor, nine diagrams, 852. Prolapse of the rectum, 864. Utei-us, 867. Puerperal fever germ, 348. Rectal fissure, 370. With piles, 370. From syjihilis, 371. Rectal fistula varieties, 372. Renal hemorrhage infarction of kidney, 441, 578. Rupia, 795. SarcincV: ventriculi, i6i, 166, 418. Aurantiaca, 934. Saccharine fungus of diabetes, 417. Scabies, 785. Sclerosis in paralysis, 770. Section of the molluscum, 693. Kidney in meat poisoning, 945. Rectal polypus, 818, 819. Skin with the trichoplyton, 789. Sewer gas and its microbes, 936. Side view of female genital organs, 828. Spermatozoa dwarfed, 171, 960, 972, Healthy, 686, 977. Spermatic crystals, 486, 499. Spinal cord, 639, 640. Inflammation, 640, Spirillum plicatile, 411. Volitans, 257, 946. Marsh, 935, 946. Streptococcus of diphtheria, 268. Er\sipelas, 308, 414. Cerebro-spinal meningitis, 354, 413 Foot disease, 414. Pyogenes, 415, 884, 885. Puerperal, 415. Stricture of Oesophagus, 994. Rectum, 996. Urethra, 999. Suppuration of liver, 598. Taenia Solium, head, neck and 779- Crown of hooks, 780. Tinea capitis, 787. Tonsurans, 786, 798. Favosa, 791. N'ersicolor, 790. Sycosis, 792. I Tongue, 101 1. Trichina Spiralis, 781. I Tubercle Bacilli, 1022, 1023, 1025, I 1032. Tumors, Adenoma, 1 1 15. ! Section of, on breast, 1 1 16. i Adeno-fibroma, (3) 1118. Adeno-fibroma, sarcoma, 1118. i Angioma, (2) nil. Cystic of breast, 1098. Cystic on neck, 1098. Embryonic type, 1095. Epithelioma on lip, 1120. ' Fibroid, 1096. In female breast, 1096. Fibroma of the cerebellum, icgf) Hyahne myxoma, 1098. Lymphomata, 1105. Myoma, (2) 1 108. Neuroma in skin, mo. Ovarian dermoid, (3) I no. )oinl ip t. INDEX TO ILLUSTRATIONS. Tumors, Ovarian, with lock of hair, iioi. Papilloma dermoid, 1113, (3) 1 1 14. Pedunculated dermoid, iioo. Sarcoma, 1105. Sections of, (3) 1106. In bladder and in liver, 1107 ricers, Bacteria in, 1123, 1137. Cervix uteri, 1145. Discharge from, 1141. Duplicate, 1 128. Ducts and acini, II32. Germs in, Irritable, 1123. Hypertropliy with ulceration, 1145. Indolent, Bacteria in, 1124. Induration of neck of uterus, 1144. Internal walls, 1147. Intra-uterine catarrh with ulcer,! 146. Larynx, 1135. Perforating of stomach, 1130. Phagedenic, 1126. Pus from syphilitic, 1 128, 1141. Rectal, 1 141. Spores of anthrax in, 1 1 29. Tubercular, 1124, Tubercular bacilli in, 1124. Urine, Uric acid, common form in, 1152. Blood m, 1 163. Epithelial casts, 1162. Fatty casts, 1162. Fat globules from chylous urine, 1 156. Glucose fungus, 1154. Granular casts, 11 60. Hyaline casts, 1 163. Leucin, 1156. I'hosphate of lime, 1 159. Pus corpuscles of, 1158. Spermatozoa. 1164. Triple phosphates, 1 1 60. Tyrosin, 1156. Urate of ammonia, ii'Sy. Urate of soda, 1157. L ric acid crystals, 263. Uterus, normal, 646, 829. Metritis, 647. Internal view, two diagrams, 829. Gravid, uterus, two diagrams, 840. Varicocele, External appearance, 11 71. Result of masturbation, 1172. Testicle, natural, 1171. Healthy section of, 1171. Venereal chancre on lip, 1185. Bacillus in lung structure, 1200. Of skin, 1207, (41 1 211.. I'ubercle, 1207. The bone, 1210. Microbe in breast, 1185. Syphihs, 1187. In liver, 1197, 1198. Cerebral softening, 1191. Dr>- gangrene, 1216. Fatty liver, 1197. Ichthyosis, 1215. Lichen, 1213. Microbes, 121 7. Micrococcus furfur, (2) 1207. Papula, 1 21 2 Psoriasis, 121 2. Rupia, 1 21 2, 121 5. Sclerosis of brain, 1191. Syphilitic germ in kidney, 1195. Bronchitis, 1201. Softening of cerebral pulp, 1191. Sputum, 1 199. Syphilitic microbe — Lepra, 1210. of bone, 1210. Tenia tonsurans syphilitic, 1207. Vegetating condylomata of vulva, 1203. Vesicular emphysema, 299. Warts, Vertical section of, 1226. Wasting paralysis, appearance of gray matter, 771. Xeroderma pigmentosa, 1227, 122S. Yeast plant in gastric, intestinal catarrh. '161. Uterine cavity, 175. Associated with other germs, 175. In intra-uterine catairh, 285. In sewer air, two varieties, 935. BACTERICIDES CONTAIN TWO HUNDRED ILLUSTRATIONS. AN ENCYCLOPEDIA OF THE Practice of Medicine Abdomen. The trunk of the human body is divided by the diaphragm into two cavities ; the upper beino- the thorax or chest, and the under the abdomen or belly. Both the cavity and the viscera it contains are in- cluded in the term abdomen. It contains the liver, pancreas, spleen and kidneys, as well as the stomach, small intestine, colon and rectum. The bladder, lower bowel and internal organs of generation lie in the lowest part of the cavity, which is called the pelvis. The entire abdomen, with all its viscera, is lined with a serous membrane, the peritoneum, which is folded or reflected over every organ, keeping them in their proper relation to each other. The external division of the abdomen is into three parts, namely, the upper or epigastric region ; the middle or umbilical, and the lower or hypogastric. These are again sub- divided by two vertical lines, the side divisions being called the hypochondriac, lumbar, and iliac regions respectively. Diseases of the abdominal vis- cera are frequent, and consist chiefly of acute and chronic disor- ders of the digestive organs or of derangements of the nerve- plexus and ganglia there situated. These disorders, ov/ing to the presence of innumerable ganglia, and intimate anastomosing with the great sympathetic system, give rise reflexly to innumer- able cerebral affections. Besides, its importance is greatly enhanced as being the seat of 2 (17) Gall-bladder. 3. ir'ylor Right Lobe of Live Diaphragm, end of Stomach. 5. Duodenum. 6. Great end of Stomach. 7. Spleen. 8. Piece of Caul, or Omentum. 9. Pancreas (Sweetbread). 10. Small In- testine (Jejunum). 11. Great Intestine (Colon). 12. Small Intestine (Ilium). 1 8 DISEASE GERMS. the sympathetic nervous system, the seat or abode of organic and emotional life, the abdominal brain, the great sympathetic in which our emotions, desires, affections, passions, preside. The expulsion of the foi^tus before the seventh Abortion, month of uterogestation, or before it is viable, is termed abortion ; between the seventh and ninth month, a miscarriage. When it once occurs it is apt to recur about the same time in subsequent pregnancies. Causes. — These are numerous and variable, and are referable to the mother or to the foetus and its appendages. The causes in the mother may be extreme nervous susceptibility, great debil- ity, disease, plethora, faulty mechanism, violent mental emotion, fright, passion, violent exercise ; disease germs lurking in her blood as tuberculae, syphilis, cancer and those which are the factors of fevers ; sexual excesses, racing, jumping, blows ; the use of certain drugs as iodide and bromide of potass, sabina, aloes, cinchona, cotton root, borax ; thickening of the neck of the uterus is a common cause of habitual abortion at four and a half months. The causes seated in the foetus are its death, disease or rupture of its membranes. The ordinary symptoms of abortion are one or more rigors of variable degrees of intensity, a disappearance of the morning sickness, flaccidity of the breasts, uterine hemorrhage, tenesmus or bearing down, flakes of decidua with intermitting pain, and other symptoms incidental to parturition. Treatment. — This is variable, according to the constitution of the patient, but in all cases an effort should be made to prevent such a catastrophe if possible, for which purpose the patient must maintain the horizontal position in bed, rigidly enforcing rest and quietness, with a perfect freedom from care, worry or excitement, at the same time uterine tonics should be adminis- tered to brace up that organ. The best of these is the distillation or wine of the aleteris farinosa, one of the most powerful vitaliz- ing uterine tonics in the Materia Medica. This is a remedy of unexcelled therapeutic power in toning and bracing up the uterus ; it is of the greatest efficacy to all ladies who have that organ in any way damaged or suffering inertia, or who happen to be the victims of habitual abortion or miscarriage. Its use during preg- nancy, especially prior to parturition, renders labor easy and speedy, and its peculiar action on the uterine fibres renders it a prophylactic against all ulterior results, such as after-pains, metria, etc. Opium in some form is the remedy to arrest uterine contrac- BACTERICIDES. ig tions, thus : Opii pulv. grs. x ; Dover's powder and pulverized asclepias, of each grains xxx. Mix. Make 1 5 powders, one every three hours. No plug or tampon, or any other body should be introduced into the vagina unless there is excessive hemorrhage, as its presence excites uterine contractions and expulsion of its contents. If these means fail, the case should be treated same as an ordinary labor. This is not a threatened abortion, nor Missed Abortion, an imperfect abortion. Threatened abor- tion is very common at four and a half months, especially if there is the slightest thickening of the neck, for when it begins to stretch and emerge into the body, if there is resistance, there will be irritation communicated to the fundus and contractions. When a woman has threatened abortion, she suffers pain, has a bloody discharge, and mouth of the womb is opened. An abortion may be threatened and averted, and preg- nancy go on in a healthy way. There might be an abortion in the case of twins, one aborted and the other remain and go on to development. The abortion of one of the twms may be a missed abortion, or the miscarriage of one may be a missed mis- carriage. If the foetus alone, or the entire ovum alone, comes away, the woman has miscarried, or aborted ; it may not be complete, but imperfect. The ovum may come away alone, without the mem- branes, or the after-birth ; or only a portion come away. This is always dangerous, as it is liable to give rise to hemorrhage or else lead to putrid absorption. This is especially liable to be the case if the abortion has been caused by instruments or drugs, for then there is always less or more endometritis. Imperfect mis- carriage invariably induces endometritis in subsequent life. When a woman has a missed miscarriage, or abortion from a fright or blows, the natural course of events is as follows : The foetus dies, the symptoms of pregnancy are arrested, milk may appear in the breasts, there may be a bloody oozing from the uterus, or otherwise; if the waters are not dried up, they are ab- sorbed, and the contents of the uterus shrivel up and become mummified. If the membranes remain entire, absorption is the rule, with mummification. The uterus steadily diminishes in size, but its contents remain and continue up to the full time, when they are expelled. The expulsion is frequently unex- pected ; happens while standing or defecating, and the mass, shrivelled up in a bundle, or rolled up in a parcel, is expelled. The mass is usually fresh, of a brown color, and contains the foetus in the centre. 20 DISEASE GERMS. When such a case as the above is clearly made out, the intro- duction of a catheter, or catgut bougie, into the uterus for several hours, so as to excite contractions, together with quinine and caulophyllum to stimulate uterine energy, is indicated. A collection of pus in any part of the body Abscess, (streptococais pyogenes). The process by which an abscess is formed is as follows : A damage of suffi- cient violence has been inflicted — capillary vessels relaxed. With this partial death exudation of blood products, lymph, and lymph degraded into bacteria, pass or flow through. This lymph, if the state of partial death is great, or vital force low, may break down as it is effused, becoming pus or .purulent matter, or if not so greatly depressed, the exuded lymph may remain and form a thickening or induration which may remain in the minute interstitial struc- ture of a part. Effused lymph may remain in a part indefinitely or may be ab- sorbed, or may suffer some accidental shock, when it may sud- denly break down. The lymph dissolving into pus, making for itself a cavity, makes its way to the surface or to some natural outlet of the body. The breaking down of lymph into pus is invariably ushered in by a rigor or chill, and if there be pain, heat, redness, swelling, they each change in their character ; pain becomes throbbing, heat diminishes, redness changes into a livid color ; swelling be- comes soft, flaccid. Pus, or the streptococcus pyogenes, may make its appearance in a different part of the body from whence it was formed, as in the case of psoas abscess in disease of the spine. The pus may find an outlet either artificially or naturally, or it may be absorbed, and cause blood poisoning. In order to prevent suppuration or the formation of pus in a cavity, the stimulation over the affected part must be in propor- tion to the amount of depression which caused the original lesion — or as powerful as the structure of the part will bear without causing its destruction ; local stimulation should not only be pow- erful, but, as far as the nature of things can, germicidal. Who has not witnessed the splendid remedial action, the ozone gener- ating power, of turpentine in peritonitis, and pleuritis — the persist- ent action of a saturated tincture or oil of lobelia in periostitis of the phalanges of the fingers ? When the rigor comes, the precursor of abscess, heat and mois- ture unremittingly applied are the proper remedies, with free open- ings and counter openings to afford a free egress to all purulent productions. BACTERICIDES. 21 The pus of all abscesses is simply the lymph from the biood — altered, changed — degenerated into the bacillus pyocyaneus — the microbe of pus. Acarus foUicu- lorum, mag- nified. This wood cut affords a beautiful illustration Acarus of a microscopic parasite residing in the seba- FoUiculorum. ceous sacs, and hair follicles of the human skin. They are met with in almost every person, but most numerous in those whose skin and liver is torpid, or in those who suffer sexual perversion. They vary in length from one-fortieth to one-hundredth part of an inch. The head is always directed downwards and when a large number is present, they collect into a conical bundle, the larger end of the cone being formed by their heads. Their number varies from two to three in a follicle and in some cases as many as fifteen. The parasite posseses eight thoracic appendages of the most simple and rudimentary kind ; the mouth is suc- torial ; sexes are distinct. In order to eradicate this parasite, the liver, bowels, skin should be well stimulated, brought into an active condition, sexual perversion overcome. On the nose, cheeks or other parts where sebaceous glands are numerous, after first bathing with warm water and drying off, a ten-per-cent. solution of peroxide of hydrogen should be applied. A perfect arrest of the function of the liver, so Acholia. that the various materials from which the bile is formed accumulate in the blood, and cause blood and brain poisoning. It is a state or condition which is extremely liable to occur during the progress of almost any acute or chronic disease of the liver, but an almost invariable attendant on acute atrophy and fatty degeneration, such as is present in yellow fever, in which there is a destruction of the hepatic cells, with rapid wasting of the gland. Acute atrophy of the liver is the direct result of the presence of a fungus or microbe in the blood impairing the nutrition of the gland, much aggravated by venereal excesses, mercury, alcohol, and by mental and physical prostration. It is impossible to explain how those microbes, or their spores or ptomaines, can cause such rapid metamorphosis in a gland so rich in blood vessels, as to cause one-half or more of it to disap- 22 DISEASE GERMS. pear in a few days, without the blood vessels themselves being affected. No other disease has the least analogy to it. It is most present in chronic alcoholism, where all cases show a fatty Hver. Indeed the general pathological condition found among all drinkers is interstitial deposits of fat, and an infrequence of fibroid tissue. Next in order to alcohol comes the germ syphilitica, which acts directly as an eating fungus upon the hepatic cells.; the cancer microbe eats up the glandular epithelium and thus leads to an arrest of function. More rarely is acholia due to chronic inflam- mation with either amyloid or fatty degeneration. Whether then the cause be microbes or poisons, or plastic lymph effused in an inflammatory process, an impermeable state of the ductus communis choledochus and an arrest of the capil- lary circulation take place. An effort at treatment should in all cases be tried. Locally over the liver, con. ozone, followed by hot poultices ; internally some of the following remedies should be tried: Chionanthus Virg., euonymus, with an eight vol, solution of peroxide of hydrogen. Inflammation of the sebaceous glands and hair fol- Acne. licles, with retention of the gland secretion, which is degraded into bacteria. The treatment embraces both local and constitutional measures. The diet should be very nutritious, but plain, embracing abun- dance of vegetables and fruit ; all stimulants avoided, such as wine, malt liquors, tea, coffee. Glycerite of sulphur, administered in the evenings in sufiflcient doses to move the bowels. Boroglyceride paste applied to the patches, over night, is a par- ticularly serviceable and efiflcacious remedy. Distillation of jequi- rity is also of great value. That which is common in young men and women at and sub- sequent to puberty is best relieved by dusting on the microbe powder during the day, and applying an ointment made thus : Iodide of sulphur, grains 25 to one ounce of ozone ointment, or re- sorcin jelly. Baths of alkalies, iodine, are invariably of service. The liver in all cases should be well stimulated by chionanthus, perox- ide of hydrogen. The affection is presumably one which is Actinomycosis, dependent on the presence and activity of a micro-organism. The micro-parasite is a member of the fungoid class and consists chiefly of a mycelium which divides in a dichotomous fashion, and gives rise by its BACTERICIDES. 23 spread from a centre to a radiated appearance, whence its name— ^ actinomyces — is derived. The circumferential ends of the myce- lial sprouts have a flask-shaped swelling. The little masses of felted mycelium may be recognized by the naked eye as sul- phur-yellow bodies of about the size of a hemp-seed. The disease which this parasite is supposed to cause may develop in many parts of the body. The most common site appears to be the jaw and parts bounding the mouth. The affection in animals has long been known in this situation under various names, and has been re- garded as a form of scrofula and as a new growth. It is believed that the parasite gains an entrance through the medium of a carious tooth or some wound of the gum leading to the jaw-bone. There is but little to be said of the morbid anatomy of the disease. A swelling forms in the jaw, and gradually increases in size. This tumor in its earhest stages may be punctured without any matter being let out, although it gene- rally has an elastic and semi-fluc- tuating consistence. A section made into a tumor in the early stap"e of its existence shows a reddish-white area sprinkled in places with gold-colored granu- les. Later on abscesses and fistu- Ise form, in the discharge form which the sulphur-colored bo- dies maybe seen. Broadly speak- ing, the tissueof the morbid new growth, which must be regarded as inflammatory rather than sarco- matous, has very much the characters of ordinary granulation tis- sue. Actinomycosis may occur primarily in the respiratory tract proper. It is localized to the bronchial mucous membrane, giving rise to the signs and symptoms of chronic bronchitis, with fetid ex- pectoration, in which the actinomyces are often readily discovered. Primary localization of the disease is in the parenchyma of the lung, from whence it is propagated to the pleura and to the pravertebral tissues. Some of the cases have many of the clinical characters of empyema with discharging sinuses, and in such cases a complex system of fistulse not infrequently undermine^ the morbid tissues. The structures in the posterior mediastinum and prevertebral re- gions are often affected, and the bodies of the vertebra may become carious. In another class of cases the disease begins primarily in the intestinal canal. In some of the cases the foci of the dis- ease are widely disseminated. The liver, spleen, miuscles of the Actinomycosis. A nodule is shown composed of round cells, in the centre is the clump of actinomyces sur- rounded by large transparent cells. Magnify- ing power 350. 24 DISEASE GERMS. back, and muscular substance of the heart, have been shown on post-mortem examination to have numerous centres of actinomy- cosis. Large abscess cavities may form behind the peritoneum as well as behind the pleura, and these may communicate by many perforations of the diaphragm. The symptoms necessarily depend chiefly on the localization of the disease as well as on its rate of progress, and present therefore extremely varied clinical pictures. A group X A Zeiss {z=: 3-5 inch; shows probably the earhest stage of growth : each separate coUeciion of lungus consisting of fine filaments radiating from a common centre. The portion of fungus as seen in this cut is older, more matured. Under this power some of the filaments are apparently thicker than the majority, and are club-shaped. No doubt the fungus effects an entrance by the mouth, taken in with the food, through the medium of a crack, fissure on the gum or a carious tooth, and at first appears as a whitish nodule looking like tubercle. This nodule becomes the neoplasm, the swelling or abscess, a purulent cavity. No doubt the disease is transmitted in man very readily by the use of imperfectly cleansed dental instruments, by the cups of public fountains or the like. There is no structure or tissue in the body exempt from the entrance of this germ ; besides the mouth, the crypts of the tonsil, larynx, bronchial membrane, lungs, intestines, testes, ovaries, bones. By certain experiments we are led to regard the actino- myces as the result of a highly degenerative change in the life history of man. The diagnosis rests upon the discovery of the small yellow granules in which the fungus Acitnomycosis from human liver. BACTERICIDES. 25 may be detected. The disease must not be confounded with extra-peritoneal abscess about the soft tissues of the jaw due to carious teeth. The fungus bears cultiva- tion well in almost any nu- trient menstruum — it pro- duces the same micro-or- ganism by inoculation. The form we meet with in cattle is the same as what Actinomycosis from tongue of ox, for comparison. occurs m man. The treatment which is of utility is a general alter- ative and tonic course of re- medies, in which germici- dal medicaments should play an important part. If the germ is in the mouth peroxide of hydrogen and solutions of boroglyceride are invaluable ; if in the intestines, resorcin ; if in the bronchi or lung, glycerite of ozone ; if in the bones, saxifraga. Acti7iomycosis finds a favorable location for breeding in the liver, which is often mistaken for cancer or syphilis, but a microscopi- cal examination of the faeces indicates its true character. It seems quite possible that the weakening of the system by the microbe of syphilis, cancer, or by the excessive use of mercury, is a cause why it is found in the liver. One thing is certain, the microbe is communicated from cattle to man, and passes from man to man by contact. It behooves us to take all possible means to make a careful diag- nosis, and if the disease is recognized in animals it should be at once stamped out and not allowed to spread from one to another and endanger human beings. It has been recently demonstrated Addison's Disease, that disease of the suprarenal capsules, or what some term Addison's Disease, is due almost entirely to an infiltration of those glands with the tubercular bacilli. This disease germ, once deposited in the suprarenal capsules, grows, and goes through its different stages of growth and degeneration, causing chronic interstitial inflam- mation and fibro-caseous and calcareous metamorphosis. In the early stage of the disease the capsules become enlarged from 26 DISEASE GERMS. the presence or aggregation of the bacilli. These germs gene- rally localize in the centre of the gland, grow and breed outwards, usurping its entire structure; as it reaches the vortex, cheesy and calcareous defeneration change is uniform. In rare commences in the centre. This cases the bacilli are deposited in points or nodules in the glands, which gives it a lobulated appear- ance ; whichever it may be, their proper structure is entirely oblit- erated, no sign of gland structure is left; on a cut section it appears yellow. The structure and functions of the suprarenal capsules are the same as the lymphatics, pink marrow and mesenteric glands. The lesions of the nerve centres of the suprarenal capsules and great sympathetic account for the phenomenal pigmentation and discoloration of the skin. The spleen is enlarged and softened ; the liver, kidneys, lungs, stomach, intestines, spinal cord and brain are dotted over with tubercle ; even the testes and prostate are implicated. The blood is anaemic, fibrin dimin- ished, red discs altered in size and. form, and does not run together as normal corpuscles, o w i n g to the lymph spaces being crowded with tubercle ; the white globules are in- creased in number. Lurking deep in the vital stamina there is great pov- ert}' of nerve force, a paralytic state of the vaso-motor fibres of the great sympathetic, and, as a consequence,, the blood is imperfectly and unequally distributed. In addition to the discoloration or bronzing of the skin, we have the characteristic features — anaemia, gene- ral languor or debility, with extreme prostration, expressed by a loss of muscular power, weakness of pulse, remarkable feebleness of the heart's action, breathless- ness upon the slightest exertion, dimness of vision, functional weakness and irritability of the stomach. The progress of the disease is very slow ; melancholia is not uncommon, drowsy,, dreamy languor, dizziness, and syncope not infrequent. Heart failure predominates all through ; anaemic murmurs are heard as the disease advances, the skin becomes a lustrous bronze,, and the mucous membrane of the lips and gums are strongly pigmented. Sight and memory fail ; convulsions and choreic A vertical section of the human kid- ney ; a, exhibits the suprarenal capsules, which are infiltrated with tubercle in Addison's disease. BACTERICIDES. 27 symptoms, followed by delirium or comatose state. The urine is normal in quantity, albuminous ; uric acid, coloring matter are in excess with the microbe indicum. In eighty per cent, of all cases tuberculosis of the most intense character is present. It is regarded as an infectious blood dis- ease, more especially common among males in the adult period of life, and is found associated with cancer, apoplexy, and waxy and fatty degeneration of glands. Numerous cases have recently been discovered in which there was no tubercular infiltration of the suprarenal capsules at all. As the tubercular diathesis is so intense, the germs blocking up all the important blood-raising glands, it has generally been regarded as incurable. All remedial measures, up to the present time, have been in- operative. Accepting the theory — a disease of nervous bank- ruptcy, with intense tubercular growth — positive benefit, at least a great prolongation of life, results from the use of germicidal remedies, and a tonic treatment, nutritious diet, the avoidance of everything that would debilitate, -with rest in the recumbent pos- ture, and the avoidance of all insanitary states. Glycerite of ozone, in twenty-drop doses, has been found a most efficacious remedy ; alternating with either the glycerite of kephaline or tincture of oats, to which quinine and tincture of ignatia have been added. The stimulation of the cervical sympathetic with concentrated ozone, with general faradization of that nerve, are important factors in the treatment. Pseudo-leucocythaemia is a peculiar disease Adenoma, of the blood, like leucocythaemia dependent upon an enlargement or hypertrophy of lymphatic glands; glands of neck, axilla, groin symmetrically enlarged, not inflamed or fused together ; thoracic and abdominal glands also affected. Patient becomes weak, loses flesh, soon out of breath on exertion, symptoms of pressure at base of chest or abdomen, gradually increasing debility. It is also called Hodgkin's disease, or malignant lymphomata. The lesion of this disease does not differ from lymphomata. They are divided into hard and soft tumors. The soft lymphomata are of an encephaloid consistency. Their color is of a reddish gray, studded with spots of extravasa- tion. As the glands enlarge, they become confluent, forming a large, soft, fluctuating, lobulated tumor. Hard tumors have a fibrous feel. It is well known that the lymphatics preside over or are car- riers of nutrition or lymph, but how they influence the blood in 28 DISEASE GERMS. the production of white cells is unknown. The spleen, lymphat- ics, mesentery, suprarenal capsules, and the pink marrow of the bones constitute the great lymph channels ; in each or all of them when obstructed, damaged or diseased, there is the prevail- ing characteristic cropping out — excess of white corpuscles. The diagnosis of the disease is not difficult, the swelling of the glands in the neck, armpit, or groin are significant; but when the deeper glands are affected it is more difficult. In all forms, however, emaciation and anaemia are marked and progressive. Usually enlarged spleen, palpitation, slight fever, muscular weakness. A general alterative and tonic course should be tried, and a highly nutritious diet will- be found to be the most available means in the line of treatment. Change of air, and sea bathing when the strength permits, are of advantage. The entire lymphatic system, including the Adenitis, lymph canals, the pink marrow of bones, spleen, suprarenal capsules, mesentery and other glands are in health actively at work raising the blood from elementary molecules, to leucocytes, thence to red discs. Leucocytes are protoplasmic units partly differentiated so as to assume a function higher than a mere amoeba, that is, they unite in forming struc- tures that have the property of vital endowment in a particular direction. All the structures of organic things are made or built of cells, and these cells are differentiated leucocytes. The white cells have amoeboid movements, and thus change place and form. Tissues become active as these movements are differentiated and then there are classifications of types of tissues. The respiratory, circulator^' and digestive tissues are primordial, and in the first of the series of life ; generation is carried out only on the primi- tive plan of motion by mere division, as fission, budding, etc. In the organic structural animal wherein tissues are so far differ- entiated as to be set apart for the performance of certain specific functions for the good of the organism at large, the leucocytes that form the secretory cells are only slightly differentiated from the primitive leucocyte, and their functions are substantially the same as the primitive ones, but they have the additional property of converting the pabulum of their nutritive material into a func- tionating product in a special way. A gland cell is the singular thing that is creating out of its own protoplasm a new material, using its nutritive substance to elaborate the constituents of its secretion. A muscle cell uses its pabulum to differentiate move- ment ; a nerve centre cell to differentiate impulses that originate reflex movements. BACTERICIDES. " 29 In the treatment of disease we have to do with these differen- tiated leucocytes, or modified amoebas. Sometimes the power to take oxygen is degraded, or the power to expel detritus from the innermost parts is impaired, or the power to rejuvenate itself is injured in some way by some adverse state, into other living matter. We are ever dealing with primitive elements when we approach a living thing, no matter how complex it may be in arrangement of its cells and tissues. A partial death of a portion of the lymphatic system strikes at the root of organic life. An inflammatory condition may arise from various causes. 1. Simple Adenitis. — May be the direct result of a blow, walking, absorption of some irritating poison through an abrasion. Such an inflammation or irritation is very common at the elbow, axillae, knee, groin. The chain of femoral glands may enlarge as the result of a wound on leg, foot, ingrowing toe-nail; while irritation of the penis affects the inguinal chain (bubo). The glands at the back of the neck frequently enlarge when there is irritation of the scalp, and the cervical glands become enlarged in diphtheria, malignant stomatitis, scarlatina, etc. 2. Tubercular Adenitis. — In individuals whose vital forces are greatly below par, where the tubercular bacilli are present in the blood, either as the result of an infection, or a special degradation of normal bioplasm into the bacilli, or from both, especially in children, the glands of the neck from some irritation will become inflamed, irritated, enlarge slowly, suppurate, the tubercular bacilli will undergo its usual changes, become caseous then calca- reous. If there happens to be irritation of the bowels, the mes- entery will take on an analogous condition, become engorged with the products of inflammation, and the microbe of tubercle, masses or chunks of the bacilli can be felt through the abdominal walls. 3. The Microbe of Syphilis. — The adenitis which almost in- variably accompanies a soft chancre, or a gonorrhea, is very apt, if the treatment be not correct, to be accompanied with a viru- lent bubo, which comes on about a week after infection ; inflam- matory symptoms run high, acute pain, rigors, fever, great swelling and sometimes suppuration. The true syphilitic germ, in the inoculation, the hard chancre, often migrates to the lym- phatics of the groin giving rise to multiple bubo ; as a rule the migration of the germ is painless, no suppuration. The indura- tion proceeds slowly from gland to gland, in the inguinal chain till all are affected. They are never very large, are always hard, and can be moved about under the finger. Various other glands throughout the body become germ-laden and enlarged, as in induratedc hancre of the lip, the submaxillary become indurated ; 30 DISEASE GERMS. in chancre of the fingers in washerwomen the glands of the axillae are enlarged. 4. Cancerous Adenitis. — In whatever part of the body a can- cerous infiltration takes place the lymph glands m close prox- imity to the aggregation of germs become engorged, partly with products of inflammations, and partly with cancer germs. In grave cases they become a valuable element of diagnosis and prog- nosis. The most common examples are the enlarged sub- maxillary in cancer of the lip and tongue, the axillae in cancer of the breast. 5. Adenia, or Hodgkins Disease. — This affection is character- ized by an enlargement of all the lymphatic glands of the entire body. They often attain great size, but do not suppurate, but there is invariably associated with it marked anaemia, vastly diminished red corpuscles in the blood, but no increase in the white, spleen and suprarenal capsules generally enlarged. 6. — In the plague, or relapsing fever, anthrax, glanders, or farcy, malignant erysipelas, dissection wounds, phlebitis from any cause, malaria, bite of an enraged man, etc., there is apt to arise a general enlargement of the lymphatic glands throughout the body, along with hypertrophy of the spleen, and an increase of the white corpuscles of the blood. Treatment of all forms of adenitis require great energy and sound judgment. Within these few years past, it has been clearly demonstrated that the filling up of the lymphatics, as we have in adenitis, is chiefly due to the germs of disease, a concrete essence, an absolute and visible germ in all cases, whatever the form may be. The gland is but a bacteriological colony when irritated. So in all cases a rigid germicidal treatment should be inculcated, both internally and locally. In all cases, comp. saxifraga, phytolacca, iodol, and special remedies to sterilize the microbe ; locally plantain leaves, iodo- form, sozoiodol, resorcin and ozone ointment ; peroxide of hydrogen. An animal membrane Adipose Tissue, or tissue, consisting of an aggregation of minute spherical pouches or vesicles, filled with fat or oil. The tissue itself is organic and vital, the vesicles secreting the fatty matter from the capillary blood-vessels with which they are surrounded ; the secreted matter or fat is inorganic and ^^'^l^^I^!"^' devoid of vitality. The adipose tissue differs from cellular or filamento as tissue in having the vessels closed, BACTERICIDES. -, I •SO that the fat does not ooze through even when fluid. A con- • siderable layer of fatty tissue under the skin, over kidneys and in or on the mesentery, around large ve7sels and nerves, around joints, is not incompatible with a high standard of health. Fucus vesiculosus with dioxide of hydrogen strips the muscular tissue of a redundancy of fat. By this term we mean the presence in the Albuminuria, urine of an albuminous body, v/hich is coagu- lated by heat or precipitated by neutraliza- tion. It was once regarded as a diagnostic symptom of Bright's disease, but recent researches have caused it to lose this its primi- tive meaning. The variety of the pathological conditions under which albu- men may appear in the urine is very great, as congestions, inflammation, .mechanical obstruction to the circulation of the kidney ; whenever disease germs are present in blood as the malarial microbe, the bacillus of tubercle, cancer syphihs ; the germs of diphtheria, scarlatina, variola, erysipelas, etc. ; in blood diseases proper, as anaemia purpura, and also in diseases of the heart, lungs, liver, in peritonitis, pregnancy, diseases of the brain and spinal cord, in epilepsy and various skin diseases, even after bathing. For convenience, all conditions in which albumen may be found in the urine may be arranged under the following groups : 1. Congestion of the Kidneys. — Congestion of the kidneys may result from a chill to the skin, as in bathing, exposure to cold ; from the elimination of some irritating poison, such as alcohol, uric acid, phosphorus, lead, cantharides ; from the direct action of a microbe blocking up the kidneys, as we have in scarlet fever, diphtheria, typhoid, variola, erysipelas, or from vaso- motor paralysis, the result of a concussion of the spinal cord. Passive congestion may result from cardiac, pulmonary, hepatic disease; or from peritonitis, pregnancy, or from heart failure in anaemia. 2. Acute or chronic inflammation, as w^e have when the grlands are literally blocked up with disease germs. 3. Degeneration, fatty, amyloid, cystic, forming deposits, usurpation of normal structure, with softening or thinning of the renal arterioles. These are some of the causes, and it would be interesting to discuss the mechanism by which albumen passes into the uri- nary secretion, and what causes the transudation. Is there a physical change in the lining membrane, or is there some altera- 32 )ISEASE GERMS. tion in the blood pressure, or the rapidity of the blood current? Ill all the states mentioned, from simple congestion up to con- tracting kidney, the walls of the glomeruli are actually perme- able, permitting the passage not only of thin fluids and colloids, but even of semi-solids, and this too in parts of the kidney pre- senting no recognizable structural alterations. Even a slight relaxation temporarily induced will give rise to albuminuria, and it may occur in dyspeptic people, in weak, overgrown persons, without being an indication of actual or potential renal disease. To arrest the escape of albumen, in addition to general tonics and nutritious diet, try first nitro-glycerine, then either erigeron or gallic acid and port wine ; or convallaria maidis ; or ergot, or corn smut ; or aromatic sulphuric acid and quinine. This is met with either acute or chronic. Alcoholism. In acute alcoholism, the mucous membrane of the stomach and duodenum is greatly congested. Patches of aphthcTe ioidmnialbicans) are formed upon it, and the mucous membrane of the stomach is covered all over with a thick ropy mucus, heavily loaded with the sarcinae ventriculi, slightly tinged with blood. The gastric juice is altered in quantity as well as quality. The brain, lungs, kidneys are congested and the pericardium and pleura are filled with bloody serum. In cJironic alcoholism, tliere are always and invariably present chronic gas- tritis, congestion or cirrhosis of the liver, emphysema, or tuber- culosis of the right lung, fatty degeneration and dilatation of the heart, atheroma of the blood vessels and interstitial nephritis. As the whiskey in the blood circulates as a free agent, it irritates and degenerates every organ, gland and tissue of the body, retards their working capacity, and arrests the normal metamorphosis. The poison has a special action on the brain, inducing in all cases chronic inflammation, with effusion of lymph, which causes thick- ening of its entire substance ; besides the brain is literally steeped in the poison, which withers, whittles down the organ to a mis- erable state of atrophy, an anaemia. In long standing cases, cer- ebral softening occurs, and in such the viscera are fatty, the sub- cutaneous tissue and omentum being loaded with that non-vital element, if they are beer, ale or wine drinkers ; while those who drink spirits are thin, spare, prematurely old, on account of the increase of the connective tissue. Perpetual drinking gradually induces a tubercular diathesis, with the tubercular bacilli in blood. The blood in chronic alco- holism besides contains more fat than normal ; one of the first effects of the alcohol is a true chemical combination with nerve BACTERICIDES. 33 tissue, and as the ingestion of spirits is constant, both the gray and white progressively atrophy and harden. This is hastened by a state of poor blood. Differential Diagnosis. — The greatest care must be exercised in making a diagnosis. The coma of alcoholism must never be con- founded with that due to nrcemia, or apoplexy, or opinm, or any other form of cerebral irritation. In inflammation of the brain, we have the firm, hard pulse^ pyrexia, retracted abdomen, and that agonizing headache aggra- vated by noise, light, heat, motion, photophobia, all of which are absent in alcoholism. Alcoholic tremor has often been confounded with shaking palsy, locomotor ataxia, and softening of the brain. Prognosis. — If the patient is manageable, usually good. Death may occur in the acute form from active gastritis, or lobular pneumonia. Danger of passing off in a comatose state or from apoplexy. In chronic alcoholism there is always danger from chronic gastritis, ulcer of the stomach, degenerative changes in the brain, blood vessels and nerves, fatty liver and kidneys — w^hich predispose to a long list of diseases that tend to shorten life. Insanity, impotence, epilepsy, organic brain disease are its frequent sequelae. Treatment. — In acute maniac delirium, wash out the stomach by a copious emetic of infusion of lobelia leaves and bicarbonate of soda, in repeated doses until free emesis is effected, hot infu- sion of capsicum between each dose, getting full free emesis, if possible ; follow this with a saHne purge, and warm bath, followed by friction and massage to the entire body. Subsequently in- duce sleep by repeated doses of sulphonal in 30 grain doses — dose to be repeated every half hour. If sulphonal does not succeed, then try 1 5 grains of chloral hydrate with 15 grains of bromide of potassa in syrup of orange peel, which can be repeated. If this is not successful, then a hypodermic injection of ^ of a grain of sulphate of morphia. There must be a remedy selected and administered to procure 10 or 12 hours of profound sleep. On arousing from this sleep, the patient should be placed upon large doses of capsicum in alternation with tincture of green root of gelsemium or digitalis. At the same time abundance of fluid nourishment should be given, as essence of beef. The patient should be kept quiet, and diffusible stimulants like capsicum, prickly ash, ammonia, administered till he is tided over the crisis, when coca et celerina should be administered in teaspoonful doses every three hours, to appease or satiate the appetite for stimulants. Such is the most efficient treatment. 24 DISEASE GERMS. The effects of the prolonged use and abuse of alcohol are most disastrous in the production of a deteriorated race; in the creation of a type of nervous diseases of the insane group. A partial or complete deficiency of hair usually Alopecia, results from the presence of disease germs in the blood, or from indirect starvation of the follicular or peri-foUicular tissues inducing a state of atrophy. The epidermis suffers from defective nutrition, the derma con- tracts, hair follicles shrink, become patulous ; efforts may be made by the nuclei, and abortive results at hair formation may be recognized at the base of the hair sacs. The correct treatment of alopecia consists in imparting to the blood the elements of which the hair is made, such as avena and glycerite of sulphur, then stimulation to excite a state of hyper- aemia in which growth results ; this involves bathing, friction, rub- bing, shampooing, etc., simply damping the scalp with the ozone hair restorer. A scanty crop of soft, short, downy hair is peculiar to the mi- crobes of syphilis and tuberculae, and requires germicidal treat- ment and the local application to the hair and scalp daily of the following : Ty Ozone ointment, . . . . . i ounce. Oil of boroglyceride, .... 3 drachms. Resorcin, ...... i drachm. Chrysophanic acid, . . . .10 grains. Mix. In the treatment of those cases no remedy has a higher and more established value than the Ozone Hair Restorer. Partial, or complete amaurosis, or loss of Amaurosis, or vision from some disease of the retina, optic Blindness. nerve, or brain, the optical instrument, the eye, being in a normal or healthy condition. The causes that are likely to affect the brain, optic nerve, or retina, are embraced under five distinct heads, viz., anaemia, hyperaemia, reflex irritation, poisons, organic changes. Ge7teral Symptoms. — Partial or complete loss of vision, without effusion in the cornea or on lens, or any form of opacity. This impairment of vision naturally gives the gait and countenance a peculiar expression. He walks with an air of uncertainty ; his eyes, instead of being directed to surrounding objects, have an BACTERICIDES. ^^ unmeaning look, appear to be staring at nothing, or are in constant rapid motion. In partial amaurosis, movements of the iris slug- gish, and pupil dilated ; in total blindness, pupil greatly dilated, and iris immovable. When both eyes are affected, they are often unnaturally prominent, and of an unhealthy color, the sclerotic being often yellow and covered with varicose veins. An examination of the eye with the ophthalmoscope usually reveals inflammation of the optic nerve, changes in the retina or brain. Those changes are variable, consisting chiefly of relaxa- tion, effusion, thickening deposits and extravasation. Another class seems to depend on atrophy, or wasting of the retina, optic nerve, or brain. This atrophy may follow neuritis, or exist with- out. When due to tobacco, this shrivelling up or whittling down of retina and optic nerve proceeds to utter blindness without in- flammation being present. 1. Blindness due to anceniia will exhibit an impairment of vision, with all the symptoms of a diminution of red corpuscles in the blood, as vertigo, ringing in the ears, specks or spots before the eyes, pale face, lip, tongue, murmurs in the left carotid, and general debility. The causes that lead to this may be meagre, poor, or bad food, absence of sunlight, over-work, drugs, disease, fevers, long or excessive nursing, want of exercise, sexual excess. Best cured by a removal of cause, building up of blood with abundance of best of food, fresh air, exercise, and by using com- pound tincture cinchona and mineral acids, or pill quinine, iron, hydrastin, nux, sulphate quinine and aromatic sulphuric acid. 2. Blindness due to congestion or plethora^ or over-feeding and stimulation, with all the symptoms of that condition. Best treated with removal of cause or causes, free purgation, heat to feet, blisters to nape of neck, followed by irritating plaster; alteratives, as iodide of potass in syrup of stillingia or Phytolacca ; and even here, cinchona or its alkaloids, because we have no drug equal to it in restoring the integrity of the optic nerve. 3. Blindness may be due to reflex irritation, as the irritation of teething, worms, ovary, uterus, pregnancy, but more especially self-pollution, or masturbation — this latter form usualh- common, as all the inmates of our prisons, refuges, asylums, boarding- schools, retreats, are addicted to this loathsome and degrading practice. Nearly all the young and middle-aged men and women to be seen on our streets with defective vision and glasses, have been inmates of some charitable college or institute, and exhausted, drained off, their nervo-vital fluid, and obliterated the finer cere- bral convolutions of their brain, and are partialh- blind. The origin of the optic nerve being in the spinal cord, medulla, and 36 DISEASE GERMS. brain, the reflex centre, or bulb, suffers intensely, and the whole process of growth is arrested, and the perpetrator becomes a miserable victim of self-conceit, egotism and puniness. Cured upon general principles, by removing cause, and treating for masturbation and for the e)'e ; stinmlants to nape of neck, quinine, glycerite of ozone, kephaline and other tonics. 4. Blindness may be due to poisons, as tobacco, chloral h)'drate, opium, whiskey, belladonna, conium, syphilis, mercury, and the use of hair dyes and cosmetics, as the nitrate of silver, lead, bismuth, which act very disastrously upon base of brain along the ophthalmic tract. Much of the defective vision to be seen is due to the use of those agents. A discontinuance of the use of the poison, with ^ general alterative and tonic course, is usually sufficient for a cure, if seen early and persevered in. 5. Blindness may be due to organic changes in the retina, optic nerve, or brain. — These changes may be inflammatory, and proceed on to softening of the nerve or its branches, or due to atrophy from ansemia or want of nutrition. This is the most hopeless form, as white softening, or ramoUissement, is an irre- parable affection. General Treatment. — In all cases, if it is possible or practicable, the following plan of procedure should be carried out : The bowels regulated ; skin stimulated with daily baths ; two open sores at nape of neck, one inch square, on each side of the spinal column ; flannel clothing ; appetite to be stimulated and a diet consisting of animal food, eggs, white-fish boiled, oatmeal porridge and cream — a brain diet, an important factor in a case. As the optic nerve not only originates in the spinal cord, but is freely blended with the medulla, the seat of reflex action, morn- ing and night all the peripheral extremities of the nerves of the entire superficial portion of the body should be stimulated from half an hour to two hours with friction, shampooing, palpation and electricity. This faithfully performed, raises the standard ot vitality of cord and bulb, and the patient sees better at once or after a few applications. The medical treatment is the same as for chronic inflammation and softening of brain — alteratives and tonics, iodide of potass, cinchona, and especially the ozonized pre- parations, as they tend to cleanse brain and optic nerve of all extraneous substances ; glycerite of ozone, ozone water, kepha- line. Treatment to be persev^ered with for six or twelve months ; change of air and scene often of utility ; other cases benefited by rest and quietness, especially those caused by exhaustion and nervous debility. If a real organic change has taken place in the optic nerve, all BACTERICIDES. 37 remedies are useless. In all cases there should be an avoidance of all malt or alcoholic liquors ; all acro-narcotic drugs, especially tobacco, and hair dyes or tonics ; and sexual congress only per- mitted at rare intervals. Probably of all causes that give rise to the great frequency of organic amaurosis, tobacco, sexual excesses and syphilis are the most common and detrimental, and most likely to produce degeneration of the optic nerve. An absence of the menstrual flow. It is Amenorrhcea. met with under two forms : I. Retention of Menses, — This may de- pend on a variety of congenital conditions, as arrested develop- ment, organic affections, malformations, such as absence or atrophy of ovaries, uterus. Those organs may be present, but vagina may be absent, or suffer occlusion, so that if the menses are secreted, they cannot find their way out. It may depend on some disease of brain, spinal cord, or blood. A large per- centage of such cases can be rectified either with medical treat- ment or some surgical proceeding. 2. Suppression of Menses. — This is the most common form of amenorrhcea. The flow having appeared, been properly estab- lished for a while, has, from some cause, become suddenly arrested. The front part of the uterus being very profusely supplied with branches of the sympathetic nerve in highly-civilized females, the menses, while on, are liable to cease or stop from violent emotion, grief, anxiety, or from cold, damp, exposure. Instead of ceasing suddenly, as in those cases, it may disappear gradually, returning at the proper time, but becoming less and less, and then entirely stopping. It is liable to cease in acute and chronic disease, as in fevers, blood-disease, especially anaemia, cancer, tuberculosis, albuminuria. In all cases the greatest care should be observed, so as not to overlook pregnancy. The sup- pression is always attended with some constitutional disturbance ; great, if sudden ; not so well marked, if slow and gradual. Treatment. — If the case is seen at once during an attack of acute suppression, there should be an effort made to re-establish the flow, by alcoholic vapor-bath, with hot mustard foot-bath ; put to bed between blankets, with hot bricks to feet, and dry heat to vulva or over bladder, consisting of baked bran, or hops, or chamomile flowers, in bags. Aconite, with compound tincture of serpentaria, administered internally, with infusion of pennyroyal ; no cold drinks nor ice. If several days have elapsed, it is useless to try the above, or any other means, but begin at once and pre- pare patient for next period. Bowels should be regulated, cloth- ing warm, flannel round waist and hips, warm foot and hip-baths, 38 DISEASE GERMS. nourishing food. If there is any special disease it should be at- tended to, especially anaemia, with acetate of iron three times daily, with cinchona and mineral acids ; and about a week before the expected period, begin with the compound betin pill, one or two three times a day ; and if the case is stubborn, put mustard plasters on the nipples, for a short time before bedtime, for one or two nights. The compound betin pills excel all drugs in their mildness, efficacy, and certainty ; they arouse the inert, sluggish uterus into active life, restore its natural movements, and impart tone and vigor ; they are our best emmenagogues, and excel all other drugs in their prompt action. They super- sede entirely those old and deleterious drugs, such as cotton- root, savin, aloes, ergot. As soon as the flow is established they are to be stopped, and resumed the following month about seven days before the expected period. Ladies who suffer from habi- tual suppression, or where the flow is scanty, or who dread early suppression, can maintain menstrual activity for a long length of years, and thus keep the freshness of youth in their nervous sys- tem and skin indefinitely. Of the long list of remedies noticed, there remain caulophyllin and pulsatilla, and of these much can be said of a favorable nature. Caulophyllin, the resinoid pre- pared from 'caulophyllum thalictroides, known under the various names of squaw root, pappoose root, blue berry, has been recog- nized as a valuable therapeutic agent from very early times, and has been highly spoken of by many physicians of note. Its name, " pappoose root/' suggests the uses it was put to by the natives long before the cultured minds of our present physicians investigated its properties and catalogued its claims. There seems to be a a;eneral agfreement among^st those who have studied its action that its effect is chiefly felt by those motor nerves which are connected sympathetically with the menstrual organs, and that this action is of a sedative character, allaying that irrit- able condition of the generative system which so often lies at the root of functional irregularities. As a remedy in these derange- ments, in " irritable neurotics, '^ especially when they are marked by disturbances in the sacral plexus, it has undoubtedly acquired a sounder reputation than most of its competitors, and deserves a permanent place in the select circle of approved remedies. But its action, although often favorable when administered alone, is much more reliable when given in combination with pulsatilla (anemone pidsatilla, Pasque flower), which has long been known as a popular and effective remedy in uterine functional derange- ments. As Pulsatilla increases the beneficial action of caulo- phyllin, so the latter increases the action of the former, and it is, therefore, when they are both combined that we get the most BACTERICIDES. 39 perfect emmenagogue that our present state of knowledge has yet suggested. Indeed, it is not too much to say that this com- pound emmenagogue redeems from the charge of imposture the reputation of its dilapidated class. Vicarious Meiisiruation may occur as a form of amenorrhoea ; that is, the menses may be suppressed at the vaginal orifice, but are thrown off by the nose, mouth, eyes, ears, or blood-stains by the skin, by ulcers or by necrosis, if present, or by odors about umbilicus, or eruptions. The real cause of vicarious menstruation is either inertia or atrophy of the uterus ; so great that the uterine wave is abolished or abrogated. The cure consists in stimulating the uterus with hip-baths, horseback exercise, or moderate walking exercise, the betin pill, massage, iron, pulsatilla, cinchona, and most nourish- ine food. The prolonged retention of urine in the Ammonaemia. bladder over a definite time results in its de- composition, in a change of its constituent elements, the most prominent of which are a fungus and carbon- ate of ammonia, which are taken up into the circulation, produc- ing a special form of blood-poisoning. The retention of the urea and its conversion into carbonate of ammonia give rise to cystitis, a catarrhal and dysenteric state of the bowels, in which a greenish, alkahne, yellow fluid is passed from the bowels, with abundant spores of the fungus. The causes which give rise to this state of fungus growth and decomposition are stricture, en- larged prostate, paralysis or atony of the bladder, pyelitis, sacculated kidney, cystitis, etc. Old or young men, with en- larged prostates are the victims p „ "^S^f ^'^'?,\f ^ of this malady. '^%^^>^ / - **' brown ; headache ; 40 DISEASE GERMS. insomnia ; and, as the blood becomes more crowded with the spores and carbonate of ammonia, insomnia is more persistent; restlessness gives rise to somnolence, lethargy, with low, mutter- ing delirium, with the ammoniacal odor more intense. The most important point in the treatment is the removal of the cause ; but as atony of the bladder and enlarged prostate are the common causes, time is needed. The patient must have im- mediate relief, or death will ensue. Relief is best afforded by the introduction of a catheter and draining off of every drop of the ammoniacal urine, subsequently injecting the bladder with a tepid germicidal solution of either boroglyceride or peroxide of hydrogen — if the latter, a few drops to the pint. This proceeding must be resorted to even when the patient seems to be sinking, because the moment the bladder is washed out a rapid improve- ment takes place. The bladder must thus be emptied and washed out daily, and the patient placed upon the proper doses of either peroxide of hydrogen, or ozone water, or comp. oxygen, to neutralize the excess of ammonia present in the blood. Virginia stone crop operates well in alternation with the uric acid solvent ; the pichi in that last compound operates in all cases most favorably ; they should be used persistently. The enlarged prostate must be got rid of, and till that is effected, the urine must be drawn regularly off. I have found the following formula to be unexcelled to get rid of an enlarged prostate ; thus, say about 7 p. m. insert one cocaine suppository ; allow it to remain ; before retiring wash out the rectum with about half-a-pint tepid solution of boro- glyceride, which is to be passed off; as soon as that is effected, inject one tablespoonful of the following : '^i Ozonized distillation of hamamelis, . . .^iv; Papoid, grs. xxxii. Mix. This is to be permitted to remain over night. This mixture of ozonized hamamelis and papoid acts energetically upon the effused lymph which, in the process of chronic inflammation, has been effused into the interstitial structure of the prostate. To be effective, it must be applied as above. The cocaine sup- pository produces anaesthesia of the prostate, a state most favor- able for the dissolution or absorption of lymph. Follow it in about two or three hours with the papoid mixture. Peroxide of hydrogen has also been most successful. BACTERICIDES. 41 Or waxy or starchy usurpation of structure, Amyloid De- is a peculiar affection occurring only in indi- generation. viduals who have suffered long from the pre- sence of the microbe of syphilis, the bacilli of tubercul?e, the micro-organisms of cancer ; prolonged osseous suppuration. This form of degeneration is decidedly an attend- ant upon old sores, wherever there is pus or muco-purulent mat- ter present in the body, as in empyema, chronic bronchitis and pemphigus, malignant variola, dysentery, ulceration of the blad- der, phosphorus necrosis. Besides, amylosis occurs sometimes in chronic gout, rheumatism, malarial poisoning, alcoholism. Although this appears to be the field of origin, still there is some mysterious cause, some terrible wreckage of- vital ele- ments, which so degrades or alters the living matter of our own t)odies into a disease germ, w^hich in some manner evolves starch granules or molecules ; these are carried by the blood through- out the entire body and deposited only in weakened parts and in- crease in bulk by aggregation of molecules. The microbe, which is present in all cases of amylosis, and Avhich is pathogenic of the disease is : The BacilliLS Pyocyaneus. — This microbe is present in the blood in all cases, but is most abundant if pus or muco-purulent matter be present, especially if that be of a greenish color. Taken either from pus or blood, it appears in the form of slender rods, linked in twos or threes, or collected in irregular masses, spore formation present and active. Easily cultivated in liquid gelatine, in twenty- four hours the culture has the greenish appearance of pulp. The pigment or coloring principles is '' pyocanin!'' Micrococci can be extracted with chloroform from the pus or washing of bandages — the microbes crystallize in the same fluid in the form of needles, rods, prisms. The injection of this microbe into animals gives rise to amyloid degeneration. The bacillus pyoganeus which gives rise to this species of degen- eration is not a carbo-hydrate, but a nitrogenous body. The heart, spleen, intestines, liver, kidneys are most frequently affected — each one besides may be complicated with the presence of other germs, or the amyloid germ may exist alone. The symptoms of general amyloid degeneration, present noth- ing very distinctive. Great and progressive debility, pale, waxy ap- pearance, inability to get around, urine abundant, of low specific gravity, small amount of albumen, paraglobunuria, hyaline casts. The treatment of amyloid degeneration is not by any means ■encouraging. The removal of causes is most important as the 42 DISEASE GERMS. destruction of the germs of syphilis, tubercles, cancer — any suppurating focus, by a general alkaline and tonic course — but when the proper structure of an organ is once usurped by starch granules it can never be restored. Amyloid degeneration naturally takes place on the coats of arter- ies, which carry the starchy, products in the blood, small arteries, especially the renal glomeruli, also the vessels of the spleen, liver,, intestines and lymph gland. Waxy degeneration of the intestine is usually a complication or waxy kidney and liver. The primary seat of amyloid deposit in the intestines is the arterioles. The small intestines are much more frequently than the large. When it takes place it entirely^ destroys the secreting faculty of the absorbents, causes the mucous membrane to become pale, shiny and slightly oedema- tons ; on the application of the iodine test, small maroon-colored spots appear in the villi, where the earliest changes occur; later oa the entire muscular coat becomes involved, until finally the •entire walls of the intestine are fused into one homogeneous mass. Generally infiltrated of the solitary glands ; Peyer's patches are less affected than the surrounding tissues. TJie symptoms of amyloid intestinal degeneration are usually masked with those of waxy liv^er and kidneys with which it is. invariably associated. A general amyloid degeneration of the intestinal tract exerts a. potent influence upon the general nutrition of the body — great exhaustion, emaciation, anaemia — a serous, persistent diarrhea are the best points in diagnosis. Amyloid Degeneration of the Spleeji. — The causes which give rise to waxy spleen are the same as predispose other organs to it^ as the germs of syphilis, tuberculae, cancer, chronic alcoholism,, malaria, etc. It is found deposited either through the entire spleen, or in nodules, or granules in large quantities, which causes the enlarge- ment. On cutting the speen, it is crispy, smooth, sh-ining and gives the characteristic reaction to iodine. Late in the disease anorexia, vomiting, hemorrhages. Amyloid Degeneration of the Kidneys. — Chronic intestinal nephritis, invariably precedes starchy deposit in the kidney — it is a weakening process which permits an exudation from the blood, and is effused into all weakened structures simultaneously. The primary causes we have stated. When the deposit takes place in the minute arteries, the secreting tubes and cells soon become involved, waxy products appear on isolated patches, when an increase of size takes place, the kidneys become hard, crispy — the change is most marked in the malpighian tufts. BACTERICIDES. 43 The increase of size is due entirely to the presence of starch bodies, which look like grains of boiled rice. All parts, the glomeruli, arterioles, veins and basement membrane of the tubules become infiltrated. In addition, fatty granular and hyaline bodies are found. However slight or indistinct, the iodine test is most reliable — placed upon the degenerated tufts, it always gives the character- istic iodine reaction. The usual method of the disease making its appearance is as follows : An individual suffering from tuberculse, syphilis, cancer, rheumatism or some suppurative disease, begins to realize that he is losing flesh, strength, becoming weaker, more feeble, loss mental and physical, a general goneness on very slight exertion, short- ness of breath, has a very pallid, waxy countenance and passes a very largely increased amount of urine — being compelled to rise several times during the night in order to pass it and in large quantities ; weight in the upper part of the abdomen, with a gen- eral fulness, with enlarged liver, spleen and kidneys ; oedema at ' the ankles, indigestion, occasional vomitings. Such a train of symptoms are significant, together with the altered, pale, waxy complexion. The usual increase in the quantity of urine is up to about lOO ounces, with a very low specific gravity of 1005. Very little dropsy. The nephritic trouble is simply an emunctory of the body weakened ; anatomical changes due to a usurpation of the structure of a gland by starch. Recovery is impossible. It may be arrested, retarded, but never cured. Our best remedies consist in a general alterative and tonic course, pushing special remedies, such as the iodide of potassium, iron and nux vomica. Amyloid Degeneration of the Heart. — Waxy degeneration is never met with except in connection with similar changes in other organs of the body, and is invariably due to a constitutional cause ; it consists in the formation of a shining homogeneous sub- stance in the primitive muscular fibres, which gives the reaction of amyloid material. It is most frequently met with in the walls of the right ventricle, causing its cut surface to present the char- acteristic appearance of waxy metamorphosis. The primar}- changes take place in the connective tissue surrounding the mus- cle-bundles. The presence of the syphilitic germ is the primary cause. The principle symptoms attending it are cardiac failure, with waxy degeneration of other organs, as the liver and spleen. Cardiac failure, with a syphilitic taint, affords good reason to suspect starchy degeneration. 44 DISEASK GERMS. The treatment, a general alterative and tonic course, with strophanthus, convallaria and other remedies to strengthen the heart. Amyloid Degencrction of the Liver. — Seventy-five per cent, of all cases of waxy liver occur in males between 30 and 50. The presence of the microbe of syphilis in the interstitial structure of the liver is undoubtedly the chief cause. Malarial germ saturation of the liver is also a very prominent cause, as well as prolonged suppuration of bone and the micro-organism of tubercle in lung. The degenerative process begins in the walls of the capillaries and minute arteries. The microbe causing the pecular blood changes gives rise to the deposit of a substance resembling albu- men in its reaction. Its reaction is characteristic, a watery solu- tion of iodine changing it to a deep red-brown. The liver is always enlarged, hard, like a stone, non-elastic, and its substance some- w^hat heavier than normal. The liver cuts with a creaking sound, like bacon, hence the name lardaceous is applied to it. Its advent is never well defined — rather obscure — occurring as it almost invariably does with other wasting diseases of the body. A sense of weight, fulness and constriction in the right hypochon- drium, never amounting to pain, great discomfort; jaundice, ascites are not essential symptoms. When jaundice is present, it is due to an intermittent catarrh of the bile ducts. Later on in the dis- ease, diarrhea and vomiting on the slightest irregularity in diet. An?emia and progressive debility are ever present. There is a great increase in the white corpuscles of the blood—the patient has a peculiar waxy look and peculiar odor; faeces are pale, they do not contain any bile. The urine is highly albuminous, of a lower specific gravity, increased in quantity. These urinary symptoms increase as the disease advances. There is a bulging of the hepatic and splenic regions, the area of dulness of both being greatly increased. The prognosis in all cases is most unfavorable ; it has no exact duration, but usually merges onward to a fatal termi- nation. General principles of treatment are strict attention to warm clothing, general hygienic surroundings, daily baths of iodine and ammonia are of importance, followed by massage. A most gen- erous diet ; but in all cases forbid saccharine, starchy and alcoholic food or drink. Vegetable tonics such as hydrastis, salix niger, comp. tincture of marticaria, cinchonia. Preparations of iodine kill the microbe, and are invariably of the greatest utility. These should be alternated with the chloride of ammonia, which always produces most salutary results. BACTERICIDES. 45 Dropsy of the cellular tissue is the most striking Anasarca, symptom of chronic interstitial nephritis, and one which very naturalh' attracts the attention of the patient. It is common in both the large white as well as the con- tracting kidney. It seldom makes a decided appearance until the hypertrophied heart breaks down, when it appears with other signs of collapse of the whole body. It is first seen in a bagging below the eyes in the mornings, then in the legs and ankles, latterly higher up, indicating a failure of the heart to maintain the struggle any longer. The dropsy of the cellular tissue is due in a great measure to obstruction in the kidneys, although in every case there is a decided heart failure. A breaking down of the kidney, and heart failure ; in addition, there invariably exists a watery state of the blood, accompanied with increased permeability of the capillaries, caused by the pres- ence of urea, an acid toxic, in the blood. {See Dropsy.) Poverty of the Blood. — A condition in which the Anaemia, red corpuscles are diminished or reduced to eighty, sixty or even lower than forty to the one thousand parts, instead of one hundred and thirty, which is the healthy standard. The liquor sanguinis is also poor in albumen, but may contain an excess of salts. The common causes are poor food, over-work, absence of sunlight, deleterious trades, as operations in lead, mercury, phosphorus, the fumes of which are powerful agents in impoverishing the blood ; disease, hemorrhages, drugs. Red Corpuscles as seen in normal atrophy of gastric glands, defective assi- ^^°°^^' milation, lack of afresh air and muscular activity, malignant dis- ease, imperfect nutrition and impaired sanguinification, excessive loss or drain of vital secretions, excesses, passions, mental shocks, and it may be due to parasites, as the trichinae, taenia, and other micro-organisms that find their way into the alimentary canal by food and water. The Ordinary Symptoms of anaemia are great debility, pallor, blanched appearance of skin and mucous membrane, loss of appe- tite, in some cases with an intolerance of food, often nausea and vomiting, constipation or diarrhea. As a rule, in the earlier stages of the disease the breathing is quiet, only on exertion, which produces marked breathlessness ; but in the advanced 46 DISEASE GERMS. Stage we have great difficulty in breathing. Attacks of syncope or fainting fits are Hable to occur, but not so frequent as one would expect ; the action of the heart is generally regular and quick, often very feeble ; the impulse is often widely visible, undulating and thrilling ; the area of cardiac dulness is increas- ing laterally, due either to dilatation of the heart or retraction of the lung. Aortic and pulmonary systolic murmurs, with palpi- tation of the large arteries of the neck, often visibly pulsate and are the seat of local murmurs. The jugular hum is seldom ab- sent, and pulsation of the jugular vein is often observed. The pulse is soft and compressible, quick, jerking, empty. There may be enlargement of the thyroid, protuberance of eyeballs, with vertigo and nausea, volitantes or specks or spots before the eyes, albumen in urine, oedema and dropsical effusions into the chest, pericardium, peritoneum and cellular tissue ; amenorrhoea ; occasionally fatal syncope, coma. There is usually no enlargement of either liver, spleen or lym- phatics, and albuminuria is slight and transient. As the disease is often due to hemorrhage, epistaxis, haemop- tysis, menorrhagia, haematuria, we are liable during an attack to have a recurrence which should be guarded against ; but in the sanguine or hemorrhagic diathesis, this is so persistent that it is liable to occur even in the retina of the eye, being most abundant around the optic nerve entrance. It is frequently associated with white spots and areas due in part to leucocyte-like cells, in part to degeneration of retinal tissue. Slight febrile symptoms are the rule. Anaemia is often divided into simple and pernicious, the latter term being applied to it when due to bad food, conjoined with pregnancy or lactation, or repeated pregnancies, or digestiv^e or intestinal disorders. Malarial influences in the production of haematuria give us the best and most common illustration of per- nicious anaemia. It is not well to call the profound blood change that is set up by direct nervous shock, fright, grief, very perni- cious, as it is a factor of simple anaemia. The cause for anaemia should be sought for in two directions, diminished activity of blood formation, or excess of activity in blood destruction. The degree to which the haemoglobin may be diminished without being fatal, is about one-fifth of its normal quantity. After the blood is drawn we observe irregular massing of corpus- cles into pear-shaped, biscuit-shaped or globular forms, and the coloring matter accumulating in the corpuscle at one point, indi- cating a greater proneness to form changes in healthy blood. At the same time can be seen small fragments of corpuscular matter, evidence of the disintegration of the corpuscles. BACTERICIDES. 47 In our diagnosis of anaemia neither the spleen, nor lymphatic system is to show any evidence of change ; if they do, then it may come under another head. The theory of the blood formation of the bone marrow has not been sustained. The alterations in the blood and marrow in the form of altered corpuscles are met with in cancer, and they seem to be dependent on the cachectic state rather than the cause of it, and not in anaemia. There are three other blood diseases that bear a close resem- blance and analogy to anxmia — a resemblance due to the factor common to all of them : the diminution of the oxygen-carriers of the blood. In anaemia, a decrease of red corpuscles ; in chlorosis, an imperfect evolution of the blood ; in leucocythsemia, an increased production of white corpuscles and an incomplete conversion of them into red ; in pseudo-leucocythaemia there is •deficient formation of red corpuscles ; in leucocythaemia, hyper- trophy of spleen almost invariably present ; in pseudo-leucocy- thaemia, the lymphatic system greatly infiltrated. Chlorosis is essentially a disease of nervous origin ; centres of life are depressed, hence the process of cure is slow but pro- gressive. In the treatment of anaemia general principles must be ob- served as to the removal of cause, enjoining quietness or rest in recumbent posture, attention to clothing and secretions, abund- ance of fresh air and sunlight. The true aim in treatment is to introduce, as quickly as assimilation will take it up, the most nutritious food with mineral acids, iron, cinchona and other tonics. The nourishing diet embraces milk, raw eggs, restora- tive soup, raw beef, essence of beef, blood, fish, poultry, roast beef ■and mutton, at stated intervals with pepsin if digestion is feeble. Our best remedies are those that increase blood formation most rapidly. Aromatic sulphuric acid and sulphate of quinine : ■one ounce of the former to thirty grains of the latter. Dose — fifteen to twenty drops thrice daily in water ; or compound tinc- ture cinchona and simple syrup, of each two ounces ; to which add two drachms of muriatic acid. — Mix. Dose — a teaspoonful thrice daily in water. The greatest possible benefit is derived from peroxide of hydrogen in anaemia, it acts as a scavenger to the blood, it is a life-giving element, oxygenizes every tissue, increases the red discs. Benefit will be derived from iron, provided it does not cause irritation or fever, or provoke constipation, the acetate or muri- ated tinctures or iron by hydrogen. To prepare the acetated tincture, take a pound of lath nails and •cover with good strong, sharp cider vinegar, or dilute acetic acid ; 48 DISEASE GERMS. steep for ten days, then strain. Dose — Half a teaspoonful in a glass of water three times in twenty-four hours, or fifteen drops of the mu dated tincture in the same quantity of water, and as frequent. Iron by hydrogen operates well in the following com- bination : Iron by hydrogen, thirty grains; sulphate of hydrastin, thirty grains ; sulphate of quinine, twenty grains ; solid extract nux vomica, eight grains. — Mix. Make thirty pills. One every four hours. In administering those remedies, select one preparation of iron to one of tonic ; give each every four hours, two hours apart. Open bowels with nutritive enemata or suppositories. As the patient progresses to recovery glycerite of ozone should be given, as it supplies deficiencies in the blood. It is an invaluable remedy in anaemia — aids powerfully in the restora- tion of the devitalized fluid to its normal constituency. When recovery takes place, a change of air to the sea shore is good, fresh food if available, is judicious. The term anchylosis signifies a fusion or Anchylosis, union of the ends of bones in a joint, in which lymph, one of the products of inflammation, has been effused and become organized either into ligament or bone. This naturally divides it into two forms, true 2ind false, the former in which the effused lymph has become thoroughly organized into bone ; the latter in which it is simply ligamentous. Bone or ligament, neither tissue in a joint being of original formation, nor so vital, is capable of absorption with modern remedies, and the aversion existing among a very large percent- age of physicians against interfering with stiff or anchylosed joints is removed. The precaution of removing the urate of soda or uric acid from the blood by the uric acid solvent should always be observed, as it is not desirable to have either of those agents liberated in the joint during treatment. It has been demonstrated in thousands of cases that ozonized clay will excite and procure absorption of all adventitious matter in the form of fibrous tissue, that class of tumors in the breast, stomach, bowels, ovaries. The action of the ozonized clay made into a poultice with cold spring water, and applied to either a true or spuriously anchy- losed joint is destructive to the inherent elements of the lymph in whatever state it may be ; has marvellous power of absorption of the disintegrating mass, and its prompt elimination from the body. BACTERICIDES. ^O It acts by enclosmosis, penetrates right to the mass, and will cause the lymph to gradually disappear. The peculiar faculty in effecting this is, that the clay must pro- duce no irritation, 7io pain, no redness of the cutaneous surface. It must be applied daily, and as it is very hydroscopic, will not retain its ozone verv^ long unless in a dry state ; it is best to mix a little, what is to be used at one time. There are numerous old cases in which bony union is perfect — ^joint immovable; on these the clay will act well in diminishing the calibre of the effused products, but on the phosphate of lime it exercises no chemical action, hence in true anchylosis, forced rupture, a breaking up of organized products is often necessary. The more general use of one of nature's products will speedily rid us of a class of deformity very common. It is well to bear in mind in the management of all cases of anchylosis that the secre- tion of synovia is much augmented by increased nutrition of the brain, so that in all cases, while guarding against the formation of uric acid, the vital elements of brain nutrition should be stimu- lated with oats, kephaline, etc. A swelling, pouch, sac or tumor, caused by the Aneurism, dilatation of the coats of an artery. It may em- brace one or all the three coats of the vessel, and may extend a long distance. When all the coats of an artery are dilated, but not ruptured, it is called a true a?icurism. Dilatation, with rupture of one or more coats, constitutes a false aneurism. The internal and middle coats are frequently ruptured or removed in patches by the detachment of foreign particles or the burrow- ing of disease-germs ; the blood then comes in contact with the external cellular sheath, dilating it into a pouch or sac. The ex- ternal wall of the tumor in this case condenses, acquires a cover- ing by effused lymph, and becomes thick ; and if the patient enjoys average health, the sac will become very firm. The divi- sion or rupture or tear of an artery may result in extravasation of blood into the areolar tissue, and thus form a diffused aneurism. Varicose aneurism can only happen when a vein runs over an artery, as when the brachial is punctured in opening a vein. The blood rushes into the vein, rendering it varicose ; nsevus, or aneurism by anastomosis, so common on the heads of children. Causes. — The absence of support, inherent weakness of or- ganization, a weakened or diseased state of the walls of blood- vessels, the deposit of morbid matter in the blood on the walls of an artery, as particles of starch, fat, calcarea, tubercle, and these, being washed away by the current of the circulation, leave the 50 DISEASE GERMS. Spot to which they adhered weak or ulcerated, and impair the elasticity and vital power of resistance of the vessel ; when, if the circulation is excited by mental or physical exertion, as cough- ing, straining, lifting, hoisting, pulling, rowing, jumping, the force of the circulation presses heavily on the weakened part, and a bulging or aneurismal sac is formed. Morbid states of blood are favorable for aneurismal tumors. If they arise from local violence, they are called traumatic, and spontaneous when they arise without local injury — a distinction of no moment. Symptoms. — A sac, pouch, swelling or tumor, pulsating syn- chronously with the action of the heart, located over an artery, which, when equally compressed, is emptied of its contents, and when pressure is removed the blood rushes in with a whirring sound. They tend to increase in size, and if near the heart give rise to different morbid states of that organ. Treatment. — Men, from their more laborious mode of life, are more obnoxious to aneurisms than females, and are better sub- jects for a spontaneous cure by coagulation, as their blood con- tains more fibrin and a much greater percentage of red corpuscles than women. We shall briefly enumerate the various methods of treatment before speaking of nature's method. A ligature applied to the main trunk of an artery cuts off the circulation, the pulsation in the sac at once ceases, a coagulum is formed, which, if vital force is good, is gradually absorbed, and the whole mass degenerates into an impervious cord, the circula- tion being carried on by the collateral branches. This may all look well, but if there is disease of the artery, as there often is, a union of its internal coats may not take place, and when the ligature sloughs off in one or two Aveeks, secondary hemorrhage and death ensue; besides, it is only on the thigh in Scarpia's tri- angle, or in the arm over the brachial or about the head that it can be applied. It is not adapted for the internal forms which are so common. Pressure, where it can be applied, is of great efficacy in dimin- ishing the flow through the sac. It gives the fibrin of the blood a chance to coalesce and cause coagulation, which is ultimately absorbed. Electricity, applied by means of several needles in- serted into the aneurism, produces instantaneous coagulation of its contents. It is best adapted to small tumors. Nature's method is the best. Fibrmize the blood, restrain the circulation, and coagulation is certain. Begin by the administra- tion of a rich animalized diet, beef, eggs, milk, cream. Improve the digestive organs and increase fibrin in blood with nitro- muriatic acid and compound tincture cinchona, or aromatic sul- phuric acid and quinine. After a few weeks, enjoin absolute rest BACTERICIDES. r i of mind and body, and put patient on digitalis to keep pulse at sixty, steady. Fresh, rich food, no alkalies ; do not use acon- ite, or veratrum viride, or belladonna, for however valuable their action on the heart may be they keep up fluidity of blood. After the pulse has been kept at sixty, under care of a skilled nurse, for one week, use either ergot or carbolic acid internally for about a week, and coagulation of contents of the sac is almost certain. Under such treatment patient must retain the recumbent position, as that slows the heart's action about twelve per minute. The digitalis must be administered in from eight to fifteen drops in water, every three hours, never permitting contractions to ex- ceed sixty. This drug not only slows the heart, but contracts or astringes the heart, arteries and veins ; their calibre is smaller, and the tendency is for the blood, if rich enough, to clot in hollow organs, as the aneurism. This clotting begins on the walls of the aneurism and gradually merges to the centre unlil a clot forms. The ergot or carbolic acid must be very carefully watched, and discontinued if any bad feelings are experienced about the heart. Of all methods this is the best. Aneurism of the heart is found in two Aneurism, Cardiac, forms : I. TJie acute variety depends on a laceration of the endocardium and muscular tissue, through which the blood passes to form a pouch. In this pouch fibrin is de- posited, while at its entrance is a fringed margin with vegetations attached. 2. The c] ironic form results from some inflammatory condition of muscular fibre or endocardium. Walls of sac consist of endo- cardial and pericardial membranes unbroken, while the muscular fibre seems to be replaced by a fibroid tissue. Either kind gives rise to obscure and uncertain symptoms ; passage of blood into sac may cause a murmur. Death usually occurs suddenly from rupture. Aneurism of coronary arteries is not infrequent. The symptoms of this form of Aneurism of Thoracic aneurism are often obscure in their Aorta. early stages, bearing a strong resem- blance to disease of the heart. If the aneurismal tumor be large and is developed quickly, there is disturbed action of the heart, with some modification of radial pulse ; dulness on percussion around portion of vessel from which 52 DISEASE GERMS. aneurism springs; cough, wheezing, difficulty of breathing, spit- ting of blood, difficulty and pain about back and chest, superficial veins of chest and neck swollen. If the aneurismal tumor be- comes very large and pulsating, rises out of the chest, producing protrusion of sternum and ribs, then the diagnosis is easy. If the aneurism presses upon the trachea, there is difficulty of breath- ing and cough ; when on one or both recurrent laryngeal nerves, aphonia, with troublesome cough, severe paroxysms of laryngeal suffocation, pain coming on ■ at intervals ; when on oesophagus, symptoms of difficulty of swallowing, engorgement of absorbent vessels and glands, inanition and symptoms of stricture. If the aneurism is in the ascending, near the heart, the patient suffers from angina pectoris, resulting from pressure on the plexus of nerves ramifying on each side of the aorta and communicating freely with the cardiac ganglia and plexuses of the ventricles. Contraction or dilatation of pupil on the affected side, accord- ing as pressure is sufficient to irritate or paralyze branches of sympathetic nerve. Often blowing murmurs can be detected. If the heart be compressed by a tumor, so as to impede the action of the valves, a systolic or diastolic murmur will result. Pressure on aorta or on pulmonary artery may produce a murmur. In false aneurism there is generally a murmur both with entrance and exit of blood into the sac ; or there maybe one loud and rasping murmur from the passage of blood over the roughened inner sur- face of the vessel. In true aneurism, or the mere dilatation of a part of the wall, murmurs seldom audible. Even a small open- ing into the canal of an artery into aneurismal sac, and a rough- ened state of the arterial tunics from degeneration, will give rise to a murmur. A peculiar thrilling or purring tremor is often felt over the sternum. The termination may be death from rupture externally, or into pericardium, or into the pleural cavity, or into the trachea, or into the bronchial tube ; or the patient may die from exhaustion consequent upon long-continued suffering, or there may be a fatal destructive inflammation of lung, owing to the compression of pulmonary vessels or pressure on pneumogastric. Very common in ladies from Aneurism of Abdominal falls, lifts, strains and bearing Aorta. down efforts in labor. Patient describes it as a feeling as if something had given way; most generally met with just behind stomach. It exists from a mere distension of the descending aorta to a large sac ; machinists, especially those pulling long heavy bars of steel, are common sufferers. BACTERICIDES. 53 Empty the bowels ; see the patients before they partake of food ; lay them on back, knees drawn up, and the tumor can be easily made out. If large enough to interfere with the vermicular move- ments of the stomach, the case is not so favorable for a cure. If that organ be undisturbed, treatment will soon do its work in effecting a speedy cure. In aneurism in chest or abdomen all bodily and mental excite- ment must be avoided, all prominent symptoms alleviated ; gen- erous, reparative diet to be allowed ; not over one pint of fluid to be used per day ; great attention to the secreting and excreting functions, and in the abdominal, the method of treatment by slowing the heart and fibrinizing the blood resorted to. Aneurismby anastomosis, or mother's mark, afor- Aneurism mation of dilated arteries, veins or capillaries. or Arterial Xcevi, met with most commonly in Nsevus. infancy and youth. The diseased vessels become enlarged, elongated and tortuous, forming tumor variable in size, irregular in shape, spongy, compressible and pulsating — a murmur being audible. Venous Noevi give rise to irregular tumors of a purple color, which feel doughy, and are diminished in size by pressure. Capillary Ncevi are most common ; for the most part they are congenital, begin usually as a red or purplish spot, which gradually spreads. They are generally met with on the scalp, or face or neck ; rarely on other parts, and involve skin or subcutaneous parts, and of all sizes, from a strawberry up. Treatment. — When very small and producing no disfigurement, and not increasing in size, they are best left alone, as nature often effects a spontaneous cure by a coagulation and absorption of their contents. There are several methods of treatment, a removal by the knife, or ligature, which is rarely advisable ; destruction with caustics, as brushing it over with ethiate of sodium, or nitric acid, or super- phosphate of zinc ; electrolysis and coagulation of blood by gal- vanism, or in the application of remedies to excite adhesive in- flammation, as injecting with perchloride of iron, or vaccination with croton oil, or painting with collodion and tannic acid, paint- ing with tincture of iodine. Cardiac neuralgia, or as some term it Angina Pectoris, cardiac epilepsy, from the fact that some cases are accompanied with a warning, a partial death of the cardiac nerves, in which severe intermittent 54 DISEASE GERMS. pain is felt about the heart, with a sense of strangulation and a feeling of impending death, or it is a neurosis due to organic change in the nerves ; occurs most frequently in advanced life ; more common in men than women. It seems to be associated with ossification of the coronary arteries and fatty degeneration. The cardiac nerves are specially involved in cases of ossification of the coronary arteries, as they are in such close proximity throughout their whole course, for these nerves not only accom- pany the arterial trunks, but pass into the muscular parietes of the heart along with the coronary vessels ; for nervous filaments can be traced as far as the third or fourth subdivision of the arter- ies ; here we lose sight of them, even in the largest animals. The pain radiates or shoots through the connection of the cardiac plexus with the spinal to the brachial and cervical plexus. Causes. — Disease of the brain, morbid states of blood, stimu- lants, tea, whiskey, tobacco, sexual excesses, mental excite- ment, heart starvation from impure blood, defect in organs of diges- tion and assimilation, mal-assimilation, heart badly nourished, over-exertion, mental or physical, loss of sleep, liver working sluggishly, brain under-fed, the weakened nerves of heart poi- soned by products of mal-nutrition or disease-germs, as syphilis ; the waste-laden or disease-germ blood produces spasm, worry, struggle for existence, etc. It is intimately associated with gout ; albuminuria, diabetes and hepatic disorder. Symptoms. — Generally the first attack comes on after ascending some slight acclivity, or making some slight exertion, or after a meal. It comes on with a sudden seizure of excruciating pain in the heart, shooting from the breast-bone to back, often accom- panied by a feeling of constriction in the chest as if grasped by a vise. The pain is localized, still, it may shoot toward the shoulder, down the left or both arms, even down to the lumbar nerves. This brings the patient to a stand-still ; he fears to breathe, but if he chooses to breathe he can do so freely enough ; he feels a sen- sation as if of impending death, and a ghastly paleness overspreads his countenance. The pulse ma}' be regular, or it may intermit or stop, or be feeble and irregular. After a few minutes pain suddenly ceases, and the patient is well, but dreads another attack or recurrence. At first there is often no lung difficulty, as asthma or emphysema or dyspepsia ; it seems to be brought about by some trifling exertion, some emotional excitement of heart's ac- tion, but as it progresses it does not seem necessar)^ to require an exciting cause, as it will come on when he is asleep, the patient waking up in a paroxysm of anginous pain — a pain so excruciat- ing and commanding that no words can express its intensity; it is appalling; it unnerves the strongest mind, and death would BACTERICIDES. 55 seem to be preferable to such suffering. The sudden violent pain produces sickness, faintness, depression of heart's action, pale and anxious countenance, coldness, cold, clammy sweat. As the struggle passes off patient regains his usual health, often appears quite well. Whatever produces depression in the function of the fibres coming from the posterior roots of a spinal nerve, and as its result pain or neuralgia, produces also depression of function of motor fibres coming from the anterior root of the same nerve, and as its result sub-paralysis of the parts to which it is distributed. Hence we have in angina pectoris two distinct sources of depres- sion of the cardiac action ; (i) we have the most depressing effect of a pain, the most acute and severe that the human body can ex- perience ; and (2) we have the action on the cardiac motor gan- glia of the same cause which, acting on sensitive nerves, gives rise to this excruciating agony ; for we cannot suppose that the de- pression of motor is any less than the sensitive ones ; that is, that the epileptic paralysis of motion bears a relation to the acute- ness of the pain, which is the index of the depression of the nerves of sensation. Should death take place as the result of an attack, the heart will be found flabby, uncontracted, due to inhibitory paralysis. Death is not due to spasm, for if it was it would be instantaneous ; whereas, it is gradual, a progressive lowering of the heart's action, becoming feebler and feebler until it ceases to beat. The main theories that have been advanced to explain the phe- nomena of the seizure are, spasm of the heart, depression of car- diac plexus, dilatation of heart, and ossification of coronary arter- ies. Pain is a symptom of variable significance here ; it is always intense, arising and ceasing suddenly, and accompanied with a feeling of approaching death. Angina pectoris has no relation to fatty degeneration, in which there are faintings, cardiac asthma, feebleness of the pulse or of the cardiac impulse, with yellowness or pastiness of the com- plexion, and an arcus senilis. Treatment. — This resolves itself into two distinct divisions — dur- ing the fit and intermission. During the fit our measures are but palliative, but much more ample than what our forefathers possessed. They had only the use of external stimulants and narcotics — vain hope where minutes are precious. Modern discovery has changed all this. We now have remedies that can be administered by in- halation or hypodermic injection, that can give the patient instant relief of that terrible pain. Foremost among all our modern appliances for this dreadful breast pang, we place nitrate of amyl, a drug of great power, a volatile narcotic. To obtain a satisfactory result it must be fresh ; 56 DISEASE GERMS. not kept in bottles, but in hermetically sealed capsules or pearls, a dose ranging from three to eight drops in each, opened, dropped on a piece of lint and inhaled. It is perfectly safe, and may be entrusted to the patient with the certainty that he will not injure himself by its use. It gives immediate relief, alleviates and re- moves the pain. It flushes the face, quickens the pulse and lowers the blood pressure on the heart. If the nitrate is not procurable, or fails on account of its properties being lost in bottles, let the patient inhale a few drops of chloroform, and just as it begins to narcotize, inject hypodermically one-quarter of a grain of sulphate of morphia, so as to have the patient pass from the chloroform sleep into the morphia sleep, from which the patient will wake up in about eight hours, free from pain, but exhausted. Is there no danger from chloroform in fatty or flabby heart ? No, not if carried to the point we desire. Nearly all cases of fatty or flabby heart are due to heart starvation, and are benefited by such a stimulant if car- ried to a certain point, just its slightest effect, from which the morphia at once reacts. No diseased condition need deter the careful and cautious use of the remedy. In reckless hands it is not safe, but with care it is all right. Angina is such a depress- ing disease that we need perfect narcotism of the nerve centres through which the action takes place — a perfect setting free from all depressing influences. Ether is also excellent, but not rapid enough in its action. Nitro-glycerine gives the most complete relief in angina ; one to two drops of a one-per-cent. solution in serious cases gives the most complete relief from pain. Administer in water, and con- tinue during the intermission thrice daily, increasing the dose to eight drops. It lessens the attacks, breaks their frequency and force. Lobelia, sambul. and other antispasmodics are of little utility. However satisfactory our treatment may be with some of the above or other remedies during the paroxysm, it is during the intermission that the most striking results are to be obtained. 'Dur- ing that period the most strenuous efforts must be made to improve the patient's general health, and especially to tone up his heart ; avoidance of cold, damp, strong exercise, walking after meals, sexual intercourse and mental excitement ; rest, warmth in open air, driving or sitting is to be recommended. His diet must be regulated, to consist of the blandest, most nutritious and unstimulating foods, as broiled beefsteak, boiled fish, eggs, milk, cream ; avoid everything difficult of digestion, or that will give rise to flatulence, or stimulate and thereby weaken the heart. Prohibit tobacco, tea, whiskey, etc. The whole sys- BACTERICIDES. 57 tern must be attended to. Mild laxatives ; an active skin by- sponging and friction. A healthy stomach and liver does much to improve the tone of the heart, but a healthy brain and pure blood will aid more. The irritating plaster, two pieces an inch square, or else repeated small blisters, of undoubted efficacy. A very persevering course of vegetable alteratives and tonics should be resorted to, as phytolacca and iodide of potassa, stil- Hngia and iodide of sodium ; mineral acids and cinchona, qui- nine and iron. Either the irritating plaster or belladonna plaster to be worn constantly over the heart ; the former is preferred ; some are partial to the latter. While pursuing an alterative and tonic course, changing remedies weekly, and keeping two open sores at nape of neck freely discharging, then a special class of remedies are to be given to improve the faulty nutrition of the heart. We shall enumerate a few of those remarkable drugs : digitalis, arsenic, sulphur, quinine, phosphate of iron, nux vomica. Digitalis in small doses, not exceeding four drops of the tincture thrice daily, is invaluable in promoting the nutrition of the heart. Fowler's solution, in four-drop doses after meals, is invaluable in cardiac neuralgia and weak heart, being a special tonic to the nerves of the heart. Quinine, iron, hydrastin and nux increase the nerve nutrition, render them less liable to pain, and are especially valu- able in all cardiac neuroses. More recently cases have been most successfully treated with sulphate of sparteine and strophanthus. Domestic animals, as the cow, horse, sheep, goat, Anthrax, camels, poultry, etc., like man, if placed in a condi- tion adverse to their vitality, are liable to have the primary elements of their nutrition degraded, changed or altered into a disease germ, a giant form of bacteria, which, either in their own bodies, or if communicated to man, have wondrous power of growth and reproduction in the blood. The bacillus anthrax is peculiar to cattle, and may be com- municated either by close contact, food or water, or otherwise, from one species to another, during which the microbe acquires an intensity, virulence and activity which is typically fatal to life. Its migration from animals to man is attended with most fatal results. The micro-organism is so very tenacious of life that it will live for centuries in the wool, hair, hides, dried flesh, or blood of the affected animals. The causes are adverse states, as ex- posure, insanitary conditions, over-crowding, bad, meagre food, neglect ; essentially contagious and infectious. 58 DISEASE GERMS. Anthrax may attack man in three different ways — mahgnant pustule, anthrax oedema, and internal anthrax. The mahgnant pustule is usually the result of inoculation, and is mo.st frequently met with on the hands, arms, face and neck, or some exposed part of the body, and commences as a small red point or pimple, which may be painless or attended with a sting- ing sensation like that of a wasp-sting. A small papule speedily forms, which becomes covered by a flat vesicle which enlarges and usually bursts, discharging a clear bloody fluid ; a central black eschar forms at the base of the discharged vesicle, and a crop of other smaller vesicles form around it. The surrounding tissue becomes inflamed, so that the vesicle is seated on a hard base, with a sort of erysipelatous blush and swelling extending for a considerable distance. The central eschar enlarges, and the corona of vesicles, as well as the inflammatory sore, enlarges, and the oedema becomes quite great, so much so that if seated on the face, the head, neck, and shoulders become involved in the general doughy swelling. The lymphatics of the neck are seriously involved. If the patient weathers the crisis, the central slough separates and the wound granulates and heals. The constitutional symptoms are those of a malignant poison, — rigors, high fever, nausea, vomiting, prostration, sleeplessness, labored breathing, exhaustion and delirium. Death may occur early or not for several days. Internal anthrax is as rapidly fatal with or without internal lesions. It is usually brought about by the bacteria giant cells finding their way into the blood by the air, food and water. Lesions, or rather colonies, of the micro-organisms are found in the bowels, liver, spleen, brain and blood. The symptoms of the internal are prostration, vomiting, dys- phagia, pain, uneasiness in abdomen, colic and diarrhoea, the latter often bloody from the first ; collapse and cyanosis. Death is often quick. The symptoms of the form without internal or external lesions are those of extreme prostration and malignancy. After death in any of the forms the blood is found filled with large bacteria. Thrombosis of blood-vessels by masses of bacilli, not uncommonly an artery or vein being filled with a clot or plug loaded with germs. The recognition of anthrax is often difficult and obscure, unless we have a good history, as a wool-sorter, butcher, tanner, or hair or wool operative, or an attendant upon diseased cattle, or drink- ing water into which the refuse of an alpaca, or mohair, or tan factory empties, or is close by. BACTERICIDES. 59 The prevention of anthrax among our domestic animals is of national importance, — the mode is simply good food and care, an avoidance of overcrowding, and all insanitary states, abundance of pure water, cleanliness, ventilation, etc. The blood of all suspected cases of anthrax should be at once examined, and if there are present in that fluid stiff and long rods as seen in the annexed diagram, ,- ^ ^ ...j » ^ and those rods multiply by divi- ^^^^^^^ (^ ^^-^"L^ sion of spores and grow into long, "^-P-^/ f^ 0_P^ *! (^ jC^ ^ homogeneous looking, straight or iO^^rs'/rO % ' Q/"^/©© twisted filaments, then our diag- 'Ip^ o" ^» C^ ^c''^ G) nosis is positive, as the germ is q O qV?,o ^ ^ "g) "0*^^(3 pathogenitic of the disease. To o G)«^ j <^ '''^'^^'^^-?* Q^ aid this the spleen is usually large, ^^-7 Q) ^^3* ^ (3 r\ ^ full or engorged with the germs. '0 ^ -O^^^t'Q'^Va ^--^ The disease can be best studied © ^ * ^^^— ^ ^-^(^Q^ r. in its pustular form in a factory in -X^/' (3> ® ^ r^''^.^ * which wool is used, or alpaca, mo- ' ,Y '.vD -, ^y" " « ^ hair, or the^ fleeces of our own Badllus Anthrax as seen in the blood of a domestic animals who have died wool-sorter. from the disease. If the serum or any exudation from the pustule is placed in the field of the microscope it will give us the annexed appearance. Bacillus anthrax, the degraded bioplasm of cattle changed under adverse circumstances into a giant bacteria, give rise to J splenic fever, cattle plague, malignant pustule, ^ % wool-sorter's disease. A thorough knowledge ""^***' of this bacillus is of the greatest importance to i^\%^ the human race. Its morphological and bio- '^ . / logical characteristics have been thoroughly 9 ^^ ^ ^^^ worked out. It is one of the best of all mi- VS^^' **-^ crobes to study out, to cultivate, and give one *'=^"" an appreciation of germ evolution. ^thf pufofaVustuTe'oS The bacillus anthrax will grow in a nutrient the hand of a wool-sorter, fluid at almost any tcmpcraturc ; besides, it will grow in water and cast off spores, which become permanent seeds. The effusions, effluvia from mouth and nostrils of affected animals, being germ-laden in a pasture field where decaying animal and vegetable matter affords nutrition, the bacillus will grow on the surface of the soil. The treatment of anthrax must be highly germicidal, and carried out according to the indications present ; no time for experimenting, as it runs its course with amazing rapidity. If there be fever, antifibrine, in sufficient doses to equalize circulation. Peroxide of hydrogen is a remedy of rare value, administered /' 6o DISEASE GERMS. every two hours in alternation with 15 -grain doses of resorcin. These two remedies seem to be capable of annihilating the germ; and, to the pustules on the hands, face, or elsewhere, a paste made of either iodol or resorcin with an equal quantity of ozone ointment. If a good preparation of peroxide of hydrogen is not obtainable, then some of the following remedies should be used : Con. ozone, in 15 drop doses, alternated with 15 grains of re- sorcin every two hours respectively. Concentrated ozone, two ounces : chloroform, one ounce. Mix. Keep constantly applied over spleen. Concentrated tincture of kurchicine is a remarkable germicide in anthrax, kills the microbes, and virtually grasps the patient from the abyss of death. It must be administered in precisely the same manner as in malignant malaria — not a drop of water given till the drug has done its work, which will be known by an ex- tremely profuse, fetid sweat, prostration, when beef tea and brandy must be freely given. Mysteriously strange, obscure, sudden death, occurring in the families of woolen operatives, tanners, alpaca and mohair sorters, should in all cases be regarded with extreme suspicion, and the slightest evidence of indisposition on their part promptly at- tended to. _^_^ Loss of the cerebral faculty of speech and of Aphasia, the power of expressing thoughts by writing or gesture. A simultaneous loss, in a greater or less degree, of the memory of words or acts, by means of which words are articulated, and also of intelligence. That transitory form so common in the recovery from fevers, typhoid and diphtheria, due to congestion or anaemia, from which recovery always takes place, is not what we desire to notice ; it is the form that is permanent and due to softening of the brain from embolism or thrombosis, hemorrhage, or poison of syphilis, or due to the absorption of lead, nitrate of silver in hair dyes, or the inunction of bismuth and arsenic in face powders, or to the terrible effects of nicotine in tobacco. These agents in their use cause irritation and softening of the posterior portion of the third frontal convolution of the brain on the left side. Symptoms, — It may come on either slowly or suddenly, and may or may not be associated with germinal softening. It is ushered in by loss of the power of speech, which may be regained and recur again and again. In some cases words are recovered and employed and ultimately lost. Again, speech may make a temporary return under excitement, and then leave. Movement of lips, tongue and larynx may be healthy. There may be con- BACTERICIDES. -5 1 sciousness of what is wished to be expressed, and yet complete inability to express the thoughts by speech, writing or even ges- ture. The patient may know the use of an object, but cannot name it. They may read, but if they understand what they peruse they forget directly, as they will pore over and over again the same page. There is the greatest possible diversity in the impairment of the mental powers, usually hemiplegia and a com- plete breaking down, with the worst form of cerebral disease. In cases clearly due to the use of hair dyes, face powders, tobacco, syphilis, gout, if not of too long standing, there may be hope from the general treatment of chronic inflammation of the brain : especially, plasters and blisters to nape of neck, with alteratives and tonics. Iodide potassa in alternate use with ozone-water. These two remedies are of infinite value in clearing the brain of such deleterious compounds. When aphasia is due to the use of the peroxide of hydrogen as an auriferous hair dye, no remedy is of any avail. Loss of Voice from Functional, Blood or Organic Aphonia. Disease, operating upon the vocal cords, varies in degree from a slight hoarseness to complete dumb- ness. There are numerous varieties, as aphonia from absence of tongue ; aphasia, the loss of the cerebral faculty of speech by dis- ease of the base of brain from nitrate of silver, lead, bismuth in hair dyes and cosmetics, and disease-germs as syphilis, tuberculae, diphtheria ; aphonia from warts, tumors near the glottis ; aphonia fromthe different forms of chronic laryngitis : aphonia from loss of nerve power, as in typhoid, and apho7tia from irritation re- flected, as in teething, worms, masturbation. It is unnecessary to describe them all as they are spoken of under their respective heads. There are two forms, however, that might be enumerated — functional and organic. I. Functional Variety. — Reflected irritation tells badly on the larynx. Children often lose their voice in teething, worms and the like ; women who suffer from uterine, ovarian or other forms of irritation of the genito-urinary organs suffer much and often. The irritation of the clitoris with hypertrophy of that organ causes a wonderful harshness of voice, rough and masculine. Males of effeminate type, sensitive disposition, are great victims of aphonia, if addicted to masturbation. The squeaky voice, with or without loss, is notorious. Some men will suffer from aphonia from sexual excess or a gonorrhea. If this reflected or functional form is permitted to continue long, the vocal cords are liable to suffer atrophy or paralysis, to become flaccid and power- less. DISEASE GERMS. 2. Organic Form. — This is apt to be present in old cases of chronic laryngitis, perforating ulceration in the syphilitic or mercurial form. It might also follow diphtheria, morbid growths, disease of blood and brain. Treatment. — This requires great tact and good judgment. The removal of causes is of vast importance ; teething, worms, irrita- tion of the organs of generation, male and female ; the destruc- tion of all disease-germs in the blood, appetite promoted, nourish- ing diet, shower baths, irritating plaster to nape of neck, equable temperature, 75°, moist atmosphere, inhalation of warm, atom- ized sprays of ammonia, tincture of hydrastin, gargles of chlorate of potass, bayberry, iodol and oxygen. General alterative and tonic course of treatment, using freely such remedies as glycerite of ozone and kephaline ; phosphated tincture of oats, saxifraga, phytolacca ; and as tonics, quinine, iron, hydrastin, nux vomica, fluid extract black willow bark. If the cases do not yield, large doses of bromide of potass, calabar bean, and tincture of green root gelsemium, to diminish irritation of cerebro-spinal axis; atomized sprays of peroxide of hydrogen. Aphthae. This affection is one of the most common of all diseases due to the presence of a disease germ. This is not surprising when we realize the fact that 75 per cent, of our entire population suffer from tuberculae, and 50 per cent, from the syphilitic germ. Aphthae, properly speaking, consists in a degradation or alter- ation of the living matter of nutrition of the mucous membrane of the mouth into the disease germ oidium albicans and lepto- thrix buccalis. A pure change of bioplasm in the mucous and sub- mucous coats, which first exhib- its itself to the naked eye as a point of redness, small, round, then effusion takes place which elevates it into a vesicle or blister. There may be only a few or a crop of them, they may re- main isolated or coalesce and form patches. They may take place on the lips, gums, cheeks, tongue, palate, tonsils, or extend down- wards through the oesophagus. Causes are very numerous, all disease germs in the human blood, more especially the microbes of tubercle, syphilis; the poisons of mercury, lead, etc. The Oidium Albicans of Aphthae. BACTERICIDES. 63 Simple mal-nutrition will so change the embryonic elements of nutrition into the disease germ the oidium albicans, which when once evolved, is capable of independent existence with pro- digious powers of reproduction. Associated with the evolution of the germ, there is usually profound constitutional debility. The germ may be evolved as the result of simple mal- nutrition, then there is no real diagnostic mark but the mal-nutrition and ordinary symptoms of inflammation and ulceration. When the bacilli of tubercle act as the predisposing cause, the diagnosis rests chiefly upon the peculiar mottled cheesy appear- ance ; usually there are associated with it laryngitis, bronchitis, pulmonary tuberculosis. The syphilitic form is recognized by the copper-colored ap- pearance of the ulcers in which the germ is imbedded. That due to mercury and lead has a slate-colored, metallic hue in the ulcers and also a peculiar fetor of the breath. The form peculiar to infants, Infantile AphthcE, is very apt to arise from the imperfect cleansing of the mouth, or the child being permitted to lie with the nipple in its mouth. Particles of milk lodging in the crevices of the mucous membrane become sour or rancid, and give rise to irritation of the mucous mem- brane ; or it may be due to heated milk from over-work on the part of mother, or the lactiferous fluid may be bad. It may come from diseased children kissing each other, or diseased adults kissing healthy babes. Once the disease germ is developed in the child's mouth, the nipple of the mother becomes similarly affected ; vesicles forming, then cracks and fissures, filled with colonies of oidium albicans. The general health suffers. The child becomes irritable and restless ; some fever, debility, cough, vomiting, diarrhea, and general want of nutrition. The small white blisters become ulcers on the tongue, cheeks, gums, palate, tonsils ; breath is fetid, and if they extend down there may be difficulty in swallowing ; and if there be much debility, the case may merge into ulcerative stomatitis or can- crum oris. All forms highly contagious and infectious. Treatment. — In the treatment of all forms of aphthae we must recognize the pathology of the disease, an innervation of the powers of hfe, a condition of constitutional debility which predis- poses to this peculiar degradation. So in the treatment a strenuous effort must be made to im- prove the general health by a tonic and alterative course — such tonics as preparations of cinchona and mineral acids, avena 64 DISEASE GERMS. sativa, glycerite of kephaline, remedies to correct the mal-nutri- tion, and alteratives, as comp. saxifraga. All insanitary states avoided and a most generous scale of dietetics prescribed. In the form of mouth washes or gargles, such germicides should be used as will annihilate the germ, painting the microbe patches with either aromatic sulphuric acid, or tincture of siegesbeckie orient or distillation of jequirity,andthen using washes of either infusion of hyssop and resorcin ; or solution of boro- glyceride ; or of comp. oxygen ; or a few drops of peroxide of hydrogen added to water ; or chlorate of potassa, or chlorate of carbon ; or infusion of hydrastis, and boroglyceride. If the aphthae has descended, there is usually great prostration or debility, and germicides must be administered internally. In such cases either the glycerite of sulphur or ozone act promptly, kill the oidium albicans, and heal up the diphtheric- looking ap- pearance of the mucous membrane which had been so completely riddled soft, loose, friable by the germs. This term is applied to an engorgement of blood, Apoplexy, with or without extravasation of blood, in or upon any organ, as the brain, cerebral apoplexy ; in or on the cord, spinal apoplexy ; in the lung, pulmonary ; and so on with other organs. As generally used, the term denotes an exhausted state of the cerebral pulp, either with anaemia or congestion — the state of vital exhaustion so great as to cause the patient to fall down as if from a blow. Causes. — Anything that tends to exhaust the vital integrity of the brain, whether that cause may be predisposed to by hereditary tendency, peculiar types of conformation, aggravated or intensified by sedentary habits, high living, protuberant bellies, large heads, florid features, short, thick necks, high shoulders, a predisposition to hemorrhage. Apoplexy is also engendered by disease of the liver, heart, kidneys, ossification and calcareous degeneration, and deposits of cerebral blood-vessels, gout, intemperance, embolism, impure air, tight neckties, stooping posture. Varieties. — Nervous or simple apoplexy^ fatal with a trace, is rare ; the sanguineous, or that accompanied with extravasation of blood into the brain, very common ; and the third form, the serous, in which the serum effused is simply present and has no relation to an attack. A stroke or an attack is usually followed by stupor or coma, and the comatose condition may cease in various ways. It may gradually pass off, leaving the patient well ; BACTERICIDES. 65 or it may terminate in incomplete recovery, mind impaired and some part of the body paralyzed ; or it may terminate in death. In the latter case, on examining the brain, we find either no ap- pearance of disease, or else extravasated blood is discovered in the ventricles, or pons varolii, or to a certain amount in the cen- trum ovale majus, or in sac of arachnoid, or there may be a copious effusion of serum into ventricles or beneath arachnoid, with or without cerebral softening. That form which is fatal without any trace is very rare. That in parturient women is generally a clot embolism from ergot. Morbid Anatomy. — Cerebral hemorrhages are of all sizes, from minute capillary extravasations to large clots containing several ounces of blood. Preceding the hemorrhage, the ruptured vessel is the seat of miliary aneurisms, due to arterio-capillary fibrosis, which begins in the perivascular lymph spaces, and extends to the tunica intima. ]\[icroscopic deposits, or aneurismal dilatations, globular, sacculated or fusiform, are developed in innumerable numbers, and it is through their ruptured walls that the hemorrhage occurs. Besides, it is often due to fatty and calcar- eous degeneration. The general locations of ex- travasation are the intraventri- cular nucleus of the corpus striatum, optic thalamus, cere- bellum and pons varolii. If the apoplectic clot is not immediately fatal, change will take place in the clot — the se- rum will be absorbed — the clot may undergo fatty or other forms of metamorphosis, and it may become encysted. Warnings. — Frequently there are no premonitory indications or threatenings ; when there is, they are characterized by head- ache, vertigo, muscae volitantes, or transient blindness, or double vision, ringing in the ears, a feehng of weight and fulness in the head, often bleeding from nose, fits of nausea, occasional sense of numbness in limbs, loss of memory, great mental depression, in- coherent talking, drowsiness, indistinct articulation, and partial paralysis of foot, limb, face, eyelids. An attack usually begins in one or other of three forms : I. Patient falls suddenly down, deprived of sense and motion, 5 Cerebral Apoplexy. Horizontal section of the cerebrum through a clot in the left optic tract. A, A. Clots from hemorrhage. B, B, Area of tissue stained with blood pigment. (56 DISEASE GERMS. like a person in a sleep ; flushed or even livid ; breathing ster- torous, pulse full but slow, much below the natural standard ; often convulsions, or rigidity, or contraction of the muscles of the limbs on one side. 2. Sudden, and it may be excruciating pain in the head, pallor, sickness, faintness, often vomiting; frequently the patient falls to the ground in a state of syncope, coma. In other cases, instead of falling, the pain in the head is accompanied by a slight and transient loss of consciousness, then headache, with heavy op- pressed feeling in the head, which terminates in forgetfulness and coma, from which recovery is rare. Clot of great size is generally found in the brain. 3. Or it may come on with all the symptoms of cerebral hem- orrhage, paralysis of one side, loss of speech, but no loss of con- sciousness. The paralysis leads to coma, or it may pass off and the patient recover ; or it may pass off and death suddenly occur in a few hours or days,, or it may terminate in another attack. Apoplexy has well marked and general characteristics ; its duration varies in all cases from a few hours to as many days. Complete and total unconsciousness ; pulse generally at first im- perceptible or small, but as the patient rallies, stronger and fuller as the shock wears off, but slower than natural and often inter- mittent; respiration is slow and embarrassed, or stertorous; frothy saliva flows from the mouth, and in bad cases the body is covered with a cold, clammy sweat ; face is either congested, swollen, livid or very pale; eyes dull, glassy, pupils insensible to light, often one contracted or the other widely dilated ; ptosis, or drop- ping of eyelids, or squinting, according to the nature of the effu- sion and its location ; teeth firmly clenched, power of deglutition lost or impeded, bowels constipated, motions passed involuntarily, involuntary micturition. When it is of the sanguineous type, it is not unusual for neck and even shoulders to show congestion and lividity. Incomplete recovery is almost always followed by paralysis. Trcatmrjit. — If the condition in any of its three forms is sus- pected, the patient should be warned to guard against all bodily exertion, as running, jumping, lifting, hoisting, or violent mental emotion or passion, or straining at stool ; and tea, coffee, tobacco, whiskey, beer and venereal excitement strictly forbidden ; heavy meals or much animal food, stooping, tight neckties, hot baths, and even extremes of temperature to be avoided. Diet to be nutritious but light, bedroom cool, well ventilated, to sleep on a hair or straw mattress with head high ; hair kept short, shower or cold water bathing, daily moderate exercise, bowels to be open twice dai^y. Two points of irritation between shoulders kept BACTERICIDES. 67 discharging, at least one inch square ; a little capsicum in socks. If there is vertigo, bleeding at nose and headache, bowels more active, bromide" of potassa, tinctures of aconite and belladonna administered. If not speedily relieved, wet cups to nape of neck -and shoulders. If anaemia is predominant, cinchona, mineral acids, with nutritious, easily digested food. Suppose an attack to have taken place, and that it is of the sanguineous type, with coma, labored breathing, pulse slow, im- perceptible almost, the face turgid with blood, almost purple or black, neck ecchymosed, etc. Then our treatment would be precisely the same as for acute inflammation of the brain : shave the head and apply hot water, wet cup nape of neck and shoul- ders ; mustard roller to feet and limbs, free purgation with com- pound powder of jalap and senna, with a few drops of croton oil, and repeat it;. head high; and if stertorous breathing continue to be placed on right side; then veratrum viride with bromide of potassa ; otherwise, general principles. Suppose it is an attack with anaemic syncope; no pulse, sighing respiration, cold clammy skin, pale face, etc.; we must stimulate; warm water to head, no cups nor free purgation, but stimulants. An effort must be made to rouse the patient with stimulating enemas, nutritious diet, and a course of treatment similar to chronic inflammation of brain. Effusion of blood into the cord may take place Apoplexy, at any part, and in a small or great degree, either Spinal. in its substance or from its membranes. It may be a result of active inflammation or of concus- sions, blows, falls, over-exertion, degeneration of coats of blood- vessels, as fatty, calcareous caries of the vertebrae. A meningeal hemorrhage may extend quite a distance in the cord, but generally is cir- cumscribed; a clot of varying size may involve either the gray or white matter, or both. TJie symptoms will vary ac- cording to the seat of lesion. Acute and sudden pain in back, sometimes in head ; of ten severe convulsion's; diffl- . ^ . .,,,.,, , , , . .p , . , . , An ettusion of blood with the substence of the cord. cult breathmg if high up, with heart's action depressed, with pal& and cold skin; if not high 68 DISEASE GERMS. up consciousness not impaired, the spasm then being confined to- limbs. Effusion into substance of cord produces paralysis in all parts supplied with nerves coming off below its' seat. If hem- orrhage be very slight, loss of power occurs slowly. If effu- sion is suspected, a further amount is to be checked hy perfect repose and application of ice in an intestine along the spinal column. Subsequently, the galvanic cautery followed by poul- tices, the faces of which are covered with aconite and belladonna liniment. Large doses of bromide of potassa and calabar bean with general alteratives and tonics, guarding all points very care- fully. Extravasation of blood into the lung tissue Apoplexy, is usually greater in amount than what takes Pulmonary, place in the brain — usually there is a complete laceration of tissue, or a cavity of considerable- size with the blood in it either completely or semi-coagulated.. The apoplectic extravasations are never much circumscribed,, usually a mass of blood in shreddy oedematous infiltrated parenchyma. It may prove immediately fatal, if the pleura is extensively perforated. If the patient does survive the accident, recovery takes place either by adhesion of the torn surfaces of the lung after the absorption of the extravasated blood, or by the formation of a capsule of connective tissue around the clot,, after which the latter undergoes a cheesy, cretaceous or pigment degeneration, and remain permanently imbedded in the lung. Diffused pulmonary apoplexy may occur from a very large infraction; it results from disease and degeneration of arteries.. A branch of the pulmonary artery may suffer from a small aneu- rismal condition, and give way through slight exertion, as running, jumping, a fall, fractured rib, gun-shot wound. Disease of the coats of the artery may cause it, or erosions from the devastations of the cancer germ, or the bacilli of tubercle. Common in males- three to one after the twenty-first year. Symptoms. — Profound collapse, profuse hemorrhage, extreme difficulty of breathing, lividity, are the chief symptoms. Asphyxia,, convulsions, due to the bronchi being filled with blood. It is often difficult to determine this from other diffuse pul- monary hemorrhages. It often goes unrecognized until a post- mortem is made. Recovery is rare, and only possible when the rent in the lung is slight. Treatment. — The diffuse form of pulmonary hemorrhage is not amenable to treatment, as the patient dies from the hemorrhage and shock. Diffusible stimulants with quinine may be tried,, administered freely. BACTERICIDES. 69 A genus of entozoa or intestinal worms. The Ascaris. species are very numerous, one of the best known is the ascaris hnnbricoides^ commonly called the round worm, whicli occurs in the intestines of man and some of the lower animals, and bears a striking resemblance to the common earth worm. When once in the alimentary canal, to which it gains access by its eggs being incorporated in some article of food or drink, it produces a deterioration of the general health and reflexly irritates the brain, giving rise to cerebral anae- mia, which is indicated by the pale face, dilated pupil, indigestion, fetid breath, cough, grinding of teeth, rolling of head, spasms. An immense number of remedies are in general use for the expulsion of this parasite, the most effectual of which is santonine. It does not in all cases kill the worm, but acts by making their dwelling-place disagreeable to them. One or two grains of pulverized santonine should be triturated in five or ten grains of sugar of milk and administered every other night on retiring, in water, followed the morning afterwards with a dose of comp. syrup of rhubarb and potassa to move the bowels. As a general tonic to the intestinal tract, so as to brace it and prevent the eggs of those parasites lodging in its folds, the ozon- ized extract of stone crop should be administered for six or eight weeks. Ascaris vermicidaris, or thread worm, is a very Ascarides. common species, both in children and adults. It infests chiefly the lower portion of the colon and rectum, great numbers often being present. They are white in color, not more than half an inch in length. Their presence is indicative of great inherent weakness of organization, and their generation due either to eggs swallowed in food or drink. They occasion intolerable itching, irritation, loss of sleep and impairment of the general health. In the treatment of ascarides an effort must be made to improve the general health by all possible means. A most generous diet, gentle exercise, a judicious use of tonics and alteratives. The patient should be placed upon the internal use of Virginia stone crop for three months. Before the usual daily evacuation of the bowels, an injection of any one of the following agents, infusion of quassia, golden seal, wormwood, goldthread, stone crop, or a solution of boroglyceride ; resorcin, naphthaline, will be found of great efficacy. On retiring in the evening the bowels should also be copiously injected, so that its contents may pass off; then about two ounces jQ DISEASE GERMS. of ozonized witch hazel injected and permitted to remain over night. In this way a speedy cure is effected. An effusion of serum into the cavity of the abdo- Ascites. men may arise from numerous causes, although the two principal are peritonitis and disease of the liver 1. In acute, but more especially in chronic, inflammation of the peritoneum, effusion of serum takes place in great abundance, but the inflammatory process may subside, leaving the cavity of the abdomen pretty well filled up with fluid, when effusion still pro- gresses onward owing to a distension or unravelling of the peri- toneal fibres or sacs. 2. All morbid states of the liver, whether it be an inflammatory process or due to the gland being blocked up by disease germs or microbes, causing an interstitial death or destruction of the hepatic cells, with either hypertrophy or atrophy of the gland. Microbial engorgement of the liver is a more common cause of enlargement than either alcohol or mercury. Enlargement is a more fertile source of effusion than atrophy, from the oblitera- tion or wiping out of its proper structure by fatty, amyloid or cystic degeneration, blocking up the portal vein, obstructing its normal circulation. In addition to those two principal sources of dropsy of the abdomen, there are always more or less exosmosis of serum from the blood in disease of the heart, spleen, kidneys, anaemia ; besides, it is often the result of extensive burns. The recognition and diagnosis of ascites are not by any means difficult. The history of the case and the physical appearances are good points as to whether the dropsy arises from an ob- structed or clogged-up liver, or from chronic peritonitis. If from the liver, the sallow or yellow skin, congested conjunctiva, brown-coated tongue, cough, dulness on percussion of the upper lobe of the right lung, pain in shoulder, liver indurated either small or large, drowsiness, urine loaded with bile ; whereas, if from chronic peritonitis, none of the above symptoms will be present, but the upper portion of the body will be greatly ema- ciated, features pinched, countenance anxious, skin shining, super- ficial veins dilated, abdomen greatly enlarged. Ovarian cysts sometimes become enormously enlarged, so as to fill up the entire abdominal cavity, and the diagnosis is often difficult ; at a late period generally, however, it can be made out. A good plan is to cause the patient to stand up, spread the fingers of the left hand over the right side of the abdomen of the patient, and tapping gently with the right hand the left side of the abdomen ; a wave, a sense of fluctuation can be felt undulat- BACTERICIDES. 71 ing from side to side. This fluctuation or vibration is most valuable and reliable. Bowels might be emptied with a dose of oil, then the patient placed in the recumbent posture, then on percussion there is resonance, bowels floating on the top of the fluid. In the recumbent posture, if there is water in the cavity of the abdomen, there will be a sense of suffocation from the water pressing up against the diaphragm ; great difficulty of breathing ; respiratory murmur cannot be heard so low down as in health ; tubular breathing; apex of heart elevated and pressed to the right side. Very generally there is swelling of the feet aiid limbs ; if the heart and kidneys suffer, cedema of the face and arms. There is a general depreciation of vital force, — debility, emaciation, prostration, want of appetite, sleeplessness, inability to lie down, invariably ending fatally when due to organic disease of the liver. In the treatment of these cases, success usually attends our efforts when due to peritonitis ; but when dne to organic dis'-^ase of the liver, the effusion may be removed again and again, but it will re-accumulate, because the cause does not permit of removal. The removal of the water from the cavity of the abdomen is effected thus : — the patient must be built up in every possible manner, placed upon the richest diet, and every possible means taken to improve h's general health. A few days before any strenuous effort is made to remove the effusion by the three emunctories of the body, the patient should be either placed upon an infusion of digitalis, or upon the tincture of stro- phanthus. The action of either of these two remedies gives tone to the heart, — unlocks the flood gates of the body. These reme- dies should be followed up with diaphoretics, of which the alcoholic vapor bath is probably the best; diuretics, of which hair-cap mo.ss^ squills, bitartrate potassa and apocynum are efficient; hydra- gogue cathartics, as mandrake combined with nitrate and bitar- trate of potass; squirting cucumber. These means failing, an alterative course should be tried; all remedies failing, then the abdomen should be tapped. This term is generally used to designate sus- Asphyxia. pended animation, produced by the non-conver- sion of the venous blood of the lungs into arterial. The supply of air being cut off, the unchanged venous blood of the pulmonary artery passes into the minute radicles of the pul- monary veins,- which require arterial blood to excite them ; more or less stagnation takes place in the pulmonary capillaries, and death frequently ensues from this cause. Besides, the non-oxy- 72 DISEASE GERMS. genized blood is very poisonous to the brain, and has no stimulus to the ventricles of the heart. It is believed that asphyxia occurs before the oxygen has dis- appeared from the blood, because it is held by the haemoglobin so firmly that the tissues cannot obtain it. Thus, suppose no oxygen is admitted by respiration. It is well known that all the blood in the body passes through the heart and lungs in the time of one complete circulation, that is, in about twenty seconds; and we have it on eminent authority that in this time one-third of the oxygen is used up by the tissues. According to the per- cussion theory, the stroke of the left ventricle arterializes the blood, that is, liberates the oxygen from the haemoglobin, and this arterialized blood is carried to the tissues. The haemoglobin does not get sufficient time to recombine with the oxygen, because of the successive strokes of the heart and the vibrating thrill kept up in the arterial ramifications. The free oxygen is used up by the tissues in the capillary circulation to the extent of one-third. After leaving the capillaries, the tworthirds of oxygen again re- combine with the haemoglobin, and in this condition return to the heart, along with one-third of haemoglobin that has lost its oxygen. In ordinary circumstances this one-third would again obtain oxygen from the alveoli of the lungs; but if all the oxygen there has been used up, of course it cannot obtain any oxygen. The blood flows from the lungs to the left ventricle, when it is again arterialized, and again sent out through the arteries ; but as there is now a large amount of free haemoglobin present in the capillary circulation, it will seize hold of a part of the oxygen, and the tissues will obtain less than the usual supply. With each successive circulation, the amount of oxygen available for the tissues will become less and less, until the tissues receive none, because all the oxygen set free by each beat of the left ventricle is seized hold of in the capillary circulation by the reduced haemoglobin. The tissues die from want of oxygen, because there is too much reduced haemoglobin present, a substance having a greater affinity for oxygen than the tissues possess, a result that would probably occur, as in drowning, in the time of six or eight complete circulations, that is, in three or four minutes. Causes. — Whatever prevents the ingress of air into the lungs, as effusion of lymph in acute laryngitis; congestion of the lungs in pneumonia; drowning, strangulation; obstruction of the larynx by foreign bodies ; inhalation of chloroform, carbonic acid gas, other poisonous gases; narcotic poisons; injuries to the medulla oblongata; dislocation of the spine in cervical portion. In all forms the treatment resolves itself into the removal ot BACTERICIDES. , ^73 foreign bodies; or water; allowing an ingress ot pure air into the luncrs, and in inducing^ warmth and circulation. AspJiyxiafrom Drozvning. — The first effect felt by a drowning person is an urgent feeling of anxiety in the chest ; the pulse becomes weak; the respirations become less, and the blood of a venous hue. The venous blood acts as a narcotic poison on the brain — produces insensibility, loss of voluntary motion ; surface becomes of a livid hue ; the heart ceases to beat ; the sphincters relax ; body sinks to the bottom. If life is utterly extinct, the pupils are dilated, jaws clenched, fingers and thumbs contracted, face pale. Reanimation may take place from five minutes to three-quarters of an hour after immersion. Asphyxia from Strangulation.— T]!^ first effect of tightening the cord around the neck is the suspension of respiration, and en- gorgement of the brain with blood ; then sensibility decreases ; ■epileptic convulsions come on — suffusion, lividity, turgidity of the face and upper part of the body; eyes open; features distorted; hands clenched ; sphincters relaxed. If the air is not perfectly •excluded, the sufferings are: engorgement of head and brain greater. The action of the heart becomes more active as the ■death-struggle progresses, and continues beating after respiration has ceased. Asphyxia from Poisonous Gases. — Carbonic acid gas is the most common — burning charcoal. The usual symptoms being a deep sleep, with intense, throb- bing headache, with weight and heat, especially about back of head ; strong pulsations and.tightness across the temples ; vertigo ; increased action of the heart, and often violent palpitation ; con- fusion of ideas ; failure of memory ; nausea ; hysteric sobbing. If the vapor has been breathed for some time, the symptoms will be : noises in the ears, partial or total loss of vision, disturbance of the senses. Asphyxia, under the above conditions, depends upon accumu- lation of carbonic acid gas in the lungs, the want of oxygen in the blood — the natural stimulus of living tissue. Appearances zvhich Indicate Death. — Total suspension ot breathing and heart's action ; eyelids half closed and pupils •dilated ; jaws clenched ; tongue appearing between teeth, with frothy mucus about the mouth and nostrils ; fingers semi-con- tracted, with coldness and pallor of the surface. Treatment of Asphyxia from Strangulation or Suffocation, Anaesthetics, Gases, etc. — Rule i. To Maintain a Free Entra)ice of Air into the Wind- j)ipe. — Cleanse the mouth and nostrils ; open the mouth ; draw 74 DISEASE GERMS. forth the patient's tongue and keep it forward ; an elastic band over the tongue and under the chin will answer this purpose. Remove all tight clothing from neck, chest or waist. Make sure that there is no foreign body lodged in pharynx, larynx or ceso- phagus. If water is there, place patient on abdomen, over a hogshead and give half a dozen rapid rolls. Then Rule 2. To Adjust the Patieiifs Position. — Place the patient on his back, on a flat surface, inclined a little from the feet upwards ; raise and support the head and shoulders on a small^ firm cushion, or folded article of dress, placed under the shoulder- blades. Supposing natural respiration has ceased, proceed- — Rule 3. To Imitate the Movements of Breathing. — Grasp- patient's arms just above the elbows, and draw the arms gtntly and steadily upwards until they meet above the head. (This is for the purpose of elevating the ribs, and thus expanding the chest and drawing air into the lungs.) Pressure on the breast- bone will aid this. Repeat these movements alternately, deliber- ately and perseveringly, fifteen times in a minute for two or three- hours, or until a spontaneous effort to respire is perceived; imme- diately upon which, cease to imitate the movements of breathing^, and proceed to induce circulation and warmth. Should a warm bath be procurable, the body may be placed in it up to the neck» continuing to imitate movements of breathing. Raise the body- in twenty seconds in a sitting posture, and dash cold water against chest and face, and pass ammonia under the nose. Patient should not be kept in the bath longer than five or six minutes. Rule 4. To Excite Inspiration. — During employment of above method, excite nostrils with snuff or ammonia, or tickle throat; with a feather. Rub chest and face briskly ; dash, alternately,. hot and cold water on them. Rule 5. To Excite Circulation and Warmth. — Wrap patient in dry blankets and commence rubbing limbs upwards, firmly and energetically. F'riction must be continued under dry blankets or over dry clothing. Promote warmth of body by application of hot flannels, bottles or bladders of hot water ; heated bricks, etc., to armpit, over stomach and heart, between thighs and to soles of feet. On restoration of life, when power of swallowing has returned^, a teaspoonful of warm water, warm brandy and water, or coffee, should be given. Patient should be kept in bed ; disposition to sleep encouraged. During reaction, large mustard plasters to chest and below shoulders will greatly relieve distressed breathing. In cases where the base of the brain is weak, or where the nar- cotic, or gas, or anaesthetic operate with peculiar violence upon that part of the nervous organism, the jaws become not only BACTERICIDES. 75 clinched, but immovably rigid, so that the mouth cannot be opened ; then the following method of resuscitation must be enforced. It is of special utility to the drowned. The Method of Artificial Respiration for the Treatment of the Droivned. — Rule i. The moment patient is taken out of the water instantly turn him downward, with a large, firm roll of clothing under stomach and chest. Place one of his arms under his forehead, so as to keep his mouth from the ground. Press with all your weight for three or four, or five seconds, each ti ne upon the patient's back, so that the water is pressed out of lungs and stomach and drains freely out of mouth. Then : Rule 2. Quickly turn patient, face upward, with a roll of clothing under back, just below shoulder-blades, and make the head hang back as low as possible. Place patient's hands above his head. Kneel, with patient's hips between your knees, and fix your elbows firmly against your hips. Now, grasping lower part of patient's naked chest, squeeze his sides together, pressing gradually forward, with all your might, for about three seconds, until your mouth is nearly over patient's mouth ; then with a push, suddenly jerk yourself back. Rest about three seconds ; then begin again, repeating these bellows-blowing movements with perfect regularity, so that the foul air may be pressed out and pure air drawn into the lungs, about eight or ten times per minute, for at least one hour, or until the patient breathes naturally. Note. — The above directions must be used on the spot, the first instant the patient is taken from the water. A moment's delay, and success may be hopeless. Prevent crowding around patient, as abundance of fresh air is important. Once he breathes be careful not to interrupt it. If they are very long apart, carefully continue between them the bellows-blowing movements, as before. After breathing is regular, let patient be rubbed dry, wrapped up in warm blankets, a little brandy and water can be given in small occasional doses, and then be left to rest and sleep. If no physi- cian is near, any bystander can carry out these rules, as it requires no expert. The above method is undoubtedly the best for the ejectment of fluids from the stomach and thorax ; with it there is no need in opening the mouth, which is usually closely clinched, and of drawing the tongue forward, which is impossible, the position of the patient obviating this necessity. The compress on is most complete, and capable of the most delicate adaptation ; it can be performed by one person in almost any situation, and continued as long as there is any use. It is the essential method in drown- ing, as it empties the water-logged thorax, relieves the filled ;76 DISEASE GERMS. bronchi, releases the immovable diaphragm, and thus makes respiration possible. In the first position, a roll of clothing under the stomach and thorax makes shoulders the highest point ; the nostrils and mouth the lowest. The displaced fluids run downwards, cleans- ing the upper air passages, which are perfectly drained. Then the pressure upon the back causes a complete ejectment of the fluid, and we have a free passage for air established ; an open air- way and imitation of the natural movements. The best method of compression is to place the thumbs at the bottom of the cartilages of the ribs along their front part. The force then applied to the ribs is through the medium of the thoracic walls, so distributed as to give no shocks, no violence, but cause the ribs to move in their intercostal spaces. A person of the most average intelligence can easily understand the two rules laid down. The kneeling position is not tiresome ; the parts to be pressed are raised to the hands ; the weight of the body is the chief force, and there are intervals of complete rest. It is true, the rate of respiration is one-half slower than other methods ; but even with that, there is more oxygen supplied than a partiall}^ asphyxiated person can breathe, or bear, or assimilate ; besides, it has the advantage of allowing better diffusion and minimizes superfluous disturbances. It is of especial advantage in drowning, because in that form of asph)-xia the jaws are inseparably clinched, the slippery tongue is receded into the pharynx, and the epiglottis has fallen back so that no air can enter, and our first method cannot be carried out. It is very doubtful whether it is not the best for chloroform and syncope ; it is certainly the quickest. In asphyxia from chloroform, same management, and cloths wrung out of boiling water over heart, even to vesication. Intense Cold. — Cold acts chiefly from without, freezing inwards, causing serous congestion of the three great cavities, with giddi- ness, inability to see, weakness and rigidity of limbs ; almost imperceptible respiration and pulse; tendency to profound sleep, or coma. Patient must be placed in a room without fire, and an attempt made at restoration of circulation and sensibility by rub- bing the body with snow, or ice, or cold water. Frictions with flannels, long continued ; very gradual application of warmth; a stimulating enema, warm milk, with capsicum, coffee, beef-tea or warm wine. Syncope, — Fainting, sudden prostration. Remedies are : recum- bent posture, to slow heart twelve or fifteen beats per minute ; head low, cold air ; cold water dashed over head and chest ; smart beatine on chest with a wet towel ; friction or mustard BACTERICIDES. 77 plasters over region of heart ; small quantities ot ammonia or brandy. The syncope in ansemia and chlorosis must be cautiously treated, with brandy, wine, carbonate of ammonia and beef juice, given both by the mouth and rectum, with artificial heat over the heart and extremities. The recumbent position should be maintained until the action of the he^rt is nearly normal. Narcotic Poisons. — Patient to be placed on side, head slightly raised ; cold affusion ; heat to extremities ; stimulating applica- tion to chest and back ; the use of stomach pump. The antidote with tea, or coffee, or solution of acetate of ammonia, or one drop of a one-per-cent. solution of nitro-glycerine upon the tongue will often excite the heart to action. An irritation of the nerves that supply the circular Asthma, muscular fibres of the bronchi, causing spasm or contraction. This irritation may be in the periphery in the bronchi, or in the medulla oblongata, so that paroxysms or fits may be induced by reflex or direct mechanism, that is to say, the stimulus to contraction may be central in the medulla, or it may be in pulmonary or gastric portion of the pneumogastric, or in some other part of the nervous system, besides the vagus, and being transmitted to the medulla by incident, is thence reflected by motor filaments. A very good plan is to arrange causes under three divisions : ([.) Central causes in the medulla oblongata. (2.) Peripheral causes in the bronchi, lung, stomach, heart. (3.) Affections of blood. (i.) Often hereditary; pecuHar types of conformation; idio- pathic. (2.) Reflex; disease of heart, stomach, lungs, alimentary canal, skin. (3.) Germs in blood irritating the weakened cerebral bulb or periphery, as tubercle, syphilis, rabies, gout, etc., so that asthma, has always at the root of it some central nervous irritation, or some peripheral source of it. The causes embraced under these, then, are very numerous, as diseases of the chest and abdomen, some latent skin disease, certain winds, changes in atmosphere, especially dryness, with increase of oxygen and diminished electricity ; inhalation of disease-germs or irritating substances, the micro-organisms of plants, flowers, hay, malaria, gout, rheumatism ; non-acclimati- zation or incompatibility to soil, location or country. If there is no apparent cause, blood-germs, as syphilis, rabies, tuberculse. 78 DISEASE GERMS. An asthmatic is thin, of a nervous temperament, round-shoul- dered ; countenance expressive of attacks of suffering ; cheeks hollow; voice rather hoarse; slight cough; suffers from nervous dyspepsia. Symptoms. — Languor, lassitude, debility, headache and drowsi- ness, often digestive derangement ; or it may occur suddenly without any of those signs. Most generally the patient falls into a sleep, when he suddenly awakes with a sense of suffocation or constriction about the chest ; smothering and difficulty of breath- ing increases until there is a most fearful struggle for breath. Patient gets right up in the sitting posture and assumes various positions to facilitate respiration. Chest becomes distended to its utmost limit. The contractions of the circular muscular fibres of bronchi are so great that they offer a perfect obstruction to the entrance or exit of air. On placing ear to the chest, no natural breathing audible, but dry murmurs, loud wheezings, shrill whist- lings are heard. Pulse becomes small, feeble, almost impercepti- ble ; eyes staring, protruding from sockets ; countenance anxious ; lips purple ; temperature of body falls to nearly 8o° Fahr. But after a while of intense suffering, the ski* becomes bathed in a copious sweat. After that usually the spasm breaks and the pa- tient obtains relief Cough, with some expectoration ; paroxysms ceases, and patient falls asleep. One attack may follow another, or there may be a series of light attacks violent enough to keep patient up in his chair to midnight. Attacks may come on every night or at long inter- vals — often periodical. Asthma is very capricious, kept up by some climates, some aromas, gases, houses, beds, etc. During the interval or between attacks patient enjoys moderately good health. Men are more frequently attacked than women. Asthma, denominated hay, ragweed, roses and the micro- organism of plants and trees does not differ in symptoms. The bacilli of the vegetable kingdom acts as an irritant to the peri- phery of nerves in the bronchi ; it is reflected to the bulb and transmitted back — hence the spasms. The duration of asthma is apt to be tedious if not arrested promptly at the start. Its effects or results are, thickening of the circular muscular rings, with effused lymph, causing a permanent narrowing of tubes and wheezing respiration ; dilatation of the air vessels into sacs or pouches, as in emphysema; dilatation of ventricles of the heart from emboh'sm ; general break ino^ down of the nervous system, nervous dyspepsia, alkaline diathesis, etc. Treatment. — During the attack, if the stomach is loaded, an -emetic of lobelia ; or if suffering from constipation, copious -enemas. Then the great object in treatment is to relax bronchial BACTERICIDES. ^q spasm. For this purpose some of the following remedies should be tried, selecting one until one is procured that is effectual. Lobelia, useful in a number of cases ; when it produces nausea and •collapse the attack often ceases. Compound powder is best form. A cup of strong coffee will often ward off an attack ; so will a strong glass of hot whiskey punch. Inhalation of chloroform or other anaesthetics, like ether, are of little utility. Iodoform dissolved in ether and inhaled may be useful if due to catar*-h. A dose of two grains of iodide of potassa, the same of car- bonate of ammonia, with twenty drops of tincture of belladonna, may ward off an attack. Sulphate of sparteine is an effective remedy in asthma — it begins to act in about thirty minutes after it has been taken by the mouth, .and its action lasts from about five to six hours. This rapidity of action, at first consisting in a stimulation of the heart, rise of -arterial tension not occurring until a little later, indicates the use of sparteine in asystolic conditions of valvular disease where a speedy effect is desired, giving it superiority over more slow'ly acting drugs in asthma. In these conditions, too, a small dose should be employed (one- -sixteenth to one-quarter of a grain), since in these doses sparteine .seems powerfully to stimulate and regulate the heart with the smallest rise of arterial tension, perhaps not more than is the normal accompaniment of increased cardiac force. Diuretic effect is most marked with fairly large doses, half a :grain to two grains ; with small it is not so evident, but is often present. Flushing of the surface of the body occurs in from one to two hours after administration in most cases. Nitrite of amyl, five drops on a cloth and inhaled, or iodide of ethyl, six to ten drops inhaled; either one increases the bron- chial secretion, gives instant relief Their effects are transient but often curative. Nitrite of amyl in alcohol operates like a charm, as follows : Alcohol, half an ounce; water, one ounce and a half; ni4:rite amyl, three drops. — Mix. Add to half a tumbler of ice or cold water and drink at once. The alcohol keeps up the action of the nitrite of amyl for some time. Such a combination relaxes the arterial vessels to their minutest subdivision, relaxes organic mus- cular flbr#. One or more drops of a one-per-cent. solution of nitro-glycer- ine produces, within a few minutes, a diminution of tension and wonderful relief in breathing. Its effects are marked and durable. The fluid extract of quebracho is used most successfully in asthma. A teaspoonful, repeated every ten minutes, relieves the difficulty of breathing. 8o DISEASE GERMS. The fluid extract of euphorbia piluHfera has a most dtcided effect in nearly all cases of asthma. Catalpa of most use in chronic nervous cases Members of the medical profession are disgusted with the end- less complications and combinations of antispasmodics, and have sought other remedies, as jaborandi and its alkaloid, pilocarpin. The powerful revolution which that remedy produces in the dis- tribution of the blood, has a most beneficial effect in asthma, attract- mg the blood to the skin and salivary glands, and by diminishing its volume through the copious perspiration and salivation. The interstitial changes in the lung after its exhibition is followed by amelioration of all the symptoms. Its use requires care and cau- tion. The alkaloid, by hypodermic injection, is preferable to the fluid extract, in doses of about one-third of a grain. During the action of drug, recumbent posture. Antispasmodic fumes may be used in the absence of better remedies ; they owe their properties chiefly to ammonia, or some acro-narcotic, nitre paper, stramonium, belladonna and lobelia ; cigarettes produce when inhaled intense hyperaemia, as may be seen in the buccal, pharyngeal, laryngeal mucous membrane of habitual smokers, and exudation which tends to soften and detach obstinate mucus. With such remedies, we endeavor to overcome spasm ; and with the use of the bromine compound as laid down under hooping-cough, in doses of a teaspoonful every three hours, we make an effort to ward off attacks, and in the interval we try curative measures. Curative Treatment. — Great care and diligence to ascertain cause or causes. If there seems to be a catarrhal condition, treatment as laid down under that head ; if there are latent germs, present in the blood treat accordingly. Dogs licking children's hands, in whose mouths the germ of rabies are often present, is. a fruitful but unthought-of cause of asthma in adult life. Power- ful alteratives, as iodide of potass and ozonized glycerine ; indeed,, these constitute the most certain way of curing asthma, whatever its origin may be. Blisters or irritating plasters to nape of neck on both sides, an open sore. If there are any reflex conditions,, remove them. If digestion is weak, cinchona compound and mineral acids, pepsine, gentian. If there is evidence of malaria, tincture iodine, green-root tincture of gelseminum with quinine. If no cause can be discovered, a general alterative and tonic course. Rosin-weed and a large list of worthless drugs are now dis- carded in the cure of asthma. Every possible means taken to improve the general health by tonics ; the most nutritive diet, regular mode of life ; daily use of BACTERICIDES. gl the cold shower or sponge bath ; removal of dyspepsia ; meals to be taken at such hours that digestion may be completed before retiring to bed. Flannel clothing. To sleep on hair or straw mattress ; bed in all cases to be insulated from the floor or wall by glass castors, so as not to permit the electrical forces to be drawn off. A suitable house, location or climate selected. As to the effects of asthma, thickening of the rings of the bronchi, alteratives, irritating plaster are of great utility ; other terminations managed on general principles. One of the most common diseases of the spinal Ataxia cord, and consists in an increase of its interstitial Locomotor, connective tissue, forming a ribbon-like sclerosis of the white posterior columns and horns of the cord, and posterior roots of the spinal nerves, leading to gray de- generation, with peripheral structural change in the cranial nerves. These changes usually begin in the lateral part of the posterior column in the upper lumbar and lower dorsal regions and extend upwards and downwards, and in old chronic cases the sclerosis may even extend to the medulla oblongata, Ataxia is most frequently met with in men (rarely in women), generally between the ages of twenty and fifty. Neurasthenia acts as a predisposing cause ; whereas, anything which will impair the integrity of the nervous system, as cold, wet, mental and physical overwork ; masturbation, sexual ex- cesses ; depression of spirits ; deleterious food ; insanitary condi- tions ; poor blood; prolonged lactation ; the use of tobacco; sup- pression of the menses ; blows ; falls ; concussions, act as excit- ing causes. It may either be an attendant or a sequela of dis- ease germs in the blood, more especially the microbe of syphilis ; pneumonia, diphtheria, fevers, and the like. Ataxia is generally ushered in with nervous prostration, fol- lowed by a gradual disturbance of sensation, loss of co-ordinating power of the lower extremities, with indications of paralysis. There is sometimes temporary diplopia and color blindness, with unequal contraction of the pupils. The course of the disease is slow and progressive. In a large majority of cases, in the pre- monitory stage there is intense pain in the limbs, of a sharp, tear- ing character ; incontinence of urine ; spermatorrhea or nocturnal pollutions ; sexual hyper aemia ; but most generally there is a per- fect loss of sexual desire. Extreme weariness, nausea, vomiting, aching in the stomach, with a sense of formication and numbness in the skin, with a tightness or girdle sensation round the body are present in a number of cases ; while in another class we 6 82 DISEASE GERMS. liave rectal, vesical and nephritic neuralgia, with cerebral cis- turbance. The nervous disturbance is very variable, a sense of numbness in the hip, a pricking sensation in the knee joints, a sensation of some soft substance between the feet and the ground, an un- steadiness of gait ; walks like one intoxicated ; if the feet are brought closely together, the eyes closed, the body will sway to and fro and then fell ; patient is compelled to watch his feet while walking. Later on he throws out his feet and hands with forcible, irregular, jerking movements. The loss of co-ordinating power is so great that the patient by and by is unable to walk. Marked loss of sensation in feet and legs and of temperature. Sensation blunted, senses impaired, but the higher cerebral faculties are rarely impaired. The abolition of the tendo-reflex is one of the diagnostic signs of the disease. A peculiar inflammatory affection often attacks the joints, knee hip, shoulder, elbow, which often terminates in a complete disor- ganization of the articular surfaces. Paralysis of the sphincter muscle of the bladder and rectum, bed-sores and numerous other distressing symptoms. The recognition of the disease is based entirely upon the symp- toms enumerated, and it cannot possibly be confounded with any other malady. The efficacy of treatment depends a good deal upon the stage at which it is commenced. An alterative and tonic course is the most reliable. The utility of comp. saxifraga, phytolacca, in alternation with cinchona and the mineral acids cannot be doubted. The glycerite of kephaline, tincture of oats, comp. tincture mar- ticaria, in alternation with tincture of belladonna, cannabis Indica, phenacetin merit a trial. Locally to the lumbar region of the spine, an irritating plaster 9-inch X 6-inch, longways across, should be worn so as to keep up an absorbent action, but never to cause an ulcerated surface — on about one half the time, off the other. The use of electricity, by faradization and otherwise, is of little benefit compared with warm baths of sulphuret of potassium, alternated with cold baths and massage. These are of great efficacy. The suspension treatment is barbarous in the extreme; there is nothing in it to commend it to common sense, far less science. Bowels should be scrupulously cared for, well regulated. The diet and mode of life should be such as is most conducive to the highest degree of health. Everything which will preserve nerve-force and prevent exhaustion. BACTERICIDES. 83 Pulmonary collapse or atelectasis is a condi- Atelectasis. tion of the lungs in which there is a partial or total absence of air in the alveoli. Congenital atelectasis occurs in feeble infants or those born pre- Tnaturely, where the nares or other parts necessary to respiration are plugged with mucus. Pulmonary collapse is more rare in adults than in infants. Any disease or condition which weakens or obstructs the power of inspiration may induce it, such morbid states of the brain, light clothing, paralysis of the vagus ; syphilitic disease of the BACTERICIDES. 93 the sebaceous secretion, and then wash off. Young men should! follow same practice every day. This would not only promote health, vigor, and growth of the penis, but would do much to- prevent masturbation, nocturnal emissions. It would have a salutary effect. The oil need not be used unless there is the white, cheesy secretion ; it will suffice to drop- cold water on its neck, with the foreskin retracted, or drawm back. The poison of venemous reptiles- Bites of Rabid Animals and rabid animals is a living and microbe, which when introducedi Venomous Reptiles. through the true skin enters the- circulation, where it grows with, prodigious rapidity, excretes ptomaines freely. The micro-organ- isms from all bites either have a tendency to destroy the blood or by their ptomaines the nervous system. In the former case, a. species of erysipelatous inflammation of the skin and cellular tissue is predominant ; in the latter, a peculiar train of nervous symp- toms, as intense pain in the wound, radiating in the course of the nerves ; prostration, faintness, rapidly followed by feebleness of" pulse, bilious vomitings, difficulty of breathing, profuse sweatings,, jaundice, convulsions. The treatment of the bites of all rabid animals should be : aL ligature above and below the bitten part to prevent if possible- the ingress of micro-organisms into the blood, or nerve cells ; wet; cups, hot fomentations if cups are not handy, free incisions with-, abundance of hot water, peroxide of hydrogen, to encourage free bleeding and annihilate all microbes ; after the wound has bleed freely and been thoroughly cleansed of microbial matter, it should be dried, and wood ashes or caustic potassa freely applied, then irrigation with ozonized vinegar, followed again with a spray oF peroxide of hydrogen, or chloride of ammonia in a poultice. Immediately, or as soon as possible, bactericides should be- administered so as to render the blood so thoroughly sterilized that no microbe can live in it. This can be effected with ai. variety of remedies, subsequently mentioned. In the case of bites by rabid animals, giving rise to erysipela- tous inflammation, the microbe may be in the cellular tissue or blood or 'both; the nearest lymphatics are apt to become- engorged with the microbial mass, which gives rise to abscess and. doughy swellings. In cases of this kind free incisions cannot be resorted to too> early, followed by germicide pouhices, as charcoal and yeast :. linseed meal and resorcin. 92 DISEASE GERMS. Before the application of these pouhices, the entire affected surface should be painted with an ointment of salicylic acid and creasote, or oil of boroglyceride. In another class of cases the germ of the reptile or snake becomes imbedded in a nerve or its neurilemma, and grows with great rapidity, so prodigious that either the germ development or its ptomaine may cause death in twenty minutes, the entire nervous system becoming perfectly paralyzed, the cutaneous surface shrunk and withered and as white as snow, constriction of chest, threatened paralysis of the involuntary muscles often taking place a few minutes after the bite. In all such cases there is no time to wait on the action of drugs, and the quickest and safest plan is to procure anaesthesia of the nervous system for ten or twelve hours by the copious drinking of good brandy or whiskey until perfectly drunk. It must be given in half-pint doses •every few minutes to obtain the desired result. It is most extra- ordinary the quantity necessary to be given in some cases. During the quasi-suspension under whiskey there seems to be no pabulum for the germ elaborated, and it dies in the body, the bitten person recovering from his anaesthesia or stupor well. A still more certain method is to combine liquor potass with the brandy or whiskey. The liquor potass completely neutralizes snake poison. It should be given in the brandy in ten, twenty or thirty drop doses sufficiently often. The brandy stimulates, rouses, carries the potash into the blood, and enables it to over- take and neutralize the poison in the blood. The saturation of the system with the alkali until the secretions are alkaline is the point to be aimed at. The permanganate of potassa has the same power, but owes its property to the potash alone. To all bites of venomous insects, as wasps, mosquitos, spiders, •and poisoning with ivy, sumach and other agents, a saturated solution of muriate of ammonia, or better still concentrated ozone or peroxide of hydrogen. A boil or carbuncle is an oil-gland of the skin Boils filled with lymph, and interspersed through that or l}'mph are to be found the staphylococcus pyo- Carbuncles. geims aureus. The microbe is pathogenic of the malady, bears cultivation well in chicken broth. Carbuncles on^y differ from boils in their size, they contain the same microbe. The pus of either will inoculate and reproduce the original in either man or animal. The primary cause is depression of the vital powers and the exciting causes are malnutrition, derangement of stomach and BACTERICIDES. g^ bowels, and a degradation of normal living matter into bacteria, which pass into the blood and find their way into the oil-glands of the skin, probably in search of free oxygen. The cause of the malassimilation may be overcrowding, bad ventilation, filth, bad diet, as pork, meagre, or insufficient or sameness of food, indeed^ anything that depresses the stomach. Sy^nptoms. — Brown-coated tongue ; nausea ; loathing of food ; constipation ; fetid breath ; heats and colds ; fever, with head- ache and languor ; inflammation of an oil-gland on nape of neck, back, limbs, or anywhere where glands of that class are numerous ; gland fills up with the lymph and bacteria, and resem- bles a sugar-loaf, apex pointing inwards and broad base on sur- face ; vary in size from a pea to a large pear ; the largest are usually met with on back. The gland is a regular cyst or sac, whose lining membrane is a secreting one. By proper treat- ment, before lymph breaks down, they may disappear ; but if they progress, lymph breaks down, patient has a rigor, then throbbing, and suppuration goes on until either relieved by na- ture or art. In some cases there is a large crop, great constitu- tional disturbance and danger ; in other cases, a solitary one may- create quite alarming symptoms. In the treatment of all cases of boils or carbuncles, w^e have a bacteria-coated tongue, very sluggish liver, and in order to excite a healthy action of the alimentary canal, it is good practice here to adminster a rousing emetic of lobelia ; and in order to cause rapid absorption of the drug let the patient drink abundance of tepid alkaline water, or warm water to which bicarbonate of po- tassa has been added. This will aid in cleansing the stomachy and the lobelia has a most marvellous effect in retarding and even retrograding microbe evolution. This should be followed with an alcoholic sweat ; and the bowels freely opened with a saline cathartic. For a tonic to promote an appetite and keep up a brisk stimu- lating action on the liver, a teaspoonful of the following mixture should be administered every four hours : Compound tincture of cinchona; simple syrup; of each two- ounces ; nitro-muriatic acid, two drachms. Mix. Bowels kept free with salines, or a dose of the phosphate of soda at bedtime. Some bactericide should be given between the respective doses of the cinchona mixture, such as either tincture of lycopodium glycerite of sulphur, or peroxide of hydrogen, or ozone water, or brewer's yeast, resorcin, creolin, sulphide of calcium. Some remedy to sterilize or annihilate the microbe. The lyco- podium or glycerite of sulphur has a most remarkable action upon the microbe of boils, so have the other remedies enumerated — one selected which the physicians deem best. ^4 DISEASE GERMS. Locally, if case is seen early, before any indication of the forma- :tion of pus, and the patient is desirous to prevent an abscess, the boil may be injected with either peroxide of hydrogen or gluco- -zone, which will destroy the bacteria, and the lymph will be ab- sorbed ; or another plan, a paste of the solid extract of bella- donna and resorcin, equal parts, might be tried; or it might be painted with concentrated ozone and chloroform. Even more i-nergetic discutients might be applied, such as ozonized clay, iodized oil, iodol, etc. If there is the slightest speck or point of softening, any evi- >dence that a change to perfect downward evolution has taken place, that suppuration is inevitable, there are several plans which can be adopted. In resorting to surgical procedures, it must be borne in mind that the shape of the boil is like a regular sugar-loaf cone, and for a perfect cure a complete riddance of the germ colony, the sac with its contents must be exfoliated or thrown off, or destroyed, as its contents are extremely contagious, liable to affect healthy parts. A most excellent method is to protect the adjacent parts, all around the boil, wipe the surface of the boil dry, then take a stick of caustic potassa and apply, burning down into the sub- stance of the boil. This should be done thoroughly. Subse- •quently the action of, the caustic potassa must be neutralized with •vinegar, and an antiseptic poultice applied ; latterly it should be liealed up with black salve or ozone ointment. Another good method is to make a crucial incision down through the boil and divide it into four parts ; subsequently treat as above. Electrotysis may be tried, but it is simply a method of less painful cauterization. The diet in boils should be the best, and very generous, includ- ing beef, mutton, poultry, eggs, milk, with abundance of vegeta- bles and fruit. Operatives in copper, zinc and tin are Brass Founders' liable to several morbid conditions from Disease. the inhalation and absorption of the fumes of the metals. Most generally the metal has an affinity for the fine delicate nerves of the duodenum and brain, like lead and bismuth, but workers in brass have a regular cachexia produced by the metal, a feeling of languor and depres- sion, peculiar sallow hue of skin, with anaemia, and febrile attacks like intermittent fever. The attacks, however, do not come on with regularity. In the stage of chill there is usually constriction or tightness about BACTERICIDES. 9S the chest, and in the last stage, which is followed by a profuse •sweat, the linen is usually stained with the eliminated metal, and it has a brassy odor. Poisoning by brass and tin is much more common than is ■generally supposed. Many of the indescribable derangements •of the digestive tract are due to minute portions of those metals ■finding their way there from various culinary articles, as kettles, pots, etc., and also from the cocks and spigots of soda fountains, mineral-water bottles, and ordinary water-pipes. An oxalate of tin is to be found in every article preserved in tin cans, as toma- toes, peas, asparagus, which is exceedingly toxical and capable 'of producing a well-marked train of symptoms, identical in their character with brass poisoning. The preservation and cooking of edibles in tin and brass vessels is a prolific source of disease, ^nd measures of some kind should be adopted to arrest the spread of this latent form of poisoning. Treatment. — Workmen should avoid the fumes of zinc and "brass ; iodide potass unites with them freely and causes their •elimination. In some cases lobelia emetics are of great efficacy, followed by cinchona and mineral acids ; bowels to be regulated ^nd alkaline baths used daily. The degree of heat that can be borne by Burns, Scalds, the human body without causing injury depends very much upon the medium through which it is applied, as well as the organization of the individual. The degree of partial death inflicted upon the body may be embraced under three grades, as crytJienia, vesication^ Mlceration. The danger of burns depends a good deal on their intensity ; the extent of surface injured; the degree of disorganization ; the importance of the part, the age and power of vital resistance of the patient. Symptoms. — There is the shock ; state of prostration or col- lapse, which is often dangerous. The pallor, coldness, sighing respiration, shivering, feebleness of pulse, and other indications of imperfect reaction and exhaustion, followed by fever with congestion or effusion in or upon brain, lungs, bowels ; or it may be reflex, and produce spasms, convulsions, or there may be the tedious, dragging symptom of hectic during the stage of cicatri- zation or otherwise. Besides the above, the arrest of the insensi- ble perspiration of the skin naturally gives rise to a tendency to serous effusion in one or all of the three great cavities, and if the burn partakes of the character of a blister, there are grave changes 96 DISEASE GERMS. that take place in the blood, especially if the blister is extensive.. The serum in the blister is found not to be water from the blood,„ but rich fibrinous liquor sanguinis — and this exudation of blood plasma causes the blood to be thicker, more concentrated, and its- relative proportions of corpuscles and plasma modified to even a. fatal extent. This concentration of the blood reduces the blood pressure, and retards the flow of lymph, and interferes with the general nutrition of the part. Treatment. — The first point is to bring about reaction by dif- fusible stimulants and artificial heat to the extremities. After reaction, open bowels with castor oil or cascara. If reaction is imperfect then administer aconite and serpentaria for fever. If there are reflex symptoms, as spasm, antispasmodics by mouth and rectum, followed by bromide of potass and calabar bean. Pain must be relieved with hyoscyamus and opium. Repeat until comfortable. Any congestion of brain, lungs, bowels to be treated on general principles. If tonics are required, let them be cinchona and ammonia. Give plenty of fluid nourishment, as; milk, beef- tea, raw eggs, juice of raw beef, or raw beef extracts. • In all cases relieve pain and nervous irritability. Locally, to burns, nothing can excel the carbolic acid and olive oil ; one ounce of the acid to six or ten of the oil, according to age and thickness of skin. It stimulates, destroys micro-organ- ism, and aids healing ; saturate lint and apply. The following is excellent in burns or scalds : Boroglyceride paste, eight ounces ; two-per-cent. solution of cocaine, one ounce ; resorcin, half an ounce ; mix ; absorbent cotton, a sufficient quantity to hold the above in suspension. Apply to any burn. Instant relief of pain, all inflammatory symptoms arrested, bacteria destroyed. Any application that will exclude air from the injured surface should be applied until this is procured ; as molasses, lard, and flour, vinegar or starch, and white oxide of zinc and oil. In burns of the second degree (blisters) do not puncture nor interfere with the cuticle. The great danger of burns in this stage is due tO' the amount of liquor sanguinis in the blister, and death is due to the blood changes so induced in that fluid. This, of course,, is best remedied by the juice of meat. The dressing in all cases should be changed thrice daily, and precautions taken against deformity. Inflammation or partial death of the mucous Bronchitis, membrane of the bronchial tubes. It may be acute or chronic, and affect the larger or smaller tubes, or both; or one or both lungs throughout, or only a por- tion of them. BACTERICIDES. qj7 A very dangerous form of inflammation, Bronchitis, accompanied with great fever and prostration, Acute. and danger of a spread of the inflammation to the vesicular texture of the lungs, or a plug- ging up of the bronchi with effused lymph and collapse, or inflam- mation of the substance of the lung with blood, lymph, liquor sanguinis, etc. The causes are usually cold, damp, wet, exposure to vicissi- tudes of weather, inhalation of irritants, etc. Syinptonts.— Shock, with indications of prostration, violent headache, with rigors, and a high grade of fever ; pulse often 140 ; respirations from thirty to forty ; heat 105° up ; a sense of intense soreness or rawness over the affected part ; tightness or constric- tion of the chest; hurried or excited respiration, with rough wheezing ; incessant hacking, dry cough at first, afterwards expectoration of viscid, glary, frothy mucus, and afterwards of muco-purulent matter ; pulse, although frequent, is weak ; tongue heavily coated, nausea, great anxiety, with indications of pros- tration and collapse. Inflammation of the main trunk or large-sized tubes is attended with much less danger than the smaller branches. In the smaller branches, there is a greater tendency, in a fit of coughing- or excitement, for the tube or tubes to be blocked up by thick viscid, tenacious phlegm, which, on taking a deep inspiration, is liable to be pushed down ; acting as a cork, preventing the air from reaching a lobe of the lung, hence collapse. A portion of lung not filled by air becomes quickly hepatized or vesicular, emphysema is produced ; so that in either case we have a vital organ incapable of aeration. On percussion of the chest in bronchitis, the lungs should exhibit resonance and clearness from top to bottom ; at least, no marked aeration should be detected, with the exception of increased resonance in emphysema, or the dull, flat sound of hepatization in collapse. On auscultation, in the early stages, dry sounds or rales can be distinctly heard, like air rushing through a red hot tube. If heard over the main trunk or large branches, it is called rhonchus ; if over the small branches, sibilus. Rhonchus to the large, sibi- lus to the small. Sibilus bespeaks danger ; rhonchus almost free from it. These dry sounds are usually only heard the first iQ.\sf days, for once the inflammation has terminated in effusion and its products have poured out from the inflamed membrane, those dry sounds are displaced by moist sounds, called large crepita- tion, if over the large tubes ; small crepitation if over the small. So rhonchus and large crepitation are the dry and moist sounds 7 98 DISEASE GERMS. of large air passages ; sibilus and small crepitation of the smaller branches. Its duration, under good treatment, should not take over a few days. Ireatment, — Recumbent posture in bed, temperature, 70° Fahr., air to be moistened by hot steam. If stomach is badly deranged and tongue foul, a gentle emetic of lobelia ; if there be constipa- tion, open bowels quickly with enemas and salines. Diet to con- sist of warm beef tea, warm gruel, or warm milk and arrow-root, warm mucilaginous drinks, as flaxseed tea, wine whey ; heat to feet. Mustard is to be applied over chest and back, large plasters, followed with hot poultices of flaxseed meal and glycerine. There are several methods of breaking up the attack. If seen early, one is by the administration of large doses of tinctures of aconite and veratrum every half hour, till pulse is seventy, and then at less frequent intervals. This is a good plan, another plan is to administer either antipyrine, or antifebrin till temperature is normal ; still another is to give small does of lobelia until the' patient becomes slightly nauseated and pulse down, and tlien at less frequent intervals. And a fourth good expedient is to use iaborandi or its alkaloid ; the former in fluid extract, or, if the latter, by hypodermic injection. If jaborandi or pilocarpln be used, the patient must cease drinking and spit out his saliva freely. The powerful revolution which this latter remedy pro- duces in the distribution of the blood, has an instantaneous effect in attracting the blood to the skin, relieving the bronchial mucous membrane. Its action is quick in giving relief; besides, it favors the expulsion of the obstructing plug in the air passages, prevents the formation of viscid mucus, prevents the swelling of the large bronchial glands and initiates reparator\' process in the bronchial tract. In an urgent case the four methods might be combined. As soon as the urgent symptoms are perfectly con- trolled, an alkali, such as the muriate of ammonia or chlorate of potassa, or carbonate of ammonia or potassa. The effects of alkalies are very marked, indeed. They soothe, soften and aid expectoration, and if given in combination with an acid, the dry rales subside and are replaced by moist ones; expectoration copious, and cough less frequent and less troublesome. Con- valescence to be established upon alteratives, as the ozonized n-lvcerine, phytolacca, and tonics, like quinine and mineral acids. ma)' be a sequel of an acute attack, Bronchitis, Chronic, or it may come on of itself from the same causes that produce the acute, or from the presence of microbes in the blood. BACTERICIDES. qq Symptoms. — General symptoms -of nervous prostration, lan- guor, lassitude, debility, face white, features sharp-pointed ; nervous dyspepsia ; phosphates and chlorides in urine ; great emaciation, harassing cough, even habitual ; great difficulty of breathing, shortness of breathing ; sometimes a sense of soreness or rawness, in other cases this is absent. The lungs in ordinary cases should be clear from top to bottom, but as it generally assumes one or other of two forms, this may not be the case. One form, without expectoration, tends to emphysema ; the other, with copious expectoration, leads to pulmonary consolidation. The former will have unusual resonance on percussion ; the latter, dulness. If there is expectoration, it is copious, and aggravated by exposure to cold or damp, bad living or change of temperature. There is little rhonchus or sibilus in chronic bronchitis, but abundance of moist crepitation, large and small. In all cases the nutritive disturbance proceeds from the surface of the bronchi and gradually spreads to the stroma of the lungs, terminating in atrophy or in sclerosis. Dilatation of bronchi, with condensation of surrounding tissue, often results ; some- times a sort of bronchial catarrh, with excessive muco-purulent discharge. The winter coughs or colds, recurring annually, are but the precursors of more permanent forms of bronchial inflam- mation. When interstitial sub- _______.,^___^.^;:rr==3c^>i:v^.^.^'^ o stance of lung is -^^ ^^~^~^^^^^-^^ ^ ,-_w-<^ greatly affected ~^-om the vegetable kingdom we take oak bark, phytolacca, yellow dock and sorrel, all crushed. Make an extract and apply ; or the expressed juice of the sheep sorrel alone in the form of an inspissated extract, and applied on leather, will remov^e it ; but before these last two are applied, the cuticle must be destroyed. Another favorite paste for the removal of a cancerous tumor is to drop C. P. sulphuric acid on saf- fron, until a paste is formed ; when of the proper consis- tency it is applied, and almost, as if b}- magic, re- duces the entire mass of germs to a charred mass. If the tumor is very large, it is re- peated daily until destro\'ed. It is unnecessar\' for us to give the different formuhij in use, suffice it to say that the chloride of chromium paste is in ver}' general use for all large cancers, and the ozone paste for smiil ones. These two do their work etTectiv^ely, whichever is used, and should be applied daily until the cancer drops oiit, after which it is a good plan usually to poultice for a few days so as to cleanse the wound thoroughly. Poultices of linseed meal and boroglyceride should be applied every three hours, and as soon as the granulations exude healthy pus, strap it with adhesive strips and dress with either stramonium or ozone ointments, or an ointment made thus : Ozone ointment, one ounce ; lac sulphur, Scirrhous cancer of the abdomi walls BACTERICIDES. I2i three drachms ; willow charcoal, pulverized, one drachm. Mix ; or an ointment composed of ozone ointment and resorcin. We shall now describe the microbe in various locations of the bod\\ This case (p. 1 20 ) of cancerous infiltration of the abdominal walls, involving the skin, cellular tissue and border of the recti muscle, ■was first removed by the application of the chloride of chromium paste ; roots or prolongations destroyed by papoid and thallin ; healed kindly under ozone ointment. The internal remedies were Chian turpentine, saxifraga, Phytolacca. Owing to disease of the teeth and nose, the Cancer antrum is greatly weakened, and if the microbe of of the carcinoma be present in the blood, it is very liable Antrum, to be effused into this cavity with the liquid, semi- liquid and glandular substances, so often found in this locality. The s}'mptoms are aching, uneasiness of the cheek, preceded by acute throbbing, pain, rigors, fever, followed by slow and progressive enlargement. If unrelieved, there will be bulging of the cheek, extrusion of the eye, obstruction of the lachrymal duct, depression of the hard palate, loosening and dropping out •of the teeth and closure of the nostril. In some cases it will burst into the nostril, mouth, or through the cheek. The pain is intense. The treatment should consist in making a free aperture into the antrum by extracting either of the molar teeth, and a trocar pushed up through the empty socket into the antrum. If the teeth are all sound, then an opening should be made through the membrane of the mouth, above the alveoli of the molar teeth, and the bone be pierced by a strong trocar. The contents should be thoroughly stirred up, whatever they may be, and thoroughly evaluated ; the cavity washed out every morning with a solution of resorcin, creolin or other antiseptic, and general treatment for cancer inculcated. This makes its appearance chiefly in the form of Cancer epithelioma, although the scirrhous, medullary and of the melanotic forms are quite common. Lip. Irritation is the grand exciting cause ; the pipe or cigar has been mentioned as the principal source of irritation, but numerous cases occur where the individual is not addicted to this habit. It is also true that it is chiefly the lower lip that is affected, very seldom the upper. The great frequency- 122 DISEASE GERMS. of cancer of the lower lip may partially be accounted for by its situation, position and mobility. Most generally met with on one side. As all cases of cancer are both contagious and infectious, it is doubtful how many cases may be directly due to the pernicious practice of kissing. We are strongly of the opinion that numer- ous cases of cancer of the lip are due to direct inoculation in the act of kissing. It is a notorious fact that all disease germs may be communicated in this way. Daily we see the germs of tubercle, syphilis, diphtheria, small-pox, etc., in the vapor and exhalations of the mouth, passed from the affected to the non- affected. This occurs at all hours and is thought nothing of. The indiscriminate kissing of infants is highly prejudicial to the little one, its tissues as a rule, are fresh, free from disease germs, the activity of growth great, metamorphosis rapid ; in its nurse's arms, in the perambulator or carriage, it is the victim of kissing. How many of those maids and busybodies who kiss are free from the latent seeds of disease, especially disease germs ? What are the habits of those maids ? Echo answers — What ? The germs of cancer are deposited in early life upon the lips of children and are indelibly fixed there, remain latent if vital force is averaere, but break out the moment that is shattered. The activity or latency of disease germs in those who care for children is of great importance ; active or latent they can be com- municated by close contact, especially by the mouth, in the secretions of which specific germs are always present, and all kissed children run a chance of inoculation by the saliva. The diagnosis of cancer of the lip is easy, the diathesis, the induration or sore on the lip, the pain sharp, lancinating, infiltration of the lym- phatics. The extreme difficulty in the applica- tion of any of the plasters at this point renders cancer of the lip the most eligible for removal by the knife; as a general rule it is the best method, push- ing local and internal remedies vigorousK- after its removal so as to prevent its re- currence. Some cases arc effectually got rid of by either of the pastes, chloride of chro- mium, ozone ointment and resorcin. A most interesting case of epithelioma of the lower lip in a young lady, aged twenty-one. The exciting cause of irritation seemed to be the insertion of a peculiar colored thread between BACTERICIDES. 12^ the teeth. At nineteen a httle thickness was discovered and thought nothing of; it kept very painful, gradually enlarging until twenty-one, when she sought relief. This case was placed upon Chian turpentine mixture, saxifraga, phytolacca, glycerite of sulphur, etc., locally. The cancerous infiltration was brushed over every morning with lactic acid followed with a paste of resorcin and ozone ointment. It completely exfoliated in twelve days, leaving a healthy sore, but a little gaping. To rectify this deformity, a hair-lip pin was inserted and bound well in its place with metallic sutures. This was retained for six days. The dressing all through was the resorcin salve, it healed kindly and left no scar, irregularity or deformity. If the germs of cancer are present in the blood of Cancer an individual, latent or active, whether they are the of the result of heVeditary contagion or infection, the breast, Breast, being an exposed portion of the body, is ver}' liable to suffer an irritation, a deficiency of life, a relaxation ; and these micro-organisms being so small that they can float in the air, exude through the walls of the capillaries, colonize, form a growth or tumior. The very presence of throwing out germs, or infiltration, is in itself irritation which causes more to be effused, and when they are thus deposited, they are capable of a new and independent existence, with prodigious power of growth and reproduction, deriving their nutrition by endosmosis and roots or prolongations penetrating into the adjacent tissue. The sources of irritation of the female breast are very numer- ous, as the handling of the breast and nipple by the infant ; articles of modern dress, as corsets ; certain occupations ; keeping articles of value in or near the bosom ; and as there is a perfect anastomosing, or blending or joining of the nerves of the uterus and ovaries, all abnormal conditions of the latter organs' tell disas- trously on the breast, so that all diseases of the genito-urinary organs are productive of irritation in the breast, as a perversion of the sexual act, masturbation, metritis, catarrh, indeed all diseases. The natural weakness of the left side, the immense ganglia of the great sympathetic nerve, reflected over the spleen, heart and left breast, tell us in unmistakable language why cancer is so frequently found in that breast. Besides, this furnishes a clue to why worry, struggle, care, sorrow, mental toil, neurasthenia, aid in the same condition. There can be no doubt, irrespective of causes already laid down, that monotony, sameness, isolation of 124 DISEASE GERMS. location, diet, with a toil-worn depressed nervous system, are productive of carcinoma. The male breast is a mere rudimentary gland, has none of the exquisite development of the female, none of that high organ- ization, very little sensibility. Cases in it are rare. A few cases, once in a while show themselves, due to irritation of the buckle of the suspender. In a total of looo cases of cancer of the breast, of which I have taken note, there were 1 50 cases of encephaloid against 850 cases of scirrhous. If it were possible to obtain statistics of all cases of cancer of the breast which present themselves, we think that the proportion of scirrhous breasts to those of the medullary would be about the same. All forms of cancer are met with in the breast ; scirrhous and medullary most common ; while epithelioma, fungous hsematodes or rose cancer and lardaceous are not so prevalent. The recognition, of cancer of the breast is easy, the pain sharp, lancinating, serves to distinguish it from all other tumors; numb- ness of the arm of the affected side ; retrac- tion and oozing from the nipple ; enlarge- ment or induration of the lymphatics in the arm-pit, with the ger- mal diathesis which is usually well marked. The general con- stitutional treatment for the destruction of Tlie same cancer, taken from a pliotograph after remov, the cancer germ should be enforced. If the tumor is very small, an effort to get rid of it without destroying the skin might be BACTERICIDES. 1 25 tried with the sulphate of manganese lotion or distillation of the jequirity, or a combination of the succus belladonna with iodide of potass, or the resorcin ointment. If too large, or growth too active, then its removal by one or other of the germicidal plasters should be decided upon. The attending physician is the best judge. All such applications are painful, some much less than others. These, if active enough, should have the preference. A case of open, mixed cancer of the breast (p. 124) ; scirrhus and medullary removed by the chloride of chromium paste in nine days ; healed up well in twenty-one days. No recurrence. All the illustrations in this article are taken from photographs of actual cases treated by the most scientific cancer specialists in the United States.* This case, a lady of immense wealth, widow, seventy years of age, had for seven years hid her malady from hernearest relatives. It commenced as a small pim- ple, and gradually spread until it assumed the appearance it has in this cut. From the back and left side of the head, an elevated, ulcerated, circular growth is seen to arise, measuring 5 yi inches in diame- ter. It bled readily, and pre- sented all the appearances which are usually found associated with epithelioma. The general health was very poor, and there was quite considerable enlargement of the post-cervical glands. The treatment consisted in the use of tonics, alteratives, includ- ing the Chian turpentine mistura, alternated with the ozonized glycerite of sulphur. A paste consisting of one-half pound each of resorcin, and * The treatment of cancer in the United States has been completely revolutionized ; the empirical and barbarous methods, the knife and caustics, have been very generallv abandoned, and physicians of the highest culture, of the most eminent scientific attain- ments and profound skill have adopted the germ theory of its origin, and are to-day successfully curing a very large percentage of all cases which come under their cog- nizance with bactericides. Among those great luminaries of scientific medicine and benefactors of our race, we would respectfully mention E. J. Skelton ^ Sons, 3/. D., of Bloomfield, Iowa; Prof. F. I, Mehrman, M. D., of Oakland, California; R. II. Randolph, M. D., Portland,- Oregon ; C. V/. Bozihon, lola, Kansas ; Dr. Artcr, M. Z>., Lima, Ohio; B. L. Robinson, M. D., McLean, N. Y. ; Ilenrv IVanier^ M. D., Sprmgfield, Mass. 126 DISEASE GERMS. ozone ointment, to which was added ten grains of hydrochlorate of cocaine. This was spread on leather and apphed night and morning over the entire mass and a httle beyond. In twenty -four hours it shrivelled up amazingly, and so continued for nine days, when it dropped off. The same remedy, about a half weaker, was continued till it healed up, which it did in twenty-eight days, forming an excellent cicatrix. A case of epithelioma of the forehead, under the charge of one of the enumerated specialists, was subjected to a very similar course of treat- ment : tonics, Chian turpen- tine mistura, glycerite of sul- phur ; locally to the tumor, ozone ointment, resorcin, papoid, and thallin. The germinal mass exfoliated in ten days, and healed up in a month. Three other sarcomatous nodules were forming on the cheek, to which the resorcin and ozone ointment alone were applied. Under this they disappeared in five weeks. This case originated in the removal of hairs by the barium depilatory when she was thirty-two, and had taken years to as- sume the present size. An excellent cure was effected. A very remarkable case of epithelioma of the tongue, which had been tampered with until it assumed a true medullary form. The hopeless condition of the patient justified a trial of almost any remedy. He was placed upon a general alterative and tonic treatment, including saxi- fraga, Chian turpentine, etc. The germinal mass protuding from the substance of the tongue, was first sprayed with peroxide of hydrogen, and then brushed over with lactic acid, gargle of distillation of jequirity used. Not making as much progress as was deemed proper, a ten-per-cent. solution of chromic acid was used instead of lactic acid, with the best results, the entire mass exfoliating in eight days. BACTERICIDES. The Chiaii turpentine, glycerite of sulphur, and saxifraga inter nally ; and locally the peroxide of hydrogen spra)-, gargle of dis- tillation of jequirity used till it healed up, taking in all about four weeks. At the age of forty-four, a' small pimple appeared on the side of this gentleman's head, above the ear, which became very painful, and commenced to grow slowly and discharge sanious, ichorous, cancerous pus, with its characteristic odor. It continued to gradu- ally enlarge for nine years, when it presented this ap- pearance, a large fungating growth, involving the ear. W^hen he applied for relief iie was placed upon the usual germicidal remedies, Chian turpentine, saxifraga, Phyto- lacca, etc. To the large medullary mass of germs, the ozone paste was applied daily and care- fully watched, fearing it might penetrate to the bone. In six days the entire mass dropped off completely, leav- ing neither root nor branch. Sore healed kindly in five weeks under the ozone and resorcin ointment. This is the diagram of a case of scirrhous infiltration of the skin, cellular tissue over the antrum. It had been gradually increasing in size for over two years ; pain intolerable, yielded kindly to the application of equal parts of ozone oint- ment and resorcin, which was bound over it and ap- kept peeling off, growing less and Carcinoma on the cheek. plied fresh twice daih'. It 128 DISEASE GERMS. less, till at the end of nine weeks it entirely disappeared. The internal treatment consist^ in the use of the conium pill for pain, and the use of Chian turpentine mistura, saxifraga, phytolacca. An excellent cure was effected. This illustration affords a most instructive lesson as to the utility of bactericides in the treatment of cancer, the tumor at the outer canthus of the eye, on the lid, was removed by the knife, being- a non-malignant sebaceous ; while that at the outer angle of the mouth was schirrous, very painful. Two lower bicuspids and a few cragg}' stumps of teeth were re- moved, and then to the cancer the ozone paste was applied ever}- morning for seven consecutive days, when it dropped out, leav- ing a clean, healthy-looking sore. The edges were brought together by hair-lip pins and a few wire sutures, resorcin oint- ment applied, no other dressing. Wound healed promptly, pins and sutures removed, and good union effected. He shortly afterwards was discharged, with instructions to continue for six months the Chian turpentine mistura with the saxifraga. This he neglected. A month later on, he returned with a hard painful mass be- neath the chin, extending to the jaw on each side, but rather further to the right than the left side. In the centre of the mass below the jaw was a prominent swelling, the size of a marble, distinctly fluctuating ; skin ever it red and thin, much pain and tenderness ; movements of tongue unaffected ; speech clear ; de- glutition, free. Four days later on, this swelling beneath the chin began dis- charging thin, watery, cancerous pus ; a few days later, as if b\- magic, the sore rapidly fungated, and became as large as an orange, with the surrounding tissue involved. The case looked very gloomy ; Chian turpentine, saxifraga and the conium pill were ordered internally, and the ozone oint- ment, pound for pound, with resorcin, was ordered to be kept constantly applied. In a few days the whole aspect of things was changed, the mass commenced peeling and shrinking, and in five weeks entirely disappeared. Made a perfect recovery. BACTERICIDES. 129 In this diagram, the ozone paste was applied fresh every morn- ing; both tumors dropped out entire on sixth day; subsequently dressed with the ozone oint- ment and healed up very kindly. The internal reme- dies consisted of alteratives and tonics, embracing saxi- fraga, phytolacca and gen- eral remedies ; case pro- gressed well to a complete and perfect recovery. This, and all the illustra- tions of cases, exhibit clearly the utility of bacter- icides in the management and cure of cancer. The desideratum of the age is the introduction of more potent remedies to destroy the germ, and leave healthy tissue unimpaired. Two scirrhous infiltrations, one on arm, the other on forearm. It may truly be asserted that, in every Cancer of the case of the cancerous cachexia, the liver Liver. is impHcated through the agency of the germ-laden blood passing through it, espe- cially if the liver is weakened by alcohol, malaria, mercury, or great mental strain. The varieties met with are scirrhous, medid- lary, melanotic, colloid. Germs deposit themselves in the interlobular spaces, crowd the capillaries, and obliterate them. Rapidity of development is the characteristic of the medullary. The melanotic is remarkable for its blackish pigment. The diagnosis of cancer of the liver is obscure, the loss of weight, strength, and ambition ; anaemia, loss of appetite, flatulence, vomiting, constipation, alter- nating with diarrhea; jaundice, oedema of the feet; hemorrhages from all the orifices ; stools clay-colored, urine scanty. Cancer of the liver may run its entire course without pain, without jaun- dice, but in the largest proportion of cases there is pain anterior to posterior, pain in right shoulder. There may be a large bulging over the liver, large smooth nod- ules can be felt, and are visible. The nodules are umbilicated, and are diagnostic of the disease. 1^,0 DISEASE GERMS. No curative measures of any avail, the palliation of symptoms are all that can be done. Cancer of the brain, arteries, heart, intestines, kidneys, gall duct, pancreas, spleen, pleura, are all incurable when once estab- lished. The only point of decided interest is the diagnosis, which, in nearly all cases, can be made out by cachexia, by the pain, by the cancer germs in the urine. Cancer of the Lung. All varieties and grades of the cancer germ are found in the lung. Medullary or encephaloid are the most common, then the other forms. It occurs in nodules of various sizes, situated through the lung substance, or in more rare cases, in larger masses. In either form they cause great destruction of tissue and hemor- rhage. One lung is usually implicated, in which the germs make great ravishes. The etiology of pulmonary cancer is the same as cancer in general ; often precedes or is asso- ciate with cancer of the breast. Diagnosis. In can- cer of the lung there is pain anterior and posterior ; in the expectoration and urine the germ is easily detected by the microscope. Besides, the cancerous cachexia will aid the diagnosis, otherwise, difficulty of breathing, cough, ha^^moptysis, rapid emaciation, pleuritic symptoms resemble tubercle. There is usually very little difficulty in its recognition. Such cases are most unfavorable, and can only be palliated. Cancer microbe in tlie lung. ancer of the Rectum. Cancer may be defined to be a disease in which certain primary elements of the blood are changed, altered, or degraded, by adverse states or conditions prejudicial to life, into a disease germ. This germ may remain latent in the blood until some part of the body is weakened, irritated, damaged, or BACTERICIDES. I 3 j ulcerated, when the blood so germ-laden passes through the weakened part, an exosmosis of the germ is likely to take place. Whenever a disease germ or microbe passes out of the bounds of the circulation, they acquire a prodigious faculty of growth and reproduction. The probability or improbability of extirpating a cancerous growth depends altogether upon the judicious use of local and internal germicides. It is, therefore, a wise rule to adhere to in all cases, never to tamper with a cancerous tumor or growth until the blood and lymphatics are cleared of germs ; once this is accomplished the growth should be seen to. A very large number of our people possess a cancerous dia- thesis (blood-germ laden with the cancer microbe), and have no tumor or growth visible, simply because there is no local irrita- tion, no weak part through whose vessels the germ can pass out of the bounds of the circulation. The exciting causes about the rectum are irritation, fissure, catarrh, piles, ulceration, fistula in ano. General Symptoms. — The early indication of this distressing malady are often very slight, such as sluggishness of the bowels, or diarrhea from the presence of germs. As the germs grow, a slight discharge of blood, or blood mixed with mucus, or puri- form matter is commonly met with. This is at first voided with the faeces, or in micturating, or independent of any evacuation The quantity of blood thus lost varies from a streak upon the fecal substance, to two drachms, or as many ounces. The dis- charges are the results of the microbes burrowing in the rectal walls, perforating the vessels. Gradually the fecal evacuations are impeded in various de- grees, obstinate constipation or scanty discharges of thin fluid are from time to time ejected. When consistent the fecal matter is usually slender or flattened, ribbon-like, or hollowed on the surface. Later on evacuations are arrested, and relief is obtained at long intervals, and with much agony. This is the common run of cases. In others, fecal matter continues to be ejected in small pieces. The hindrance to the passage of the contents of the bowel is occasioned by the cancerous tumor or infiltration. Besides, the disease germs paralyze the bowel. The bladder is occasionally involved, and the discharge of urine is affected in various ways, sympathetically or by that organ being involved in the cancerous infiltration. Pain, anterior and posterior, is an in- variable attendant upon cancerous disease of the rectum. It may be inconsiderable in degree, a mere teazing uneasiness, to one of intolerable anguish, without remission. Pain in the rectum and 1^2 DISEASE GERMS. its immediate neighborhood ; over the sacrum ; along the peri- naeum ; in the fold of the nates on both sides — when on one side^ most frequently the left, down the thigh on its back part, and even, but rarely, the calf of the leg. The pain in sacrum is the most severe, even to the sphincter, so that the affected individual,, if sitting, will sit sideways, or partly supported by two chairs. Cancer germs in the rectum give token of their presence by a perceptible loss of flesh ; by a puffed waxiness of appearance ; by the yellow tinge of the eyes ; by the deep aspect of depression and taint of the system ; lymph canals and liver engorged with, the germs, the general health is undermined. The symptoms will vary with the location and character.. Scirrhous, colloid, and epithelial, and soft and fungoid are common forms. Usually the deposit is first met with between the mucous and muscular coats of the bowel, usually at a single point, low down, two and one-half inches up, or so high that it is out of reach ; or it involves the whole circumference of the gut, and spreads longitudinally towards the orifice of the bowel, as well as upwards, perforating in all directions. The germs often migrate to the neighboring parts ; to the anus, first infiltrating the skin, then ulcerating ; or an abcess and fis- tula may come in the ordinary way and extend from the skin to the interior of the bowel, and burrow far and deeply into the parts. When the cancerous deposit is high up, it is liable to eat through the bowel and form an immense shapeless mass, in which the bowel becomes imbedded. It often becomes adherent to the sacrum ; presses upon the nerves. In some cases it migrates into the bladder, uterus, vagina, ovary, etc., establishing communications by an ulcerative process, giving rise to grave complications. In tracing cancer of the rectum through its course, we have seen that the germ first locates between the mucous and muscu- lar coats of the intestines, and follows the course of the blood vessels ; most frequently the first deposit is at the distance of two and one-half to three inches above the orifice of the bowels. Treatment. — Patients so affected should be put upon a general alterative and tonic course, with the best of diet and good surroundings. Pain must in all cases be relieved with the comp, conium pill. Bougies of various kinds should have a fair trial,, and should be used for months. They should be made of suck agents as will destroy the germ colony in and on the bowel. They are made of the following ingredients : Resorcin, thallin, papoid, in butter of cocoa. Otherwise the general treatment of cancer should be vigor- ously enforced. BACTERICIDES. 133 They should be persevered with, and while using them, if any 'new growths sprout out and obstruct the canal, they should be destroyed by rubbing them over with lactic acid or ozone paste, or chromic acid. Then the introduction of a bougie, and later washing out the bowel. In manipulating a cancerous deposit in the rectum, the ■only immediate danger to be dreaded is hemorrhage, and this must be carefully looked for and skilfully managed. Constipation and looseness are equally to be dreaded ; as the former is the most common, a laxative becomes necessary. The ^enema of water in very many cases accomplishes all that can be desired. The most frequent variety of oesophageal Cancer cancer is epithelioma, although scirrhous and of the medullary are not uncommon. CEsophagus. The infiltration of the mucous membrane by the germ begins, then it migrates slowly into the muscular rings, invading all the tissues of the oesopha- gus, causing stricture of its calibre. Above this narrowing there is either uniform dilatation, or a pouch, often as large as an orange. If the mass of germs involve the entire oesophageal wall, it may press upon one or both pneumogastrics and lead to the -development of pneumonia or pulmonary gangrene. Two-thirds of all cases of oesophageal cancer occur in males between the ages of forty and sixty. It is easily recognized by the pain. Anterior and posterior pain is one of the earliest symptoms of the affection, beginning dull, burning, lancinating, aggravated by the passage of food. As it grows the canal narrows, stricture takes place, flatulence, regur- gitation of food and vomiting, with steadily increasing emaciation ; cough, difficulty of breathing, hoarseness from pressure of the mass of germs ; cachexia is well marked, hemorrhages become frequent ; the bloody fluid vomited contains large massesof the cancer germs; the adjacent lymphatics are usually implicated, and there are usu- ally fatal hemorrhages or septicaemia. The average duration of cancer of the oesophagus is one year, but many cases succumb in a few weeks. In the treatment great attention should be paid to nutrition, food finely chopped, semi-fluid, entirely fluid. Nutrient enemata should be given ; diet nourishing in the highest possible degree. Pain must be relieved by dissolving the conium pill, introducing it into the rectum. Bougies, armed with papoid, should be in- troduced with great care down to the cancerous mass and an effort made to dissolve it with papoid or trypsin, combined with •thallin. 134 DISEASE GERMS. usually commences as a small pim- Epithelioma of the pie, which continually increases in Hard and Soft Palate size, becoming a fungating growth, with a grayish white color, raised, whose edges soon become hard and everted. With this deposit of the cancer germ the surrounding tissues soon become impli- cated, the tonsils become swollen and tender, hard and red, and gradually ulcerate. The uvula, the pillars of the fauces and the free edge of the velum palati also become implicated. Progressively onwards, fissures, ulceration in patches over the greater part of the soft and hard palate take place ; in some loca- tions a mere excoriation ; over all the affected area, not occupied with the cancer germ, the mucous membrane is hard and thicker. The pain is usually severe in these cases. The most successful treatment of such cases is to paint over the nodules either with a ten-per-cent. solution of chromic acid or the pure undiluted lactic acid ; use mouth washes of distilled jequirity or boroglyceride. The only remedy so far successful in killing the growth of the germicidal mass is the Chian turpentine, in half dozen teaspoonfuls daily ; this, in such doses, speedily arrests germ evolution in the blood, affords complete relief from pain, the enlarged lymphatics diminish in size and ultimately disappear. Cancers of the hard and soft palate are generally slow in their progress and are more tardy in yielding to the action of ger- micides. Cancer of the pancreas, though by no Cancer of the means a disease of very great rarity, is suffi- Pancreas. ciently uncommon to call for more than pass- ing notice. Its rarity is, as already mentioned, not very great. The gland is usually enlarged, but not always. Sometimes it is even diminished in size. The growth invariably affects first, and most extensively, the duodenal end, or head, and it is by means of this peculiarity, as we shall see later, that its clinical diagnosis is rendered possible. The growth is usually a carcinoma containing large epithelial cells in alveoli, surrounded by fibrous tissue. The proportion of the cells to the fibrous tissue differs greatly. In some there are many collections of cells, while in others there appears to be hardly anything but fibrous tissue. It is these latter cases in which the gland is of small size, or even shrunk below the natural. Another sort of primary growth found in the pancreas resembles the structure of a tubular gland, and is called adeno-sarcoma. These two forms originate in the gland BACTERICIDES. 135 tissue and the excretory ducts respectively, and are called the type glandidaire and cxcretoirc. As a rule the cancer does not give rise to deposit in many other organs. The liver is the most commonly infected, and the smallness and great number of the liver growths in this case, sprinkled thickly through its substance without altering its shape, are pathognomonic of their pancreatic origin ; but they certainly do not always occur. The symptoms of the disease have been considered very nu- merous and very obscure, but they may be much simplified if we place them in their classes according as they depend on the ana- tomical position of the pancreas, its function in the general economy, and on the nature of the disease which has attacked it. To take the last condition first, where the growth reaches a large size a tumor may, of course, be felt with more or less dis- tinctness in the epigastrium, and the conjectures as to its origin will be more or less plausible accordingly. Where it remains small it cannot in general be felt at all. Pain is more inconstant here than in most other cancers. When it occurs it is often felt in the back, often referred with more or less accuracy to other parts of the abdomen. When these are absent we can only fall back upon the fact that cancer of this organ produces, as does cancer in other situations, anaemia and emaciation, but these symptoms are more marked and more rapid here than elsewhere, in proportion as the gland attacked is more concerned with nutrition. Cancer of the pancreas hardly ever lasts six months from the first appearance of symptoms. Nor is this surprising when we remember that the pancreatic digestion combines in itself the features of all the others. Like the saliva, it turns starch into sugar; like the gastric juice, it digests albumen ; and like the bile, it emulsifies fats. In disease of the organ we should therefore expect that traces of defect in all these functions should be discoverable ; and of all of them, indeed, traces have been discovered. In some cases, though but few, stdrch has been recognized in the stools by the aid of the mi- croscope. In some undigested muscular fibres have been seen to pass away with the fseces or to return in the vomit. Both these, however, are less easily recognized and less distinctive than the fatty stools which have frequently been observed, and the fatty vomit which is occasionally seen. The fat is generally recog- nizable by the naked eye as an oily liquid, as waxy lumps, or as an actual coating on the {-^ao-^. Sometimes, however, it needs a microscope to show the fat globules intimately mixed with the mass. An easier plan is to shake up a small piece of the faeces in ether, and either evaporate the latter in the tube, leaving a fatty deposit behind, or on blotting-paper, which will show the charac- 136 DISEASE GERMS. teristic translucent greasy stain. In one case at least of pancreatic disease fat has been found in the urine, but this seems too rare an occurrence to be of any importance. In spite, however, of the enormous importance of the pancreatic digestion, its failure does not bring about other digestive symptoms with anything like the frequency that might have been expected. There certainly is often loss of appetite, but it is by no means constant. In a case known to us the appetite did not fail till a fortnight before death. Pain after food is occasional, but rather uncommon than the re- verse. It has been before now suggested that a typical symptom of pancreatic disease is a watery diarrhea, but on the contrary, many, if not most cases are constipated. One very curious symptom remains which, though rare in cases of cancer, is not infrequent in other pancreatic diseases, and is even common in pancreatic calculus. This is diabetes mellitus. Theories to account for it have been equally numerous and unsatisfactory ; the fact alone remains. Summing up, then, the symptoms already detailed, we are obliged to confess that neither those derived from the nature of the growth nor, with the exception of fatty stools, those depend- ing upon the pathology of the gland can give us any trustworthy help to diagnosis ; and even when the characteristic faeces are pre- sent it maybe questioned whether they do not depend upon an al- teration in the supply of the bile, rather than upon disease of the pancreas. Luckily, the morbid anatomy of the affection is more fruitful. Cancer always, as before said, involves first and most extensively the head of the pancreas, and in this situation it can hardly avoid pressing on the common bile-duct as it passes down between pancreas and duodenum. The jaundice which is thus produced, though in rare cases absent, is by far the commonest symptom of pancreatic cancer, and is in itself peculiar. In the first place it is commonly very deep, far deeper, for instance, than the jaundice typical of cirrhosis of the liver. Next it is very per- sistent, not as often occurs in cases of gall-stones, intermittent, or as catarrhal jaundice, transitory. Thirdly, the liver is not greatly enlarged as in cases of cancer, nor diminished as in cirrhosis, but undergoes a curious change. In the early stages it is usually swollen, sometimes tender, and may reach to an inch or even two inches below the ribs in the right nipple line. But later it begins to shrink, and at death is hardly ever found larger, sometimes smaller than natural. This change probably is due to cirrhosis beginning round the bile-ducts, caused by the pressure of the ob- structed bile. When enlarged it might be thought to be a liver in the hypertrophic stage of portal cirrhosis, but this is excluded by the deepness of the jaundice, and more surely by the fourth BACTERICIDES. 137 characteristic sign, the distended gall-bladder. The gall-bladder is always dilated, and may in some cases reach considerably below the umbilicus. This, taken with the deep jaundice, proves that both the cystic and hepatic ducts are free, while the common bile- duct is compressed or obstructed, and it is this combination which is so significant. For the common bile-duct, three inches in length, runs for two-thirds of its extent under cover of and between the duodenum and pancreas. For the first inch or so, it runs into the lesser omentum, and is here liable to compression from enlarged abdominal glands. Persistent jaundice points strongly either to a blocking up of the duct by calculus, stricture, or disease of the duodenum or pancreas. In all cases of deep and persistent jaundice, with distension of the gall-bladder, without symptoms of gall-stones, if the liver be but a little enlarged, the disease will in all probability be cancer of the head of the pancreas. This diagnosis will be confirmed if wasting sets in early and progresses quickly. The treatment w^hich is available is to supply the deficiency by pancreating the food, before it is administered, and placing the patient upon the Chian turpentine mistura, which has a remarka- ble effect on the germ-laden pancreas, the ethereal peroxide of hydrogen. All forms and varieties of cancer are to be Cancer of the met with in and on the penis. Usually a Penis. result of contagion and infection. Scirrhus, epithelioma, medullary, etc., etc. A very large percentage of these cases commences with a peculiar scaly or horny excrescence on the corona glandis, prepuce, and oftentimes on the areola of the nipples. This scaly or horny infiltration is in the ?arly stages unaccompanied with any decided pain, simply uneasiness, misery. A scale from the prepuce placed in the field of a microscope gives us the annexed diagram. If attended to just at this point the growth is irrested, and no further trouble. There are two methods of procedure, either pack the head of the penis and all affected parts every night in boroglyceride paste, or apply the resorcin paste ; either one will cause a complete exfoliation of the morbid tissue, leaving it soft and in a healthy condition. The usual remedies for the destruction of the cancer microbe The horny excrescence magnified loo diam- eters. 1. The spore sprouting into the area a and b. 138 DISEASE GERMS. should be resorted to for a period of six months. These should embrace active bactericides, saxifraga, Chian turpentine, Phyto- lacca. The stomach, next to the Hver, is the most Cancer of the frequent seat of the locahzation of the cancer Stomach. germ in the internal organs. We meet with all forms and varieties here ; we enumerate them in the order of their frequency as follows : scirrhous, medullary, colloid, villous, melanotic, epithelial. The germ in two-thirds of all cases deposits itself near the pyloric extremity, migrating or infiltrating the stomach upwards,, and downwards into the duodenum ; the other one-third of cases infiltrates the cardiac orifice involving the oesophagus. Scirrhus, few germs, but much fibrous tissue, appears as a grayish, white, opaque nodule in the submucous tissue; the germs are few, the fibrous tissue abundant, so there is a great hardness or induration, which causes contraction of the surrounding tissues, and puckering of the mucous membrane. The germs in their growth radiate in all directions where there is least resistance, forming nodules. A dark slough often forms on those eminences, which may ulcerate and expose the cancerous mass ; this may either extend deeply or spread widely so that the neoplasm is found in all directions. The lesions which follow the presence of scirrhus are dilatation of the stomach, chronic gastritis, perforation. The medullary form begins at the same locations, and forms a large soft nodule. Cancer of the stomach occurs most frequently between the ages of forty-five and sixty-five ; more common in males than females. TJie diagnosis is not difficult, we have the cachexia, the breath, skin, urine, stools, the pain anterior and posterior, the cancer germs in the vomited products, and in urine. A tumor sometimes large, hard, irregular, nodulated ; some- times small, deep-seated and elastic, can be felt ; which will be a guiding landmark to distinguish it from all forms of dyspepsia. It is hardly possible to mistake cancer of the stomach for gastric ulcer, abdominal aneurism or nervous dyspepsia. The symptoms are plain and most decided : pain anterior and posterior, anorexia, a sense of goneness, uneasiness, distension, with nausea and vomiting, pyrosis, gnawing, lightness in stomach. The pain may not be referred to the stomach, but referred clear through to the interscapular region; those symptoms put in an appearance long before the germs in the walls of the stomaclv BACTERICIDES. 1 30 make much headway. But as germ growth becomes active, vomiting is persistent. Hiccough, flatulence, constipation are often annoying and dis- tressing. Great mental depression, debility, emaciation, haggard countenance as it progresses, hemorrhages set in, rusty, brown, blackish blood loaded with germs, or if from the bowel tarry. The yellowish green color of the skin changes to a jaundice hue, chiefly due to the cancerous mass pressing upon the Hver. Often febrile symptoms, hectic, tongue becomes loaded with the oidium albicans, urine loaded with urates, often serious com- plications. The duration is from a few weeks to three years and a half. The prognosis is regarded as unfavorable. TJie treatment almost altogether consists in ameliorating prominent symptoms, so as to afford all the relief possible from the pain and vomiting. The diet sho.uld be liberal, nutritious, concentrated, with a moderate allowance of milk-punch at stated intervals. During the whole course of the disease, the C. conium pill should be administered thrice daily for the relief of pain and to retard the cancerous growth ; constipation should be overcome by the use of kola nut paste. Germicidal remedies are often effective in retarding cancerous growth, and arresting the development of the microbe. The use of one or two of the following remedies at a time are worthy of a trial. Papoid triturated with salicylate soda and resorcin have proved effective in causing the dissolution of the cancerous mass, let it be scirrhous or medullary. Trypsin has a similiar action, glycerite of sulphur, or the emulsion of Chian turpentine, have proved effective. Liquor cerii has been of great utility, peroxide of hydrogen in alternation with the sulphide of lime. The pill composed of papoid, thallin, and sulphonal operates well. Ozonized clay kept over the stomach has a magical effect (acting by endosmosis) in causing a dissolution of the germinal mass. It may be bound on over the region of the stomach, but never kept long enough applied to cause any irritation. If the stomach rejects all food, rectal alimentation will be necessary. The most common variety of cancer of the Cancer of the tongue is epithelioma. The diathesis being Tongue. present, some point of the tongue being sub- jected to constant irritation, there appears at that point a small unhealthy ulcer, or a deep-seated nodule,. 140 DISEASE GERMS. usually on its edge ; ulcer becomes circular in shape, with ragged, -everted edges and a wide indurated base. The surface of the cancerous mass has a dirty white or grayish aspect, later, red, papillated, friable, but very hard. As it progresses onward, it slowly involves the whole tongue, which becomes large, unevenly lobulated, covered with several ulcers ; hemorrhages often take place. All the glands of the mouth and throat, submaxillary and sublingual are infiltrated, and the oral cavity is filled with the cancerous mass. Cancer of the tongue is met with most frequently in man in middle life, between thirty-five and sixty ; some local irritation, .as a carious tooth, the stem of a pipe, is an exciting cause. It is easily recognized by the sharp darting pain in the ulcer ; the pain aggravated by the movement of the tongue ; pain runs along the course of the fifth nerve. As the lymphatics become engorged, salivation be- comes profuse ; as hemorrhages are not infrequent, anaemia is soon well marked ; the breath is truly diagnostic ; the germinal mass destroys healthy tissue with extreme rapidity. The duration of the disease is about fourteen months. The destruction of the germ, the relief of pain, the mainten- ance of the vital powers are the principal indications of treat- ment, a remarkable case ; cured by the Epithelioma^of the tongue. Epithelioma of the tongue application of papoid. Ozone paste was applied twice ; the mouth and throat gargled thrice daily by the distillation of the jequirity and solution of chlorate of carbon ; in the interim papoid was applied. Very similar cases of cancer of the tongue, with a fungating growth in the floor of the mouth on the left side, involving the gum and edge of the tongue for nearly two inches. All the sur- rounding tissues densely infiltrated. Ozonized emulsion of Chian turpentine was tried, in alternation with resorcin, and a sufficient quantity of glycerite of sulphur to move the bowels ; growth painted with a ten-per-cent. solution of chromic acid and crarcrle of chlorate of carbon was used. BACTERICIDES. 141 Epiihelioma of the tongue. were used alternately every hours ; mouth kept moist with decoc- tion of slippery elm with a few drops of peroxide of hydrogen. i^b ut every four days the lactic acid wa^ used ; this had an affinity for th ■ germs without destroying the norma! tissue of the tongue. In two weeks the dilute acid was used. Case made an excellent recovery, healing kindly about the seventh week, and remains well. This case resembled the above in many of its essential features, and in- stead of the lactic acid, a ten-per-ceni. solution of the ozone paste was usee! for killing the germs in the ulcer on tongue ; this was brushed freely over it, and followed by a mouth wash of distillation of jequirity, alternated with a wash of peroxide of hydrogen. Same internal treatment as the first case. This is a photographic illus- tration of epithelioma of the side of the tongue, with a medul- lary mass protruding through it ; a well marked fissure run- ning towards the point and an ulcer in the centre ; tongue well indurated throughout its whole substance. The submaxillary glands were considerably infil- trated and cancerous cachexia well marked. This case was placed upon comp. saxifraga and phytolacca, and the conium pill was admin- istered to relieve the pain. The large medullary patch, the fissure and ulcer in the centre, was brushed over with the pure concentrated lactic acid ; mouth washes of chlorate of carbon and rhl^n*nn«-<-ri soda thre- Epithelioma 011 edge of tongue. «4- DISEASE GERMS. There was immense peeling off of the germ-smitten tissue, which seemed to make away with the induration. The re- sults were very efficacious. The recovery of the patient was rapid, and tongue healed up very kindly. This case was treated with the powdered jequirity, the beans decorticated, submitted to the action of peroxide of hydrogen, reduced to an im- palpable powder, blown or dusted on the ulcer every five days, caused a complete exfo- liation each time it was applied. Mouth washes of borogly- ceride were used every four hours, and occasionally a piece of resorcin jelly, dissolved in warm water, was used for wash Cancerous ulcers on tongue. Cancerous ulcer on tongue, and gargle. The result was ex- tremely beneficial, even miracu- lous, in ridding the mouth of this most destructive microbe ; breath became sweet ; the whole character of the patient changed to one of life and vivacity, in- stead of the lethargy of death. The internal treatment con- sisted in the use of saxifraga, Chian turpentine and exalgine. The numerous ulcers on this tongue, were each, once a week, brushed over with concentrated lactic acid ; mouth washes of chlorinated soda, alternated with a wash prepared from the resor- cin jelly. Case improved rapidly at first, but rather slow after sixth week. Mouth washes were changed BACTERICIDES. 43 iCaneer of the tongue, involving its mucous membrane and papilla. to distillation of jequirity, and one of chlorate of carbon. This change operated beneficially ; cicatrization set in, progressed favorably ; healed entirely up in nine weeks. The fluid extract of hydrocotyle was used in this case instead of the saxifraga, and glycerite of sulphur to move the bowels. Exalgine was most beneficial for pain. A most remarkable case of cancer of the tongue, in which the microbe infiltrates its entire mucous mem- brane and its papilla; it has resisted the usual remedies. It drifted into the hands of one of the eminent specialists whose names are men- tioned in this article. A solution of ozone paste was tried, under which it seemed to do well, but it was discontinued on account of its diffusibility, and a paste made of thallin,papoidand glycerine was tried, that is, spread over the entire tongue ; this caused a dissolution of the can- cerous infiltration. It had to be ap- plied daily, but operated exceedingly well, so that he got rid of it entirely about the tenth week. The mouth wash used was a solution of boro- glyceride and peroxide of hydrogen. Internally, saxifraga comp. and Chian turpentine were the remedies used. The treatment of this case was en- tirely different and much more suc- cessful. The entire diseased surface of the tongue was brushed over with lactic acid, the ulcer in centre receiv- ing three applications. Mouth washes of distillation of jequirity, alternated with the chlorate of carbon, were used with most success. Large masses of dead germs were exfoliated after each application. The lactic acid was ap- plied six times, a week apart. Healed ""ZS ^\Si^^:^:f:^;\:i^^ 144 DISEASE GERMS. completely by the ninth week. The internal remedies the same a.s in the other cases. Cancer of the generative organs is un- Cancer of the doubtedly the most formidable affection Uterus. to which woman is liable. The liability exists at any age, but is most decided after thirty years of age, the proclivity existing up to fifty years of age, after which the liability becomes less and le^s. The forms met with in the uterus are the scirrhous, medullary and epithelial. The causes which give rise to so much cancer of the uterus are repeated abortions, sexual incompatibility and venereal disease, which give rise to chronic inflammation or partial death of the uterus. A low grade of uterine inflammation lies at the root of all female complaints, which continues from year to year until the cancer germ is thrown out. It does not necessarily follow that all cases of chronic inflammation do thus terminate, but all such must be guarded with a jealous eye. Mercurialization, monotony, sameness, isolation, solitariness, sexual excesses and other states unfavorable to a high standard of vitality or longevity, or conditions unfavorable to a high state or grade of existence, a degradation of the normal living matter of the body takes place into a diseased germ called the cancer or malignant bacilli ; true, these germs may also be received into the body by contagion and infection like other micro-organisms. In whatever manner they are brought about, by spontaneous de- gradation in the body, or by local contact, or by inhalation, the}- make the human blood their pasture-field, for in that fluid they grow and multiply prodigiously if vital force is low. It is a well- known fact that an individual with millions of cancer germs in the blood may live along to a good old age; if there is no local weakness or irritation, there is no colonizing of germs, but let an organ or tissue, or part of the body be weakened by anything, as the pipe on the lip of the smoker, or a contusion on the breast, or anything that will relax or weaken tissue anywhere, then an exosmosis or efl"usion, or exudation from the diseased gej'm- loaded blood takes place and growth and fruition of the germs will go on with amazing rapidity. Now, of all organs in the body of modern ladies, none are so liable to suffer depression as the uterus ; its intimate connection with the ganglionic nervous system ; those millions of little brains, those reservoirs of vitality ; its blending with the sympa- thetic system render it susceptible of being depressed by emo- tions, desires, affections, passions, so that the struggle for exist- \ BACTERICIDES. j^^ ence, exciting literature, certain modes of life, sedentary employ- ments, sexual excesses, etc., spend their action upon this special organism ; besides, at the climacteric period there are important anatomical and physiological changes that cause weakness, such as the atrophy and obliteration of vessels, shriveling up of ovaries and uterus and suppression of important functions, etc. Cancer of the uterus is, without a doubt, the most common and grave form of germ disease among women. The affection is generally ushered in with symptoms of general debility, a gone feeling, headache and backache. The neck of the uterus thickened, indurated, notched. In this state it may remain stationary for years, while, if the health is poor, it may proceed with rapidity towards cancerous ulceration. In- flammatory symptoms usually are present and darting pains like needles are felt, as if piercing the part, both anterior and pos- terior; ulceration follows. The leucorrhoea, which before existed, now becomes highly purulent and fetid, so much so that ts odor can be detected some distance from the patient ; then follows con- stitutional irritation, disorder of the stomach ; patient becomes gradually worse, insomnia, pain in the pelvis is constant, with oc- casional lancinating pain ; the cachexia is well marked ; the pa- tient becomes weak and irritated; paroxysmal hemorrhage, slight at first, but gradually becoming excessive and exhausting. On examination per vaginam we find the cervix uteri pain- ful to the touch; and instead of the natural nipple-Hke projec- tion, its surface is broad, hard, ragged, chapped. The extent of the induration can be appreciated by an examination per rectum. Bladder and rectal complications often set in early. If the disease is not arrested the germs eat in all directions, vessels are laid open, hemorrhages increase in frequency and in amount ; ulceration extends to the bladder and rectum ; and the state of the patient is truly deplorable. It is only in the earlier stages of the disease that any hope can be held out, if later on it admits of no cure, the patient must die, and all that can be done is to alleviate her sufferings. If seen early or late, the bowels must be kept very regular : the vital force must be sustained by a most nutritious diet ; daily baths ; the sensorium must be blunted with the conium pill, rectal suppositories of cocaine; and pastiles of hyoscyamus. Tonics and the general treatment for the annihilation of the germ carried out. In cancer of the uterus, the Chian turpentine has proved invalu- able and efficacious. The mode of administration is to keep the bowels regular by the administration of a sufficient dose of the ozonized glycerite of sulphur, and give one teaspoonful of the lo 46 DISEASE GERMS. emulsion ot Chian ttirpe^itine thrice daily — the emulsion is thus prepared : One ounce of the Chian turpentine is to be dissolved in two ounces of pure sulphuric ether. This solution has been termed the turpentine essence, and the emulsion is made by adding one ounce of this essence to a mucilage of acacia (one ounce and a half of powdered gum arable and water to nine ounces), making a ten-ounce mixture, a teaspoonful of which contains about three grains of the drug. The vagina should be cleansed out thrice daily with any of the following antiseptic washes. Boroglyceride, iodine, chlorinated soda, permanganate, resorcin, by or with a fountain syringe. Our only hope is, if seen early, before the destruction of tissue of vital parts has taken place. This illustration exhibits an epithelial growth, the size of a small crab apple, situated in the posterior wall of the neck of the uterus ; it bled freely when touched, and thus prevented any further exploration. The patient, aged thirty-five, had suffered for eight months with pain above the pubes, radiating back to the sacrum, with profuse muco-purulent discharge of an intensely fetid odor. The treatment of the case consisted in enjoining rest, with tonics and nourish- ing diet, vaginal douches were used morn- ing and night, consisting chiefly of boro- glyceride, creolin, resorcin, and internally the Chian turpentine mistura w^as pushed vigorously, commencing with one tea- spoonful three times daily, increasing gradually to ten teaspoonfuls. The growth every second day was painted with lactic acid. This treatment was continued for four months, the Chian turpentine being left off for three or four days every two weeks consecutively. About the end of the first week the distressing pain had entirely disappeared, both the quantity as well as the factor of the discharge commenced to grow less ; in five weeks the tumor began to wither, hemorrhages ceased, a new era of life seemed to dawn upon the patient. Gradually the tumor seemed to waste away, growing less and less, till about the fifth month it entirely disappeared. Epithelioma — neck of uterus radically cured by Chiau turpentine mi;>tuni. BACTERICIDES. 147 Infiltration of the uterine os and neck with the microbe. On examining the uterine neck, the stump left was irregular, notched out but showed nothing whatever of a cancerous nature. In six months from the commencement of treatment she had entirely recovered and the normal function of the uterus was restored. Photographic illustration of a case of incipient infiltration of the OS uteri, with the cancer microbe. A cure was effect- ed in six weeks by the following reme- dies : Once every seven days for four consecutive weeks the contents of three jequirity capsules were blown over the dotted induration, which each time caused a gelatinous exfoliation to peel off; in quantity it would fill a tea-cup. The succeeding night the va- gina was packed with the boroglyceride paste, which caused an exudation of serum with dead cancer germs to the amount of four ounces ; the following night two cocaine cones. This plan was pursued persistently, one night the boroglyceride, the next the cones ; every seventh day the jequirity wafers for four weeks ; induration entirely gone. Injections of slippery elm infusion, to which either peroxide of hydrogen or sulphide of lime was added ; alternated with a solution of resorcin. Internal remedies, Chian turpentine mistura, saxifraga and tonics. This illustration, in which the cancer germ had penetrated farther up the uterine neck, was treated precisely as the former, with the exception that the OS and neck were painted every ten days with lactic acid, and in- jections of boroglyceride, chloride of lime were used. The cocaine cones were used per vaginam thrice daily. Internal remedies were Chian turpentine mistura, thallin, phytolacca, sulphide of lime. An excellent cure was effected in about four months. Epithelioma of the neck of the uterus— the microbe infil- tration extendnig into the entire neck — ulceration just beginning. 148 DISEASE GERMS. Epiiheliom i of the neck of the uterus, proceeding into the stage of ulcera- tion: three distinct fissures. This wood cut is a representation of a case of very irritable^ and exceedingly painful carcinoma of the os, neck, penetrating to the body ; induration, sharp lancinat- ing pain anterior and posterior ; hemor- rhages and extremely offensive dis- charge. The patient was well broken down, the cachexia of cancer decided.. The treatment here consisted in ap- plying the ozone paste directly to the three fissures and over the fungating nodules. In the application of this paste, the greatest care was observed, all around the cul de sac well pro- tected, the paste was applied by a small paint brush, moderately thick and retained two hours ; then carefully washed off by repeated douches of castile soap and hot water. In a week a large mass completely exfoliated, leaving the parts ragged, uneven. These were touched up every few days with lactic acid, which gradually smoothed them off. Vag- inal injections of boroglyceride, resorcin, creolin and other bactericides were used. The internal remedies consisted of Chian turpentine mistura, with thallin, saxifraga and phytolacca. In nearly all cases in which the Chian turpentine was used, pain ceased about second or third day ; not so in this case, so it was determined to try exalgine for the pain. This remedy was dissolved in dilute alcohol, and added to fl. extract of licorice. Six grains were administered at three, and six more at ten p. m. It had the desired effect, immediate amelioration of all pain ; a subsidence of all that inhe- rent irritability. This drug is a powerful antiseptic, and seems to have an affinity for the cancer germs. The diagram here pre- sented, was an epithelioma of the posterior neck of the uterus, and wall of the va- gina ; several nodules ap- peared. The growths bled freely on the slightest touch, and almost filled up the va- ■ ^^'^'^'"'^^"^^ -' ^^^ p-^---- "-'^ -^ '^- "'--• gina, and entirely prevented an exploration of the uterus ; the lymphatic glands were free, and there was no rectal or bladder complication. As there was no plan of treatment left open^ BACTERICIDES. 49 she was placed upon the Chian turpentine emulsion ozonized, alternated with fifteen grains of resorcin, three times daily, to be rapidly increased to nine teaspoonfuls, and sufficient doses of the glycerite of sulphur administered to move the bowels ; the growths were touched three times with a solution of ozone paste (one in twenty) ; the vagina washed out thrice daily with boro- glyceride solution. With this treatment the germ-growth was arrested, and gradually disappeared, and the neck of the uterus resumed its normal position. This treatment was kept up for four months, pain had ceased ; all infiltration disappeared, and the very slight discharge had no odor ; at the end of six months entire recovery took place. The diagnosis of uterine cancer in the early stages is best effected by the microscope ; in the latter stages the growth cannot be mistaken, as we have the discharge, its odor and pain to guide us. The cancer germ may localize itself in any part, usually the cervix, low down near the extreme orifice, or high up near the internal ; evolution may begin in the glands near the surface, or in their deeper parts. The following remarkable case occurred in the practice of one of the physicians mentioned in this article. A patient after years of suffering, backache, pain in sacrum, frequent micturition, a vaginal ex- amination showed the os to be large and patulous; high up in the posterior wall of the cervix there was a hard mass the size of a bean, which felt like a small fibroid. She was not seen again for a year, when the neck of the uterus presented the appearance as is seen in the annexed cut. She was placed at the time under an active anti-cancerous treatment. The entire cancerous nodule was brushed over several times with lactic acid. This was followed by packing the vagina with boroglyceride paste. The next day this was removed, and the va- gina and cancerous infiltration well washed out with a ten-per cent. solution of peroxide of hydrogen. The lactic acid was again ap- plied, when the cancerous mass began to assume a dirty, leather color ; followed by the boroglyceride packing. I continued this right along for twelve consecutive days, when the entire mass exfoliated and was expelled. The edges from which it severed healed kindly in three weeks by the daily use of pastiles prepared from the boroglyceride. Cancer of neck'of uterus. 50 DISEASE GERMS. Numerous cases of uterine cancer commence at the inner orifice and form a nodule, occupying the whole of the posterior lip. At first in a case of that kind, the uterus is a little enlarged, freely movable. The posterior lip becomes thickened, and on its an- terior surface, a small ulcer appears which gradually extends on to the vaginal surface of the lip, a depression form.s with hard edges, which soon begins to bleed on the slightest touch. The annexed diagram is taken from the frozen dissection of a patient's uterus who died while under treatment for cancer of the uterus from pneumonia. The uterus was extirpated. The organ was then found to be three and a-half inches in length ; the walls of the body were somewhat thickened, but" appeared to be healthy. The cervix was considerably enlarged, the enlargement affecting chiefly the posterior wall, and an ulcer was situated on its anterior surface, just within the os exter- num. The surface of the anterior lip was papillary. Section showed the posterior lip to be occupied by a mass of the size of the kernel of a walnut. This reached upward to the inner orifice, and occupied the whole thickness of the wall, and it reached down- ward to the portio va- ginalis, but it had nowhere penetrated through the mucous membrane of the portio. The growth looked to the naked eye as if it were encapsuled, but this appearance seemed to be due to the pressure of the growth on the parts immediately surrounding it. Cancer might develop in the cervix from more than one centre, one being; situated near the os externum and the other near the OS internum. And cancer might attack mucous polypi growing from cervical canal. Cancer appeared to attack the posterior more frequently than the anterior lip. It had a tendency to grow downward so as to invade the vaginal portion and outward into the peri-cervical tissues, and it showed but little tendency to in- vade the body, although growth in this direction had been ob- served. After having invaded the peri-cervical tissue, its tendency appeared to be to grow downward in the cellular tissue around the vagina, and outward into the bladder and broad ligaments. V First commenced as an epithelioma, which eat away the neck followed by medullt^ Certain drugs, as cantharides, balsam of copaiba. *^ f^ o®*^ ^**' etc., are very liable to cause it. Retention of &h^ .<'^'^ urme from any cause is a proline source oi __ this affection. o=c.. cc=====^ - , - , . . A^licrococcus urea, paiiio- No matter how caused, contmence or m- genie of catarrh, or ui- continence of urine will occur; the evolution <^--tion of the bladder. of the micrococci urea, a microbe which is indefatigable in keep- ing up acid fermentation in the bladder. The evolution of this germ in the bladder in all cases of catarrh adds greatly to the difficulty of cure. Besides the micrococcus urea by millions there is the pus microbe, and numerous others in a state of growth. The urine is scanty, passed with difficulty pain in the back and loins, an uneasy sensation in the bladder; if the urine is permitted to stand, it deposits more or less mucus ; sometimes the quantity is so great that on exposure to cold it becomes solid,, and there is oftentimes difficulty in expelling it from the bladder. Impotency, loss of sexual desire and power ; nocturnal emis- 1^8 DISEASE GERMS. sions are likely to occur ; sometimes the patient is unable to urinate; has a sensation of scalding in the urethra; blood may occasionally be seen in the urine. Indispensable to a successful treatment the patient should be placed upon the very best of food, of the most nourishing charac- ter; daily bathing; flannel clothing; external warmth, and bowels regulated to once in twenty-four hours. Inculcate an alterative and tonic course of remedies, such as alteratives and tonics, embracing saxifraga, phytolacca ; compound tincture cinchona; mineral acids; coUinsonia; bay berry ; stone-crop. At convenient intervals drink either an infusion of buchu, uva ursa, praira brava, queen of the meadow, couch grass, triticum repens — whichever two should be selected, which diminishes the muco-purulent discharge, and one used one week, the other the rext. If the patient is unable to empty the bladder, urine should be drawn off with a catheter, not a drop of residual urine left in the bladder. Drinks of a demulcent character to be taken but very sparingly, and all alcoholic stimulants rigidly forbidden. Besides this general treatment, rest and the destruction of the micrococcus urea. To effect this, ozonized soluble bougies, composed of either re- sorcin, or thallin, or papoid ; one might be conveniently run into the bladder daily and permitted to dissolve. This mingling with the micrococci effects their destruction. Failing in this the blad- der might be injected twice a week with glucozone, or a solution of resorcin, or peroxide of hydrogen. If the urine be loaded with other germ, besides the micrococci urea, as the microbes of syphilis, cancer, rheumatism, the use of the bougies, or injections are imperative. Internally, the course of remedies must be so modified as to permit the introduction of some bactericide to sterilize the blood, and to render it so that no germ will live in it or the bladder. Select some of the following, either the ozonized uric acid solvent, or the peroxide of hydrogen ; benzoate of sodium, or the sul- phide of lime. Patience, perseverance, with those new remedies and powerful germicides, with attention to all minor details, will ultimately effect a cure. Catarrh is a general term applied to a devital- Catarrh, ized condition of mucous membrane. Catarrh of Bronchial, the frontal and nasal passages ; catarrh of the bronchial tubes, of the pulmonary tissue, of the stomach, bowels, bladder, womb, vagina, prostate; in each and BACTERICIDES. 159 all there is a relaxed condition, an excessive secretion, a degrada- tion of bioplasm, into a disease germ of some species, the sim- plest of which is the amoeba, the simplest and lowest type of mi- croscopic life. This disease germ, properly speaking, gives rise to catarrh bronchial, while the conferva, bacillus of tubercle and other mi- crobes give rise to bronchitis proper. This disease germ consists of a simple cell or an aggregation of cells, each of which maintains an independent existence, and capable of prodigious power§ of reproduction by segmentation in a proper fluid, and so light that they may diffuse themselves through the atmosphere. They resemble an O or globose form, gelatinous or albuminoid, like those in nasal catarrh. No nervous system, no organs, no trace of a mouth can be detected in them, but contain a nucleus and by looking very minutely at them under a high power 2500 diameters, one or two or more pulsating spaces can be detected, which finally sprout off Their movements are contractile, in which, by inhibitory action, they take in nourishment. They spread by contagion and infection, and are capable of entering the blood, producing a diathesis, in which anaemia and nerve prostration are predominant. The mucous membrane in health exudes a sufficie/it amount of secretion for lubrication atid no more ; and in that no disease germs are present. But the slightest deviation from health, degradation takes place and disease germs are present. The symptoms and diagnosis same as chronic bronchitis. The profuse ex- pectoration and the presence of this microbe are the landmarks in diagnosis. Catarrh of the bronchial tubes is best and most successfully treated with bactericides. They should be inhaled nasally and -orally ; taken on the stomach, and also used in bath ; in other words, the blood and all the tissues of the body should be so saturated with germicides that no diseased micro-organism could possibly exist in the body. Glucozone is the best of all remedies for inhalation with the cold spray atomizer. Remedies on the stomach, select from some of the following : peroxide of hydrogen, distillation of pine needles, glycerite of ozone, ozonized tar syrup, avena sativa, tolu and resorcin, creo- sote, carbolic acid and tincture of iodine, terebene. For baths, pine-tree-needles extract, which gives us a perfect saturation of all the fluids and solids of the body with ozone, in which condition no microbe can live. l6o DISEASE GERMS. A weak, relaxed, irritated state of Catarrh, the mucous membrane of the stomach. Gastric, in Adults, which gives rise to an excessive secre- tion of mucus. Whenever mucus is in excess in the stomach, the sarcina^ ventricuH and yeast plant make their appearance in more or less abundance, according to the state of vital depression present. Whether this sarcinae be the result of degraded living matter of the mucous membrane, or a true vegetable germ or fungus, or parasite, produced like yeast plant by saccharine fermentation and. swallowing atmospheric air, is not as yet definitely settled. It has, nevertheless, been clearly demonstrated that this fungus, let it be animal or vegetable, grows like all other living matter and with remarkable activity, so much so that it distends the stomach enormously by its presence and makes life a misery. Causes. — As eighty per cent, of our entire population suffer from the presence of this parasite in their stomachs and more than two-thirds of all cases of dyspepsia are of the catarrhal form, it is important that the causes that produce it should be clearly appreciated. Hurried or improper mastication stands first ; in this the food is bolted down, has little if any secretion from the mouth glands, no parotid juice, no element in it to pre- pare it for gastric digestion, but simply an offending, irritating: bolus. Add to this the pernicious habit of drinking at meals large quantities of fluids of any kind, but especially iced or cold drinks, which completely arrest the process of digestion for the time being. Beer and tobacco rank next as great stomach depres- sors; so are cold food and drink, ice cream, saccharine and starchy food, alcohol, drugs, as bromide of potass, alkalines generally. Our climate is productive of it, sudden vicissitudes of tempera- ture from heat to cold, insufficient clothing, anything that will cause congestion of the mucous coat of the stomach with an ex- cessive secretion of mucus. Plence it is often brought about by irritation or disease of adjacent organs, as morbid states of the liver, bowels and rectum, chronic bronchitis, nasal catarrh, tuber- culosis of the lungs, and emphysema. The instant the mucous coat of the stomach is damaged or irri- tated, an excessive secretion of mucus takes place, and simultane- ously with that there appears in the stomach of the individual the sarcina and yeast plant. As the sarcina appears first upon the scene and is the more tenacious of the two plants, it merits our primary attention. The fungoid mass or jelly, thick, clear, ropy,, cohesive in consistency, placed in the field of a microscope of ordinary power, reveals it to be made up of blocks, or squares, or BACTERICIDES. l6l The sarcinse ventriculi as seen in the vomit of all patients suffering from gastric catarrh. cubes, or packages, as seen in the annexed wood-cut, quadrangu- lar in form, the' cubes consisting of fours, sixteens, sixty-fours, etc. These squares live, grow, propa- gate by millions by segmentation, imbib- ing nourishment from the degraded mu- cus of the stomach, and new additions from the same source. When this altered bioplasm or changed living matter takes place, the sarcina ap- pears in the stomach, and finds its way into the blood and is subsequently to be found in those having this form of dys- pepsia in the fluid of the ventricles of the brain, bronchi, bladder, rectum, uterus, vagina. The presence of this organism, this dangerous parasite, is in- variably accompanied with the cryptococcus cerevisia, or yeast plant. This fungus is too well known to need a description, being present in the process of fermentation. The annexed cut gives a true appearance of this plant as seen under the microscope in the form of round or oval disk cells, vary- ing in diameter from one four-hundredths to one eight-hun- dredths of a line, with smaller germs in their interior. They grow by protrusion of gemmules, and. germinate from several points of the primitive fungus cells. These shoots throw off new gemmules and gradually form rows of single or branching cells, connected together like beads. This peculiar arrange- ment of cells, and the fact that they cannot be acted on by acetic acid, is characteristic of the plant. This fungus exists in great abund- ance with the sarcinae in the stomach, and is also found in the urine, uterus, fccces, with or without the co-existence of saccharine diabetes. Both the sarciuct and the yeast plant are to be found in all domestic animals as well as man. The presence of two such parasites in the human stomach necessarily gives rise to Syinptonrs of a pungent, depressing char- acter, general prostration, a feeling of gone- ness, faintness, emptiness, with all the symptoms of dyspepsia, flatulence, acid eructations, heartburn, pyrosis, coldness in the extremities ; tongue has a coat, but usually a white fur with slime ; breath sour-smelling, with disturbance of the head, II The yeast plant taken from the ejected fluid from the stomach in gastric ca- tarrh, magnified 200 di- ameters. ]n those celh marked x, a young cell is seen grow- ing in I he interior ; while in the large ceil marked xx, there is a simulta- neous internal produc- tion and external gem- mation of cells. 1 52 DISEASE (;ERMS. heart, liver and other organs ; appetite capricious, a craving for food, an inabiHty to eat which vomiting relieves — tremen- dous spells of eructation of wind, with regurgitation of acid fluids, the result of a fermentation in which the sarcinse and the yeast plant are in abundance. The congenial abode of the sar- cinae is the stomach ; they always can be detected in the mouth, in the thick, ropy, glairy mass, brought up by a proper emetic, in which they can be seen, living, growing and reproducing by seg- mentation. They often attain great size, and break down and die, and they may be thrown off by the mouth or pass down on the bowels and pass off in a sudden, unexpected attack of diarrhea. If they become very large before breaking down and passing either by mouth or bowels, they give rise to great abdominal distension. The presence of the sarcinse ventriculi in either the stomach or bowels is the great factor of lactic acid in the human body (rheu- matism), and all the accumulated experience of Europe and America point to this plant as the precursor of cancer of the stomach, catarrh of the colon or rectum, and a factor in the pro- duction of tuberculosis. The treatment of this form of dyspepsia requires the finest tact, skill, and a thorough appreciation of the germ theory of disease. The malnutrition due to those parasites, their method of feeding being chiefly upon liquids, their removal by washing out the stomach, their starving out, their direct* destruction, the prevention of the secretion of mucus which loads and obstructs the function of the stomach — in order to accomplish all this and more too, we must depart from the ordinary methods of grappling with disease. The general points to observe are, an avoidance of all care, worry, or mental strain, no over-work, no excess ; active but not fatiguing exercise in open air ; daily cold baths, followed by fric- tion ; flannel clothing ; a diet consisting of broiled tenderloin steak or chicken, soft-boiled eggs, boiled fish, buttered toast, oat- meal mush, baked potatoes and ripe fruit. Rigidly forbid veal, pork, salt or corned beef or fish, fried or boiled meat, pastry, nuts, sweets, cabbage, tea, tobacco, alcohol, all fermented liquors and all liquids at meals. Order is Nature's first law, so there must be perfect regularity in all things, eating, sleeping, defecation — three meals of solid food per day, with proper intervals between, and in this interim between there must be no mastication, no nibbling, no odd snap or luncheon. The mastication of the food must be thorough, not hurried, but so that a proper admixture of the food with the sali- vary secretion takes place. Hurried meals are mischievous. BACTERICIDES. 163 Rest after meals, but no sleep, as the latter retards the digestive process. Having thus laid down the above and other precautions as to food and digestion, one or other of the following methods of treatment should be tried : either starve the germ out or destroy it. Method of starving the germ out. — If this method is decided upon, it must be arranged that twice a week, for a period of from six to twelve weeks, an emetic of pulverized lobelia leaves should be administered thus — the patient, prior to taking it, should drink very copiously of tepid water in which bicarbonate of potassa is dissolved ; follow this with frequently-repeated draughts of lobe- lia infusion (one ounce of leaves to one-half pint of boiling water), sufficiently cold to admit of being drunk freely ; continue till free emesis and ejection of the germ or parasite or a portion of it takes place. Follow this lobelia emetic up by encouraging the patient to drink freely of an infusion of kaki (one ounce to the pint) ; add to this a few grains of capsicum to render it more stimulating to the gastric mucous membrane. The persistent administration of kaki infusion at stated intervals arrests the secretion of acid mucus in the stomach, braces, astringes the mucous coat, and thus cuts off the pabulum upon which the parasites, sarcinae, live — and thus it starves. Repeat the emetic every four days ; fol- low closely with the kaki. No other emetic will serve the purpose ; as lobelia itself is a great germicide in nature, it retro- grades all germs, checks their development and growth, steri- lizes their micrococci. An invaluable remedy for the purpose of starving out the mi- crobe is the Virginia stone crop in alternation with ten grains of resorcin in liquor cerii ozonized. Thus the remedies thoroughly astringe the mucous coat, and prevent the germ receiving nour- ishment from the gastric mucus. Destroying the germs in the stoinacJi must be adopted or tried. Here, of course, it is very difficult to select remedies to be admin- istered on the stomach that will enter, unite with, or penetrate, or chemically cause a dissolution of the fungoid mass or jelly. Besides, patients who have had this parasite in the stomach for a long series of years suffer from atrophy of the pepsin glands, with functional incapacity. Remedies to be of service here must be highly antiseptic and not impair the stomach in any way, but rather increase its vigor. The sarcina ventriculi is sterilized, completely annihilated, in the presence of either of the following remedies : Peroxide of hydrogen, a few drops added to water, is most effectual. In attacking the fungus it liberates the ozone, which 164 DISEASE GERMS. unites with the fungus and destroys it — does not impair, but rather increases, the gastric function — tones, strengthens. The sulphide of lime or the chloride, well triturated in sugar of milk, is most efficacious. Ozone water or comp. oxygen must not be overlooked. Ozonized sulphur water,. added to an infusion of columbo, is not to be despised. Ox-gall, thoroughly washed of all impurities with the dioxide of hydrogen, then evaporated to the consistency of molasses, to one hundred parts add two hundred of pulverized willow char- coal, with ten parts of capsicum ; mix. Make into three-grains pills ; one two hours after meals thrice daily. Papoid, a vegetable pepsin from the carica papaia, combined with the boroglyceride, gives excellent results, as it is one hun- dred times more potent in antiseptic power than ordinary pepsin,, and acts better on the peptic glands. Modern dietetics, adulterated food, early Gastric Catarrh precocity, have within these few years back in Children. given rise to the sarcinse in children — twenty years ago a rare disease. Now it is one of the commonest derangements of that period of life among rich and poor. It is a constant danger to hand-fed babies, and forms one of our chief obstacles to the raising of infants. In older children it is of frequent occurrence. It seriously affects their nutrition, and interferes with development and growth. Mothers term it biliousness. The little one loses its appetite, mopes, lies about, has a dull, pasty or yellow com- plexion, and looks dark under the eyes. At night it sleeps badly, and is restless and irritable during the day. If the tongue is protruded, there is a fur on it, with a coat in centre ; the breath is sour-smelling ; there is a fulness about the stomach ; all indicating catarrh of the stomach, which, with its fungus, inter- feres with the digestion of the food. It may be vomited, or pass by the bowels, but it leaves the stomach weak, and another crop is likely to follow, nutrition is seriously impaired. In addition to the above symptoms, affected children complain of pains in abdomen and sides, and are likely to suffer from vertigo, syncope from pressure upward of the distended stomach against the dia- phragm and heart. Bowels usually are constipated. These symptoms are greatly aggravated by an injudicious diet on the part of the mother, as supplying the child with an excess of fermentable food, as potatoes, puddings, sweet cakes, etc., which feed the sarcinaj and keep up the dyspepsia, which is a BACTERICIDES. 165 source of great discomfort to the child and anxiety to the parent. The whole system is being fed by an acid, generated by the germ, and aggravated by the food, and the child is irritable and exces- sively restless. His speech is hesitating ; he may stammer; his muscles may twitch; his eyes wink, and he is nervous. Nausea and vomiting are not always present. If there is vomit- ing, the products are sour-smelling fluid, and thick, ropy mucus. Frontal headache is rarely absent ; it is often distressing ; urine highly acid, loaded with uric acid. Nutrition is always inter- fered with ; the child wastes perceptibly, or there are fainting fits. In curing gastric catarrh in children, the sarcinae must be either removed, destroyed or starved out. The acrid mucus and germ is the constant cause of acidity and fermentation ; they keep up a bad train of symptoms. The greatest benefit is derived from the peroxide of hydrogen in small doses, frequently repeated. This should be alternated with the sulphate of cinchona or some bitter tonic. The peroxide of hydrogen, combined with an equal amount of glycerine, administered in a little water after meals, instantly parts with its ozone, which kills the microbe, the factor of gastric catarrh. The sarcinae being removed, digestion improves, increased assimilation, a priceless boon of the dyspeptic. The average dose is fifteen drops to one ounce of water. The ozonized cascara sagrada lozenge is a powerful microbi- cide. One administered thrice in twenty-four hours is efficacious in the destruction of the sarcinae, in destroying the activity of all bacteria and micrococci. Its active properties are due to the ozone which it contains, and which it liberates in the stomach and destroys the microbe. Resorcin, arsenic, naphthaline might be tried. The Virginia stone crop is the father of a class of remedies of the greatest possible utility in sterilizing the sarcinae ventriculi ; it is much more energetic in its action than either collinsonia or bayberry. It is a drug from which the greatest possible benefit accrues in either catarrh of the stomach or bowels. Same remedies as in the adult may be tried with success. Bowels should be kept regulated by the administration of a decoction of flaxseed or slippery elm, to which a small amount of olive oil is added. Diet carefully guarded ; no starchy or saccharine agent given ; nothing to aid fermentation ; toast, milk and lime-water. As soon as tongue cleans, appetite returns ; boiled fish, white of chicken, lean broiled mutton. It is not well to press the child to eat ; rather refrain. To give tone to the stomach and strengthen digestive powers, sulphate of cinchona or wine bitters. 1 66 DISEASE GERMS. In order to prevent gastric catarrh becoming a prevailing dis- ease among children, mothers must learn, that all sugar and starch articles of diet are poisonous to children. They should also be made aware* of the great utility of a flannel binder or roller next the skin as an indispensable article of a child's dress till it reaches three years of age. This roller should reach from the armpit to the groin ; not pinned too tightly. The resisting power of all children should be fortified by gradually bringing their morning and evening bath to cold water. It must be a very gradual process in weak children, in all cases followed by active rubbing. To bring children to the cold bath, and practice it properly, has a most tonic effect upon the system generally, and confers great resisting power upon the part of the child, and reduces its susceptibility to any change. Mothers should also be instructed of the utihty of brisk massage over body after child has been dried off. Sarcina intestina has all the essential elements Catarrh of that found in the stomach, only much smaller Intestinal, in size. It is found in the duodenum, and throughout the entire intestinal tract ; in the vomit, faeces, lungs, blood, urine, in the form of yellow patches,, green or reddish. Peculiar groups of four, eight, sixteen, thirty- two cubical cells with rounded edges, closely placed against one another. The fungus gives rise to a functional disturbance of the bowels^ independent of any organic lesion. Intestinal dyspepsia may be a primary affection, brought about by cold, mechan- ical irritation or mental depression, or it may be brought about by catarrh of the T* ^^^3?T® stomach, or by structural changes in the " '^ / mucous membrane of the alimentary ® >^^^^^P^ canal ; altered conditions of the secretions d> of the, small intestines ; the presence of Sarcin2eintestinaiis--a dwarf form undigested food, or the ingcstiou of im- found in the bowels. iMicrobe o ' o found in the duodenum in full- propcr food ; an altcratcd state of the fledged masses, as \r\ d ; c m ^ ^ - ^ r ,i • . .• the small intestine; ^ and a. muscular coats oi the mtestmes, gcncr- ^^'s« bowel. ,^ll^ accompanies malnutrition. In catarrh of the bowels, all or some of the symptoms of dys- pepsia are present. Pain may be present, of a dull aching char- acter, radiating over the upper portion of the abdomen. Not acute, more likely if present, to prevail two hours after the in- gestion of food, nausea and vomiting when they do occur, de- pend more upon the stomach derangement than upon any intes- @0 BACTERICIDES. 167 tinal disturbance. Constipation, gaseous distension of the large intestines, are prominent symptoms. The various coats of the bowels are so thoroughly relaxed that there are often immense fecal accumulation. After repeated attacks, general health fails, he loses flesh and strength and begins worrying about himself, fearing some organic disease. As a rule the appetite is seldom impaired To effect a correct diagnosis, administer a large dose of castor oil, followed with copious draughts of either an infusion of flax- seed or slippery-elm, then take the albuminoid portion of the evacuations and place a portion in the field of the microscope, and the sarcinae will be seen. In the treatment, it is well to regulate the diet. This is import- ant; patient should abstain from all fatty, saccharine, or starchy substances, and eat solid food, meat and vegetables ; daily bath- ing ; an avoidance of tea, coffee, tobacco, and all fermented liquors ; a freedom from care and worry ; of drugs which yield the best results, collinsonia, stone crop, bayberry, salol, naphtha- line, resorcin. In intestinal catarrh, the peroxide of hydrogen is invaluable; true it does not, like salol, destroy the pathogenic germs, but it unites with them, renders their ptomaines inert, and thus the tissues, being relieved of the deleterious effects of the ptomaines, combat successfully the germs. Injection of the bowels above the sigmoid flexure with copious injections of creolin are of immense utility. The best of all these remedies is the Virginia stone crop, which is a priceless drug in intestinal catarrh. Nothing in the materia medica which can be compared with it. Repeated irritation of the lining mem- Catarrh Nasal brane of the nose, sinuses, posterior nares, (Chronic). larynx and bronchi, so devitahzes, modifies, changes and degrades normal living matter into a diseased germ ; the amoeba, which is simply a degradation of the normal bioplasm that nourishes the lining membrane of the respiratory mucous membrane, that gives us rather a compli- cated disease, one both contagious and infectious. We also find the disease-germ in the mouth, urethra, vagina, but always more perfectly developed and in larger quantities in the air passages. Chronic catarrh, then, may be defined to be chronic inflam- mation of the Schneiderian membrane, with this change of its own living matter, or matter concerned in its nutrition, into the disease-germ, amoeba. It is most erroneous and unscientific to 1 68 DISEASE GERMS. assert that it is caused by syphilis or tubercle. Those disease- germs may impair the vital stamina of the patient, but cannot produce the amoeba. Our highly oxygenized atmosphere, our very variable climate, the extreme susceptibility of our people to climatic changes, with our violent winds and atmospheric currents, absence of trees, etc., render our people very liable to catarrhal affections. The most careful microscopical examinations of an immense number of cases fail to exhibit any germ but the amoeba. When it occurs in a young or tubercular subject, the tissues being soft and not very vital, the amoeba of catarrh eats up the structures rather voraciously, and as soon as they reach the cartilages of the nose, all their proper nutriment being gone (for they cannot live on cartilage), and the vital powers being very low, the oidium albicans makes its appearance ; then we have that pungent, indescribable, fetid odor characteristic of ozsena. When the Schnei- derian membrane and frontal sinus are alone implicated, wkh no appreciable odor, it is termed catarrh ; when the amoeba have crept up the eustachian tube, ^?/r^/; when they have penetrated down the fauces and larynx, laryngeal ; when they have moved still further downwards on the bronchi, bronchial; asthmatic when they gnaw the periphery of nerves in the circular muscular fibres of the rings of the bronchi. Aromas or parasitical states, such as the bacilli of hay, the mycelia of roses, ragweed, and other vegetable germs, are not capable of living in human blood; nevertheless, they can blight normal bioplasm of the respiratory mucous membrane, and thus cause the appearance of the amceba. Plence, catarrhal conditions are named after those special vegetable agents. Diseases of the respiratory mucous membrane are very prevalent, each capable of causing tubercuhi:^ : (i) by reflex action; (2) by the amoeba entering the blood. Catarrh is often the starting point, as it is the most common of the entire class. When it takes place, its offspring, the amoeba, begins to enter the blood and produce a special diathesis of its own. Its chief characteristics are languor, lassitude, debility ; a peculiar pasty or doughy appearance of the skin ; pains in the limbs; headache, with a sense of tightness across The amoeba — the germ of na^al catarrh diameters magnified. BACTERICIDES. 69 the forehead ; excessive muco-purulent discharge from the nos- trils, or trickling down the throat, (which creates hawking), loaded with amoeba ; or if there is much oxidation, the discharge may dry up and become impacted in the nostrils. If the amoeboid colony runs up the eustachian tube, it will cause deaf- ness : if it moves downwards (for it is a living mass), hoarseness and aphonia ; if still further down, on the bronchial tubes, in- creased hawking, cough, emaciation and discoloration of the skin due to imperfect oxygenization of blood ; if down the oesophagus, dyspepsia. As it is very liable to cause amyloid degeneration of liver and kidneys, there may be some swelling of cellular tissue and oedema of ankles. It is not only a contagious and infectious disease, but loath- some, and liable to give rise to so very many other affections, as epilepsy, consumption. It is nearly identical with gland- ers in the horse ; it is simply a difference in size and viru- lence of the germ. Inhuman catarrh the amoeba is a mi- croscopical dwarf; in gland- ers in the horse it is a giant. Of all the disease-germs the amoeba is the most in- teresting to study. It can be seen with a low power, its movements and habits can be seen so accurately; even its mode of nutrition, opening and closing them- selves to receive foreign par- ticles, inclosing and appropriating them and even imbedding them in its very substance. As they enter the blood they no doubt impair the red corpuscles, and cause a peculiar form of anaemia. To treat nasal catarrh with success, there must be an effort made to build up the general health of the patient, the secretions regulated, warm clothing; the very best of diet, an effort made to change the diathesis which the microbe creates ; alteratives and tonics should be given for two or three months to kill the germ in the blood; comp. saxifraga and phytolacca ; comp. tincture cinchona and mineral acids. Irritating plaster to the nape of the neck to stimulate the origin of the olfactory nerve in the medulla oblongata. Then a selection of a bactericide made to \vash out the germinal mass. This is best effected by the use of The pathological state of the lining membrane of the nose — showing the disease-germ amoeba in active work, eating up the tissue. I/O DISEASE GERMS. the ozone ct chlorine, which might be used every twenty-one days for a few times. In between the very severe detergent ac- tion of the ozone et chlorine, mild douches of boroglyceride, or gold seal and borax, should be used. Other methods of management should be resorted to, as douches of resorcin, creolin, naphthaline, boroglyceride, etc., are also effectual. Peroxide of hydrogen is of immense utility in catarrh, in the destruction of the germ, but best used in the form of glucozone in a cold atomizer, it should be used several times daily, it rarely fails to effect a radical cure. This ozonized distillation of witch hazel is fully as strong in germicidal action as the peroxide of hydrogen, and more easily^ managed. Being a remarkable solvent to lymph, it is of great utility in chronic cases ; and the results obtained from it in chronic cases of all catarrhal affections of the nares, eustachian tubes, middle ear, throat and lungs, have, in the fullest sense,, been most satisfactory. Many cases of eustachian deafness of long standing, due to the migration of the germs, have been effectually cured by this remedy. Excellent snuffs are the pulverized horse-chestnut, boracic acid pulverized, microbe powder. Ointments, jellies, nasal pastiles, or pencils, etc., are in some cases very successful. Incorporate in these such agents as resor- cin, iodol, thallin, etc. Various affections of this gland are fre- . Catarrh of the quently mistaken for spermatorrhoea. In Prostate Gland, catarrh proper, we find a clear, viscid, tena- cious fluid, like the white of an egg, eniirdyr destitute of spermatozoa, oozing or passing from the urethra. Such a condition is generally due to debility, relaxation, the sequel of a gonorrhea, or some perversion of the sexual act ; a damaged prostate is apt to be irritated by the lactic acid of rheu- matism, or the lithiate of soda of gout ; any irritation will excite an exudation. If the weakness or irritability of the prostate is great, the sphincter muscle at the neck of the bladder becomes implicated in the debility, then there is likely to be a stoppage in the act of urinating, or it may be passed drop by drop ; and if passed with difficulty, residual urine and fungus formation are like to occur. The presence of prostatic catarrh invariably gives rise. to sem- inal weakness, spermatorrhcea, an oozing away of semen, or the oozing of a ropy viscid fluid from the tubular glands of the BACTERICIDES. 171 prostate, after micturition or defecation, or a diurnal weeping, or nocturnal involuntary discharges ; in or among all there is usu- ally spermatozoa. The most common form is due to a relaxed condition of the spermatic vessels and ducts, caused by masturbation, excesses, or ill-treated gonorrhea, a difficult and troublesome affection, open- ing the door to impotency. Under the microscope this exudation, or leakage, has the ap- pearance represented by this wood-cut : mucus, shreds, floating spermatozoa. The spermatic fluid may be wasted in this way for weeks, months, years, without the individual being aware of the drain upon his vital forces. Large quantities are usually ejected if bowels are constipated, in the form of a tenacious fluid like the white of an egg. Whether this seminal debility be due to urethral or prostate hyperaesthenia, the best remedies are cocaine suppository, which is of great utility, very advantageous, in overcoming prostatic tenderness, and continence of urine. Ozonized urethral bougies, gelatin prepared from papoid, resorcin and cocaine, when introduced into the ure- thra, clear up to the prostate and into the bladder, exercise a most remark- able sedative influence on the motor and urinary centres in the cord, and a powerful absorbent, action on the lymph effused in the gland. They are worthy of daily insertion. That great sexual sedative, salix niger ozonized, which has effected so much in diurnal and nocturnal seminal emissions, can be administered with marked benefit in catarrh of the prostate, in doses of half a teaspoonful three times a day. I have in a few weeks cured cases of many years' standing. In eighty cases treated with this drug, I have done more real good in ten days than by years of the old methods. It is altogether different from other remedies ; it does not impair,, but rather augments virile power and passion ; in every case it has afforded great satisfaction ; in arresting the oozing, over- coming the hyperaesthenia. Nearly all cases are much benefited by the administration of the uric acid solvent, in very small doses ; the advantage of this com- bination in irritable prostate is often quite great, as it most effec- tually neutralizes the acid state of the urine, and acts as a genital sedative. Spermatozoa as seen in the urine of patients suffering from prostatic catarrh. 1^2 DISEASE GERMS. I have made considerable use of the saw palmetto in different morbid states of the prostate ; its action is best suited to catarrh of that gland with atrophy, the drug being a great gland stimulant. The direct medication of the prostate is best effected by the soluble gelatinized bougies ; they afford immediate results, and patients are not discouraged by waiting. In some cases the catarrh is aggravated by seminal emissions, very frequent ; in other cases, almost complete impotency, yet, in most instances, a few bougies inserted make a great change. Catarrh is a chronic inflammation of a mu- Catarrh of the cous membrane, hence there may be a catarrh Rectum. of any mucous membrane; and incidental to this partial death, there is a degradation of the primary elements of nutrition into a disease germ ; hence all catarrhal affections are contagious and infectious. ' The amoeba is the microbe we find present in the nose, larynx and bronchial tubes ; in the stomach the sarcinae ventriculi ; in the uterus and vagina the amoeba bacteria and sarcinae ; in catarrh of the rectum a whole category of germs are found, with their ptomaines. Rectal catarrh is the most common, more dangerous to the general health and longevity than catarrh of any other part. The sensibility of the rectum is so limited and obscure that the affected individual often does not suspect the real nature of the difficulty, but complains of general lassitude, and debility from the disease germs and ptomaines re-entering the blood. In cases of catarrh of the bowels, interspersed throughout the frothy, slimy discharges blended with the sarcinae are to be seen a bacterium which bears culture well in beef broth, rendered alkaline with bicarbonate of soda, pathogenic of rectal catarrh. Causes. — The principal causes of rectal catarrh are torpidity of the liver, brought about by irregular habits of life, alcoholic drinks, malaria, sedentary habits, certain drugs, cold, damp, ex- posure, tight lacing, pregnancy. Symptoms . — These are often obscure, a species of diarrhea or dysentery is most likely to exist, or if not that, constipation, with itching. In catarrh of the rectum the mucous membrane only is supposed to be affected, whereas in inflammation of the rectum proper all the coats of the bowel are affected ; still the symptoms of catarrh are almost identical with a general inflammation of the various structures ; there is apt to be heat, burning soreness, exces- sive tenderness, copious muco-purulent discharge, the rectum re- BACTERICIDES. ly^ laxed, slight protrusion, blood and nerve poisoning, due to the germs re-entering the blood. Treatment. — The causes which produced this affection must, if possible, be removed, and then the patient should be placed upon a general alterative and tonic course of treatment, embracing the following special remedies : saxifraga, Virginia stone crop, c.oUin- sonia, mineral acids and cinchona, and then the bowel should be specially attended to. Either of the following formulae is of great utility in all ca- tarrhal states of the rectum. They should be added to thin starch and injected into the bowel three times a day : ^, Distillation of hamamelis 6 ounces. Fluid extract hydrastis .....*•• 2 ounces. Tincture calendula . 2 ounces. Mix. A tablespoon ful. Three times a week twenty drops of the following, added to thin starch : ij^. Oil eucalyptus 2 drams. Phenol sodique 4 drams. Glycerine 3 drams. Mix. The following is of great utility, nay, unsurpassed, as a vital restorative to the rectum. Ij',. Fluid extract juglans 2 ounces. Fluid extract Virginia stone crop ... 2 ounces. Fluid extract stone root 2 ounces. Mix. A teaspoonful added to half a teacupful of slippery-elm water every three hours. A catarrhal state of the entire alimentary canal is often present in pulmonary phthisis and insanity, and is often the cause of a fatal termination. The microbes of either affection along the entire tract, the exhausting discharge, soon reduce flesh and impover- ish the blood more than any other state. The real causes of this catarrhal state are the intense acidity, the presence of germs, ptomaines, lardaceous or phosphatic de- posits on the bowel. In nearly all these cases ulcers on the intestinal tract begin below the duodenum, but in the small intestines they are insigni- ficant compared to the worm-eaten appearance of the large bowel. The localizing of disease germs follows the line of the blood vessels, specks of congestion isolated, coalescing, broad or per- ly^ DISEASE GERMS. forating in the colon and sigmoid flexure, and as they reach the lower bowel it is not uncommon to find ulcers of great depth. Recognizing their microbe origin, there should be a persistent (use of stone crop, salol, naphthaline, peroxide of hydrogen. Numerous and varied are the causes Catarrh Uterine which excite catarrhal conditions of the (Endometritis), inner lining membrane of the uterus. The most common are, various forms of ova- rian disease ; frequent abortions ; the irritation produced by the retention of the placenta, or shreds of lochial discharge; the introduction of instruments. Some drugs are productive of it, as excessive doses of bromide of potassa, aloes, savin, sudden suppression of the menses from cold or damp, masturbation, men- tal excitement, torpid liver, tight lacing, gout, rheumatism, incompatibility in married life. As there are, so to speak, so many grades of irritation, we have an immense variety of symptoms. Take the acute variety, in which there is fever, high temperature, rapid pulse and respi- rations, general irritation, sallow complexion, loss of appetite, headache, pain in the loins and the lower part of the abdomen, sacrum, groin and inside of the thighs ; a sense of great heat and fulness about the pelvis, and bearing-down. Bladder very irrita- ble ; a desire to pass water every few minutes, which is loaded with uric acid. Diarrhea and tenesmus, and, subsequently, constipation. Tenderness on pressure over ovaries and uterus. After a day or two, thick, ropy, tenacious discharge, which, after a while, becomes muco-purulent, and is tinged with blood, and imparts a greenish-yellow or greenish-red stain to the chemise or other body linen. There is often piles. This acute form should be treated with rest ; warm hip-baths ; mucilaginous drinks; open bowels with cascara; ^administer either antipyrine or antifebrin for fever ; pastiles of cocaine both per vaginam and rectum every four hours. As soon as the acute stage has been overcome, three teaspoon- ful doses of the wine of aleteris farinosa should be administered every three hours, alternated with other uterine tonics. The chronic form is the most common, and runs a tedious course, with headache, languor, lassitude, debility, great mental depression, obstinate dyspepsia, flatulence and constipation. A sense of weariness, if not pain, about loins, sacrum, groin, inside of the thighs, and bearing-down. The discharge now is thick, ropy, tenacious, very abundant, glairy, like white of egg. Often, under the microscope, the sarcin?e and yeast-plant germs can be BACTERICIDES. 75 Bacteria of yeast plant. V '^^-Nir"') vent this terrible scourge in all our I \ ^'p'^ I. -^ "^tZ^ large cities? The insanitary condi- i ^-^^ ^ ^^^ '^^^^ ^^ tion of cities during the heated term, /s^^ )j ^Z)^)^ and the condition of overcrowding, '^^Sc' S^-n does not admit of a remedy ; but the *^ c ^ O vitality of the child and welfare of the Dwarfformofthecomma-baciiius ^1 1^1 r T^i found in the green stools of mother can be taken care of. Ihe cholera infantum ; magnified 700 mother is of primary importance — her ^''"" health and comfort ; her food should be nutritious ; her mental and physical powers should not be taxed ; she should do everything possible to maintain a very high standard of health, and avoid work, anxiety, or any depressing influence. Men- struation and sexual congress should be prevented during nursing. The health of the little one should be promoted by fresh air, good milk, flannel clothing, and in an especial man- ner by wearing the flannel roller round the abdomen until they are two years of age. Daily bathing with cold water, followed by friction. Cradle-rocking to modern infants, whose parents' nervous system has been developed at the expense of the physi- cal, is very hurtful. Dandling, shaking or jolting is also very injurious. The little one should be kept quiet, cool, free from jolt or motion, and from the solar rays. Its diet, until teeth appear, should be the mother's milk ; and if that is not sufficient, cow's milk, very slightly diluted ; no starchy article of diet per- mitted to be used, nor sugar in anv form. 1 82 DISEASE GERMS. As soon as the disease makes its appearance, vigorous means must be taken to arrest it ; an emetic of the wine of ipecac, fol- lowed with sufficient doses of the neutralizing mixture to open the bowels freely, followed with lime-water and milk, and a plaster consisting of equal parts of pulverized allspice, cloves, cinnamon, peruvian bark, and a very small amount of capsicum, wet with vinegar,. spread between fine book muslin, and applied over entire abdomen ; taken off every three hours, the caked mass broken up and remoistened with vinegar, or if not that, concen- trated ozone. An evening bath is also to be recommended ; well dried and rubbed, and followed by inunction of several ounces of warm olive oil. If case does not improve, then give liver a rousing up by administering one or two grains of leptandra in a little compound licorice powder, following it up with teaspoonful doses of the expressed juice of raw meat every three hours ; put- ting patient upon tincture of white hellebore, which has such an immense sphere of action on base of brain, eighth pair of nerves and liver — dose must be regulated by the physician in charge — and begin at once with bactericides. From among that class of drugs, the ozone-water, the sulphurous acid, or tincture of iodine and carbolic, or the solution of chloride of lime, sahcylate soda, salol, lactic acid, resorcin, creolin, are probably the best to destroy the germ. Alkaline antiseptics, however valuable they may be, act rather freely on the liver. We cannot doubt the efficacy of the chlorate or permanganate of potassa, or sulphate of soda, but in few cases dare we sanction their use ; so one of the above must be selected, and administered often and with regularity* The entire success or non-success in the treatment consists in the use of germicides and nourishments. Head to be kept cool ; socks, with dry mustard, to feet ; fever to be controlled with aconite; any brain symptoms, the bromide mixture; and, above all, keep up nutrition, confining diet to mother's milk, milk and lime-water, and juice of raw beef If the case recovers, and means are available, the child should be removed to the country, away from the pestilential influence of a large city; a tonic, antiseptic course of treatment carried out for some months, with such remedies as glycerite of ozone, ozone-water, cinchona, and aromatic sulphuric acid. Prof James M. Bunn, M.D., of Altoona, Pa., the most brilliant bacteriologist in that State, says : The comma-bacillus is the cause of the green stools of cholera infantum. This can readily be ascertained by a microscopical examination of the discharges^ when there will be found an innumerable number of the patho- genic bacilli ; the coloration is not due to the bile pigments, which are entirely absent, but to a peculiar pigment secreted by I BACTERICIDES. 183 the bacilli themselves, and which can be reproduced by artificial cultivations of the microbes. Bile is entirely wanting in the rice-water discharges of epidemic cholera, as well as in the green stools of cholera infantum. The disease in all its forms is essen- tially contagious, although indigestion, mal-assimilation prepares the soil, favors the production of the bacillus. The greatest success in treatment is from the use of germicide remedies. Take either mucilage acacia or syrup of tolu, four ounces ; add to it three or four drachms of resorcin, thirty drops concentrated ozone. Mix well ; give half a teaspoonful every hour. Stop milk entirely; feed on barley water and port wine ; the bacilli lodges and breeds in the casein ; multiplies to an alarming extent in the casein clots. So starve and kill the germ. Paint abdomen with equal parts of con. ozone and chloroform — a powerful stimulant and germicide — arrests germ evolution. Care should be taken to employ disinfection of the stools to prevent the spread of the disease, and, with proper care, we claim that this microbic form of diarrhea may be reduced to a minimum. This term is applied to a condition of extreme Cholera nervous prostration, with cold skin, feeble pulse, in- Morbus. terrupted respiration, cold breath, a cadaverous ap- pearance of face, blue feet, hands, nose, ears, with nausea, vomiting, frequent motions of the bowels, with cramp or knotting of the intestines, and the cholera-germ in stools. In our climate, with its inhabitants suffering from an incessant nervous strain or worry or struggle, we meet with cases of cholera morbus in all seasons of the year, chiefly among our adult males, although it is more prevalent when the system is enervated by heat, or when there are violent transitions from heat to cold. Chmatic changes affect those who have their nervous systems prostrated by overwork or anxiety ; and especially so if the stomach is irritated by offending material, as green or unripe fruit, some acid or acrid cond tion, acting on the stomach and liver as an irritant, or upon the brain, involving its base and eighth pair that supply the liver. The disease may be traced to other causes, but the true cause is to be found in a depression of the great sympathetic, eighth pair, and brain, the spinal cord being involved in the first dorsal vertebrae. Bacteriology teaches us that in whatever way the microbe is evolved, either by nervous depression, aided by the irritating ac- tion of green fruit or vegetable, or some indigestible compound as clams, or some other irritant, the comma-bacillus is present in the bowels, actively, energetically excreting ptomaines, that deadly alkaloid which produces all the alarming symptoms of the disease. i84 J)ISEASE CiERMS. Syuiptoms. — It usually comes on with nauseau, soreness, pain in stomach, vomiting, purging, which rapidly exhaust the patient ; when, by and by, those terrible cramps or knotting of the intes- tines by spasm, the features becoming cadaverous ; breath cold ; skin cold and clammy ; hurried or short respiration ; cramps in the legs ; coldness of extremities ; intermitting pulse. Treatment. — This must be pursued with great energy. Ad- minister at once thirty grains of bicarbonate of potassa in tepid water ; follow quickly with an emetic of a mixture of equal parts of lobelia, capsicum and valerian. Repeat dose after dose, until emesis is very thorough. Use the same as an enema. After the stomach is thoroughly evacuated, con- tinue with same remedy in small doses sufficient to keep down spasm of the bowels. Apply artificial heat to stom- ach, feet, limbs. Open bowels either with neutralizing mixture or com- pound licorice powder. Commence, as soon as the stomach will retain anything, with either the tincture ot white hellebore and antiseptics, as ozone-water, or tincture iodine, and carbolic or sulphurous acid, per- oxide of hydrogen or salol, or creo- lin, or naphthaline, or resorcin ; or if these are not handy, then use eu- calyptol. The lobelia compound is invaluable for relaxing of spasm and overcoming the prostration. If, after the bowels have been freely moved, the stomach is still irritable from the presence of the germs, and will retain nothing, administer the following : cam- phor, thirty grains ; capsicum, ten grains ; sulphate of morphia, one grain. Mix, and make ten powders ; and, while triturating, add five or ten drops of oil of peppermint. Give one powder every half hour. After the stomach has been quieted, continue with antiseptics and tonics until recovery is complete. The comma''bacUlus al work in the tubuhir glands of the bowels vieor- oiisly excreting ptomaines, the deadly alkaloid oi rigor mortis, immediate- ly sterilized on the administrat on of ozonized creolin. Human beings, whose nervous systems aie Epidemic devitelized by overwork, exhaustion, privation. Cholera. anxiety, struggle for existence, and subjected to depressed electrical states of the atmosphere, ex- traordinary meterological conditions, and the absence of ozone, have within their bodies certain living elements altered or de- i^raded bv those adverse conditions into the cholera-germ. There BACTERICIDES. 185 The microbe of cholera (the comma-bacillus), the different forms it presents in its various stages of growth. can be little doubt that this germ is the modified Hving mat- ter, either of the base of the brain, the spinal cord down to the last cervical verte- brae, whence eman- ates the sympathetic, or else the eighth pair that supplies the liver. In proof of this, we often find cholera-germs, the comma-bacillus, in those whose nervous systems are shatter- ed, and who suffer from diarrhea. Be- sides, the appearance after death points to those parts as being at the origin of the trouble. When once developed, it is capable, like all other contagious diseases, of being propagated by con- tagion and infection. It is not, however, contagious in a high •degree, but can be carried by human intercourse, by clothing, merchandise, ships ; undoubtedly often spread by water, milk. Symptoms. — The symptoms of this disease are divided into three stages, which may be classed as follows : 1. Irritability, languor, lassitude, sleepiness, confusion of head, pale countenance with nausea, vomiting and diarrhea. 2. In addition to the above aggravated symptoms, the dis- charges become light-colored and serous; white flakes and rice- water discharges appear; the pupils become contracted, spasms, cramps, coldness of body, with intermittent pulse. 3. Blueness, with rigid spasm, suppression of urine, collapse. The general symptoms of those three stages in detail are as fol- lows : copious vomiting and diarrhea; stools are entirely des- titute of bile, and consist mostly of water, containing large quanti- ties of epithelium and albumen, resembling rice-water ; they con- tain also a large quantity of chloride of sodium ; cramps in muscles, causing them to contract into cord-like masses or knots ; spasm; the pulse is soft and easily compressed ; varies from ninety '(^;.^^x 4 From the rice-water stools of a case of cholera. Masses of single comma-bacilli ; circular farms; semi-circular forms; magnifying power about 1400. 1 86 diseasp: germs. to one hundred and ten; general temperature 65° to 70° F. ; the- expression of the features is ghastly or cadaverous ; eyeballs sunken, glassy ; cold, clammy sweat ; breath cold ; so is the tongue and mucous membrane of mouth ; distress at pit of stomach, with burning; albuminuria, suppression of urine; great thirst; circulation gradually diminished; respiration impeded; hence great prostration. The heart now becomes affected ; so do the blood vessels, by a spasm of their muscular coats. The sugar-generating faculty of the liver is suspended, so that there is an icy coldness of the skin and breath, and blueness of the lips and skin generally. The force of the germ-disease and its ptomaine is on the nervous sys- - tem, which becomes early and decidedly affected; hence the un- natural and whispering voice, shrinkage of the entire body,, pinched features, and contracted pupils ; muddy-looking com- plexion ; sinking of the eyes, pupil immovable, cornea flattened. If symptoms are not relieved, the breathing becomes less frequent,, the whispering voice spasmodic, and if the pulse is at all percep- tible, thread-like and intermitting ; circulation arrested from para- lysis of the heart; intellect clear; evacuations involuntary, and not a trace of bile in the stools. If the patient survive forty-eight hours, and exhibit signs of improvement, he may recover rapidly if the pulse rises and the stools become bilious, and respiration, and circulation be restored. But very frequently improvement is only temporary, headache, drowsiness, tonic or clonic spasm, vomiting, stertor, coma, usher-- ing in death. All those symptoms are due to the lightning-speed evolution, of ptomaines by the microbe ; so rapid that the bacilli have not time to elaborate in the blood, the ptomaine of the comma- bacillus, is like alkaloid strychnine, chemically, for if it be injected' into any animal it at once produces diarrhea, vomiting, spasms,., torpor, collapse, and finally death. 7'he appearance after death, aside from the rigid contraction- and stony feel of the muscles are a white liver, effusion in the ventricles of the brain and spinal, the latter being congested and compressed by a serous exudation, in which ptomaines are abun- dant. Death is so rapid from the excretions of ptomaines that the comma-bacilli are not to be found in the blood, but only in the- tubular glands of the intestines. Treatmc7it. — If an epidemic prevail, the most careful sanitary and hygienic measures should be observed, and the very highest possible standard of health maintained ; the very best of food used ; no green fruit ; no alcoholic drink ; no late hours ; no-- mental or physical overwork ; no overcrowding. The best pre- BACTERICIDES. 187- ventive is small doses of sulphate quinine, and abundance of good food. On the very slightest derangement of the bowels, that is, nausea, vomiting, or diarrhea, give small doses of the neutralizing cordial, with tincture of opium, until it is relieved. At the same time, apply sinapisms of capsicum and vinegar over the bowels and down the spine ; and, as a drink, give sulphurous acid in water. Any other symptoms should be promptly re- lieved, the patient kept in the recumbent position for a few days,, and plain, nutritious food given. If the disease has set in, and is seen first in its premonitory or first stage, the patient should be put to bed in the best ventilated apartment in the dwelling ; its temperature kept about 80° Fahr., and arrangements at once made to have him surrounded with dry heat, heated sand in bags. The diarrhea and vomiting are evidently efforts of nature to get rid of the germ, and it is often a good plan right here to administer an emetic of equal pares of lobelia, bayberry, and capsicum. Afcer it has acted, try some one of the following remedies in solution, so as to get the liver to secrete and discharge the bile : rub abdomen and spine with oil of capsicum cut with alcohol, and apply artificial heat, and let the drink be sulphurous acid and water. Opium in every form is contra-indicated, because it increases the congestion of the cord. Large doses of bromide of potassa, ranging from fifteen to thirty grains, with ten of carbonate of ammonia, and twenty drops of tincture of calabar bean should be given frequently. If the case is more advanced, pupi's contracted, spasms, cramps,, coldness, biueness, intermitting pulse, these symptoms are promptly met with the following : Tincture of lobelia, capsicum, and American valerian, of each one ounce. Give a teaspoonful in water every half-hour, and occasionally a dose of the bromide, with tincture of white helle- bore. Cholera-germs are difficult to destroy, but with the lobelia compound we have had good success. Of all drugs in the ma- teria medica, it alone retrogrades the growth of the germ, and sterilizes it. Its properties are really incomprehensible ; it holds the position ; no more are developed under its influence; it gives nature a chance to rally to legitimate work ; every drop that is given benefits; the respirations becomes more frequent; heat in- creases ; breath becomes warm ; pulse, imperceptible at first, be- comes wiry and full ; blueness and contraction leaves the surface ; the paralysis of the eighth pair is relieved ; bile appears in the stools ; spasm and contraction are relieved, and the eye acquires its brilliancy. It must never be given to the point of vomiting ; its action- I 88 DISEASE GERMS. must be guarded, and held on to, and persevered with, so as to enable the vital forces to recover themselves. Its action is im- mense in cholera. If sinking is threatened, compound tincture of capsicum and quinine should be administered repeatedly. Juice of raw meat, well salted, should be given often. If thirst is intense, iced champagne or chloride of sodium, carbonate ot soda and chlorate of potassa in w^ater should be given. If vomit- ing is incessant, medicine and drink in small doses every few minutes, with capsicum over abdomen. Dry heat, in the shape of hot sand bags around the entire body of the patient, reaching from axillae to toes, and from the groin down the inner aspect of the thighs, and also along arms ; while being changed, friction with tincture of capsicum. Hold spasmodic action in abeyance. As soon as stomach settles, keep on with juice of raw meat, and give antiseptics, as ozone water, or sulphurous acid, or carbolic acid and tincture of iodine. In cholera the insulation of the patient is of great importance ; bed in middle of the room, head to north, glass under feet of the bed. The evacuations should be removed in a bed-pan, with a solu- tion of sulphate of iron, and the greatest of caution should be exercised in diet, allowing little but beef-extract, milk and bicar- bonate of soda, farinaceous substances, until bile appears in the stools. Convalescence should be established upon cinchona and min- eral acids, baths, irritating plaster the entire length of the spine, holding on to antiseptics for four or five weeks after recovery. A morbid condition of the nervous system, char- Chorea, acterized by a want of control of the motor nerves which supply the muscles in the waking state ; which gives rise to irregular, tremulous, and ludicrous movements of the voluntary motions, most common between the ages of five and fifteen, among those of a neurotic temperament and feeble constitution ; girls are more obnoxious to the affection than boys. Causes. — It is supposed to originate in a jar, or want of har- mony, between the gray and white matter of the spinal cord, probably brought about by falls, blows, shocks of various kinds acting upon a weakened cord and bulb. More active, exciting causes are anaemia and other blood diseases ; teething, worms, dyspepsia, skin eruptions, retarded catamenia, constipation, cold, insufficient food, excessive loss of blood, pregnancy, disease of bladder, rectum, mental emotion, passion, masturbation, and BACTERICIDES. I go o'her reflex conditions at the origin of all star\/ed cerebral areas. Nearly one-half of the cases of chorea that we meet with in city practice is due to defects in our high-pressure system of education. Over-schooling produces a nerve shock, peculiarly liable to affect the nervous system of children whose food is meagre or adulterated (their brain is under-fed), or who live in the midst of insanitary surroundings. A city child is more feeble, less able to cope with disease, than those in the country;, the law of reflex impressibility is keen in the former, and the daily endurance of mental toil, with its incidental shocks, produce a jar, a want of equilibrium, between the gray and white matter of the spinal cord, hence the chorea, the penalty. With a different system of education, a vast amount of child-suffering might be prevented. Symptoms. — The commencement of this disease is character- ized by nervous depression and debility. The involuntary mo- tions begin by slight twitching of the muscles of the face; then other muscles become affected, and one or more limbs ; features often curiously contorted and twisted ; vacancy of countenance ; articulation impeded; appetite irregular; often constipation ; gen- erally one-half of the body more affected than the other. Irre- gular action ceases during sleep. The disease may last for a life- time and produce no bad results, whereas in other cases the nervous system becomes impaired and there is a rapid breaking^ down. It produces difficulty of respiration and retards the functions of the heart. It is apt to be attended with danger. TreaUncnt. — In the treatment of all cases of chorea, a complete change of habits and occupation, and a resort to the fresh air of the country ; abundance of exercise, and a very generous diet, together with daily baths and friction to skin, are indispensable. The closest scrutiny of the case, as to whether there be any blood affection, or reflex irritation, especially of the genito-uri- nary organs. All causes must be removed, if possible, and a special treatment inculcated for each ; the secretions well stimu- lated. The great impressibility of the nerve-centres must be seen to by the daily application of stimulants to each side of the spinal cord, as friction with stimulating liniments, the irritating plaster, ice, or use of menthol ; some one of these selected, and,, internally, bromide, Scutellaria, calabar bean, sumbul. These latter not only relieve the impressibility of the cord to reflex action, but help to control the involuntary movements. Whatever treatment may be deemed best to control the move- ments, sumbul or scullcap, we must ever keep in mind that there exists starved cerebral areas, v/hich must be overcome by kepha- 190 DISEASE GERMS. line and avena sativa, and as the brain only picks up its pabu- lum from the blood during repose, sleep must be prolonged indefinitely. Our best curative drug in chorea is the ozonized extract of sumbul, being a powerful antiseptic. It reaches a class of cases, in which the malarial, rheumatic and other microbes play an im- portant part in the excretion of ptomaines. The remedy kills the microbes and neutralizes the poisonous alkaloid in the intes- tines, and thus diminishes reflex irritation. The jar or want of equilibrium between the gray and white matter of the cord is completely arrested during sleep. It is therefore, a good plan to prolong sleep and thus cut short the mischief which is being carried on in the nerve-cells by the in- cessant, unnatural activity. Prolonged rest affords an oppor- tunity, a restorative, to the discordant nerve-cells to be at rest. Massage is most effective, persistent for two hours, morning and night ; induces sleep. Sulphonal and paraldehyde are efficacious remedies, in alter- nation with the sumbul. The patient should be put upon an alterative and tonic course, and special remedies as to its cause. If retarded menstruation be a cause, in addition to the bromide, Pulsatilla and caulophyllin ; comp. betin pill and acetate of iron. If rhenmatisni be suspected, manaca, salicylate soda in liquor ammonia acetatis ; cascaradyne ; colchicumi, phosphate of qui- nine ; uric acid solvent ozonized. If it has appeared subsequent to the metastasis of a skin erjp- tion, ozonized sulphur water ; lycopodium, saxifraga. If uterine irritation is suspected, pulsatilla, aleteris farinosa wine, Indian hemp. If due to fright, mental distress, belladonna, stramonium, ma- crotys, nux. The usual remedies if worms are suspected. If due to disease germs in the blood, saxifraga, phytolacca. Other remedies sometimes successful are arsenic, bromide of gold, nitro-glycerine, avena ; this latter being a powerful nerve "tonic and food, is admirably adapted to imperfect development of the nervous system, whether partial or general, and is markedly suitable to children who are precocious, whose assimilative func- tions are not up to the task of supplying the waste consequent upon active brain expenditure ; such children while needing rest and restraint rather than encouragement in the development of their faculties, will be so greatly improved in physical strength by the use of the oats as soon to resume their intellectual trammg. BACTERICIDES. I pi Chylous urine, or the excretion of urine of a Chyluria. milky appearance from the presence of fatty mat- ter in a molecular state. In addition, there is gen- erally present liquor sanguinis, blood-corpuscles, fibrin, and albu- men. The urine, after standing a little while, coagulates into a trembling mass resembling common size or blanc-mange. Coin- tnon in tropical latitudes, and is associated, not always, but in many instances, with the filaria in the blood. Associated with this condition of the urine, there is great lassi- tude and debility; pains about loins and stomach; very great mental anxiety ; loss of flesh. It is usually intermittent in its nature ; chylous for months ; healthy for same space of time, and then recurs on and on. Treatmefit. — Sea air, salt-water baths, very nourishing diet ; flannel roller over abdomen ; tonics, such as Warburg's tincture ; -eucalyptol, kurchicine, cinchona, and mineral acids. According to the last census, there were Climacteric three millions of women in the United States Disorders, between the ages of forty-five and fifty, undergo- ing the change of life, and this number is annu- ally kept up by fresh recruits ; so that we have, at all times, about that number. The importance of the period, the history of suffer- ing endured, cannot be approximated; neither has its diseases been adequately investigated. The terms, change of life, turn of life, critical period, etc., are understood to mean a period of life beginning with those irregu- larities which precede the last appearance of the menstrual flow, and ending with the resettlement of health on a new basis. This is usually divided into a premonitory period, the actual stoppage or cessation of the flow, and the adaptation of the system to the change. The first indication of failure of ovarian energy is irregularity, when the failure is complete, perfect cessation. Although it is termed a critical period, it is not to be deemed fatal, if the patient's system is healthy. It is a gradual change, leading to better or worse ; to complete recovery more frequently than to death. The streams of life, instead of flowing on in a smooth, tranquil current from the cradle to the grave, are marked by rapids, or milestones, which are critical, metamorphic, or developing epochs. Seven, fourteen, twenty-one, are clearly and distinctly written on the first part of life ; forty-two, forty-nine, and sixty-three, are less deeply cut, but are distinctly visible in the latter period of life. Those periods are characterized by important changes. 1^2 DISEASE GERMS. which give a peculiar aspect to the physiognomy of the humara body, and impart a family likness to the diseases of epochs justl}r deemed critical, in which one or several organs of the body undergo changes. The object of each critical change in our bodies is to insure the greatest amount of health for each subse- quent period of life. This object, if the vital forces are of average strength, is effected quickly; but if there be debility or disease, then there is more or less disturbance, according to the degree or intensity of that state. The critical changes of denti- tion and puberty are frequently brought about without any dis- turbance or ill health; nevertheless, they are often followed by debility. At critical periods the activity of important apparatus may be too powerful, and disturb other organs, or too feeble to react on others. When the energy of the preponderance-seeking organ is above or below par, health may be impaired. With regard to the influence of critical periods of life, first and second, dentition influence both sexes alike and in the same way. Puberty is common to both ; but the impulse given to the con- stitution of man, by the perfect development of the sexual appa- ratus, is, in genet-al, fully effective and all-sufficient to insure its permanent activity until extreme old age ; whereas, in women the crisis is very liable to be delayed or perverted ; and even when puberty has been fully and effectively established, the health of woman is dependent on those oscillations of vital force, which render it most uncertain. The chemical activities of a woman cause her to mature early ; the inertia of man's nature renders him slow, late in maturing. The same inherent qualities of sex give woman an early change ; whereas, man's change is delayed (if not too early precocious) till a good old age, he being capable of begetting children to seventy or eighty; whereas, the moment a woman changes, fecundity ceases. It is true that children begot by very old men are of very feeble vitality. Although' most women change at forty-five or forty-seven years of age, it does not follow that sexual appetite is extinct. Sexual congress may not be enjoyed by some, whereas others never have a warmth of feeling until the change of Ijfe takes place. The large proportion of women, oh cessation taking place, become callous,, indifferent, lose their sexual vivacity and vigor. Menstruation, healthy or morbid, marriage, pregnancy, partu- rition and lactation, are critical eventualities in a woman's life, curing some complaints, giving greater activity to others ; and when, after having lasted thirty years, the action of the reproduc- tive organs is being withdrawn from the system, then there arises a series of beautifully adapted critical movements, the object of which is to endow a .healthy woman with a greater degree of BACTERICIDES. ig^ strength than that which she had previously enjoyed. But this will not occur if there are disease-germs lurking in her system, such as cancer, tubercular, syphilis ; then the seeds of those germs, when vital force is low, are liable to become active and destructive ; because the very essential of the change, debility, brings them into active growth, and causes them to locate and grow in the very organs in which the change is progressing. The change stimulates their growth ; imparts to them fresh activity. So, as a rule, it is at this period we meet with the greatest proportion of cases of cancer of the womb, and breast, adenoma, and other tumors. The change of life is only critical to the diseased. It is only they who need fear the crisis. To the healthy^ to those who live according to natural laws, eat healthy food, avoid balls, tight lacing, bad literature, and seden- tary occupations, nothing is to be feared. It is well to make no hap-hazard prediction, but if there is no disease, the process will not be critical. True, the disease may be got rid of; if so, it will mitigate the condition. The change does not cause disease ; it detects it, brings it into active existence, and causes an aggra- vation of it. Thus congestion of the womb, chronic inflamma- tion of the ovary, etc., existing at the change, become excessive. Disease has little tendency to leave or become inactive or quies- cent during the change. The critical nature of a period is shown by its effects on the health in ensuing years. Thus puberty is not only a crisis of most of the complaints of the preceding years, but it determines the health of the subsequent thirty-two years, for good or evil. In like manner, the change of life, if it can be consummated in a salutary manner, will influence the succeeding period ; nay, it will govern the whole subsequent period of life. So we can prognos- ticate, from the manner of the crisis, whether the after-life shall be good or bad. Five years after a woman ceases tells its own tale in the great additional strength of constitution. The greater sanative change, the greater longevity of woman after the period, her less liability to disease and death, her very remarkable good health, and almost total immunity from the general run of ailments render her last stage of existence a comfort and a blessing. From forty to fifty-five is a general period of invigoration for both sexes — a period in which the daily work of nutrition is very actively carried on in our bodies, rendering them stronger, more vital, healthier, and thereby insuring a more perfect performance of all the functions. The change in man is carried on insensibly, and worked out without disturbance. In woman the passage is often full of danger, if natural laws have been violated; but the 13 ig^ DISEASE GERMS. very great improv^ement that follows the change is so salutary as to compensate for all the suffering. Although the phenomena of change of life are principally due to withering of the ovaries and suspension of their functions, it is aided by and associated with other structural changes, which take place in both sexes, due to coming age, such as the ossifica- tion of the cranial bones ; atrophy of spleen, and lymphatics ; changes in bone, marrow ; degeneration of some form ; a smooth- ing down of Peyer's patches in the bowels, and some shrinkage of the brain proper. But after cessation a woman's constitution is entirely remodelled ; she takes a new lease of life ; decay and suffering have then less hold on her, and she begins life anew. The importance of the change cannot be too highly rated, espe- cially if easily passed; for if it is accomplished without much dis- turbance, so will the future period be healthy ; but if gone through with great suffering, then we may expect the subsequent time to be one of long-continued misery. It is a final settlement for good or evil, and it may be reasonably entertained that if it does not excite the activity of some disease-germ in the body which previously existed there in a quiescent state, and the vio- lence of the change be not excessive, it is reasonable to conclude from thousands of pre-existing cases that the rest of life will be passed in uninterrupted good health, and unusual longevity attained. The invigoration of the health which follows is often accompanied with a great improvement in personal appearance — where the thin and emaciated become fat and comely, where the timid become bold and daring ; while another class become mas- culine, and lose their feminine appearance ; their cheek bones project, the skin loses its velvety feel, creases show themselves, and stray hairs start on the upper lip or face. The effects of a suspension of ovarian action has a marked in- fluence on all the emotions, desires, affections, passions, as well as on the brain proper, giving rise to debility, prostration, nervous irritability and confusion. Puberty and change of life are caused by physiological and anatomical changes in the same organs : puberty is ovarian evo- lution ; the change of life, involution or stoppage. The true seat of both is in the reproductive centre in the brain ; the one growth, the other death to that special centre; the ovaries being merely the organs to perform the work. When, with proper age and perfect blood development, this co- ordinating reproductive centre in the brain matures (puberty) the seed or egg organs, the ovaries, increase in size, become v^ery vas- cular, and begin to let fall ovula or eggs every twenty- eight days, and cause in modern civilized women menstruation. When the BACTERICIDES. 195 reproductive centre in the brain dries up, which it usually does after thirty-two years of activity, the change has come ; the ovary or egg-bed, which, during the active period was smooth and tur- gid, becomes dried up, shrunken into a knot like a peach-stone, and it becomes difficult to trace the cavities of the Graafian vesi- cles, for their walls are pressed together. A few years later they shrink ; wither still more ; become atrophied, so much as to be no larger than a bean, and latterly completely obliterated, being marked by fibro-cellular tissue. This ovarian atrophy, or shrink- age, or wasting, or withering, comes from a want of germinal influence from the brain ; there being no use for the organs, they wither and die. This change is accompanied with corresponding changes in the fallopian tubes, determined by the same cause; these tubes contract, wither, become impervious and perfectly obliterated. The same condition of non-use, want of stimulus, or enfeebling energy causes the womb to contract, become small, round like an orange ; its neck becomes thinner, and shorter, and obliterated, and in some cases an obliteration of its mouth takes place. The vagina becomes very narrow, short, and there is a shrivelling up of the pampiniform plexus of vessels which pre- viously supplied the organs with blood, which accounts for the remarkable coldness of the parts. Incidental to this general col- lapse, the broad ligaments that retain the womb in its position also shrink and disappear. The breasts, which are a part of the reproductive system, also become cold, small and wasted. During the change they are often seriously affected, being painful and congested, if not otherwise diseased. It would be a matter of infinite surprise how so many phenomena of health and symp- toms of disease could be determined by two little bodies whose structure does not appear complicated, but the fact is unquestiona- ble that not the bodies, but the brain, is the source or seat of change. The ovaries are energized by that nervous centre of sexual power located in the spinal cord, opposite the fourth lum- bar vertebrae, and supplied from the cerebral centre ; but although a central act in the brain through the cord, there can be no per- fect exercise of sexual power without well formed and healthy ovaries. The ovaries influence all parts of the body (directly the cord and brain) through the medium of their nerves, for as they have both ganglionic and cerebro-spinal nerves, they can react on both the ganglionic nerves and their centres, and the cerebro- spinal and their central organs. Whether the ganglionic be an independent system of nerves, or an offshoot of the cerebro-spinal nervous system, it is not necessary here to discuss. All are agreed that vaso-motor nerves follow every capillary to their minutest ramification and govern 196 DISEASE GERMS. the nutrition of every part of the body. All organs of nutritive Hfe are supplied with ganglia and a plexus of ganglionic nerves ; but they all communicate together, and with a larger plexus and more voluminous ganglia, situated in the viscera of the abdomen. And before those foci of nervous matter were discovered, this region, that is the ganglia on the bowels, liver, spleen, bladder, kidney and reproductive organs, was called the lever of forces by which the body is moved. Sensation and motion are dependent on the cerebro-spinal nerves, nutrition on the ganglionic ; but there is a concentration of ganglionic nervous power in the cen- tral ganglia which gives and receives from each viscus a variable impetus. The ganglionic is a centre of nerve force, capable of controlling and disturbing the various parts of the body by its nervous fluid or soul. The human body is so constructed that the various component organs act upon each other in the way most conducive to health, until the age of puberty. At that time health may fail and the whole system languish, unless the reproductive organs come into full activity. From puberty to the change of life, the health of woman cannot be maintained without an energizing influence from the reproductive centre in brain and cord, so as to impart an appropriate amount of ovarian influence. If the ovarian energy reacts under proper nerve stimulus in a healthy way, it will aug- ment, vitalize, energize the visceral centre, or brain, and cause the function of nutrition to be performed with increased energy ; give vigor, instinctive consciousness of strength. If the ovarian energy be insufficient, the abdominal brain, the visceral centre of ganglionic action, is half or partially paralyzed, and uneasy sensa- tions are felt at the pit of the stomach, a feeling of sinking, of faintness, goneness, or even actual fainting is sometimes induced ; defective nutrition follows, with anaemia of the cord and brain, vulgarly termed hysteria, met with at puberty, during preg- nancy, lactation and change of life. If the brain does not furnish the necessary amount of ovarian stimulus, so that evolution is in- efficient, the menses will come on in an irregular way, off and on and likely scanty ; if it be too strong, as under emotion, pas- sion, it will react upon the adjacent viscera and cause violent dis- turbance. All the organs in the chest and abdomen are, on their front part, covered over with the cervical sympathetic, similarly en- dowed wath ganglia or little brains. They are knit together by a mysterious net-work of nerves ; they sympathize with each other at puberty, menstrual period and change of life, and in this way any disturbance of the ovaries, irrespective of reflex states, will give rise to nausea, sickness, depraved appetite and deranged BACTERICIDES. 197 bowels and kidneys. If the ovarian stimulus be too great for the allied abdominal organs, there may be pain in the ovaries them- selves ; pain, disturbing sensations, irritation which may be trans- mitted to a weakened cord and bulb, then hysteria, tetanus, nervous irritability, restlessness, hysterical convulsions, or there may be a numbness in skin and other parts. The strength or relative weakness of the nervous system may be inferred from the condition of anaemia of brain and cord that is present. The solar ganglia in both sexes form an important centre of nerve force. Insufficient ovarian influence having reached the solar plexus affects the brain chiefly by means of the pneumogastric nerve, so any disturbing influence at puberty, preg- nancy, parturition, change of life, may be shown by the distress- ing headaches, fretfulness, peevishness, irritability, capriciousness, perversion of the moral nature, moral insanity. In other cases, excessive or disturbed ovarian action is manifest by high spirits, or depression, a cloud or a weight on the mental faculties, hazi- ness of mind, brain muddled, memory faithless and an unquenchable desire to sleep during the day, remaining awake all night, almost amounting to coma, or lethargy. From puberty to the change, healthy women, when not preg- nant or nursing, drop ovules every twenty-eight days, and, as a rule, modern civilized women lose about four ounces of blood. But there are women in perfect health, who live according to nature's laws, eat healthy food, avoid modern literature as a destructive ovarian poison, that have perfect ovulation, are easily impregnated, and whose womb does not bleed on the shedding of the Qgg in the ovary and dropping within its cavity. Those women enjoy the highest possible standard of health. Indian women, in their aboriginal state, seldom lose blood at the monthly period ; nothing but a white, glairy discharge. Sexual involution has an ill-defined beginning and end, and only one fixed date, cessation. The activity of the menstrual period is usually thirty-two years, between fourteen and forty- six ; but there are cases, once in a while met with, where the' men- ses stop as early as twenty-one, twenty-eight, thirty-five, and at all periods up to sixty-one. The average, however, is forty-six in healthy women, and more cease to menstruate at forty-five than any other period in life. It depends greatly on accidental conditions of life. Blows on the head or back, frights, and other nervous states may prevent its appearance, and arrest it at any time, either when the discharge is on or off, and if the shock is grave, forever. Its continuance depends greatly on the state of the health, the richness and purity of the blood, the freedom from worry, struggle, shocks, jars, and uterine and nervous igS DISEASE GERMS. disease ; but taking all these into account, the average among our ladies is forty-six. Races, being essentially distinct, have each their pecuharities in menstruation. It is said that the Hin- doo women run from twelve to sixty, when free from disease ; and the Laplanders and other races have different peculiarities and eccentricities. Ovulation and menstruation stand together, very nearly as cause and effect. Periodicity is an element in woman's nature. Vaginal blood, even if it occurs with periodicity, when late in life may not be menstrual, but may come from congestion, ulcera- tion at the neck, polypi, and other morbid states. Still there are^ as we know, rare cases of cessation at sixty-two, or later, in strong constitutions ; so it is well to be guarded. Cases at sixty and seventy menstruating are mostly due to some disease. Out of one-half million women who become mothers from under twenty to above fifty, seven thousand bore children from forty- five to fifty years of age, and one hundred and sixty-seven were mothers after they passed their fiftieth year. Cases of menstrua- tion admit of great variation. Isolated cases are met with at six; more numerous at eight to eleven. Still there are a greater number late, from eighteen to twenty-two ; while the general average does not vary from fourteen to forty-six. The Irish, at home in their salubrious atmosphere, with a fish diet, are remarkable for their fecundity. Their nervous systems and their ovaries are endowed with wonderful activity. The fish-eating and oat-meal-consuming races, as the Scotch, Swedes^ Danes, Canadians, have strong procreative powers, and reproduce themselves speedily. Ovarian activity, then, is commensurate with constitutional vigor. An unusual prolongation of ovarian life and longevity indicates a healthy condition of the functions of vegetative life,, and when prolonged, it implies great vigor, strength, and endu- rance, and means a good old age. During the wear and tear, struggles, hopes, cares, sorrows, vicissitudes of life, the ovaries are often simply paralyzed, and their action suspended ; when the difficulty is removed their function will be resumed. Visceral disease has the same effect ; when the disease is cured, and better health brought about, their activity is restored. There may be a stoppage for a long time,, and then a recurrence. A woman past the age of fifty-three may be regarded beyond the age of child-bearing, except in very rare and exceptional cases. Pregnancy late in life is often mistaken for other diseases ; and late labor is dangerous to the mother ; indeed, it may be regarded as an extraordinary risk. BACTERICIDES. 199 Cessation is often delayed by morbid blood and affections of the womb and nerves, ulceration of the os. We will again repeat that there may be uterine bleeding without menstruation. It should not be called menstrual unless it occurs between fourteen and 'forty-six ; comes periodically, or with periodical paroxysms, and the blood has the characteristics subsequently described. On the approach of a fever, or pneumonia, or intense worry, or excitement, the womb of an elderly lady may bleed. Early cessation is very common, and consists in a premature paralysis of the ovaries ; and this extinguishment of the repro- ductive force m.ay be caused by hard work, worry; miscarriage, or induced abortions, falls on back, cold, fright, wet, purging, cholera, fever, long trouble, drugs, occupations — all paralyzing influences. It is called early any time before forty-six, whether it be at twenty-one, twenty-eight, thirty-five, or forty-two. This condition runs in families ; mothers and daughters resemble each other in this special department only. Women of the same family usually begin to menstruate at the same date ; have the same kind of trouble, same eccentricities, same complications ; cease at the same time, with the same peculiarities ; and even die under the same conditions. In this alone they resemble the mother; in their mental characteristics and conformation, they are specially the same as the father. Prostitution has a fearfully deteriorating influence on both brain and ovaries, and causes a loss of reproductive power. The vagina of a woman whose sexual act is loose and varied is cold ; it has lost its vital vigor and contractility ; it has no vivifying influence on the male. Its mucous membrane is purple or livid ; it has none of the cherry redness of the virgin, and it is even in a more dilapidated condition than that of the woman after the change. As a consequence, if they live over the three years allotted to their abnormal existence, they change, irrespective of age. Even the conditions of life have a modifying influence on menstruation and change ; the former comes on late in the poor and ceases early ; whereas in the rich, it is early and holds on longer. Menstruation usually takes place about the period of full moon in about two-thirds of all cases ; the other one-third, in the middle of the month. In spite of this disparity, there can be no doubt but that ovulation is regular, inevitable, uninterrupted ; but the menstrual function shifts, owing to some special attribute of the nervous system, and this fact shows that it is governed by nervous influence, and explains how strong emotion may repel or alter the time of its appearance. Menstruation is the effect of ovarian action, the shedding of an 200 DISEASE GERMS. ovule; but the menstrual flow, or a discharge of blood can occur without ovulation, just as ovulation may occur without menstru- tion. Nervous emotion, over-exertion, reading sexually exciting literature, passion, hearing disagreeable news, fatigue, quarrel, and jars, will bring on menstruation in some ladies without an ovule being shed. That sudden passion should cause the uterine surface to perspire blood is a well-known effect. Taking all the facts into consideration, it is more than prob- able that the recurring monthly discharge in the human female is a secretion, or rather excretion, from the lining membrane ot the uterus and fallopian tubes, without degenerative change other than that commonly associated with augmented functional activity, and comparable with that occurring in any other organ of the body under similar circumstances. The average duration of the menstrual function is thirty-two years, which is the possible duration of female fecundity, and that of each successive generation. The mode of stoppage in the largest percentage of women is by gradual diminution of the flow ; by a sudden stoppage of the usual flow, or by a flooding or successive floodings, or by alternate copious or scanty flow, or at irregular intervals longer or shorter than twenty-one days. The greatest number exhibit a diminution, a gradual decrease in quantity, and also in the time of its duration ; the other class, where it is erratic and the duration irregular; the next class, where there is flooding, the flow growing less and less, and at long intervals apart, till it becomes a mere show. The discharge, at first like blood, becomes blacker and blacker, clotty, then like cinder-dust or dirty-green water; in other cases like a lochial discharge, in smell. The menses, in health, are not to be re- garded as pure blood ; there are certain chemical elements in them induced by the brain, ovarian act, the presence of the ovule, that renders this blood totally different from the blood circulat- ing through the lady's body ; so much so if it is absorbed, owing to sudden suppression, it will not mix, but is thrown off at some weak point in the skin, lungs, nose, bowels ; it is sweet, not salt- ish like pure blood, but prior to and during the change it is still further altered in quality, whether it be scanty or profuse, at first paler in color, or later, brown or simply green water. As a rule ovarian influence begins to fail before menstruation becomes ir- regular, because when the sexual organs are healthy their loss of power is gradual, the ovarian forces become feebler and feebler until they can no longer determine any influence over the uterus, and the discharge subsides. The Period Before and After Stoppage. — The date of the last regular menstruation is to be taken, and the time calculated dur- BACTERICIDES. 201 ing which the flow became irregular, scanty and the health unset- tled. The length of the premonitory stage of irregularity, off -and on, varies from a few months to six or seven years ; the aver- age time being two years and a half before, and two years and a half after. This divides it into two periods of pretty nearly equal length ; the period before, with its varied symptoms, is followed by a period after, in which every twenty-eight days there are sen- sations of a peculiar kind, which continue along growing less and less. These monthly occurrences are very varied, embracing lumbar and abdominal pain, leucorrhcea, headache, diarrhea, bleeding piles, hysteria, asthma, debility, sweats, dyspepsia, stoma- titis, swollen gums, legs ; usually lasting four or five days. When all is over, the perfect recovery of health, and its re-set- tlement on a new plan takes two or three years, after which women are not liable to debility, floodings, sweats, heats and other un- pleasant symptoms of the change. Diseases, with which a woman may be accidentally affected at the change, may bar the progress of involution, and protract it indefinitely. Fibroid infiltrations in the uterus have been known to delay the change for many years. The ovaries may be shriv- elled and shrunk ; reduced to an amorphous mass of fibrous tissue, while the womb is still large, and bleeds promptly every twenty-eight days. These events are of vital importance, espe- pecially when disease -germs have been lurking in the system for years, as it brings them into active existence. The great quicksands and precipices which a woman should avoid during ovarian activity are sexual excesses ; the use of drugs ; abortions, or miscarriages ; and our modern demoralizing literature ; these, if indulged in, shipwreck her existence at the change. The removal of the ovaries during the thirty-two years of ac- tivity, induces an artificial, but genuine change. This proceeding is sometimes necessary ; this castration of the ovaries is performed when menstruation causes very serious and grave disturbance of the nervous system, as mania, epilepsy, or when they are affected by disease, as interstitial fibroid infiltrations, or tumor, that give rise to flooding, or other very fatal condition. Castration is a grave proceeding ; dangerous to life, by inducing peritonitis, and forever renders sterile the woman, and never should be done without the consent of the patient and her friends, and after con- sultation with several other physicians. The question is frequently asked, " Is fecundity possible during the change of life ?" Yes, if there are properly matured eggs '- occur all the time, or at irregular intervals, or periodic monthly. They are so common at the monthly period at this time that the>r may be considered as its legacy ; especially so, when they come periodically. The critical nature of such discharges shows that they should not be stopped, although it may be proper to restrain them. When it occurs periodically, it usually continues several years after cessation. Hemorrhage occurs in about sixty cases out of every one hundred; two-thirds of all cases from the uterus ; the other third from nose, mouth, lungs, nipple, kidneys, rectum, pubes; skin, in blotches or excoriations. They are all critical, and are to be regarded as the harbingers of serious trouble. Flooding at the change, in some cases, prevents complications, and relieves nature, and affords time for the readjustment of the system to the new order of things. Successive floodings are very common in the robust; but may occur in any temperament as often as there is an overload of blood. The sanguine, with the florid features, are specially prone to it ; blondes more obnoxious to it than the dark. A continual dribbling from the womb, at the change, is very undermining to the strength. It does not weaken down so much as when occurring at the regular periods. The best mode of stoppage is one gradual and progressive. Flooding is not always to be laid down to premonitory or existing cancer without the pain in front and back opposite, nor to ulceration of neck or womb. The whole net-work of uterine nerves are con- fused, upset, and a fright, emotion, passion, excitement, bad news, a fit of sneezing, a connection, may bring on a flooding. When floodings occur a few months after cessation, it is dangerous, because the system cannot repair itself fast, and the patient becomes much weakened thereby. Next in the order of frequency of occurrence of symptoms are Headaches. We have no words to describe the dreadful headaches of the change of life. It is a frequent, and often a ruling symptom. The pain, and its location, is very variable ; sometimes a dull, heavy pain, with drowsiness ; at other times it is frontal, sharp, excruciating ; in other cases it is in the temple, or top of the head, or at the occiput ; most frequently behind. The nature of the pain may be described as shooting, throbbing, gnawing, boring, or like a nail driven in, or as if the head was in a vise. It varies in intensity from a mere inconvenience, to the most agonizing ; sufficient to prostrate the most vigorous. It is often accompanied with nausea, or sickness in the stomach ; in some cases there is vomiting. It is purely nervous, and is present in both plethoric and ana:mic. It may be associated with pains BACTERICIDES. 20O elsewhere. It is usually off and on, or periodic ; and in some cases it is a true neuralgia of the brain, with flushes, per- spirations, hemorrhages, etc. Next in succession comes Drowsiness^ Giddiness^ like being tipsy^ so that when she walks she likes to have something to hold by, or feels like a top. The drowsiness is peculiar ; sleeps all night unrefreshed, and falls asleep during the day ; sometimes feels stunned and lost for an hour, with hot pain at pit of the stomach. Before the change she was all life and animation; clever, sprightly; but now, stupid; lets things fall out of her hands, and falls down in attempting to pick them up. Such a condition is often present at puberty, and is often bad when the flow is scanty, painful, or absent. The tendency to sleep is great, and often accompanied with an uneasy sensation of weight in the head, a feeling as if there was a cloud or cobweb on the brain that required removal ; loss of memory, power of exertion ; heaviness of head ; dulness of intellect. This drowsiness, stupor, is often a precursor of insanity. Mental stupor is often present during pregnancy, but passes off. Catalepsy, Melancholia^ Nervous Stupor are due to, and caused by a morbid action of the ganglionic system on the brain, brought about by the disturbed performance of the reproduc- tive organs. It is a kind of spontaneous narcotism. Hysterical Symptoms are quite common ; but they are always associated with nervous debility, flushes of heat, sweats, ab- dominal pain, piles, or hemorrhages, such as a gush of blood from mouth or nose. Epilepsy is very common at puberty ; disappears when the menses are established, and is very liable to reappear at the change. Very frequently the attacks are periodic, corresponding to the flow; usually go away when the change is well over. Minor symptoms of epilepsy are very common, as vertigo, sensa- tions, or aurcB, temporary loss of speech and consciousness, twitching of the facial muscles. Aphonia^ or loss of voice at puberty, is very likely to recur at change, and then disappear finally ; so with stammering or stut- tering, fear or dread. Chorea is very rare at change. Insanity, from the best statistics, is more frequent among women from twenty to forty, while the reproductive organs are endowed with their greatest activity, than between forty and sixty. This latter time, when hope is fading, and physical strength giving out, is the period when men die insane, and when women are most exempt. From sixty to eighty, when the sexes most resemble each other, insanity affects them equally. The 14 2IO DISEASE GERMS. change of life is not prone to insanity ; the puerperal state and nursing more frequently give rise to it, which explains the reason of its prevalence between twenty and forty. Dcliriiuii, Mania, at puberty, may be expected at change. The tzuo mental states known as Melancholia and Hypochondriasis are very common at the change, particularly the latter, which may be regarded as an exaggeration of other symptoms. There is often blended with it haziness of intellect, self-absorplion. love of solitude, distrust of friends, and exaggeration of trifles. There is often associated with those mental states neuralgia and hys- teria. They are most frequently periodic, corresponding to the monthly flow ; at which period she becomes very gloomy, indo- lent ; scarcely speaks, and imagines a fancied evil is about to befall her. This condition generally continues for three or more years after the change. This symptom is a most common one, often well masked and hidden by the lady ; her sensitive and loving nature is disturbed when all is changing around her, and she feels cord after cord snap that anchored her to life ; and she, if she has sufficient strength of mind, will conceal her condition. The flame of vitality cannot die without forebodings of decay, and there may spring up doubts about faded charms, failing energy, changed aspect she never before harbored, whether now she may be able to retain the affection of husband, the sympathy of friends, the admiration of the world. Because the strength, the vigor, the vivacity of youth is gone, some women try to convince them- selves that they are useless, and make themselves miserable. If unmarried, this change tells her to put aside long-entertained visions of future bliss. Apathy and sudden change of habits ; dislike to exertion, mental or physical, with want of sleep ; melancholy and suicidal tendency. There is often a remarkable perversio?i of the moral nature; un- controllable impulses to do things which they know to be wrong; often ungovernable, eccentric, reckless, extravagant, and in other cases avaricous. The temper is strange, peevish, snappish, quarrelsome, invari- ably uneven. The nervous system at the change is in a state of pertur- bation ; there is an insatiable desire for alcoholic drinks ; a true dipsomania. An hnpidse to Deceive, — Women always surpass men in their stupendous powers of deception. When a man has an object to gain he may deceive; but he does not, like a woman, find a pleasure in deceiving for deception's sake. Untruthfulness is very common, and it is not to be wondered at, under the mental BACTERICIDES. 211 perturbation present. Delirium, vertigo, distorted ideas and false notions are crystallized with deception. Kleptomania, or a desire to steal, is very common at puberty, during disordered menstruation, pregnancy, puerperal conditions, and at the change. It is most unaccountable, this impulse to steal, at all risks, at the critical period. Homicidal Mania. — A tendency to kill is a lamentable conse- quence of the change. Suicidal Mania is common at puberty, and recurs at the critical period ; less common in women than in men ; one woman to three men being affected. In women it is associated with the notion that they are possessed with the devil. Eromania, or inordinate desire for sexual gratification, is sug- gested, promoted, and intensified by morbid ovarian influences, uterine affections, and brain irritation. Woman, at the change, is an irresponsible being, being afflicted with some form of in- sanity ; the disturbance of the abdominal brain reacts upon the brain proper. Apoplexy, Paralysis, in all their forms, are common at this period. In apoplexy, there is the vertigo, the specks and spots before the eyes, the noises in the ears, the choking. In paraly- sis, the numbness, the feeling of pins and needles, the loss of sen- sation and motion, coming and going in a part, or the whole of the body. Nearly all women suffer from iieuralgia, as well as paralytic symptoms, most common about the small of the back ; lumbago in the abdomen all the time, or it may be simply monthly ; ovarian pain, colic, numbness, paralysis, sciatica; numbness in the hands, arms, feet and other parts ; neuralgia of the face, loss of voice, deafness, toothache. Nearly every woman, at the change, suffers from one or more of the above symptoms, and an endless variety not enumerated. The pains in the back, or loins, and legs, are the most common, and are generally described as radiating from the back, and an aching, numbing, gnawing, dragging, burning, or grinding. Often a sensation as if the back was broken through entirely. These backaches are often associated with pain in the ovary, or abdom- inal neuralgia ; numbness ; pricking sensation in feet and hands ; loss of power of parts are common ; burning sensations, with numbness in arms, back, and temporary loss of power; neuralgia of the eyes. There is a whole host of affections that attack the reproductive organs at the change, independent of flooding and leucorrhoea. There is a remittent form of menstruation ; vaginitis ; follicular inflammation of the vulva ; inflammation of the labia ; ulceration 212 DISEASE GERMS. of the neck of the womb ; induration and enlargement of the womb; faUing of the womb ; uterine polypus ; cancers; tumors f ovarian disease; irritation of the breasts; milk, or glutinous secretion from the breasts ; copious phosphatic deposits in the urine, with often inability to hold it; bloody urine; erectile tumor at the mouth of the urethra; rectal trouble; piles; abscess ; burning in womb and rectum. There is not much disposition to acute inflammation, as the general condition of degeneration going on protects the organs. Itching about the vulva, or pruritus, is very common, and i^ due to the sugar in the urine at this period of life, and to that coming in contact with the parts. Eczema on the lips makes the life of a woman unbearable. Prurigo and follicular inflammation begin at the change, and continue, in spite of the best treatment, for several years. Herpes,, or tetter is another annoyance. The great prevalence of vaginitis is to be explained by the continuance of sexual intercourse. Some cases are due to morbid states of the blood. A failure of health, gout, and extension of eczema up the vagina, or acrid discharges from the womb, which are muco-purulent, greenish, or yellow, or slightly tinged with blood, and more or less offensive and contagious. Vacrinitis gives rise to heat; bearing-down pains ; disturbance of bladder and ovaries. The symptoms of change in the reproductive organs are manifold. The ovaries rule supreme over menstruation; and if there is any disease lying quiescent, as a nucleus of a tumor, it will either retard, or give increased activity to the change. From thirty-five to forty-four years of age, when cessation begins to dawn in most women, sexual desire is less intense ; the married have fewer children, and the unmarried think less of marriage. This diminution of sexual energy accounts for a great decrease in the number and intensity of inflammatory uterine disease. Many women begin the change of life with uterine disease that has been undetected, or imperfectly cured, and all such conditions are likely to be intensified or aggravated by the change. Failing health gives rise to an exfoliation of the glands at the neck of the uterus at the change, so that the neck enlarges ; becomes soft, baggy. The change is often suspected by disease in the womb, or other parts; but after the change, the uterus is not liable to the old diseases of its active state. Disease is rare after, and when it does take place, it is a residuary legacy from old times. The obliteration of the neck of the womb, with the altered shape of the womb, vaginal prolapse, falling, uterine tumors, fibroid, fatty, and mineral degeneration, are quite common. BACTERICIDES. 213 Women, with cancerous germs lurking in the system, are extremely apt to have them grow between forty and fifty; although cancer, between thirty anH forty, is very common. The influence of the change on cancer is to give it an impetus, a start; to give it a rate of progression. The average duration of cancer here is sixteen months. Swelling and irritation of the breasts commence at the change ; they swell, become painful, nipples sore, ooze out serum or milk, or a gelatinous fluid, or a watery, bloody discharge. Tumors now put in an appearance ; cancer, if the germs are present in the blood. When the lacteal ducts and connective tissue are disap- pearing, fatty or adipose tissue becomes very abundant, and there are apt to be lobules of that tissue thrown out. Although disease of the kidneys is rare at the change, still there may be bloody urine, continence or incontinence of urine, and chronic inflamma- tion of bladder. Two-tJiirds of allivomen, at the change, suffer from some irritation of the stomach, liver, bowels, as dyspeptic symptoms, toothache, swollen gums, vomiting of mucus, blood ; biliousness, jaundice, constipation, diarrhea, inflammation of rectum, and enlarged abdomen. Biliary derangement at puberty, and its recurrence at the change, is the most common of all the disorders of the alimentary tract. A very large number complain of being bilious ; bitter, metallic taste in mouth, with headache, nausea, and vomiting ; bile in urine, and jaundice. This liver-irritation gives rise to the burning in the rectum, and piles, which are often so troublesome. That piles should be a common symptom is not to be wondered at, when we see the unrelieved plethora of the liver at the change, and when we bear in mind that the liver, intestines, and repro- ductive organs are covered by ganglionic nerves ; that the womb and all the viscera are supplied by nerves from the cord ; that the veins of the liver, uterus, and rectum are identical and con- tinuous ; it is not surprising that when the uterine discharge is arrested, that the nervous energy and sanguineous current should flow by the intestinal surface, and gives us bleeding piles. The swollen gums, dyspepsia, diarrhea, constipation, spitting of blood are generally periodic. A permanently enlarged abdomen is very common at the change, and is accounted for in two ways: (i.) by the increased deposit of fat in the omentum and in the abdominal walls ; (2.) to some extent, by an enlarged, inflated state of the bowels, without either diarrhea or constipation being present. The Skill gives decided, infallible indications of the change in every woman ; it loses its softness, its elasticity, its fulness, and 214 DISEASE GERMS. shrinks, and becomes withered and wrinkled ; then there are the heats, the sweats, the local burnings in hands, feet, legs, painfully hot; aching in the finger-ilails, just as if they were being pried off, a peeling, a rotting of the nails. Besides these, there are various eruptions often present on the skin, as nettle-rash, ery- sipelas, eczema, blood-spots, tetter, prurigo ; swelling of face and legs, either monthly or all the time ; varicose veins ; ulcers on leg ; boils everywhere, but especially about the seat ; abscess in the fingers, armpits, neck, groin ; sensation of insects in skin are very common ; peculiar exhalations from the skin are not un- common ; chronic rheumatism and gout, enlargement of the heart, chronic peritonitis, dropsy, are common at the change ; ulcers, goitre, discharges from the ears, nose, mouth, and nip- ples are very often present; swollen gums^ sore mouth, saliva- tion, periostitis of the small bones, and other chronic affections more rare. There is a long list of other symptoms : the long-continued, persistent debility, with regular monthly pain in ovary or womb, with laughing and crying fits, and intense burnings, to which so little attention is paid ; the irritable rectum, with tenesmus ; habitual oozing of mucus, or pus, or blood, is too often not at- tended to. The most common cause of delay of change, and consequently, prolongation of symptoms, is to be found in congestion and en- largement of the body of the womb, and this uterine enlargement, which delays cessation, is generally the result of sexual excesses, or frequent abortions. This very state, irrespective of hysteria, may give rise to spurious pregnancy at the change. If the patient is free from disease, and has led a temperate life, the rule, " like puberty, like change," will hold good, not other- wise. The change is greatly modified by temperament, by constitu- tional peculiarities or eccentricities, social position ; and. these modify all symptoms, from the debility and heats, to the pricking sensations in feet, numbness of extremities, trembling of the limbs. Some imagine that the unmarried are more liable to flooding, cancer, ovarian tumors, at the change, but this is not true ; the single pass over this critical time with much less trouble than the married, and suffer less. Women of loose habits, given to promiscuous sexual indulgence, prostitutes, those who resort to abortions, suffer immensely — words are inadequate to describe their sufferings. Such states keep up more or less inflammation through life, and predispose to much trouble at .the change. Marrying late in life is also bad ; those sexual states maintain congestion of the sexual organs, and are eminently calculated to BACTERICIDES. 215 aggravate all the symptoms enumerated, as congestion and ul- ceration of the womb, if it exist. Terminations. — Change of life in woman, at whatever age it occurs, is a final settlement, and exercises its sanative influence on the rest of her life. When it is effected, her mind emerges from a cloud, in which it has for some years been lost. All ladies, while avoiding causes that would be likely to give rise to conges- tion of the womb, should sustain their intellectual faculties well, read history, train their minds to take comfort from the fact that the period is past, which gives them an immunity from the perils of child-bearing, and the tedious annoyance of monthly restraint, thankful to have escaped real suffering. Women should not torture themselves into imaginary woes, but they should feel the ground steadier under them; they are now less dependent on others, and their mental faculties assume a more vigorous and masculme form. The change of life does not bring talent, but it imparts the power to bring out latent faculties that have been for years in abeyance. The subsidence of ovarian action depresses one form of love, — those emotional impulses which give passion energy ; but at last, when the heart becomes capable of listening to reason, love still rules paramount in the breast of woman, and whether it is called charity, friendship, affection, conjugal or maternal, it is still there. Sound religious ideas often becoitie engrafted, and take a sure hold, covering the evening of life with unanticipated happiness. When once over, and anchored in this new haven, a woman looks back on the time when her health was disturbed by ever- recurring monthly trouble, and her mind distressed by de- lusion and passion. The importance to a woman of the change is great ; she is healthier, lives longer, less risks to life, becomes stronger, and enjoys a great freedom from disease. It is said that a woman at the change loses all her personal attractions ; but this is not so. The beauty of childhood appeals for a fostering care ; the beauty of youth fascinates ; that of mature age excites ad- miration ; but in most women, after the change, there is an autumnal majesty, so blended with amiability, that it charms all who approach within its magic circle. Her sphere is wider, her social influence greater, her field of usefulness extended, and now is her time for intellectual pursuits and efforts. The cultivation of the mind, and its endowment with scientific lore, usurp the place of faded charms. Now woman becomes the guide, the mainstay, the pillar of strength to man in the difficulties and struggles of life ; 'she harmonizes society, unites its discordant elements, and stimulates the race to great, noble, and laudable ambition. 2i6 DISEASE GERMS. Time may dull the eye, rob the cheek of its bloom, indent far- rows on the brow, but it cannot smother the seraphic fire burning in the hearts of women, prompting them to console, . heal the deep and ever-festering wounds that afflict society. Those who have attained their sunset without havinj^ been granted the anxious thougrh desirable vicissitudes of wedded life, destitute of relatives and friends, may find in the philanthropic efforts of allevi- ating suffering humanity a grateful channel for their affection. Some women at the change are perfectly unstrung, unnerved, find themselves solitary and alone in the world, bereft of the sympathy of friends. Travel, occupation, history, religious duties capable of engaging her attention, should be inculcated. The continued friction of sound duties restores peace and harmony, prevents brooding, self-absorption. Isolation causes everything to lose its natural and real appear- ance and to shine with morbid tints, and should be sedulously avoided. Social Position. — The position in life exercises a special influ- ence at the change of life. Women who live in a natural way, keep regular hours, avoid reading trashy or fictitious literature, exercise moderately, do not tight lace, and keep their health good, suffer comparatively little, except it be from the flushes and minor symptoms. Women in moderate circumstances get along the best ; they are much freer from the symptoms than the spoiled and petulant daughters of the wealthy lords of civilization. The necessity for working hard, the struggle, the anxieties of poverty, the impossibility of escaping these, in our abnormal condition of society, together with insufficient food, insanitary states, increase the sufferings of the poor at the change. Certain occupations have a good or bad effect : thus, sewing- machine operators and washerwomen suffer most; the movement of the leg, in the one, keeps up ovarian irritation ; in the other, the changes of temperature to which they are exposed are highly deleterious. The close, damp, heated rooms in which mill-opera- tives, book-folders, catgut-workers, etc., work, increase their suf- ferings at the change. Hard work has its merits, it cures the nervous affections which assail the rich at this period of life ; for luxury, ease, lounging on sofas, in shut-up rooms, is the hot-bed of nervous affections ; there they grow in profusion and run into extravagant eccentricities. Few ladies are compelled to work in a heated atmosphere so injurious as the heated ball-rooms of the aristocrat. We would say to the rich and poor alike, that the best way to approach the change, is to get right down to a natural base in all things, and thus approach the critical period with a sound constitution. A condition of debilitv, which is the result BACTERICIDES. 217 •of all excess, prevents the regular succession of vital phenomena, hy v^hich the critical period is carried out ; and as the change is marked by debility, when this is grafted on constitutional weak- ness, loss of power, ill health will be of long continuance with a train of nervous disorders. With those states of urgent debility present, there is not stamina enough left to carry them through the changes successfully. All constitutional affections, all forms of diseased blood, are increased by the change. Prognosis. — Menstruation is a useful guide for the changes ; as it is ushered in, so the change ; storms at puberty will realize a stormy change. Diseases that preceded menstruation are likely to attend the change. Skin affections, as eruptions of all kinds ; hysteria, epilepsy, bleeding at nose, discharges from the ear, boils, diarrhea; erratic pains before puberty, same condition before change ; faintings, want of strength, precede the succession of vital phenomena and are likely to re-appear. Puberty does not always bring health ; there may be a lack of development, which may produce conditions that incapacitate for exertion; her mental faculties may be lost in dreamy forget- fulness ; nervous irritability may give rise to fretfulness of temper, waywardness of disposition, mischievousness. The conduct of some girls at puberty ofcen betrays a dereliction of all principle. There may be some jar or want of harmony between the action of the reproductive organs and the nervous system, so that the flow may come on on the fifteenth or twenty-first, instead of the twenty-eighth; same troubles at change. Sisters are a fac-simile of each other as a rule ; observe the same date, have the same peculiarities, same crisis, same com- plaints ; as biliousness, headaches, mental condition, everything the same at puberty; same at change. The plethoric and sanguine suffer most; very much more than the bihous and nervous, and chiefly from flooding and heats, and have a hard road to travel. A girl at ten, without any sign of cerebral or gastric disease, may manifest either a sleeplessness, or drowsiness, the result of the premature action of the ovaries on "the nervous system ; the precocity of the ovaries are very pro- ductive of nerve affections several years before menstruation takes place. Great irregularities and suffering at any period are warn- ing symptoms of a change at any age. If the ovaries work well and smoothly at puberty, and the patient lives naturally, follows physiological laws, the change will be unembarrassing, irre- spective of age. It must ever be borne in mind that it is only the minority of women who suffer those innumerable difficulties and obstacles at the change; the large proportion pass the ordeal with little or no suffering. Well-regulated habits, healthy ex- 2i8 - DISEASE GERMS. ercise, good moral and religious surroundings, and avoidance of tight lacing, of balls, late hours, unhealthy society and literature. Women, from want of instruction suffer much ; they are ignorant of what should occur, or form exaggerated notions of the perils that await them, and receive no help from their medical attendant,, because he is ignorant of their suffering. Let it, therefore, be clearly understood, that, if in tolerable health, and with ordinary care, they have only blessings to expect from the change of life. We say that the critical period is very dangerous to the tight-lacer, the dime novel reader, to the ailing, to the dancer, to the lazy, to the habitual sufferer at the menstrual period, to those suffering from uteriae disease, to epicures, for ices, improper food, sitting on door-steps, sewing- machine operators, and sexual excesses. Very great difficulties are likely to arise from marriages at the change, especially if for the first time. Such a state at the change causes the womb to become congested, and it increases in size four or five times. If" marriage is desirable, postpone it, hold it off till after the change has been consummated. Diagnosis. — Have we the means of foretelling the change, and recognizing it when completed ? Assuredly we have. The change can be predicted after forty, if there is a gradual diminution m the quantity of the menstrual flow, a gradual prolongation of the inter-menstrual periods, an occasional flooding, with heats and other symptoms ; but the grand landmarks are not this gradual cessation, or at once, but in the organic changes that take place.. The uterine wave disappears ; the ovaries are shrivelled, withered, crumpled up in a peach-stone shape ; obliteration of fallopian tubes ; atrophy of the womb, becomes round, its neck grows shorter, and thinner, and disappears; vagina becomes narrow and short ; coldness of the parts, from a shrivelling up of the pampi- niform plexus ; atrophy of the breasts; hairs on the upper lip, with vertical creases; stray hairs on the face and chin; and a. peculiar, masculine physiognomy. There is a prevailing, all- pervading debility, which cannot be accounted for by disease ; the complexion is pale, or sallow, a drowsy look, a sort of stupid astonishment, as of one seeking to raise herself to answer a question ; always some irritation of the brain, which shows itself in a knitting of the brows : the disappearance of the menstrual flow, or its irregularity, or scantiness, or its too great abundance. Cessation is to be looked upon as positive, whatever be the age, when the above conditions .are present, unless accounted for by nursing, pregnancy, or uterine disease. At forty-five it is a settled fact ; but, in order to complete the diagnosis, it is well to add, the debility, the unusual heats, the sweats, the appearance of BACTERICIDES. 219 discharge dirty brown, its total disappearance, and the other symptoms already enumerated. The sanp-uine or olethoric exhibit unmistakable indications of O J. a great aggravation of all the leading symptoms ; whereas, the nervous, with their white faces, ever-anxious, nervous look, suffer least. Cessation should never be mistaken for chlorosis, inflamma- tion of the womb, uterine polypi, uterine tumors, uterine cancer,, pregnancy, either spurious or real, or other eccentricities of the uterus. Some diseases induce early changes in a woman's nervous system, and render her barren or sterile, such as the cholera germ, typhoid germ, the germs of pernicious, malarial, or yellow fever, the germs of diphtheria ; under these the ovaries wither,, and change takes place. Blows on head and back, fright, etc., we have already alluded to, and they should be weighed in the diagnosis of some cases. Treatment. — As ladies approach the change, it behooves them to prepare for the crisis — to get rid of all little ailments or disease; to observe and carry out a special regimen, and, as far as possible, to so arrange themselves as to be ready for emergencies; eat the best of food, observe hygienic laws, and place themselves upon a course of alteratives and tonics, such as we will subsequently lay down. Those two kinds of remedies are specially useful at the change. Alteratives are particularly indicated, to aid the change, to rouse up all the glands, to relieve the system of all waste, or effete, or waste matter; and tonics, to aid in bracing up. In pre- scribing alteratives, it is necessary to guard against the prejudice, firmly rooted in the minds of many, that the change of life is synonymous with old age, which is not so ; for the very prime part of a woman's life is before her, and at the change all ladies are benefited by alteratives which are not suitable for advanced . years. Both at puberty and change, which are periods of a new birth, there is strong vital energy; it may be latent, but it is there, and the use of alteratives, which cleanses the blood, de- velops unexpected strength and great vigor, and is strictly in accordance with natural laws and the phenomena of the change. But before calling attention to those, we will lay down, briefly, the essential elements, in a dietetic, hygienic, and medicinal view, that should, as far as possible, be observed at the change in all cases, and then briefly allude to remedies for the predominant symptoms. Diet, — Women, at the change, should eat plain food, as milk, eggs, boiled white-fish, broiled beef-steak or chops, chicken, game, bread, butter, oatmeal porridge and cream, vegetables of all 2 20 DISEASE GERMS. kinds, and an abundmc^ of rips fruit; the latter to be used freely, and to an extent not interfering with digestion. All farinaceous, or starchy food, or sweets, as puddings, tapioca, rice, pies, cakes, pastry, tend to load the system with carbon, and thus generate heat ; prolong sleep ; cause distaste for exercise, and a tendency to stoutness. Forbid, in all cases, the use of sugar, tea, spices, pepper; all stimulants, together with shellfish, salted fish, or bacon, ham, corned-beef; malt and alcoholic stimulants. Coffee to be used with moderation. Women who have a tendency to become stout, require less food and more exercise than the lean. If there is great languor, weakness, nervousness, the diet should be made very generous, and the tonics increased. With the above diet, women will tide over the change well and have no further unsettlement of health to bear. If, however, women go in for eating heavy meals, stimu- lants, and excess, they will become like men, and have another change to meet after sixty-five. High living and stimulants at the change, give rise to early degeneration, which begins first in the capillaries, and steadily progresses to the larger vessels ; then to the heart, spleen, liver, kidneys ; and this degeneration is characterized by an increase of fat ; a non-vital substance in the omentum, in the abdominal walls ; and, as a result, the belly be- comes large, protuberant, pendulous. Clothing and Bathing. — Whatever the season of the year may be, or locality, or condition in life, flannel should be worn next the skin, at all times, to protect the surface from changes, to ab- sorb perspiration, so as to prevent being chilled. Bathing the entire surface daily cannot be omitted, as it is a great safeguard ; its neglect gives rise to great suffering. We might say it is im- perative, for the skin is heavily loaded with waste matter. Warm baths are the best, as they remove from the skin copious saline deposits, and other secretions left there by the heats, or the per- spirations ; besides, being in a warm bath for three-quarters of an hour enables the skin to absorb moisture or water, which allays the cutaneous irritation and dilutes the blood. The warm alka- line bath is like a gigantic poultice, applying its warmth to all the peripheral expansion of nerves, so that it becomes a splendid sedative of nervous irritability. It is perfectly manageable in all cases ; temperature increased or lowered at pleasure ; and even while in the warm bath cold can be applied to the head, or a cold shower bath to the abdomen ; or by a long-tubed syringe cold water can be thrown up the vagina or rectum to relieve uterine con- gestion. The alcoholic vapor-bath about twice a week ; on other days the hot, or warm bath for over half an hour, followed by brisk friction, is always of utility, and, and in some cases, it is well to follow up with massage. BACTERICIDES. 22 r In a small number of cases cold bathing is useful, provided there is vitality enough for reaction. The mineral water baths, whether of the sulphurous or alkaline kind, are always of the most efficacious character. Sea- water is not of so much benefit unless warm. Exercise of the muscular system relieves the congestion of the internal organs ; it depletes, causes the skin to 'perspire, the kidneys to work acpvely and eliminate uric acid freely ; it rouses the liver to action. It should be taken in the mornings ; should be moderate, not continued to exhaustion ; long walks are objec- tionable, it should just be enough to carry off the redundant energy, which, when unemployed, or not wrought off, gives rise to fidgets, nervousness, temper. Driving is excellent; but horse- back exercise should never be indulged in at this period. Change is most beneficial in all things. There is nothing that conduces so much to mental and physical vigor as change. It is a great strengthener of the nervous system in particular. Travelling places the patient in a new sphere ; new scenes ; new ideas, every one of which makes a call on her attention, solicits her interest, captivates her faculties, completely leads her away into new fields of thought ; away from old habits and asso- ciations to which she. had been long and painfully chained. Change has a most salutary effect on the brain ; under it the mind is consoled, and resumes peace and tranquillity. Nothing so vitalizing ; nothing so serviceable for the cure and prevention of disease at this critical period. Fresh air is indispensable here ; there must be an avoidance of close rooms, badly ventilated apartments, insanitary surround- ings ; the bedroom windows open at top and bottom. Amusements. — The ordinary cares of the household are at this period a burden ; there should be, if possible, a general easing- up, a lay-off, or rest. The mind could be occupied with reading history, because exciting stories, which are present in novels, induce nervousness of some shade or type ; besides, excitement is injurious. For this reason, balls, parties, concerts, operas, theatres, are excitants, and the impure air breathed in those places, in addition to their moral effect, causes them to shock the impressible, susceptible nervous system, and renders the patient sleepless and irritable. All exciting agents are deleterious, being productive of continued irritation and want of sleep, and it must ever be borne in mind that continued sleeplessness is the precursor of insanity. Night after night at theatres habitually subjects the mind to an increased intensity of feeling, which in the silence, solitude, and darkness of the night that follows,, destroys its sensibility, and eradicates its typical fissures. All amusements should be of the most stable and healthy kind. 222 DISEASE GERMS. Hygiene of the Reproductive Organs. — This is a most import- ant consideration at the change, when those organs become atro- phied and shrivelled up. Nature emphatically points, by this very condition, that their appropriate stimulus should be avoided, and it is neither wise to marry nor to have congress at this unsettled period of life. Connection at the change brings about uterine disorders and grave complications. Some assert that the sexual appetite is strongest at the change ; that the flickering flame of sexual desire gives rise to a final blaze ; that there is increased ardency. This no doubt occurs once in a while, but it is rare ; the opposite condition is the natural one, merely a distaste for connection at that period. A marked in- crease of sexual impulse or ardency at the change is a morbid desire, depending on a condition of congestion of the ovaries, spinal cord, or brain. The sexual act aggravates the trouble, and leads to serious complications. No woman should marry at that crisis ; defer it till it is over ; because if performed it will result in flooding, uterine disease, the development of uterine cancer, etc. Having regulated the general condition of the patient, she should be placed upon a general alterative and tonic course of remedies for at least five or six years ; she does not want many remedies, only a few, but they should be good ones ; but in all cases she should persevere with them faithfully, changing them at regular intervals of every seven days ; and with those breaks the same remedies can be resumed again and again with great efficacy. The best alteratives at this period are the saxifraga ozonized compound, the mother's cordial, the wine of aleteris farinosa, and the ozonized phytolacca. Select two out of the above list and give in the usual dose about two hours after meals, and change weekly. If the patient is in very straightened circum- stances, so that she is unable to procure those invaluable aUer- atives, let her do the next best thing, make infusions of blue flag, tag alder, yellow dock, and take them instead, so as to aid the elimination of waste-matter from the body. The best tonics at the change are the Peruvian bark, white mustard seed, the glycerite of ozone, kurchicine, golden seal, eentian, etc. Of these the Peruvian bark and white mustard seed are the most efficacious ; the crude bark is better than its finer preparations : one ounce of the bark to one pint of good port wine, to which add one ounce of elixir of vitriol ; allow the whole to settle. Dose, one tablespoonful three times a day one hour before meals. In some cases leave the elixir of vitriol out, then it can be given in wineglassfuls three times a day before meals. BACTERICIDES. 223 The compound tincture cinchona and mineral acids is excellent At all events, don't deceive the patient by worthless and ineffi- cient preparations of the bark, nor delude her with tasteless in- finitesimal sugar globules. There is a gigantic, a grave change to be aided, shattered vital force to be restored, and it must be effected on the principles of common sense. Next in efficacy, as a tonic, is the peroxide of hydrogen. This is one of the valuable remedies at the change. It is particularly useful to meet the symptoms of debility in a worn-out constitu- tion ; invaluable if there be indigestion, or liver trouble, with heartburn, pain or cramp, or a numbness, or a failure to sleep, nerve-tire, prostration. The cinchona stimulates the brain; favors the making of red blood, and is slightly astringent ; whereas the peroxide of hydrogen operates in a most extraor- dinary manner in disorders of the organs of digestion and assimi- lation ; on the stomach and liver especially ; stimulates the gan- glionic nerves lying over the womb and ovaries ; corrects all irregularities, and improves the general health. It is a valuable tonic, stimulant and aperient ; strengthens all the organs in the abdomen ; imparts activity. The efficacy of the peroxide of hydrogen does not depend on any specific power, but from the vitalizing energy which it imparts. There is no better remedy at the change — not one that can excel it. It relieves that indescribable feeling of debility and languor ; overcomes drowsiness ; soothes the irritable ; strengthens ; invigorates ; increases assimilation one hundred per cent., and aids the vital forces under the terrible prostration, enabling them to hold their own by its effect on the nervous system. To ladies who need constant help it affords great relief; inestimable benefit. It should be taken one hour before meals, three times a day, in 10 to 20 drop doses, always exercising care not to give an overdose. It never fails to afford great amelioration. Its gentle action on the bowels is very salu- tary, as it is always important that bowels and skin should be stimulated. One or two teaspoonfuls of the aleteris farinosa wine should be administered every three hours for five days out of every seven, then on those two days, she should take the comp. syr. partridge berry. Those two remedies should be taken steady for a period of four years, embracing, some time before, during and after that period. The aleteris is a powerful uterine tonic and restorative of the greatest efficacy, in tiding ladies over this, the critical point of Hfe. The glycerite of ozone operates well in all cases, and combines the action of both tonic and alterative. The extract of kurchicine is also a very valuable tonic. Infu- sions of golden seal, gentian, collinsonia, wine bitters are good tonics, but not of much utility at the change. Next to the 224 DISEASE GERMS. Peruvian bark and white mustard seed may be placed the kurchi- cine. All tonics are best given one hour before meals. In or- dinary cases the above simple alteratives and tonics are all that the great proportion of cases require, and can be readily carried out by the patient herself. But in addition to these there are often met a train of symp- toms some of which are present, and require special remedies and management. To these we will now solicit attention. Nervous Debility. — This debility at the change is peculiar ; sometimes it depends on an excess of blood, and in other cases upon too little blood. If it depends on an excess, for which there is no drain, it is a good plan on the first appearance of irregular- ities which characterize this period, to curtail rather than augment food. Debility, when in the family way, or nursing, is benefited and often overcome by a very liberal and generous diet ; but at the change this surplus blood cannot be utilized. In some cases it is advisable to establish a drain by applying two small blisters^ about two inches square, on each side of the nape of the neck for six hours, every second or third day, so as to keep up a slight discharge. These off and on periodic blisters to the nape of the neck are of great utility when disease-germs are suspected to exist in the blood. In debility, Vv'ith anaemia or poor blood, these must be more and better food, with rest, and a free use of the tonics already laid down. It is almost useless to experiment with others. Preparations of phosphorus, although very strengthening, im- parting keenness and vivacity to the mind, are contra-indicated,, because they predispose to fatty degeneration of tissue; of the heart, liver, spleen, kidneys. The same objection is to be urged against malt and spirituous liquors. Iron is not a good tonic at the change, as it increases the heats by retarding the action of the liver. If it is tried, the acetated tincture is to be pre- ferred. Flushes of Heat. — The skin at the change suffers from flushes,, heats, sweats, eruptions. They all pass off, as a rule, after the change. The flushes are the most tenacious, often holding on for years. Prurigo, itching, and eczema are the most trouble- some, and are blended with the hot flushes ; have their origin in the latter. In the treatment of them, it should be borne in mind that they are increased by emotion, nerve-shock, external heat, as in cooking, washing, ironing-, baking, hot rooms, hot drinks, over-feeding. In arresting diarrhea, leucorrhcea, flooding, over- clothing, all these, as far as possible, should be avoided ; the Peruvian bark mixture, the white mustard seed, are to be in- creased in dose ; the bowels to be kept rather open, and the usual BACTERICIDES. 225 daily warm baths scrupulously carried out. Various local appli- cations, "cooling," should be applied, as bay-rum and borax, borax water, and the face, cheeks, neck, breasts, or other parts can be dusted occasionally with puff powders, which are very cooling, and contain no deleterious agent. In some cases the flushes are preceded by a chilly sensation, or coldness ; some even tremble with cold before the heats come on ; others have associated with it aching in the nails. When sweats follow, it denotes great debility and congestion of internal organs. Sometimes the flushes are anomalous, preceded by strange sensa- tions in the skin, which in numerous cases resemble a beating, like an animal throbbing in the stomach, or the fluttering of a bird, sensations that disappear when the perspiration comes. Some women are living furnaces, and insist upon the doors and windows being left open in winter time, and woe betide delicate women compelled to live with them. In such cases good results follow the use of salines in alterna- tion with preparations of sulphur, as the tincture, in twenty or sixty-drop doses three times a day ; or glycerite of sulphur, or sulphur and cream of tartar; or sulphur, fine flour-sugar, and white resin. In other cases infusions of sassafras or yellow dock are of efficacy. Sweats.— These are simply evidences of great brain prostration, sweat running off the forehead or the entire body, obliging the patient to change linen several times a day, and when in bed liter- ally soaking the bedclothes. To a certain extent sweats are beneficial, they clear the body of superfluous material ; but when they are excessive they hinder the insensible perspiration — that exhalation so necessary to health. Besides, when they are excessive they denote a passive permea- bility of the skin, caused by a loss of nerve power. It is not well to check them entirely, as such a proceeding will cause internal congestion. Try such simple remedies as aromatic sulphuric acid and quinine, tincture of sulphur, or in some case a tea of pleurisy root. Leucorr/icea. — This should not be stopped, although it is well to syringe out the vagina three times daily with infusions of white pond-lily, or witch-hazel, or strawberry leaves, and if there is any itching or burning, boroglyceride should be added. As a general rule, the injection should be tepid or cold. All these remedies failing, occasionally packing the vagina with boroglyceride is of immense utility. Hemorrhages from nose, mouth, ears, nipple, navel, ulcers, vagina, are common. If they are not excessive, mitigate them, 15 2 26 DISEASE GERMS. but do not check altogether, as they are often salutary. The regular treatment by alteratives and tonics should be adhered to, but if they are violent or excessive try ergot, gallic acid, and port wine, digitalis, or the alcohol, turpentine, and sulphuric acid mix- ture. At the same time, if from the vagina, enjoin rest in the recumbent posture, head low, foot of bed elevated, cold drinks or ice in mouth, small sponges, saturated with vinegar, inserted up vagina, and changed every three hours. Great care and good judg- ment should be exercised in its arrest. Headaches are often promptly relieved by guarana, four tea- spoonfuls of the fluid extract every few minutes, or two or three grains of caffeine, or, that failing, a four-drop capsule or pearl of nitrate of amyl inhaled ; these failing, treat it under the following- head : Sleeplessness, Giddiness, Drowsiness, with Headache, or Cerebral Neuralgia, — In those depressing states, hyoscyamus is of great utility ; repeat till it affords relief. Hyoscyamus suits the nervous disturbance of the change in a most excellent manner. The dose and its frequency of administration will depend on the condition. When the pain is very great try either croton chloral, bromo-caf- feine, or guarana If these fail, then bromide of potassa and brom- ide of ammonium are of utility, either alone or combined with chloral hydrate, as follows: Take one ounce of camphor-water, three drachms of bromide of potassa, one drachm of bromide of ammonium, and two drachms of chloral hydrate. Mix. Dose, one teaspoonful every two or three hours till relief is obtained. But if that fail, and nothing will allay the intolerable pain and giddiness, which render existence unbearable, give morphia suf- ficient for the purpose rather than let the patient suffer. Sleep- lessness, with cerebral neuralgia, at the change, often resists our best remedies, and it is necessary to tack around considerably, and only in the event of all remedies failing should the morphia be given, as at no period of life is a habit so easily acquired as at the change, so that with alcohol and opium we should exercise great care. Camphor is a valuable remedy in those cases; it stimulates the nervous system to increased action ; it corrects the toxic influence which the reproductive organs have upon the brain of some women ; it abates the sexual sting by acting on the cerebro-spinal nerves of the internal organs of generation, not on the ovary or testicle. Large doses of camphor to child-bearing women do not prevent conception, like bromide of potass, nor induce impotence, but simply appeases the excitement of the generative organs at the change. It may be given alone, or with lupuline from the hops. Sambul or musk- root, tincture of green root of gelsemium, operate beneficially. The inhalation of the BACTERICIDES. 227 nitrate of amyl moderates cerebral irritability ; sulphonal or ure- than both extremely efficacious. Topical applications to the head are often of great value ; as, for instance, take two pints of water, to which add two ounces of liquor ammonia, one ounce of spirits of camphor ; mix, and apply to the head for fifteen or thirty minutes, or longer, and then remove and apply vaseline ointment. Or, another good remedy is to take two ounces of olive oil, the same of chloroform, and half an ounce of menthol; mix, and rub into the painful part. The irritability of the brain at the change is caused by and aggravated with ovarian disturb- ance, and it is a good plan to use both rectal and vaginal sup- positories of belladonna and opium. Veratrum viride, and aconite or antipyrine may be given with benefit if there is plethora. The same characteristic symptoms, as headache, giddinesss, drowsiness, are present at puberty, and at that period bromide of potass is inadmissible, and never should be given. During the change the brain is often unhinged, so that cata- lepsy, epilepsy, melancholia, hypochondriasis, insanity, apathy are present, for the management of which see those different heads. Clever women often lose confidence in themselves at the chancfe. and are unable to manage their own affairs, and their moral treat- ment, for a few years, requires great care. The disturbance of this crisis tells heavily upon her. Very frequently her mode of dealing with everyday occurrences of life betrays a want of prin- ciple, strongly contrasting with her previous rectitude, and a return to that untruthfulness that may have existed at puberty. There may also exist every idiosyncrasy — peevishness, irritability, ill-temper, ingratitude, passion, eccentricity. It is no uncommon thing for a high toned Christian lady all through life up to the change to desert her husband and children for a scamp, while others make life intolerable by their tyranny and hate the long- cherished object of their affections. Some become moody, silent, gloomy ; neither loving nor hating. Others again, in the midst of wealth talk poverty and indulge in a propensity to steal, while another class feel like committing grave crimes. The nervous system is unhinged, still it will pass away and must not be re- garded and treated as insanity, for all the strangeness of temper, the fitfulness of spirits, the perversion of character will abate and disappear under proper care. But the patient requires judicious care, removal from home excitement, new scenes, the intelligent sympathy of friends, and the support of strong minds. The most amiable at this time become annoyed with trifles, and are often passionate, quarrelsome, fretful, by the slightest worry or excite- ment. Derangements of the stomach and liver are very common. 228 DISEASE GERMS. This disturbance shows itsejf in every imaginable form of dys- pepsia and biliousness ; the kidneys also suffer. The general treatment as laid down for those affections should be carried out, and nitro-muriatic acid and phosphate of soda given. Diuretics are very valuable and deserve attention. Diarrhea is salutary and must not be hastily checked. Some- times useful to encourage by giving small doses of either of the following mixtures, say about ten or twenty grains thrice daily : sulphur, one ounce ; calcined magnesia, half an ounce ; mix ; or equal parts of borax and sulphur. In some cases of diarrhea great benefit accrues from the use of the liquor ammonia acetatis in teaspoonful doses as above. A most painful affection, caused by violent contrac- Colic. tion of the muscular fibres of some portion of the in- testinal tract, generally near the umbilicus, occurring in paroxysms. Pain almost invariably relieved by pressure, never aggravated by it ; there may be vomiting, and generally constipa- tion ; an entire absence of either fever or inflammation. During its occurrence pulse is lowered ; surface of the body cold ; face white and anxious. There are numerous varieties, as microbial, bilious, nervous, brass, lead, tin and other mineral varieties. Microbial Colic, formerly known as flatulent, due to the pres- ence of bacteria, the degraded bioplasm of mal-nutrition, induced by excess, indigestion, perverted nutrition, improper or deleteri- ous articles of diet, the delicate nerves of the intestine are affected toxically by the ptomaines of the microbe. Best relieved by the administration of an active germicide ; if an adult, a teaspoonful of either eucalyptol, or kurchicine, or Warburg's tincture ; if a child, some aromatic, as menthol ; con- centrated ozone ; peroxide of hydrogen ; resorcin, etc. These means failing, an emetic of lobelia combined with bicarbonate soda, copious draughts of tepid water. Bilious Colic. — The irritation of acid or acrid bile, or other morbid secretions, often irritates the nerves of the bowels, and causes contraction of the muscular coats. In those cases there are usually the dulness, the brown coat on tongue, the yellow tinge on the white of the eye, fetor of breath, etc. This is best relieved by the administration of small doses of the anti-spasmodic tincture, or a warm infusion of the wild yam or dioscorea, followed up with the compound licorice powder, or neutralizing mixture, with leptandra, oil of peppermint and anise. BACTERICIDES. 229 or with more active remedies to stimulate the Hver, as phosphate of soda or nitro-muriatic acid. Nervous Colic comes on from fright, cold, hysteria, gout, rheu- matism, or from irritation of adjacent organs, as the bladder, uterus, or morbid conditions of the alimentary canal. This must be promptly relieved by the administration of chlo- roform in sweetened water internally, or belladonna or anti- spasmodic tincture, phosphate of quinine, colchicum, and the cause removed. Tin Colic. — This form of mineral colic has become very com- mon since the introduction of canned vegetables, fruit, beef, fish ; and also caused by cooking soup in tin culinary vessels on petro- leum cook stoves. Relieve the pain and spasm by the usual means, and put pa- tient on the iodide of potassa and carbonate of ammonia. Copper Colic. — A most severe form of twisting or griping ; comes on suddenly ; pain is intense ; nausea, vomiting ; bowels generally loose. The countenance is anxious, of a peculiar sal- low hue ; eyes sunken and lips livid ; a purple line around gums. Common among copper-plate printers, brass founders, and from copper cooking vessels. Treatment same as lead colic. Bismuth Colic. — Bismuth introduced into the stomach blunts the sensibility of the gastric nerves, but when extensively used, as it often is by ladies in face powders and cosmetics, gives rise to colic, with a peculiar bluish, shrivelled, or wrinkled appearance of the skin, and after death, the duodenum is black with the debris of the metal. Same treatment as lead colic. Lead Colic. — Due to the absorption of lead ; hence, it is com- mon among operatives in lead works, oil-cloth factories, painters, plumbers ; drinking from lead pipes, soda water from lead taps, snuff adulterated with lead, claret drinkers, as sugar of lead is often added to wines to render them cooling ; and wine casks absorb the lead, and if ever used for carrying water in ship, they re-impregnate the water, and the sailors, or those drinking the water, become affected. Lead, whether inhaled by the skin or b-onchial mucous membrane, or absorbed by the glands of the mouth, or swallowed in water or food, or breathed from a newly painted room, diffuses itself through the body, but seems to spend the force of its poisonous effects on the fine, delicate nerves of the duodenum, giving rise to an irritation which speedily terminates in a spasm or contraction of the muscular coat of the bowel, so that it is usually ushered in by a grinding or twisting near the umbilicus, with retraction of the abdominal muscles to the spine, and pain in the back, vomiting, constipation, metallic aspect of countenance, a blue or slate-gray line round edges of the gums, with general languor and debility. 230 DISEASE GERMS. Treatment. — To prevent absorption of this metal, workmen employed in or about it should exercise great care, resorting to daily baths, wear flannel clothing, keep bowels regular, eat the most nutritious diet and spend a good portion of time in open air. Aromatic sulphuric acid, fifteen drops thrice daily in water, pre- vents absorption, and is undoubtedly the best prophylactic. Alum is not a preventive, but, if given after the lead is in the fluids and solids of the body, it will unite with the metal and form an inno- cent sulphate. Although alum has this remarkable chemical property of changing the lead, it does not prevent its ingress into the body, like the aromatic sulphuric acid. In suffering from an attack, the first thing to be done is to relax the spasm and relieve the patient from pain. The compound lobelia, with capsicum and valerian, should be administered by mouth and rectum in small doses, often repeated, so as not to excite emesis ; and if the spasm does not yield, administer thirty drops of chloroform with it for several times. Relieve pain by hypodermic injection of morphia. As soon as the spasm is relaxed and a free motion of the bowels brought about by oil, begin with iodide of potassa. This drug unites with the lead, sets it free, and also eliminates it by the skin, kidneys and bowels. The dose of the iodide should not be less than five grains, three times daily ; but it is often beneficial to give it in ten-grain doses, and combine it with either bicarbonate of potassa or carbonate of ammonia ; the whole to be given in syrup of stillingia compound. While pursuing this treatment with iodide, an everyday bath of the sulphuret of po- tassium. This should be done in a wooden bath-tub, with tepid water enough to cover the body, to which one pound of carbon- ate of soda and sulphuret of potassium should be added. The patient should remain in bath not less than half an hour, even a little longer. The diet should, while pursuing this treatment, be generous to a fault. Shock, prostration, extremely great depression Collapse, of the vital forces, such as may follow any acci- dent, injury, concussion ; inhalation or absorption of any poison ; or even from some depressing passion. The symptoms are very variable, most commonly, however, we find the patient lying on the back, with a cold skin, feeble pulse, sighing respiration, half unconscious. If the force of the shock, or injury, or poison, has fallen upon the vascular system, there will be syncope or fainting, pulse and respiration imperceptible ; BACTERICIDES. 23 1 if upon the nervous system, patient bewildered, incoherent, vomiting, coma, convulsions, paralysis of sphincters. The duration of the stage of prostration is variable, depending on the power of vital resistance inherent in the patient and the amount of violence inflicted, or poison absorbed, or degradation of Hving matter, commonly from a few to forty-eight hours. The mode or manner of recovery from shock or collapse is termed reaction — everything depending on the nature, degree, or quality of that reaction. If, aided by proper means, it is perfect, we have recovery ; if in spite of our best efforts it is altogether wanting, we have death ; if it is imperfect, then it is followed by. fever, a salutary effort of vital force for recovery. The indications in treatment are to stimulate vital forces to healthy reaction. If the patient is cold, shivering, respiration and pulse feeble, diffusible stimulants should be administered, such as brandy and water, or capsicum, or some preparation of ammonia ; if incapable of swallowing, the same remedies should be administered by the rectum in an emulsion of slippery elm, and spirits of turpentine added. The patient should be bathed all over with ammonia and warm water, after which he should be well dried and rubbed with dry mustard. If no reaction is perceptible, dry cups or scorching hot pillows should be applied to both sides of the spine, and mustard plasters with heat to the feet. Rubbing the skin is of the greatest importance, as we thereby stimulate the periphery of nerves, which stimulus is carried to the brain. Artificial heat by means of bricks wrapped in flannel, or bottles of hot water, should be applied all around the patient's body, especially inside of arms and thighs. Stim- ulation must be persevered with, and other remedies, such as nitro-glycerine in drop doses, or quinine, resorted to, the object being to establish an equilibrium in the body, and the greatest care should be observed not to over-stimulate, as we thereby produce exhaustion with cerebral excitement. What is desired is perfect reaction, so that fever, the condition of imperfect reaction, may be obviated. Insensibility from various causes is worthy of the Coma, most earnest consideration. When an individual has been picked up on the road or street insensible, irrational, or inarticulate, and his ante- cedents unknown, what is the matter? Is he ill, drunk, drugged, or suffering from some brain concussion, or from coma after an epileptic fit, or otherwise ? Syncope, trance, catalepsy, coma, are names used by medical writers to designate states of insensibility, which the public call fits. 232 DISEASE GERMS. Syncope is fainting, a condition of the body in which there is a death-like pallor, with loss of muscular power and consciousness; a faint is usually transitory, due to shock. In it the person collapses, rather than falls to the ground ; his knees are bent under him, he subsides into the sitting posture, his head drops forward, and by the time his head has thus sunk to the level of the heart, or below it, the circulation of the brain becomes suffi- ciently restored for consciousness to return. In a faint, a person seldom bruises his face. Upon waking, he may feel sick, giddy, or alarmed, but his brain resumes its thinking functions at once, and entirely. Recumbent posture on right side, articles of dress loosened, dashing cold water on face and front of chest, cautious inhalation of ammonia, diffusible stimulants. Trance is a state of death-like faintness, in which some con- sciousness is retained, but inability to speak. In trance, the body appears inanimate, there is no power to move a muscle, the limbs are flexible ; he may hear, see, and remember all that goes on around him. There is no perceptible pulse or respiration ; hence trance has been, and often is, mistaken for death, as the temperature is lowered ; muscles re-act to galvanic stimulus. There should be no hurried burial alive, or post-mortem unless rigor mortis or signs of putrefaction be present. Treat same as Collapse — artificial heat, enemata of turpentine, cups to both sides of entire spine, over abdomen ; and as soon as he can swallow, diffusible stimulants. Catalepsy^ a rare inanimate condition ; insensible, stiff, unable to move, or articulate ; pulse slow, respirations diminished ; ex- tremities cold and flabby. He or she may be pinched, pricked, beat without flinching — statue-like, but perfect muteness. There is neither the lividity of asphyxia, nor the pallor and general flexibility of syncope, nor the stertor of coma, nor the paralysis of epilepsy, nor the movements and dreamy mental automatism of somnambulism. Treat same as neurasthenia. Coma^ or deep sleep, may be due to very many causes as pressure exercised upon the brain from effusion within the ventricles, and outside of the membranes ; to alteration in the molecular state of brain from concussion, contusion, apoplectic extravasation ; to brain-poisoning by insufficiently oxidized blood; to disease germs, to uraemic blood, narcotics, anesthetics, inebriants. It is impossible to give accurately positive landmarks for diagnosing each kind of coma. Profound Coma is present in serous effusion into the ventricles BACTERICIDES. 233 of the brain, such as arises from extensive burns, or from tuber- cular meningitis in later stages. Patient is first sleepy, then drowsy, then stupid, slow of comprehension, difficult to wake, and finally, incapable of being roused at all. The breathing is stertorous ; at first he can swallow, then he fails to do so ; pupils are not characteristic, most frequently contracted, and then dilated. Coma, due to fracture or effusion of blood, as in sanguineous apoplexy, is sudden in its advent. The breathing is stertorous, pupils contracted, heat may be normal, skin perspires freely. In fracture of the skull there is oozing of blood or serum from ear and nose; or there may be blueness, humidity, ecchymosis of the eye, neck. In apoplectic cases, face often turgid with blood. Coma, due to molecular death of a portion of the brain, the face is pale, heat lowered, pupils unequal, evidence of hemiplegia, or some form of paralysis. Coma, due to some brain-poisoning, as deficiency of oxygen in pneumonia; nitrous oxide gas; the nose, lips, neck, face, and other parts are livid, often black. If patient has breathed carbonic acid gas, say from a lime- kiln, or sulphuretted hydrogen from some source, those two gases arrest the oxygen- carrying properties of the blood, and this blood-change, or damage, is not recoverable from brain- poisoning ; and coma by anesthetics and inebriants is usually detectable by the breath of the comatose person. Apoplexy and dead-drunkenness are often mixed. In Brain- Poisoning try artificial respiration, abundance of fresh air, cloths out of boiling water over heart ; enemata, say one and a quarter pints of cold or warm water, with a table- spoonful of salt ; caps to nape of neck ; mustard to feet and hands ; free purgation, if he can swallow. Fever Cojna, due to the presence of disease germs, spores, and ptomaines in blood and brain, loxically affecting the functions of life. Easily recognized by the history of the case, and febrile state. It is an imperative call to push bactericides to destroy the factor of the fever. Urcemic Coma is recognized by cedema of eyelids, or extrem- ities ; wax-like pallor, uriniferous odor of breath and skin, furred tongue, pearly conjunctiva, dilated pupils. Try warm bath^ free purgation with salines, and hypodermic injections of pilocarpine. Coma of an epileptic fit is usually recognized by the bruises, torn or soiled clothes ; indications as if the tongue were bitten. Patient to be placed on right side, clothes loosened or re- 234 DISEASE GERMS. moved ; enemata of lobelia, capsicum, and valerian ; or hypo- dermic injection of one-fourth of a grain of sulphate of morphia, if over seventeen years of age ; dashing cold water on the patient, of little service. Alcoholic Coma. — Alcohol, a toxical agent, an arrester of gen- eral metamorphosis, has a special action upon the brain and liver. In large doses it produces insensibility, partial or com- plete. Symptoms vary according to the amount of poison imbibed. There may or may not be stertor ; slow or fre- quent pulse,- temperature lowered two or three degrees ; pupils contracted, more frequently dilated. The odor of the breath chloroform, chromatic spirits of ammonia or liquor ammonia acetatis is the best agent to clear the poisoned brain. Opium, Coma. — Profound stupor, closed eyelids, contracted pupils, upturned eyeballs, pale face, cool, clammy skin, forehead beaded with heavy perspiration, limbs lax; breathing slackens, reaching as low an ebb as six per minute; coma profound; no responsive movement to pricking, pinching, or other stimulation. The body will not walk, it is only dragged; lips become livid, surface colder, breathing, at long intervals, and pulse, nearly im- perceptible. This coma may be mistaken for effusion into the pons; so it is well, in all cases of profound coma, with contracted pupil, to exercise care, unless there be collateral evidence, as a laudanum or -morpiiine bottle about, or marks of a hypodermic syringe, lest the case be apoplexy into the pons — a kind of coma that is not benefited by bastinado, beating with wet towels or willow rods, walking about, or all the caffeine, or coffee pumped into the body. In all cases of effusions, fracture, apoplexy, ad- here to cups to nape of neck, stimulants to extremities, open bowels. (See Opium.) A formation of solid, unorganized masses Concretions, within the body, either by chemical prepara- tions from the fluids, or by the accidental aggregation of solids introduced from without; in the former case it is termed a calculus, in the latter concretion. A concretion may be wholly composed of solids foreign to the body, or there may be a mingling with the elements of secretion, as with mucus or calculous matter. Beans, peas, noodles, and other foreign bodies, introduced into the cavities of the body, often become the nuclei of concretions, by attracting around them mucus, or crystalline deposits. The most remarkable forms of concretions are those found in the stomach and intestines of man, from the more solid and indigestible parts of food or o{ substances improperly swallowed. BACTERICIDES. 235 Remarkable concretions are formed in the stomach and intes- tines of man and the lower animals, from the solid, undigested part of the food, or of substances imperfectly cooked and swallowed without proper mastication. The swallowing of hair, the use of raw oatmeal, the continual use of animal food, the use of carbonate of magnesia as a laxative, insoluble carbonate of iron, phosphate of lime, pulverized bone are apt, if continued steadily, to give rise to solid concretions, varying in size from a walnut up to that of an orange. They invariably give rise to pain, constipation and obstruction of the bowels, as they are pushed along. They are very apt to lodge above the sigmoid flexure, and thus give rise to backache, derangement of the kidneys and bladder, a wearied sensation or rather neurosis of the sacral nerves, numbness on the posterior part of the limbs, general prostration. The annexed wood-cut gives a beautiful illustration of one of those concretions that were passed from the bowels, under the influ- ence of copious enemata of warm glycerine into the lower bowel daily, patient in the recumbent posture, enemata passed by a long tube above the flexure. The localizing of disease germs in different parts of the body is extremely liable to give rise to concretions. The tubercular bacilli is the most prone to effect this, especially if the deposit is made in the brain, parotid, lungs, stomach, intes- tines, ovaries, testes, pancreas, spleen, female breast, etc. There is an irritation somewhere in a tubercular patient, effusion takes place, the bacilli aggregate together, form a round mass, which by-and-by becomes milky, then cheesy, and latterly calcareous — phosphate of lime ; that is, the tubercle takes on the form of degeneration and death. Section of an alvine or intestinal con- cretion formed in su cessive layers upon a ra.sin seed. A shock or concussion is usually caused by a Concussion, jar, blow, fall, or some mechanical injury ; and it may also be the result of some depressing passion. No part of the body, no organ or tissue is exempt from a concussion. Thus we have concussion of the brain, stomach, bowels, etc. Concussion of vital organs is much more common in our 236 DISEASE GERMS. highly civilized state, than is generally supposed. For example our improved means of railroad travel and electric lighting, are highly detrimental from the repeated jars and shocks produced thereby. The strain and struggle for existence are greater — the emotions, desires, affections are more intensified, and give rise to shock to vital organs. Certain drugs have a depressing, or jar- ring action, alcohol, opium, quinine, if in large doses, give rise to a cerebral shock — phosphorus, if large dose, irritates, jars the function of the stomach, etc. All concussions are spent upon the brain, whether the cause be direct or indirect. In the treatment of brain shock, or concussion, absolute, per- fect rest in the recumbent posture in bed, so as to enable the vital forces to rally. Sulphonal or hyoscyamus should be admin- istered in sufficient doses to procure sleep ; bowels opened, stimulants applied to the extremities, and if need be to the head. A skilled physician should be in immediate attendance, who will prescribe some cerebral sedative, as aconite, or belladonna, sam- bul, valerian, bromide of ammonia, so as to induce sedation, even an excess of sleep. If brain shocks or concussions were more actively treated, there would be fewer cases of cerebral disease. If any people in the world require great precaution against concussion of the brain it is our people, v/ith brains feverishly active and literally starved for a diet of phosphates. There should be an improvement here, better brain nourishment, which our people would find in boiled white fish, oat-meal, whole corn- bread. A retention of faeces beyond the usual Constipation, period, so that when they are passed, it is with difficulty, and in a comparativly hard or indurated state. A normal condition of the body demands a movement of the bowels following the morning meal ; if this does not follow there is inertia of the intestinal track. Constipation is a most troublesome and prevalent affection. Causes. — This may be due to some constitutional defect, in- herent weakness of organization, or inertia of the nerve centres, which gives rise to scanty mucous secretion, deficiency of bile, a defective nerve supply, as exists in neurasthenia. Add to these habitual inattention to nature's calls, sedentary habits, use of drastic cathartics, malaria, alcoholic drinks, erroneous drug treat- ment, adulterated food, hasty or insufificient mastication, dys- pepsia, anything which will arrest the peristaltic wave. BACTERICIDES. 237 Symptojns. — Looking at the rectum with its immense supply of spinal nerves, its mucous membrane studded over with the most active absorbents, any retention of the faeces over twenty- four hours will give rise to headache, fetid breath, drowsiness/ fever, due to the absorption of deleterious gases, poisons, and disease germs re-entering the circulation, such a state necessary gives rise to a morbid state of the kidneys, bladder, skin, lungs. The pressure of a loaded rectum gives rise to prostatorrhoea, and seminal emissions in the male ; ovarian, uterine, and vaginal disturbance in the female. Its reflex effect tells disastrously upon the brain, often giving rise to serious nervous disorder. Treatment. — In the treatment of constipation, the cause if possible should be ascertained, and removed. The patient should be instructed, that there is no rule of health of so much import- ance as a well regulated state of the bowels. It is a very common belief that the rectum is but a receptacle for the fasces, or the refuse matter of the intestinal canal, but this is a mistake. The rectum is not a storage for the faeces, as they are naturaUy stored in and above the sigmoid flexure, just above the rectum, but when habitual constipation is induced, it is often compelled to act that part. As the rectum has a greater supply of nerves, of blood vessels, and its mucous membrane literally studded over with absorbent follicles greater than any other part of the intestines, it clearly explains why persons who suffer from habitual constipation, have dry, hard stools, fetid breath, rough skin, febrile exacerbation. Every individual should be taught a regular habit, a daily evacuation from the rectum, of all matter that approaches it for exit from the body. The great trouble is that all disease germs and ptomaines contained in the faeces, on entering the rectum, if they are not promptly discharged, re-enter the circulation again, rendering the blood germ-laden, irritating, deranging, interfering with the healthful working of every organ. Let this continue from day to day, and it silently but surely produces disease of the rectum itself. The evil results of constipation are not limited to blood poison- ing and nerve irritations. The failure of the bowels to excrete, throws additional work upon the skin, lungs, kidneys ; deranges and produces disease of vital organs. Habitual constipation oc- casions great distress and produces grave pathological changes in the brain, heart, lungs, bowels, organs of assimilation, often gives rise to chorea and epilepsy. It is often difficult to ascertain the cause, but a careful exami- nation of the rectum should be made for chronic inflammation or 238 DISEASE GERMS. catarrh, for ulceration or other morbid states. Cathartics for the relief of this difficulty are worse than useless and invariably do more harm than good. Rational attention should be paid to diet, exercise, bathing, massage, accompanied by regularity in going to stool to solicit movements; if the condition does not yield, there is some trouble with the liver, mucous membrane, nervous system. We shall enumerate briefly a few of our best remedies for habitual con- stipation. Kolatina is the best remedy in the materia medica for all forms of constipation. This principle is isolated from the African kola nut by a peculiar process of maceration, and converted into a pleasing palatable paste, and this into a refreshing fruit lozenge. Kolatina has many properties : it rejuvenates the nervous sys- tem in all cases where a poverty of nerve force exists — by this action on the brain the liver is roused into activity, the peristaltic wave heightened, strength augmented. The dose is from a half to a whole lozenge and should be taken at bedtime. It is indicated in all cases of constipation, particularly those dependent on defective or perverted nutrition, combined with in- digestion. It has been used extensively, and all have been fully satisfied of its wonderful power as a therapeutic agent, and the very best remedy in constipation, producing full, easy stools, without nausea or tenesmus. Another very valuable formula in or among neurotic patients who suffer from constipation, caused by a want of nervous energy, is three drops of the tincture of belladonna and the same amount of the tincture of nux vomica, added to a little water, administered two hours after eating. Tincture of sulphur is also a most effective remedy, in doses ranging from five to fifteen drops added to water. Enemata of one or two ounces of glycerine either alone or medicated with tincture of belladonna or nux. This is a most efficient remedy in habitual constipation, and intestinal ob- struction. Cascara sagrada lozenges, two at bedtime, are most effectual in overcoming this difficulty. Ox-gall, charcoal pulverized, and extract of nux vomica is in- valuable ; thus, ox-gall, thirty grains ; willow charcoal, pulverized, sixty grains ; solid extract nux vomica, five grains. Mix. Make thirty-six pills. One at bedtime ; or the following : solid extract golden seal, sixty grains ; comp. solid extract of colocynth, thirty grains; extract hyoscyamus, five grains. Mix. Make thirty pills. One or two at bedtime, as the case may require. BACTERICIDES. 239 Injuries inflicted Contusions, with blunt or obtuse instruments are usually followed by an extravasation of blood either into the cellular tissue or skin. Treatfnent should be active, and should consist of such remedies as rest, the application of the tinctures ofmari- ^£'^/'$y&^'^^^^^%'f gold or arnica, so as to stimulate ab- ^irii^fhii^^^^^ >\VA.\H';f/ sorption of the effused blood. If these fail, then take half and half of peroxide of hydrogen and water and apply to the part, which will prevent the contusions, followed byecchy- 1 .• r .• • mosis ; magnified 1000 diam. evolution of micrococci. ^ Chains of micrococci found in Inflammation of the mucous membrane lining the Coryza. nose, frontal sinuses, throat, accompanied with fever. The cause is usually exposure to cold or wet, or dis- ease germs. Symptoms. — Languor, lassitude, debility ; pain in head ; ach- ing in back and limbs ; fever, thirst, loss of appetite, rapid pulse, increased heat, coated tongue, discharge from nostrils ; profuse lachrymation, hoarseness, sore throat. In addition to those symptoms, the discharge from the nose is' liable to become acrid, and coming in contact with the lips causes an eruption of fever blisters or herpes. In a few days symptoms will subside and pass into a subacute form, and tonsilitis or bron- chitis may supervene, and the patient recover. If he happens to be feeble, or possess a tubercular habit, it may pass into ulcera- tion, and a chronic form be set up. In all cases there is a degra- dation of the living matter that supplies the mucous membrane of the nostrils, frontal sinuses, posterior nares and throat, into the disease-germ, amoeba, which, if not speedily relieved, will produce grave changes. The treatment to be promptly effectual must consist of bac- tericides. During the feverish stage jaborandi to diaphoresis, followed by antifebrine and tincture of belladonna till throat be- comes dry, or salicylate soda in liquor ammonia acetatis, alstonia, Pulsatilla, cimicifuga race., alternated with peroxide of hydro- gen, or else quinine ; chloride of ammonia. Inhalations of glucozone, benzoin, ammonia, camphor, menthol, nasal bougies, prepared from menthol ; benzoin, cocaine, applied locally, will often cut short an attack. 240 DISEASE GERMS. This is an indication of the presence of microbe Cough, in or on or near the larynx and bronchi, and is a symptom of various microbial diseases, as catarrh, laryngitis, asthma, croup, pleurisy, pneumonia. The act of coughing consists in first, irritation of these and other germs, and in a deep inspiration, closure of the glottis and violent expiratory effort by which the glottis is forcibly opened by the compressed air, which carries with it, in its exit, mucus or other matters which may have lodged in the lungs or respiratory passages. The nervous centre for this act lies in the medulla oblongata. It is bilateral, and situated on each side of the cen- tral raphe. It is excited into action reflexly by irritation of the respiratory branches of the vagus, distributed to the folds of the epiglottis, to the whole interior of the larynx, to the trachea, espe- cially at its bifurcation, to the bronchi, to the substance of the lung itself, as well as the pleura when it is inflamed. Irritation of the internal auditory canal at the point to which the auricular branches of the vagus are distributed, also causes coughing ; and so may irritation of stomach, liver, spleen. As coughing is a reflex act, excited by irritation applied to a sensory nerve, and reacting through a nerve-centre upon the respiratory muscles, it is obvious that it may be lessened either by removing the source of the irritation, that is, destroying the germ, or by diminish- ing the excitability of the nervous mechanism through which it •acts. Both methods are employed in practice ; one of the most common being to lessen irritation by the use of mucilaginous, or saccharine, or oleaginous substances which have no action upon the nerve-centres ; the other by acting on the nerve-centres. The action of germicides is ever for good ; the wonderful ac- tion of either the tar or creosote syrup ; the syrup toluentaine compound cannot be too highly extolled. The probable action of marshmallow, gum Hcorice, is to soothe irritation at the root of the tongue, around the fauces, as well as the trachea, bronchi or lungs. This probable action in relieving cough depends to a great extent on the mucilaginous coat. Sedatives relieve cough by entering the blood, and being carried to the medulla lessen the excitability of the nerve-centres, such as bromohydric acid with spirits of chloroform and syrup squills, or a mixture of solution of hydrochlorate of morphia ; dilute hydrocyanic acid, of each, twenty drops ; glycerine an infu- sion of gentian, of each, two ounces ; chloroform, three drachms. A teaspoonful, as indicated, every three hours. Muriate of am- monia, in five-grain doses in syrup is excellent. Cough, from teething, intestinal irritation, is best relieved in the former by lancing the gums ; in the latter by getting rid of the parasite. BACTERICIDES. 24 1 Cough Irom relaxed, or elongated uvula ; hypertrophy of the tonsils requires first, a trial of astringent gargles ; that failing, alteratives, iodide and excision. Cough, due to disease of the ear, mullein oil. Nervous cough, avena, kephaHne, sambul, coca, pulsatilla, g^entle exercise, sea-bathing, shower baths, nutritious food. A devitalized condition of the brain, caused Coup de Soleil, by solar heat and evaporation of the serum or of the blood. Sun-stroke. It gives rise to faintness, a craving for water, heat and dryness of the skin, high temperature of coldness, great nervous depression, vertigo, tight- ness across the chest; pulse variable, often quick and full, at other times thin and feeble, so that it can scarcely be felt. As the case progresses heart's action becomes violent ; stupor, so that the patient cannot be roused; face becomes pallid ; vomiting, coma, great difficulty of breathing, contracted pupils. While in this state the conjunctiva may become congested, action of heart intermittent, and just prior to death dilatation of pupils, gasping respiration, and it may be vomiting. In some cases symptoms are very insidious : mere listlessness and stupidity, with languor and debility, head feeling strange, yet* in a few hours death. In other cases after exposure to the sun, the individual has suddenly fallen down insensible, made one or two gasps, and died in a state of syncope; the brain being enervated, the blood deficient of its serum (clotty), and the secre- tions deranged. If recovery does take place, convalescence is apt to be retarded by a slight fever, some complications of heart, lungs, liver, kidneys, or from paralysis or prostration. Patient not free from danger for some time. A great while after apparent recovery symptoms of paralysis and insanity may be developed. In every case, just like recovery from inflammation of the brain, the patient is easily affected, and never the individual he was before the attack. Treatment. — If one has to be exposed during the hot season to the sun's rays, quinine is our best drug as a prophylactic ; besides, proper care of the dress and an abundance of water not iced. On no account must alcohol be used, but there may be utility in coffee or malto cocoa. The greatest good is to be derived from the judicious use of tepid or even moderately warm water, wrapping the patient in a nude condition up in sheets or blankets saturated with or wrung out of warm water, keeping them moist by pouring it 16 242 DISEASE GERMS. freely over them, so that the skin may imbibe the water, an element essentially needed in the blood, besides the revulsive effects of the water on the periphery of the nerves on the skin. The head, also, should be encased in packs, and even copious enemas of tepid water. If the tongue is coated, an emetic of mustard and salt, allowing the patient to drink freely of tepid water and bicarbonate of soda. After it has acted gently, follow with half a teaspoonful of compound licorice powder, in which one drop of croton oil has been rubbed up, and repeat if bowels are not promptly opened. Allow the patient as much water as he may desire to drink, for water is the remedy. As soon as the patient can swallow, half teaspoonful doses of the sesquicarbonate of ammonia freely diluted with water, is a good remedy to liquefy the blood, given as often as indicated by the condition of the heart. If the patient does not react, no im- provement, then cup the nape of neck, shoulders, and apply mustard plasters to feet and hands, still holding on to the water, and an alkali internally. If a stimulant is necessary, carbonate of ammonia, liquor ammonia acetatis and artificial heat ; other- w^ise, the case should be managed like chronic inflammation of the brain. This is the utmost limit of deterioration which Cretinism, can be reached by a human being without death. It may be regarded as defective, or imperfect formation or development of the body, accompanied by a dwarfish stature, malformation of the head, which is usually flat on top and spread out laterally ; accompanied with mental im- becility ; vacant staring countenance ; devoid of intelligence; the physical deformity is variable in degree; in mild cases (sporadic) the shortness of the limbs is most remarkable. The tips of the fingers, instead of reaching well down to the middle of the thighs, only extend as far as the umbilicus in many instances. The arms and hands are very short, the fingers scarcely longer than the toes. The legs are as short in proportion as the arms ; in well marked cases (endemic) the mouth is gaping wide, tongue pro- truding, saliva flowing; goitre; brutalized habits; squinting blindness ; deaf-mutism. The endemic form is common in valleys, gorges, in which neither sunlight nor purified air enters, where the inhabitants are necessitated to drink ice or snow water deeply impregnated with silicious or calcareous deposits. In addition to impure air, there is usually associated with it bad or meagre diet, extreme poverty, insanitary conditions, sensuality, incompatibility consanguinity. Whenever either endemic or sporadic cretinism is developed, BACTERICIDES. 243 and the cretin survives and reaches the age, say, of 15 or 20 years, its condition is equally remarkable and characteristic. No signs of puberty make their appearance and the mental con- dition is that of iodiocy. Such being the case, cretinism never can be transmitted, an impure sustained breed cannot be pro- duced. A cretin never can beget a cretin, procreation ceases — there is no establishment of a morbid race. Probably a hundred years hence, when our population reaches two or three hundred millions, the population necessarily re- stricted to given areas, this disease may appear in our mountain gorges or valleys. The disease admits of no treatment. Its prevention is important ; this embraces legal enactments to restrain marriage among those closely related by blood or temperament, those affected with the tubercular bacilli, or crypta syphilitica — to restriction in the use of alcohol which atrophies and whittles down the brain of the modern Caucasian. Under this term there are usually, classed three Croup, distinct pathological states : (i) a spasmodic action of the larynx, usually caused by reflex irritation, as teething, worms and derangements of the digestive tract ; (2) a species of laryngitis, due to cold, wet, exposure, often accom- panied with oedema of the glottis ; and (3) true croup with the formation of a false membrane on tongue, tonsils, uvula, larynx and trachea. In true membraneous croup, we have a micrococcus very much resembling that of diphtheria and croupous pneumonia, and although not deemed contagious and infectious, nevertheless is so, the microbe being very heavy, the living germs of conta- gion are limited to the patient. The microbe is easily isolated, either from the false membrane or blood, bears cultivation well, the cultures injected into animals produce the identical pathological condition, to with a pale red gelatinous exudation on the mucous membrane of the air passage, giving rise to bronchitis, pneumonia. The bacillus indicum ap- pears, patient dies from exhaustion, suffocation, convulsions, thrombosis. The microbe is pathogenic of the disease, and is associated with a special diathesis. Symptoms in the early stage are very similar to catarrh : slight fever, cough, hoarseness, drowsiness, suffusion of eyes and run- ning at nose. In the course of a few hours wheezing respiration ; fits of hoarse coughing ; occasional spasm of laryngeal muscles. Then the characteristic symptoms, alteration in cough, which has 244 DISEASE GERMS. now a peculiar ringing sound, rendering it brassy ; inspirations prolonged, accompanied with a crowing or piping noise ; redness and swelling of tonsils, uvula, but not so diffused as in tonsillitis ; increased fever ; breathing becomes more hurried and impeded ; cough frequent ; great prostration, with irregularity of pulse ; great thirst, irritability and restlessness ; patient's features ex- pressive of alarm and distress ; he grasps at his throat, thrusts his fingers into his mouth, as if to remove the cause of his suffering ; symptoms much worse towards afternoon and evening; a remission towards morning. If vital force properly aided with remedies overcomes the disease, cough loses its peculiar twang, becomes moist, crowing inspirations cease, expectoration takes place. But if all fail, and death is approaching, drowsiness becomes great, sleep is uneasy, child starts and wakes in terror, breathing becomes gasping and interrupted, suffocation seems impending, congestion of lungs, skin cold, covered with a clammy sweat, asphyxia, coma, convulsions or fatal thrombosis. Treatment. — There is much good to be derived from general management. Patient must be confined to bed in a room with a moist atmosphere, whose temperature is 75° Fahr.; steam atomi- zers kept running near the bed, with either resorcin, creolin, or distillation of jequirity, or iodine, or lime-water, alumina, or lactic acid ; or all failing glucozone. Calcium sulphide alternated with peroxide of hydrogen acts well in hoarseness. If symptoms resemble 'asthma, give quinine in from one to five grains every four hours ; and every half hour 30 drops of the acetic syrup of blood-root, and if there is any tendency to spasmodic action of the muscles, add lobelia. Hot fomentations to the throat, con- sisting of solutions of boroglyceride with cocaine act v/ell. Nasal bougies composed of resorcin, lactic acid, creohn, etc., pushed up the nostrils have an excellent effect. Case must be carefully watched, every point guarded, and germicides pushed. Diet very nourishing ; beef tea, cream, milk and lime-water, malted milk ; bowels kept open with enemata ; if there is fever give antifebrine, alternated with liquor ammonia acetatis and salicylate of soda. An energetic germicide treatment is essentially curative, prevents complications, as embolism. A term applied to a variety of morbid condi- Cyanosis. tions in which the microbe indicans appears in the blood and all vital organs, as the heart, brain, lungs, etc., its presence is indicated by a gasping, respiration, general coldness and blueness of the cutaneous surface; more especially the nose, lips, ears, fingers. It is a diagnostic symp- BACTERICIDES. 245 torn of asphyxia, pneumonia, Addison's disease, malarial poison- ing, purpura, organic disease of the heart, etc. In asphyxia and pneumonia, non-aeration, or non-oxygenization of the blood ; in disease of the suprarenal capsules, the excre- tion of indican is often so great as to stain the underclothing blue; the alkaloid ptomaine from the malarial germ in bad cases, evolves the indican microbe in immense quantities ; in purpura, the factor in the production of the germ is pov- erty of the nerve -force; in organic cardiac disease, the presence of this microbe is a precursor of an early termination in death. The presence of the microbe is invariably associated with embol- ism of the blood. Cyanosis at or subsequent to birth is dependent on some defi- ciency or defect in the construction of the heart, as the septum not arriving at its full development at birth ; or from permanence of the foramen ovales allowing a passage of blood from the au- ricles; or from the origin of aorta and pulmonary artery from a single ventricle, or from contraction of the pulmonary artery ; any state or condition which permits a mixture of venous and arterial blood. In the diagnosis, the history of the case, the blueness and cold- ness, the difficulty of breathing, fainting on movement or excite- ment, violent palpitation. In the congenital form, tips of fingers and toes become bulbous, nails incurvated ; imperfect develop- ment; dropsical effusions, mostly congenital ; if so, patient blue all over, often present at the termination of valvular disease. In the treatment, each individual case, dependent upon some special disease, must be managed according to its own pathology ; asphyxia and pneumonia, liquor ammonia acetatis and salicylate soda, alternated with peroxide of hydrogen and compound oxy- gen ; in purpura, malaria, disease of the suprarenal, eucalyptol is a priceless remedy. If it is a congenital, the best plan is to be very cautious in any opinions of the case, as in one-half the cases the organic mis- chief is irreparable, whilst in the other it is amenable to treat- ment. So it is well to keep the little patient warm by keeping it rolled up in blankets, with external artificial heat ; nourish carefully ; administer one or two drops of digitalis twice daily ; in a large proportion of such cases, the digitalis will contract the orifice and a cure be effected. When it appears as a symptom of other maladies, palliate the condition by the administration of bactericides; plaioa nourishing food, mild tonics, rest, freedom from mental care or worry. 246 DISEASE GERMS. Cysts. A species of degeneration which may have a con- genital origin, or may be acquired by some degenera- tive action. Properly speaking they are tumors consisting of a sac containing solid or liquid substances. They may arise by the formation of definite cavities in the meshes of the areolar tissue ; by the dilatation and growth of obstructed gland-duct or follicles ; by the erratic development of nucleated cells, which b-come exaggerated into cysts. Some contain serum, others a jelly-looking substance ; some blood, others solid matter. Cysts in the brain are usually either hydatids or cysticercus— both have been found, solitary or multiple, and may attain considerable size, and cause atrophy of the brain. Cysts in the kidneys are met with in four different forms of degeneration. Two of them follow as a natural sequel from Bright's disease: (i.) Cysts vary- ing in size from a pin's-head to a hazel- nut are common, as a result of inter- stitial breaking down and obstruction. (2.) General cystic degeneration from, atrophy and obstruction, and expan- cyst.m me kidney. ^-^^ ^^ dilatation of urinlfcrous tubes. (3.) Small cysts are often met with on the surface of the kidney, which do not interfere with its function in any way.- Sometimes they attain a great size, and form an appreciable abdominal tumor. (4.) Congenital cysts, complete or incomplete, or kid- neys made up of cysts without any trace of secreting tissue ; usually combined with other malformations. If the result of chronic desquamative nephritis, treatment same as for degeneration. In the other forms the .symptoms are often obscure. Cysts in the Liver are still more common. There is a variety of views as to their origin and nature ; some believe that they are formed by a degenerative process of the hepatic cells ; others that they are due to dilatation of the minute canals ; others that they are a new formation of vacuoles in the hepatic cells that these vacuoles are formed by obstruction and dilatation of the biliary of branches. Encysted, knotty tumors, containing a cheese-like substance Cysts in the liver. ducts, vacuolation BACTERICIDES. 247 are found in the glandular substance, varying in size from a pea to that of a hen's egg. They arise from irritation and inflamma- tion of the hepatic ducts ; steatomatous contents composed of irregular granules, free oil globules, and occasionally plates of cholesterin. Simple Serous Cysts, with clear watery contents, are sometimes found scattered over the liver, usually about the size of a small bean. Sacculated Cysts, containing a glairy fluid, are also met with. In some cases they resemble a honey-comb. The liver in some cases is crowded with such cavities. I can suggest no explanation of the fact that such changes in the liver should be so commonly associated with similar changes in the kidneys. We have no means of determining in which or- gan the change commences, though the destruction of the kidney and interference with its functions are the more marked. In some cases the increase in size of the liver is much more obvious than in the kidney, which from its position is accessible to examination. There seems to be no way in which the changes in the one could be secondary to the other. The connection between the organs is functional only ; neither anatomically nor by develop- ment are they at all related. Perhaps, to take a broad view, we may look on the changes in both organs as a constructive attempt, possibly making use of embryonic remnants, and in- tended to resist degenerative processes in the organism due to the strain of advancing years and failing powers of excretion and secretion. Cysts in the lungd^xe neither so common nor wm Cysts of the lung. so numerous as in other organs. They are alto- gether different in their origin and pathology from emphysema. Cysts in the mesentery are still less common ; when they do occur, they are found of very peculiar shapes and sizes. Cysts in the pancreas are due to the retention of the pancreatic secretion, from obstruction of the duct by calculi, or from the external pressure of tumors. Hemorrhagic cysts are rare ; when the duct is closed near its Cysts in the mesentery. 248 DISEASE GERMS. mouth, there is apt to be hemorrhage ; atrophy and cirrhosis of the gland may result from these cysts. Cysts of the uterus, closed sacs, filled with serum or otherwise, are often found developed in the walls of the uterus, or beneath the internal lining membrane or serous covering. Sometimes one part of the uterine walls is invaded with c) sts, or small bladders, while another part is infiltrated with fibrous tissue, or the ordinary fibroid tumor. These cysts give rise to trouble and inconvenience when they attain any size, such as leucorrhoea and hemorrhage. If within reach, they may be punctured. They, like the others, are unaccompanied with pain ; not infrequently give rise to uneasiness. The best treatment is a general alterative and tonic course. In order to avoid those three common forms of uterine disease, there should be a rigid avoidance of irritation of the uterus, either by tight lacing, wearing sponges or pessaries, masturbation, abortions, irritating caustics of doctors, especially nitrate of silver ; even certain occupations, as the sewing machine, should be guarded against, or other forms that aid in the production of The ear with its appendages is a perfect instru- Deafness. ment'by which the brain receives the undulations of sound from the external world, through the medium of the auditory nerve reflected upon the membrana tympani. A normal state of the brain and ear is essential to perfect hearing. Loss of hearing may be the result of a great variety of states or conditions, and supervenes as a sequela of nearly all affections of the middle and inner ear. Every disease germ incidental to the human body, when present in the blood, finds the ear a favorite structure for deposit and growth ; the microbes of typhoid and typhus fevers often leave the ear in a state of dilapidation ; tubercle, syphilis, rheu- matism, gout, their spores, germs, and ptomaines are destructi\{e to the ear, and often cause irreparable deafness ; the migratory germs of scarlatina, mumps, diphtheria, measles, nasal catarrh, produce great havoc in the ear by giving rise to points of ulcera- tion (nests), and various inflammatory changes in the ear. Microbes in the nose, fauces, throat, often find their way up the eu-tachian to the inner ear and give rise to pathological changes an' I deafness. Besides these and other affections in which the hearing is i^iipaired or permanently lost, there 2lyq: five other states in which the hearing is either impaired or lost. BACTERICIDES. 249 1. A class of cases due to aiKEinia of the brain, in which the emotions, desires, affections, passions, play an important part ; among these emotional deafness, the death of a friend, fright, Hews of a painful character ; exhausted vital force, by sexual excesses ; shocks ; masturbation ; want of nutrition in the brain ; action of the sun ; railroad jars ; meagre brain food ; isolation ; monotony ; sameness ; obliterating the typical brain fissures. Best treatment for deafness due to anaemia, is avena sativa; glycerite of kephaline ; nitro-glycerine ; coca wine ; cerebrin ; peroxide of hydrogen; removal of cause ; nourishing brain food ; every thing possible to create richer blood. 2. Deafness due to congestion, a determination of blood to the brain, as in apoplexy, etc. Best treatment, foot baths ; hot mustard water ; free purgations, stimulants to the nape of the neck and shoulders. 3. Reflex, chiefly due to teething, worms ; irritation to stomach, liver, bowels, uterus, sexual organs. The chief point is to get rid of cause. 4. Often due to the careless and indiscriminate use of such drugs as quinine, chloral hydrate, opium, belladonna, tobacco. Coca wine ; avena sativa ; glycerite of kephaline. 5. ■ Organic, due to bankruptcy of the brain ; white softening ; :^trophy, obliteration of its convolutions ; very hopeless. In all the different varieties an effort at cure should be aimed at by placing the patient upon a general alterative and tonic course of treatment, as all affections of the ear are most amenable to constitutional treatment. The introduction of so many invaluable remedies of late have effected a complete revolution in aural diseases. For example, the internal use of nitro-glycerine alternate with avena sativa operates like a charm in some cases ; in others the glycerite of kephaline, in alternation with the peroxide of hydrogen, with the use of mullein oil dropped into the ear. Brain food is essen- tial in all cases, change of air, especially the mountains where the atmosphere is highly rarefied and ozone is abundant. Saccharine diabetes, a complicated chronic Diabetes, malady, characterized by the presence of glucose or or grape sugar in the urine, blood, and all the Mellituria. solids and fluids of the body. The liver is the great sugar-forming gland, and ft is to that organ we must look for the grand predisposing cause. Any irritation transmitted to it through the medium of the eighth pair of nerves from the brain, produces an exaggeration of the 250 DISEASE GERMS. hepatic secretion, and an augmentation in the flow of urine. Still, the liver may be irritated reflexly by a diseased stomach, pancreas, spleen, either by the presence of disease germs in the blood ; or the abdominal brain, the great sympathetic, may be damaged by worry, struggle, mental depression, depressing passions. This irritation, central in the brain, peripheral in the liver, may be directly due to shocks, falls, blows, concussions, over- work, exposure to the sun, drinking ice-water when heated, or vicissitudes of climate. As a rule it comes on slowly and insidiously, with great mus- cular and nervous debility ; greatly increased flow of saccharine urine, of an apple odor, of a high specific gravity of from 1035 to 1060. Still, cases are often met with in which the specific gravity is lower ; skin invariably very dry and harsh ; obstinate constipation, gradual failure of health and strength, with loss of sexual power, pain in loins ; extreme prostration ; coldness of extremities, with sense of burning in hands and feet. Debility increases, weight diminishes, bod*y shrinks, withers ; oedema of feet ; some- ^"^ a ^ \ JJ ^ times albuminuria ; breath has a chloro- ^ Ji M o\k ff '^ form odor from imperfect combustion of sugar ; gums spongy ; teeth drop out ; mental depression and irritability ; constant sense of sinking at pit of stomach ; appetite for food voracious ; Thegiucosefungusof Diube-.es, or thirst cxtrcme ; strong tendency to ^^^^'''""^- cataract. After it has lasted months or years, the lower lobe of the right lung, which is so fully covered by branches of the sympathetic, becomes literally invaded with tubercle, colonizing from below and proceeding upward. There may be boils, eczema, psoriasis, lichen, with pruritus of the genitals. The above are the common symptoms, when it originates in the brain, the great co-ordinating chemical centre ; but when it starts in gastric intestinal catarrh, from the presence of some poisonous substance, or microbes, with its ptomaines, or morbid material generated in the intestinal tract, there may be in the early stage localized or paroxysmal pain in the upper part of the abdomen, and vomiting of green-colored matter, exceedingly ob- stinate constipation, heart affection, cerebral irritation, somno- lence, great prostration, febrile spells, in which the pulse is fre- quent and small, with very rapid breathing, with remarkably deep inspirations, dry tongue, intense thirst, and no elevation of tem- perature. By-and-by the symptoms coalesce. The whole train of symptoms point to a nervous origin at the BACTERICIDES. 251 base of brain in the fourth ventricle ; even the eye-symptoms can .be partially explained. The spinal root of the optic blending- with the sympathetic and passing the origin of the eighth pair, in the base of the brain, may receive a pathological effect ; at all events, this root brings the retina into direct communication with the co-ordinating chemical centre and the medulla. The exist- ence of this branch is interesting, as it throws light on the physiological relation between the parts affected in diabetes, the medulla and retina, and it constitutes the undiscovered link be- tween certain diseases of the spinal cord and eye. There are often wandering, or aching pains in the bones ; hyperasthenia of the soles of the feet ; flesh is tender ; feel as if they were walk- ing on pebbles ; cannot maintain their balance ; sciatica is common. Besides, the very common termination ; tubercular consump- tion, bronchitis, pneumonia, peritonitis, gangrene, may take place, or the patient die from exhaustion. To constitute the morbid condition, there must be a persistency of sugar in the urine with the symptoms. This can be readily detected by the potash, copper, or fermientation tests. It is clearly to be understood that the liver, under this weak- ened or irritated nerve, can, will secrete, and continue to secrete, sugar, without either sugar or starch being introduced into the stomach. If sugar or starch is taken in, we then are feeding a poison the system cannot get away with. What becomes of the sugar that is taken in, in some cases, even in large quantities, see- ing none of it is ever found in the chyle or portal vein ? It must be transformed somewhere, and this transformation is, no doubt, effected in the duodenum by the agency of the pancreatic juice. If the digestion of sugar does take place in that way, and it should happen that the pancreatic secretion was insufficient, from disease of pancreas itself, from the disturbing and inhibitory in- fluence upon the nerves controlling the secreting function of pa- thological events, or from the constant ingesta of sugar in too large amount, a greater or less quantity of sugar which has escaped transformation must accumulate in the intestines. Of all tissues that keenly absorb sugar the intestinal tract is the most active, especially the small intestines. When the co-ordinating chemical centre in the brain is dam- aged, and the irritation is transmitted to the liver, grape sugar is elaborated in such quantities that the ozone-forming faculty of the lungs is incapable of burning it up, hence the presence of this agent in all the tissues of the body engenders the formation of a fungus in the blood, which is easily isolated, especially from the urine. 252 DISEASE GERMS. This glucose fungus is pathogenic of diabetes, capable of cul- ture in any starchy or saccharine liquid at a temperature of be- tween 80 and 90° F. Cultures injected into animals give rise to precisely the same symptoms as in man. As a rule animals into which those cultures are injected die before the microbe of boils and bacilli of tubercle put in an ap- pearance. There is a pathological alteration of cell-life through- out the organism by virtue of which a greater or less part of the elements have lost the capacity of destroying the sugar secreted in excess. f, Treatment. — In the general management of the case, daily bathing, flannel clothing, bowels to be opened every morning, for great improvement follows the abundant evacuations of extremely offensive and almost black quantities of excremental matter loaded with ptomaines, so, as a rule, empty the bowels daily ; for it is not too far-fetched an idea that the sugar has undergone de- composition or some chemical change in the intestines, and aids in producing that terrible burning and thirst so common in diabetes. The diet is to be highly nutritious, and free from sugar and amylaceous ingredients, for then the pancreatic juice is sufficient to meet the trifling amount of sugar present. How far the pan- cn^atic juice suffices for the transformation of sugar in different cases, it is not easy to say. It is difficult to prepare a diet list entirely free from sugar, for even flesh, yolk of eggs and most acid wines contain sugar ; and with regard to vegetables, the stalks and ribs of salad and leafy herbs all contain sugar. In short, with the exception of cheese and sour milk, there is scarcely any edible to be found that does not contain sugar. If in spite of a diet of flesh, white-fish, grame, ^z?.^, beef-tea, cream, cheese, bran-loaf, gluten bread, herbaceous vegetables, the sugar does not disappear, we know that the case is beyond the reach of pan- creatic influence, or the patient may not have adhered strictly to the rules. Rigidly forbid cane sugar, but allow saccharine fruit, confectionery, potatoes, carrots, parsnips, beets, turnips, radishes, rice, sago, arrowroot, tapioca, liver, oysters, lobsters, crabs, beer, whisky, coffee. If able, gentle exercise in open air. Two small irritating plasters, an inch square, should be kept constantly ap- plied to the nape of the neck ; one on each side, and stimulation over the region of liver. A persistent alterative and tonic course commenced and persevered with ; vegetable extracts, with iodine and such tonics as cinchona. The appetite for food and drink is best appeased by the administration of the glycerite of kephaline or tincture of oats. After attending to the general management of the case, our BACTERICIDES. 253 treatment becomes decidedly empirical, and is confined almost exclusively to the use of cerebral tonics and bactericides. These are a few remedies worthy of most serious consideration. Sambid seed finely pulverized, introduced into a capsule or pearl which will hold five grains, to be taken after every meal, has a magical effect in diabetes. The use of five grains of this drug after each meal, corrects the faulty condition of saccharine fungus evolution, and it disappears from the blood and urine while taking this remedy, and the patient may eat anything on the entire list of dietetics, and for years he may prolong his life in comfort, but let the remedy be discontinued, the fungus promptly re-appears in both blood and urine. Although not a curative drug, while taking it its action works wonders. Drugs of any utility in this disease must have a germicidal action. Salicylic acid, combined with the acetate of ammonia, and alternated with the glucoside of the poplar bark is most effectual in old, stubborn cases, and is worthy of a trial. The glycerite of ozone acts very energetically upon the glucose fungus in the blood, and destroys it at the same time ; appeases the appetite for drink and food, brings the specific gravity of the urine down to a normal condition ; patient improves under its use. Chlorate and permanganate of potass, comp. oxygen, ozone water, peroxide of hydrogen, glucozone, etc., all operate most efficaciously in sterilizing the fungus. All the vegetable balsams, such as copaiba, petroleum, oil of sandal wood, pine needles distillation, will, when administered, destroy the fungus, bring the urine to a normal standard. The sulphide and chloride of lime are essentially remedies of great value. Lactic acid, salol, resorcin, iodol, sulphonal, naphthaline and saccharine, with very little benefit except a slight amelioration of the symptoms. Saccharine has probably been more extensively used than any other of the phenol products, but its prolonged use gives rise to gastro-intestinal irritation and a sweet taste in the mouth, which is very disagreeable. Good results have been obtained from full doses of the citrate of lithia in alternation with boroglyceride in from ten to twenty grain doses. Where pains are prominent, either rheumatic or neuralgic, the salicylate soda and liquor ammonia acetatis, afford immediate relief. When the disease can be traced to chronic liver disease, the nitrate of uranium is invaluable. 2 54 DISEASE GERMS. If the attending physician views the case as one of irritation of the visceral brain, he will use opium or codeia, in alternation with white hellebore and quinine, with most satisfactory results. Codeia is undoubtedly the best form, so long as it exercises a salutary effect over the disease ; narcotic symptoms early present themselves. Excellent results follow the exhibition of the cascara sagrada lozenge ; two following each meal often effects a perfect revolution upon the fungus. Exalgine is the most recent remedy, and there is no doubt that by its peculiar action on both liver and brain, it greatly dimin- ishes the amount of sugar in both blood and urine. The dose is from six to twelve grains in the twenty-four hours. Any cutaneous affection that may appear, is due to the sugar fungus, whatever it may be ; eczema, lichen, psoriasis, pruritus, must be treated by the application ol bactericides, as resorcin ointment, cerate of the pine needles, iodol ointment, ichthyol lotion, or essence of peppermint. This is usually defined as the discharge of fluid Diarrhea, or semi-fluid faeces from the bowels without pain or tenesmus. It is met with in an acute or chronic form. Both forms are characterized by frequent loose evacuations from the bowels, due to either functional or organic derangement of the small intestines, and produced by either local or constitutional causes. The evacuations vary in consistence and quality, as well as in quantity and frequency ; they may be fluid or semi-fluid ; sometimes they are watery and serous, at other times they are mixed with mucus and occasionally a little blood. In children diarrhea is readily produced and is often very troublesome to cure ; it may be acute or chronic, and in both forms is dangerous to life. Under five years of age the mortality from this cause is greater than at any other period of life, and the greatest liability is shown during the period of teething, from six months to eighteen months or two years of age. In hot climates diarrhea is more common than in cold. As regards the time of year, diarrhea is far more prevalent in the summer and autumn than in spring or winter. P [The causes of diarrhea are numerous and varied, and are divided into local and general; among the former are to be classed indigestible food, impure air and water. Amongst the latter may enumerated disease germs, which induce a diminution of vital power. It is often beneficial and due to an effort of the irritated bowel to throw off its noxious contents, as in cases where decay- BACTERICIDES. 255 ing fruit or vegetables, or tainted meat or fish are taken ; in such cases a fatal result may follow from ptomaines being evolved ; hence in order to treat a patient with success, it is always important to make out thoroughly the ^^ • cause; hence it is imperativ^e to make a division ^i-f >' V? "''b.-' of the subject into a variety of forms, but in each jV'^.-C*''^/^ and all of them are to be found the pathogenic *tV*%'^*»-V^ microbe of diarrhea. ^'^'''-'X^ This microbe is the factor of all cases, it bears * culture well, and the cultures injected into animals The microbe of ' . •' diarrhea. give us the disease. The Summer Diarrhea of Infants. — The factor operating in the causation of the summer diarrhea of children is to be found in the presence of micro-organ- isms in the food, either before or after it entered the body. Putrefactive changes split up complex molecules and form chemical poisons. Milk is the natural food of all young children, and next to raw beef is a great attrac- '^^f*?>T^^|?^^£ */^^^ tor of germs, especially so ' ' ->^-,tr,v.,?,.;^V ./ V., ^^. Oxaluria Alagnified urinary sediment, coa- sisting of uric acid, urate of soda and oxalate of lime ; from a person convalescent from typhus fever The uric acid crystals are here chiefly seen in large dense bundles, joined two and two by their bases, each bundle being composed of an enormoui number of the long whetstone crystals. The dark crystals with light cross-bars are com- posed of oxalate of lime, while the dark- colored granules occurring either singly oc in masses are urate of soda. All ages and both sexes are or liable to be affected. They often give rise to nephralgia neuralgia of the kidneys. In order to relieve this condition promptly, hot baths, hip- baths, hot fomentations to loins ; open bowels with salines, and administer copious drinks of mucilaginous agents, in alternation with the uric acid solvent, or tincture of the green root of gel- semium. In the human blood, in a normal condition, Diphtheria, we have the living matter or bioplasm, which gives nourishment to brain, bone, skin, muscle, gland, every structure of the body. It is a well-known fact that this living matter is capable under adverse states of being- changed, altered, degraded into other living matter, which is capable in or out of the body of an independent power of existence, provided heat, nourishment, and moisture be present. 268 DISEASE GERMS. Thus for example, the degraded hving matter of ordinary- nutrition becomes bacteria ; that which constitutes the nerve- nutrient matter, the microbe of typhoid fever, etc. Among the ^ower animals, even vegetables, we see the same laws prevailing, A'henever or wherever they are brought in contact with condi- tions inimical to their well-being and growth. A^nong vegetables, cereals, plants, trees, vines, when the soil is poor, or exhausted, a change of their normal living matter takes place, which is termed a blight or rot. A change or degradation of the cell elements of the organism of the plant, cereal or tree We see ilaily examples of this in the potato or grape rot, in the spurred rye, corn smut — being contagious and infectious in the vegetable, as well as the animal kingdom. In the human body, when vital force is very low, reduced to bank- ruptcy, suffers great deterioration, whittled down to a very low point, we, too, take the rot, or blight. Cer- tain vital elements within us are changed, degraded into a • disease germ. This micro-organism is best seen in the false membrane of a diphtheric patch on the mucous membrane of the fauces ; although it can be iso- lated from the blood or caught from the breath on a piece of glass held to the mouth coated with glycerine. The microbe isolated from ± patch, forms a streptococcus, consists of oval cocci, lying singly, in pairs, in rosaries, in spherical or cylindrical masses. The streptococcus of diphtheria is an active ,^ ,^, microbe, causes directly the formation of the false membrane on the mucous membranes o\\ all parts of the body ; indirectly it is a most active ptomaine excretor, hence its toxical w^ork is soon visible in the produc- ti(Mi of death. Very doubtful if any chemi- cal agent has yet been discovered which will destroy its spores. Even buried in the earth its protoplasmic life remains good. They are found in all the fluids and solids of the body. In badly smitten cases, the blood, capillaries, and uriniferous tubules are blocked up. he microbe of diphtheria, forming a polypoid mas'^, growing from the edge cf uvula, completely arrested and de- stroyed by painting and spraying with lactic acid, dil. The Streptococcus of Diph- theria. iiACTERICIDES. 269 No doubt, this disease has existed from time immemorial, in localities in which intermarriage was common, in which the drinking water was calcareous ; in which overcrowding, and other insanitary states prevail. Both the microbe and its spores are aerobic, as millions upon millions emanate from one infected individual every hour, every- thing animal : woolens, carpets, clothing, cats, dogs, rabbits, within a radius of fifty feet are literally swarming ; so it spreads by infection and contagion, and prevails endemically, as well as sporadically. As the term rot, is not congenial to the ears of the fastidious, pusillanimous members of modern society, it has been dignified by the name of diphtheria. The predisposifig causes are very numerous, and embrace such states as a tubercular diathesis, inherent weakness of constitution — a reckless carelessness of all sanitary measures. The drinking- water of our large cities, and quite a deal of our food are contami- nated with sewage. Cases could be cited in which this microbe appears among our domestic animals, as turkeys, chickens, calves, cows, dogs, cats, rabbits, etc., having the disease, and propagating either directly or through their milk or flesh to man, giving him a predisposition to the disease. The microbe on the tongue and trachea of a turkey is microscopically and chemically indentical — pathogenic of the same affection in man. The emanation from salt on ice or snow on railroad tracks— the fumes from imperfect combustion of kerosene oil ; the vapor of sewer gas, are highly depressing, nay toxical, to the laryngeal mucous membrane, it affords a predisposition, affords a causation, at least, of the malignancy of the disease. Malignant cases where tracks are salt, terribly epidemic where oil is burned. Putrid sore throat and diphtheria are certainly more common and more fatal when those states exist. Although these aid materially as predisposing causes, they do so by depressing the powers of life. The exciting causes embrace all insanitary states, as overcrowd- ing, stagnant, pent-up, air, reeking with animal effluvia, poor and adulterated food. As the germ of diphtheria has a special affinity or attraction for all animal matter, no pet bird, dog, cat, or any domestic animal within a radius of 300 feet is free from the germs of the disease, with a diphtheric patient in that area. Such are to be classified as exciting causes, namely, close con- tact to sucL '70 DISEASE GERMS. The rot fungus foot disease oidium albicans, magnified 750 diam- eters, so common among milch cows who feed on damp pas- 7~tures, or stand upon imperfectly cleaned stalls — a prolific '"source of the streptococcus of diphtheria and scarlet fever. _ The milk from cows, both in the rural districts as well as that in cities, is a fertile source, and a most active exciting cause of this malady. Insanitary states, such as grazing on dairy meadows, or drinking marsh water, or being housed in wet, filthy sheds or barns, bring upon cows the foot fungus disease, which by some unknown trans- formation becomes the diphtheric mi- crobe. Prophylactic meas- ures are of the great- est utility. The dis- ease is essentially contagious and in- fectious, and every possible means should be resorted to to isolate the affected. Still it by no means follows, that real, inevitable danger exists of contagion from one person to another ; if ordin:iry pre- cautions are observed, and the highest possible standard of health 3iiaintained, with strong vital force, it is certainly premature to conjure up danger. A teaspoonful of the glycerite of sulphur could be taken morning and night, which would keep the blood thoroughly sterilized, a state in which if any germ entered the blood it would become at once annihilated. With due attention to the thorough cooking of all poultry, meat and milk, there would be but slight fears of the disease. Another valuable prophylactic is the sulpho-carbolate of sodium^ its action, very certain to destroy the streptococcus, two to three grains every three hours, either on the tongue or dissolved in a little water. It is a priceless remedy, destroys all germs, does not interfere with any other remedy or mode of treatment. It sterilizes the blood, keeps it in such a state that no germ will enter it. Sulphurous fumigation of all suspected houses of infection should be the rule. The special characteristics are in all typical cases, with the formation on the mucous membrane of the tonsils, uvula, tongue, cheek, of the white layer, an enormous accumulation of micrococci, constituting the false membrane, extending over the fauces, .larynx, trachea. A piece of this membrane placed either on blood serum, or in BACTERICIDES. 271 but the Section of a aiphtheric membrane, the embryonic micrococci seen in the process of evokition ; the membrane is a focus ot microbes. veal or iamb broth, affords magnificent culture of the germ^ their inoculation into healthy animals does not give us symptoms of the disease, but produces septicaemia. The contagium vi- vum resides in the walls of the rods con- stituting the chains, it is pathogenic, but from the purest cul- tures thus far succes- sive generations are not obtainable. The question how this microbe acts as the factor of disease has long been in doubt, but the progress of science has in some measure cleared away this obscurity. The first idea was that when first evolved or taken in, they acted like parasites, lived upon the blood and tissues of their host. To a certain extent this is true, that they swarm in the blood, abstract from the red corpuscles the oxygen they require for vitalizing the tissues, yet it often happens that death is so sudden that the bacilli have not had time to develop in the blood in numbers sufficient to produce a fatal result. An ex- planation of this state of things is necessary. All disease germs excrete or eliminate a poisonous substance, resembling snake venom, an alkaloid, the ultimate product of putrid fermentation of organic matter, the alkaloid is termed ptomaines. As soon as ptomaines are elaborated in the blood, rigors, fever, vomiting, diarrhea, spasm, paralysis, torpor, collapse, death. Poisoning by tainted meat or fish, is due to the presence of ptomaines. The action of the pathogenic microbe of diphtheria is complex, it is nourished and multiplies at the expense of the vital fluids, and it excretes more rapidly and in greater abundance than most other germs the alkaloid ptomaine, hence its great mortality, as seen in heart failure, paralysis of the larynx and other vital parts. The general pathological appearance consists in a membrane or a granular infiltration of some mucous membrane, generally on the tonsils, uvula, pharynx ; beginning at some point on the tongue or nasal passage, the microbial mass may extend either downward in the trachea, or upwards into the sinuses of the head, eustachian tube or nose. By and by all the affected parts become infiltrated, lose their normal state and become converted into one homogeneous mass of disease germs. Heart is pale, flabby, friable ; blood germ- (272) SKCTION OF UIFHTHERIC MEMHRANE. BACTERICIDES. 273 laden, and embolised ; spleen enlarged, tense, shining ; capillary hemorrhage ; kidneys congested, plugged full of germs. Infarction, the result of emboli, is apt to occur in all the vas- cular organs. The symptoms are somewhat variable. When the vital forces in children are very feeble, especially if the surroundings are bad,, as dirty, damp, badly-drained abodes, it may break out spontan- eously ; if so there is usually great prostration ; when received by contagion or infection, it comes on slowly and insidiously, with languor, lassitude, debility, headache, pain in back, calves of the legs, rigors, fever of a continued type ; tongue heavily coated, brown, dark at root ; rarely diarrhea ; mental condition dull, stupid, drowsy ; heat, pulse, and respirations high ; face flushed ; skin hot ; often delirious. Tonsils become inflamed and swollen ; the parotid and other glands sympathize. Inflamma- tory action spreads to the uvula, fauces, pharynx, deglutition becomes difficult; if it is not properly arrested, a soft, plastic exudation or growth, vesicular in shape, fibrinous in character, is developed on the mucous membrane, in which millions of the living streptococci are lodged or imbedded. At first this grovv^th looks like little vesicles or blisters, white at first, then ash-colored. They speedily coalesce and form large patches resembling dirty, damped, washed leather; if vital force is very low they grow with extreme rapidity. As they increase in numbers they also increase in size, extent, and thickness, firmly adherent to the mucous membrane beneath. If forcibly removed a new patch is at once formed, and this colony will grow ; besides, the breath, urine, stool, are loaded with young germs which are very light, so much so that they may alight on the cheek, gums, glottis, con- junctiva, vagina. When the germ dies, membrane becomes gan- grenous, sloughs, separates, decomposes, and the breath becomes terribly offensive. When the mass is thrown off there may be sloughing or gangrene, or if vital force be well sustained, the tissues around may acquire a healthy appearance. In cases of extreme prostration it may appear on the cutaneous surface. The constitutional symptoms vary much, the breath being very fetid, and occasionally hemorrhages from nose, fauces,, bronchi. Albuminuria in diphtheria is due to the action of the mycelia. The illustration, on the opposite page (272). exhibits a section of the diphtheric membrane, showing the mother germ and its spores at work in the formation of exten- sive microbiotic masses on the mucosa of the uvula and tonsils. The engraving was prepared by the illustrious bacteriologist, Prof. George H. Day, M. D., Monroe, Orange County, N. Y., one of the most eminent physicians of the age — the most suc- cessful in the cure of microbial disease. 18 274 DISEASE GERMS. on the blood and to the fact that the Icidneys are Hterally crammed full of the disease germs. Death may take place from exhaustion, uraemia, hemorrhage, gangrene, asphyxia, embolism. In the event of recovery it is tardy, sequelae being anaemia, nerve affections, paralysis, sleeplessness, impaired or defective sight or hearing. It is apt to leave a weak or hoarse state of the voice. Stage of incubation usually about eight days. Its duration is from one to two weeks. One attack is no protection. No disease is so easily recognized as diphtheria, the general symptoms are well defined, the languor, debility, prostration, sore throat, the false membrane or germ colony, first appearing as vesicles, then coalescing into patches, having the peculiar washed leather appearance ; invariably the offensive breath ; often a dis- charge from the nostrils ; enlargement of the lymphatic glands of the neck ; rigors; fever, difficulty in breathing, stupor, delirium. The prognosis in any single indi- vidual should be carefully guarded, because the microbe of diphtheria is of rapid growth and liberates or ex- cretes ptomaines abundantly, so that death may take place at any moment, either from the ptomaines paralyzing vital organs as the brain, spinal cord, heart, lungs, causing asphyxia; dan- gers of anaemia from obstructed kid- ney ; from hemorrhage due to anae- mia, the microbe destroying the red discs. In the event of recovery, the spores and ptomaines are apt to leave some lesion of the brain or cord which gives rise to aphonia, strabismus, paralysis, which time will eradicate. In the treatment, it must ever be borne in mind that there is scarcely any disease so insidious or more fatal. It calls for im- mediate energetic administration of germicides and nourishment, yet even with our most approved remedies, in the most skilful hands, often incurable. Specific treatment a humbug and a farce ; the one idea that must prevail is to kill the microbe, build up vital force; even bactericides must be administered with judg- ment, a judgment which can only be possessed by the highly educated medical man. No amateur doctoring in such a fatal The membrane of diphtheria, as seen on the hard palate, completely de- stroyed by papoid and distillation of jequirity. BACTERICIDES. 275 disease as this ; no delay ; no mistake in the Hne of treatment when the blood is loaded with germs and their ptomaines, whose limits are incompatible with life. The patient should be isolated, placed in the best ventilated apartment in the dwelling ; free from carpets, and every precaution taken to prevent its dissemination, as it is essentially infectious and contagious. The entire body twice or thrice daily should be sponged off with tepid water to which mustard and peroxide of hydrogen are added. To the throat a solution of peroxide of hydrogen should be constantly applied, removed and re-applied again and again. It is customary to administer repeatedly small doses of tinctures of aconite and belladonna, to allay irritation in the fauces, and reduce temperature ; but this procedure is unnecessary, because the germicide which must be administered to destroy or sterilize the germ, the factor of the disease, will, by its action on the microbe, reduce temperature, relieve pain, ameliorate all the symptoms. Sulphur is the natural antidote to the streptococcus of diphtheria. The best, most efficient preparation is the ozonized glycerite of sulphur. The moment the case is diagnosed, this preparation should be administered in sufficient doses every hour until it acts upon the bowels. This will not occur until every microbe is killed. In alternation with this, a few drops of peroxide of liydrogen should be administered. For inhalation from steam atomizer ; for a gargle slightly diluted ; for painting on the diphtheric patch, no bactericide can excel the ozonized distillation of jequirity ; this remedy causes the membrane to shrivel up and exfoliate, and check further exu- dation of germinal protoplasm. The jequirity affects a diphtheric patch or colony totally different from all other germicides, caus- ing the patch to shrivel up and exfoliate. If the physician has not the distillation of the jequirity, then lie can use the sulphuret of calcium, which is prepared in the following manner : Lime, one part ; sulphur, two parts ; water, twenty parts ; boil until the quantity is reduced to twelve parts. To be used with the spray every half hour, or less frequently, according to the severity of the case. For infants, a small quan- tity of water is to be added. A change in the false membrane is rapidly induced, and general amendment follows. In some cases the membrane had entirely disappeared in one day. Cerebral and blood nutrition of the highest possible grade precludes the possibility of the elementary bioplasm being de- graded. So the moment the glycerite of sulphur affects the bowels, the entire microbial mass is steriHzed, on the verge of 276 DISEASE GERMS. annihilation ; then tonics, as sulphate of quinine, should be ad- ministered, and nutrition pushed. The very presence of this disease germ among our children demonstrates most conclusively and emphatically that vital force is low, shattered ; that the brain, the nervous mechanism needs nutrition — fertilizers to aid in its reconstruction, to promote vitality. If from some cause or other, those remedies are not deemed the best, then the attending physician must select some other less active bactericide from some of the following, w^iich we classify according to their intrinsic worth. Hydrogen peroxide as a local and internal remedy in diphtheria has not received the recognition it deserves, simply because worthless compounds have been foisted upon the profession. A medically prepared C. P. aqueous solution is perfectly clear, color- less fluid, specific gravity 10 12, without odor or taste, having a faint sensation of carbolic acid upon the tongue. Hydrogen per- oxide does not act so well as the dis- tillation of the jequirity as a solv^ent upon the diphtheric patch, but it effectually sterilizes the blood, anni- hilates the entire germ area in the blood, prevents the evolution of more germs. It is always worthy of a trial w^hen the fountains of life are stricken with this microbe. Ozonized boroglyceride, internally and locally, is deemed of utility. Excavations ma^y the microbe upon The _ drUg whcU aCtivcly pUShcd, is the hard palate; germ evolution ar- eliminated by the mucioarous elands rested by spraying it with g ucozone. r ^ i Vi i i- 11 01 the throat and salivary glands, tends to soften and exfoliate the germ membrane. Oil of turpentine often affords most excellent results, it is ad- ministered in an emulsion in doses from one-half drachm up, dis- guised with oil of peppermint. Veiy favorable results are also obtained from lactic acid, pyri- din, creolin, chlorate of carbon ; sodiurn salicylate and benzoate ; creosote, iodoform, papoid and trypsin.; hydrocyanic acid; chin« oline, chloral hydrate, eucalyptol, quinine. All the essential oils, such as peppermint, rue, thyme, cloves, cinnamon, and other odoriferous bodies, when exposed to the atmosphere, are ab- sorbed by the oxygen, which enters into combination with them and forms new bodies. This power of absorption is possessed by them all, but in the highest degree by turpentine and pepper- mint camphor. BACTERICIDES. 277 Expose any essential oil to the atmosphere, about summer "heat, oxygen is absorbed, the oil oxidized, an unstable com- pound is the result, which in the presence of water is split up into peroxide of hydrogen and an exceedingly soluble camphoric acid. This process of oxidation and conversion into negative ozone, is peculiar to all essential oils which contain tcrebene or camphoric oil. One of the sources of ozone in the atmosphere then is due to the slow oxidation of the essential oils or perfumes which are giv^en out by odoriferous plants when exposed to the sun. Their action either destroys or weakens microbes, or so attenuates them that their destructive action is prevented, hence their use in all germinal diseases. Very favorable results are obtained by inhalation ; glucozone in a hand spray atomizer, or better still the ozonized distillation of the jequirity in liquid ozone in a steam atomizer. Mercurial fumigations;" iodoform dissolved in liquid ozone is said to have a marvellous action. Gargles or mouth washes of chlorate of potassa and tannic acid, or of resorcin must not be neglected. Bactericides then are the remedies to kill the streptococcus; the selection is important. Once recovery is assured, the greatest possible precautions should be observed for a few months, for there is still danger of paralysis and heart clot from the ptomaines of the germ. Quarantine for a period of twelve weeks. All persons re- covering from diphtheria should be considered dangerous ; therefore, such a person should not be permitted to associate with others, or to attend school, church, or any pubHc as- sembly until the throat and any sores which may have been on the lips or nose are healed, nor until in the judgment of a careful and intelligent health officer he can do so without endan- gering others; nor until after all his clothing has been thoroughly disinfected, and this without regard to the time which has elapsed since recovery if the time is less than one year. Nor should a person from premises in which there is, or has been, a case of diphtheria, attend any school, Sunday-school, church, or public assembly, or be permitted by the health authorities, or by the school board to do so, until after disinfection of such premises and of the clothing worn by such person if it shall have been exposed to the contagion of the disease. The body of a person Avho has died of diphtheria should be washed with a zinc solution of chloride of great strength, then wrapped in a sheet wet with the zinc solution, and at once be buried. In no case should the body be exposed to view\ 2/8 DISEASE GERMS. No public funeral should be held at a house in which there is a case of diphtheria, nor in which a death from diphtheria has recently occurred. Except under extraordinary precautions there should be no public funeral of a person who has died from diph- theria. No child should attend, and it would be better in most cases that few adults should attend, a funeral of a person dead of diphtheria. To Avoid Taking Diphtheria. — Avoid the living germs of the disease. This is especially important to be observed by children, and all whose throats are sore from any cause. Children under ten years of age are in much greater danger of death from diphtheria than are adults ; but adult persons often get and spread the disease, and some- times die from it. Mild cases in adults may cause fatal cases among children. Because of these facts it is often dangerous for children to frequent places where adults might go with impunity. Do not let a child go near a case of diphtheria. Do not permit any person or thing, or a dog, cat, or any other animal to come direct from a case of diphtheria to a child. Unless your services are needed, keep away from the disease yourself. If you do I visit a case, bathe yourself, and change, and disinfect your clothing before you go where there is a child. It is probable that the contagion of diphtheria may retain its virulence for some time, and be carried a long distance in various substances and articles in which it may have found lodgment. Diphtheria contracted from germs carried several blocks in a sewer may, perhaps, be as fatal as when contracted by direct- exposure to one sick with it. While it is not definitely proved that the germs of diphtheria are propagated in any substance outside the living human or animal body, it is possible that they may be found to be thus propagated. Therefore, and because the breathing of air laden with emanations from decaying fruit, vegetables or meat, or from sewers, cesspools, sinks and other receptacles of filth, is believed to endanger health, great care should be taken to have the house, premises and everything connected with dwellings, kept clean and dry ; to have sewer The germ actively at work on each side of the uvula ; painting and spraying with distillation of jequirity. BACTERICIDES. 279 connections well trapped and house drains constantly well venti- lated, and to have all carriers of filth well disinfected. Do not permit a child to enter a privy, water-closet, or breathe the air from the water-closet, sewer, etc., into which discharges from persons sick with diphtheria have entered, nor to drink water or milk which has been exposed to such air. Do not permit a child to ride in a hack or other closed carriage in which has been a person sick with diphtheria, except the carriage has since been thoroughly disinfected with fumes of burning sulphur. All influences which cause sore throats probably tend to pro- mote the taking and spreading of this disease. Among the con- ditions external to the body liable to spread diphtheria, perhaps the most common are infected air, infected water and contact with infected substances or persons. Because of this, and as a means of lessening the danger of contracting other diseases, the following precautions should always be taken, but more particu- larly during the prevalence of any such disease of diphtheria. Avoid exposure to wind and to breathing cold, dry air ; also the use of strong vinegar or any other article of food which tends to make the throat raw or tender. Do not wear or handle clothing worn by a person during sickness or convalescence from diphtheria. Beware of any person who has a sore throat. Do not kiss or take the breath of such a person. Do not drink from the same cup, blow the same whistle or put his pencil or pen in your mouth. Beware of crowded assemblies in unventilated rooms. Do not drink water which has a bad taste or odor, or which comes from a source that renders it liable to be impure, especially if there is reason to believe that it may contain something derived from a person sick from diphtheria, such as the drainage of a burying ground into a well or river. Dropsy consists in an accumulation of watery Dropsy, fluid in the lymph spaces of the subcutaneous cel- lular tissue, and in the serous cavities of the body. This fluid or lymph is derived from the capillaries, and under normal circumstances is poured out into those spaces, but taken up again by the venous and lymphatic radicles as fast as it is poured out. For the production of dropsy, the equilibrium of this arrange- ment must be upset by either an increase in the outflow of fluid, or a failure on the part of the veins and lymphatics to take up the effused fluid. 28o DISEASE GERMS. The principal source of power in pumping those lymph spaces dry is the heart ; it is assisted by the aspiratory action of the thorax in respiration, and the contraction of the muscles of the limbs. When the heart fails to maintain a negative pressure in the veins, oedema sets in. All that is at present known on the subject may be embraced in the following sentence : Dropsy is an accumulation of lymph, or watery fluid, in the lymph spaces of the body, as a consequence of heart-failure, by which the fluid is allowed to accumulate ; changes in the blood and capillaries by which the outflow of fluid is increased. We must ever bear in mind that in dropsy we have to deal with a failing heart, and our chief reliance must be upon remedies that increase the heart's energy. Digitalis comes first, strophanthus and convallaria next, citrate of caffeine, nitro-glycerine and sul- phate of strychnine follow ; then sparteine and a class of minor cardiac stimulants. The heart is the organ to look after and every possible means must be taken to invigorate it : local stimulants over that organ, in the form of the irritating plaster ; the most nutritious, highly animalized diet ; massage to the entire body, morning and night ; an entire freedom from care, worry or excitement. Dropsical effusions must be removed by the aid of diaphoretics, diuretics, hydragogue cathartics. The best of all diaphoretics is the alcoholic vapor bath (See in- terstitial nephritis) ; the most efficient diuretics are the hair-cap moss, apocynum, juniper berries, bitartrate potass, nitrate potass, broom. The most active hydragogue cathartics are elaterin, colocynth. An affection of microbial origin, which gives. Dysentery, rise to irritation, inflammation of the different coats of the rectum and colon, which terminates in ulceration of the different coats of the lower bowel. Isolated from the muco-purulent matter and other products, it ^ appears in the field of the microscope as a ♦ ^^^•x body slightly elongated and oval, or short #^i»*J*\^ \ and cylindrical, with rounded ends. They ^ " ^ ' •'•* - divide by fission, like micrococci, the indivi- duals elongating and becoming constricted in ^^,, ^ , the middle, capable of spontaneous locomo- * *•• \ 1 f tion, having a flagellum at one or both ends, •* with which they perform active spinning or The microbe of ayscntery. j^rting movcmcnts. Tlicy form zoogloeain the corrugations of the bowel, in which the interstitial gelatinous substance is more copious. BACTERICIDES. 281 The microbe is pathogenic of the disease, repeated cultivations in any nourishing broth, even for successiv^e generations ; the cultures injected into animals produce in them the original disease in all its virulence. It is contagious and infectious in the true sense of the term. The presence of this microbe in the rectum, sprouting and breeding spores by millions, gives rise to great constitutional dis- turbance and fever, and the microbe excreting ptomaines gives us the intolerable griping and tenesmus, with bloody mucus. During our heated term this microbe is one of the greatest scourges of our country. The presence of this germ in the rectum and colon is found at all seasons of the year, but it is roused into activity and rapid growth, prodigious spore evolution and ptomaine excretion by weakness, solar heat, moisture, dampness, hot oppressive atmos- phere, ice water, indigestible articles of food, green fruit, alcoholic drinks, malaria, mental depression. These and numerous other causes do not operate directly upon the rectum and colon, but rather upon the liver. They cause a general condition of congestion, debility, in which area of vital depression the dysenteric microbe puts in an appearance. Symptoms. — Great constitutional disturbance in the acute form ; rigors, headache, fever, biliary symptoms, brown tongue, sallow skin, conjunctiva tinged with bile, nausea, perhaps vomiting ; fre- quent evacuations of the bowels, accompanied with pain and uneasiness of a griping or bearing-down character; the inclination to go to stool is frequently accompanied with ptomaine excretion and tenesmus. At first, the stools are dark, ginger-bread color ; then mucous, thin, scanty, bloody and often mixed with Httle hard lumps of faeces. The scanty stools give great distress ; the griping and straining, or tenesmus, is most excru- ciating, with evacuation ; m.otions are often dark-colored, and peculiarly fetid, mixed with blood, muco-purulent matter, and shreds of lymph. The bladder sympathizes ; micturi- tion is frequent, and a constant desire to urinate ; there is strangury, or only a few drops coming at a time; amount of urine scanty and high-colored; in some cases there are violent hemorrhages. It may last a few weeks and terminate in recovery, or run into a chronic form : or recovery may take place with thickening, effusion of lymph, and stricture, or gangrene of the bowel and Appearance of the mucous surface of the rectum in the first stage of dysen- tery ; ihe microbe actively at work. 282 DISEASE GERMS. Appearance of the mucous membrane of the rectum in the second stage of dysentery ; the microbe making ravages in the ulcers. death ; or the patient may succumb to the violence of the kvcr and inflammation. The pathological appearance of the walls of the rectum are most significant, especially during the first and second stage, if permitted by inefficient treatment to run that way. Every day in which germicide remedies are delayed, more havoc is made by the germ degeneration of the intestinal glands, atrophy of the mucous membrane, indurated cicatrices in both colon and rectum. In the treatment, general principles must guide ; if there be a very irritable state of the stomach, an emetic may be administered with advantage, followed by an alcoholic vapor bath, and it would be well to cleanse out the alimentary with a powder of euonymine and caffeine, say one and a half grains of each, every hour till they had done their work. Rest in the recumbent posture in bed ; one dose of exalgine in the morning, another in the evening; during the day tincture of green root of gelsemium should be given, alternated with peroxide of hydrogen, it will completely paralyze the or- ganism. If not it may be noted that this microbe is either sterilized or completely annihilated by the administration of either of the following germicides, which can be used here with brilliant success, one of which could be selected : Naphthaline in five grains, in a capsule, repeated frequently. Resorcin and turpentine, combined in mucilage of acacia, per- fectly annihilates the microbe. Eucalyptol, ten to thirty-drop doses, is excellent. Caffeine, one grain every hour. Stone crop and sulphate of quinine are most efficacious. Resorcin, naphthaline, perfectly annihilate the microbe. Kaki, as an infusion, does effective work in effacing the microbe from the bowel. This is an efficient germicide where we have a specific micro- organism inhabiting the intestinal canal, as in typhoid, diarrhea^ dysentery ; besides it has a decided action in neutralizing the pto- maines, generated or excreted by the microbe. Its first dose affords relief, fetor disappears from the stools ; subsidence of pain ; stop- page of the diarrhea or hemorrhage, reduction of temperature and a general return of all the vital functions. The bark of the root of calotropis gigantea is even more power- ful than kaki ; like kaki, best administered in infusion of the pow- dered bark. BACTERICIDES. 283 The bisulphide of carbon is much esteemed as a germicide in dysentery, the dose is variable, but when administered it quickly relieves the tenesmus, the motions diminish in frequency, the stools lose their offensive odor, the germs disappear. Enemata of infusion of kaki, green root tincture of gelsemium^ creolin and resorcin kill the entire colony of microbes. The method of giving the enemata must be considered ; the patient's buttocks should rest upon a pillow at the edge of the bed, so ele- vated that the natural tendency of the fluid entering the rectum would be to travel down into the colon. A fountain syringe is the best, with a long flexible pipe. An effort should be made to pass this into the sigmoid flexure. One enema is often sufficient to effect a cure. Whatever remedy is selected a cocaine supposi- tory should be inserted up the rectum thrice daily. Difficult or painful menstruation appears Dysmenorrhoea in gynecological practice under three forms, (Neuralgic). the first being due to neurasthenia. — Nervous dysmenorrhoea is very common among highly educated and refined ladies — those who have developed their nervous systems at the expense of the physical, those who have insufficient exercise for body, who lounge, and keep reading our fictitious, debasing, modern literature — that deadly poison which undermines their nervous systems. It may appear at puberty, but more generally it comes on from enervating causes after some years of painless menstruation, especially in the unmarried. In married fife it may come on from the irritation of frequent abor- tions, and the use of means to accomplish that act. It may be due to incompatibility in the sexual act. Symptoms. — General languor, lassitude, debility, headache, with pains in the back, sacrum and lower part of abdomen, com- ing on a few days prior to period ; an aching soreness of inner and upper part of the thighs; bearing-down, with a sense of weight in the pelvis. As soon as the discharge comes on freely, relief is promptly experienced ; if the flow is scanty, and comes on in slight gushes, the suffering is often excruciating ; it becomes paroxysmal, pain comes and goes ; often considerable pain in left ovary, sometimes in both ; no swelling or heat, or increased sensi- bility in parts. There is flatulence, constipation, hysterical symptoms or convulsions. If the patient is seen during an attack, a warm hip-bath, tea- spoonful doses of comp. tincture of serpentaria and the intro- duction both into the rectum and vagina of an obstetric cone — patient in bed. Usually this affords instantaneous relief If it 284 DISEASE GERMS. fails, let her inhale twenty to thirty drops of chloroform, and an hypodermic injection of a quarter of a grain of sulphate of mor- phia might be given. She must be tided over the crisis with great care. If aware of the attacks coming on, they often can be prevented by inducing anesthesia of the lumbar plexus of nerves Avith belladonna, a plaster of this, four inches wide by nine inches longways across the loins; the administration of tincture of belladonna internally, till throat becomes slightly dry and pupil dilated ; the introduction of a pastile up vagina, and suppository up rectum, every night at bedtime, each containing one grain of opium and one-quarter grain extract of belladonna. The above to be commenced five days before period. From two to three weeks during the interval, the following treatment should be carried out : Daily, alkaline baths, followed w th friction or massage ; flannel or silk under-clothing must be worn next the skin, especially over the loins ; most nourishing easily digested food, avoiding tea, coffee and other stimulants. Sleep must be limited to eight hours, abundance of gentle exer- cise, games, moderate work so locomotion is active ; if circum- stances permit, horse-back exercise. Rigidly forbidding seden- tary habits, novel reading, and if married, sexual congress. If there is any evidence of indigestion, columbo infusion or some bitter tonic, bowels to be regulated by taking two cascara lozenges after meals. Then the true treatment of the case begins, and select four of the best remedies in the materia medica to vitalize the uterus and overcome this neurasthenia, namely, tincture of oats and kepha- line, with wine of aleteris farinosa and comp. syrup partridge berry. Place the patient upon two of them, oats and aleteris, one week ; kephaline and partridge berry the next, and so repeat till case is cured. All other remedies as pulsatilla, cimicifuga, are greatly inferior to the above. In ladies of a rheumatic and gouty condi- Dysmenorrhcea tion, afflicted with intra-uterine catarrh, (Congestive). there are in the cavity of the uterus quite a conglomeration or heterogeneous number of disease germs in the cavity of the uterus, as the amoeba, yeast-germ, sarcinae and others. Such microbes naturally excite irritation of the internal uterine walls, and when the menstrual function is excited there is great hyperaemia of the entire uterus. Those of a sanguine, plethoric or lymphatic temperament are its victims. Causes. — Aside from the diathesis, gouty or rheumatic, and BACTERICIDES. 285: pelvic irritation, general plethora of the genito-urinary organs, from sedentary habits and occupations, it may be caused by local irritation, as abortion, exposure to cold and moisture ; sluggish- ness of the liver, displacement of uterus, and metritis. Symptoms. — Suffering begins four or five days before each period, in a general sense of languor, or weariness, with head- ache, pains in the loins ; a feeling of weight in the pelvis ; gen- eral restlessness, and irritability of the bladder; there are heats and colds, with other evidences of nervous depression. The weight in the uterus becomes a pain of a throbbing character ; then dragging in the back, aching in the hips and thighs, and bearing-down, especially when pain is on. Discharge, after a few days suffering, makes its appearance, usually slowly and gradually, scanty at first, but subsequently, after the system is relaxed by the condition of prostra- tion, it comes freely. It may come in small clots, or shreds, or flakes of membr^anes, or sometimes in the form of a large pear-shaped clot, covered with a false membrane, an exact cast of the cavity of the uterus. This membrane looks like the epi- thelial membrane lining the cavity of the uterus, analogous to the de- cidua. In some cases there is no congestion of the uterus, in others it is much engorged, often displaced ; ovaries very tender, with swelling and tenderness of breasts. If the portal circulation is sluggish there will be piles. The treatment, during the period, should consist in ameliorat- ing the condition as far possible, hot vaginal injections of a solu- tion of boroglyceride, warm hip baths; free action of the bowels, the administration of obstetric cones per vaginam and rectum, with warm, relaxing infusions of asclepias, or eupatorium per. When the period is over, and for the next three weeks, patient should be placed upon good food, daily warm alkaline baths, followed by massage ; bowels to be kept open with the cascara sagrada lozenge ; the patient to be placed upon alteratives and tonics, saxifraga, alternated with the aleteris far. ; phytolacca comp. alternated with the partridge berry. With an energetic course of these remedies for four or five months, a cure may be effected. A cure, however, may be effected much more speedily, when The yeast plant and sarcinae present in all cases of intra-uterine catarrh ; the yeast plant, sarcinae and other germs found in the cavity of the uterus in. congestive dysmenorrhcEa. 286 DISEASE GERMS. germicidal bougies are used about every four days. These bougies are composed of thallin, resorcin, naphthaline, creolin, etc., and other bactericides, and are inserted into the cavity of the uterus, patient in the recumbent posture, and permitted to dissolve and come in contact with the internal walls, entirely re- juvenating them, and destroying all germs. If any difficulty is experienced in introducing, the original plant can be dissolved and a four or six catgut bougie can receive a heavy coating and be introduced, say for one-half an hour, until the germicidal sub- stance is dissolved. The method is most successful. This term is applied to a thickening, in- Dysmenorrhcea duration, cartilaginous degeneration, or (Mechanical). stricture of the external and internal os uteri, or neck, or a narrowing of the entire canal of the neck. It may also be due to some tumor, or uterine displacement, as ante or retro-flexion ; these latter we do not in- clude in the following remarks. What we speak of here is either a narrowing of the canal of the neck, or its infiltration with lymph, or cartilage, or a true stricture of the external or internal mouths of the cervical canal — conditions that cause sterility as well as dysmenorrhcea. Causes. — The causes that give rise to this induration, or me- chanical obstruction, are inflammation, such as acute and chronic vaginitis, leucorrhcea, self-abuse, excessive coition ; congenital irritation common cause. Symptoms. — Are those indicative of obstruction to the escape of the menstrual fluid. There is the languor, prostration, nausea, vomiting, pain in loins, hips, and thighs, bearing-down ; pain in ovaries and uterus, usually some time before a scanty flow makes its appearance. When discharge does come, it is in gushes, each gush preceded by pain, and an aggravation of all the symp- toms. The bladder becomes irritable, and there is often con- siderable tenderness over both uterus and ovaries ; anaemia, con- stipation ; very much resembles labor; uterus struggling to expel its contents. An examination of these cases reveals either a small OS uteri, or an orifice of the natural size, but the canal leading to the internal os, thickened, indurated, strictured, or suf- fering cartilaginous degeneration — conditions that can readily be felt with the finger, or the uterine sound. In some cases the ob- literation is confined to the inner os. In nervous or neuralgic dysmenorrhcea, the repeated irritation from month to month often aids in bringing about this condition. In the treatment of these cases, the same plan of treatment BACTERICIDES. 287 should be adopted as in the neuralgic during the flow, comp. serpentaria tinct., the introduction both per vaginam and rectum of the obstetric cones, and all failing hypodermic injections of morphia. During the intermenstrual period, there are various forms of treatment which might be resorted to. In all cases, it is well to place the patient upon an alterative and tonic course, administer- ing either comp. saxifraga, or phytolacca, alternated with aleteris farinosa ; relieving the dyspeptic symptoms with bitter tonics and the constipation with cascara sagrada lozenge. Every other night, the vagina should be packed with boroglyceride paste, and permitted to remain over night. During the eight hours of sleep there will ooze away from four to six ounces of serum ; this has a most marvellous effect on an indurated, structured, or hyper- trophied neck, besides it is most vitalizing to the blighted os. Perseverance with this remedy is invariably attended with success. Another method, still more heroic, attended with less trouble, but still most efficacious, is the introduction of one or two jequi- rity wafers or capsules right against the uterine neck, permitting them to remain over night. These if properly appHed, will cause a complete exfoliation of all the tissues with which they come in contact. If it is not deemed advisable to use it in that way, the contents of the capsule can be blown on the os and neck of the uterus, and the same result obtained. This procedure will bring -away large fibrinous masses, a peeling off without causing any breach of surface. Its use should be followed with mucilaginous injections. Most successful, still there are cases it fails to reach. Dilatation, by means of sponge-tents, sea-tangle, and metallic and rubber dilators are worse than useless, setting up more irrita- tion and additional obstruction. Those expanding instruments may produce no bleeding, but they are very destructive, and if often repeated are most harassing to the patient, and invariably after their use the canal returns to its former size, even a little nar- rower. There is no good in either slow or rapid dilatation, and ■even the new method of dilating, lacerating, tearing, by divergent blades, is useless ; there is danger of irritation, if not of metritis, pelvic cellulitis, or peritonitis. Incision is the best plan, as it gives rise to no suffering, gives •a sure result, and is free from danger if properly performed and rapid. This is best performed by a pair of scissors, made for the purpose, one blade terminating in a probe-pointed end, which enters the os ; the other by a hook, which seizes and fixes the vaginal portion at the point desired. One stroke of the scissors divides the intervening tissue in a straight line. The proceeding is then repeated on the other side of the os, and the operation is 288 DISEASE GERMS. then completed. There is a tendency to contract again even after that. To meet this, there should be a slight nick made of the internal os, just sufficient to divide the mucous membrane and some of the superficial circular fibres of the muscular coat» This will allay spasmodic sphincteric action. The incision should be no greater, because it is superfluous, and even dangerous. At the mouth of the inner neck there are blood vessels in pro- fusion, and of considerable size. Large veins, without valves and small arteries, gap at the uterine level, and are apt to bleed very profusely if uterus is cut into. A piece of lint, saturated with the juice or extract of hemlock bark, is to be inserted between the cut edges, and patient kept in bed under opium. If the patient and friends are willing, the best plan, if the suffering is great, is to perform the operation at once, as it is only a waste of valuable time to exhaust the usual list of reme- dies on her first. Indigestion, terms used to express or indicate Dyspepsia, a train of symptoms caused by a functional de- rangement of the digestive processes ; when they are confined to the stomach, they constitute gastric dyspepsia ; when in the bowels, duodenal dyspepsia. The indigestion, or failure on the part of the stomach to digest, takes place immediately after a meal, and continues for two, four, or more hours, according to the gravity of the disease, or kind or quality of food introduced; whereas, in intestinahor bowel dys- pepsia, the uneasiness or symptoms of indigestion do not com- mence for several hours after eating. In the stomach, the food, after being slowly and perfectly masticated, and incorporated with the secretion of the parotid and other glands of the mouth, is subjected to the action of the gastric juice, a powerful solvent, being made up of a substance called pepsin. In the bowels, the digested food or chyme, is subjected to the action of the pancreatic secretion, (a gland almost immaculate, enjoying a freedom from disease most remarkable,) which emulsifies the fat, starch, and other products, rendering them fit to become proper constituents of nutrition. The process of healthy digestion is easy, speedy, and complete ; there can be no excess of it, for food cannot be too quickly and completely converted into blood ; whereas, indiges- tion is slow, painful, and imperfect. Painful, from a slight uneasiness, to pain, or actual torture ; sloiv, when the stomach fails to digest in the ordinary time, and chemical decomposition or change takes place ; defective, when the food is either altered, or fermented, or decomposed, or formed into vegetable germs, like a yeast plant. BACTERICIDES. 289 Indigestion is divided into numerous forms or varieties accord- ing as one or more symptoms predominate. It is called simple, when there is loss of appetite, pain, weight, fullness or oppression about the stomach after meals ; flatulence, nausea, vomiting, constipation or diarrhea, coated tongue and fetid breath, with headache, palpitation, heartburn, water-brash, hypochondriasis. It is called slow digestion, Avhen there is a deficient secretion of gastric juice ; a feeling af fulness and distension at the pit of stomach, with the other s)^mptoms. It is called painful, when gastralgia and heartburn are the pre- vailing indications. Wind Dyspepsia, when flatulence, eructations of gas, and acid water, as water-brash or pyrosis ; there is usually gastrodynia, or stomach-ache. It is termed Bonliniic Dyspepsia, when, with the ordinary symp- toms, there is an excessive hunger or craving for food, and even not appeased by large quantities of food. Nervous Dyspepsia, when there is a nervous temperament, white face, sharp features, emaciation, phosphates and chlorides in urine; all or most of the symptoms are present, but especially headache, like a band or scalp flying off, and hypochondriasis a decided and prominent symptom, etc. Causes. — The causes are not only numerous but varied, and embrace every derangement and lack of tone in any organ, or of the entire body. Hurried eating, with imperfect mastication from whatever cause ; improper food ; drinking of fluids at meals, or the use of iced or cold drinks or food, highly depressing to stom- ach which arrest digestion ; want of exercise ; mental anxiety ; strain on mental powers by study or struggle for existence ; gen- eral debility, or nervous exhaustion ; use of whiskey, beer, tobacco, and drugs ; excessive drinking, especially cold drinks ; diseases of the blood ; and often due to reflex causes, as diseases of the liver, spleen, lungs, heart, kidneys, and to diseases of the nervous system generally. There is, so to speak, an endless chain of sympathetic and other causes. Symptoms. — Are very variable in their nature and severity. Loss of appetite, pain, weight, fulness at or about the stomach after eating ; acidity, flatulence, eructations, nausea, vomiting, pyrosis, tightness, heartburn, oppression, wearing cramp, lan- guor, debility, giddiness, with headache, frontal, or like a band round head ; a sensation as if there was a movement of the ground ; constipation most common ; still, there might be diar- rhea ; tongue coated white or brown, or if intestinal, buff coat, with transverse fissures; fetid breath; palpitation; pains in loins 19 290 DISEASE GERMS. or limbs ; often cough ; liver very torpid ; eyes tinged with bile ; urine scanty, high-colored, and deposits phosphates and chlo- rides ; skin dry, contracted ; the brain is often seriously affected, both through reflex action, want of nutrition, and otherwise ; so that hypochondriasis is always present in either a mild or aggravated form. A look at the physiology of the stomach will satisfy anyone of the existence of an immense nervous connection — the very secretion of the gastric juice being a nervous act — for there is no gastric juice in a healthy stomach until the stimulus of food is impressed upon the gas ric nerves, which is carried to the brain, and if that organ is healthy, gastric juice will be thrown out. The ultimate relation of the stomach with the great sympathetic, and the intimate union that exists between the stomach and other organs, cause non-sentient nerves to become highly sensitive. The abdominal plexuses of sympathetic nerves always play an important part in the production of indigestion. Treatment. — In all its forms, there should be an avoidance of all care, worry, and anxiety, study, or any mental strain. A vigorous brain is of essential importance, and an easy sympa- thetic soul of great moment. Every drain upon the nervous system must be blocked off; no over-work, nor care, nor sexual excesses. Pure blood is also important; and active, but not fatiguing exercise in the open air; daily bathing; if the cold douche or shower-bath can be borne, it is best, to be followed by friction and flannel clothing ; a diet highly nutritious but light, should be laid down, consisting of broiled tenderloin steak, or chicken, soft-boiled eggs, boiled fish, toast buttered, oatmeal mush, roasted potatoes, ripe fruit, mocha coffee. Veal, pork, salt or corned meats or fish, fried or boiled meat, all slop, as soups, pastry, pies, nuts, sweets, cabbage, tea, tobacco, alcohol, or all fermented liquors, should be carefully avoided. Another important point is slow eating, thorough mastication; no fluids, warm diet, perfect regularity in eating, sleeping, and in a daily movement of the bowels, and in perfect rest to stomach between meals ; no nibbling, or odd snaps, or lunches. Not more than three meals per day, with proper intervals between. Bowels to be opened with enemata daily every morning after breakfast. Special symptoms must be relieved or palliated, in order to give relief, until a cure is effected. The most valuable remedy in dyspepsia is a healthy condition of the mouth and teeth, and thorough mastication of the food. We all eat too hurriedly. There is too little mastication, not a BACTERICIDES. 291 proper admixture of the salivary secretion ; so that there is crammed into most stomachs a mass of inadequately crushed or undivided solid matter, which acts as a mechanical irritant, sets up disease. Eating quickly, filling the stomach with indigestible material, unprepared food, renders it incapable of recovering its tone. All animals intended to feed hurriedly have the powers of rumination, or are provided with gizzards. Man is not so furnished, and it is fair to assume he was made to eat slowly. Hurried meals are highly mischievous. Then there should be rest, for a considerable time after meals, of mind and body, but, on no consideration, sleep. To sleep after meals is the worst aggravation a weak stomach can receive. During sleep, digestion in the stomach is, to a certain extent, suspended. For the Relief of Eructations and Vomiting. — One of our best remedies to effectually relieve this condition is either pepsin or papoid. It should be administered with or at the meal. Its use causes little demand to be made upon the stomach for its di§|ps- tive secretion, and artificial digestion, promptly carried out, pre- cludes the possibility of either eructation or vomiting. There is no drug to equal it, as it gives vitality to a weak organ by giving rest. The digestive powers are assisted, and the food which, in other cases, ferments and irritates, because undigested, readily becomes assimilated, because it is now digested. Some think it best to give the pepsin or papoid a little while before meals, so as to afford it some time to combine with the existing condition of the stomach, and produce a more natural effect upon the food when swallowed, after being acted on by the salivary secretion. The idea is to give the stomach rest, and promote the formation of peptone ; and as soon as normal vigor is acquired, the organ will soon respond to the production of its natural fluids. The use of alkalies in the treatment of dyspepsia, should as far as possible, be discouraged, as they tend to weaken the mucous coat of the stomach, and give rise to catarrh. Perhaps the most innocent alkali would be one teaspoonful of Hme-water to half a tumblerful of milk, or five grains of bicarbonate of potassa to the sam.e quantity of milk, once, twice, or even thrice daily. For the Relief of Gastrodynia or Stomach Cramp. — As a rule this form of pain comes on following a meal. It is of the same character as neuralgia ; it is the gastric nerves crying for more nutrition — something to vitalize them. The various preparations of bismuth and cerium will relieve this pain, but their efficacy in other respects is not good. We witness their baneful effects in ladies who use it as a face powder or in cosmetics, and to introduce this deadening, benumbing drug 292 DISEASE GERMS. directly into the stomach is reprehensible if any other remedy can be procured. Capsicum, or white mustard seeds, especially the former, is an excellent remedy, a ^ood stimulant, does not irritate like black pepper, and its use affords almost instant relief. A good form is the compound tincture of myrrh, from half to one teaspoonful after meals in warm coffee. Half or drop doses of dilute hydro- cyanic acid act well, and being an ingredient of normal gastric juice, it could be added to the pepsin. A solution of quinine in aromatic sulphuric acid is also of utility ; mineral acids, carbolic acid and tincture iodine ; warm plasters, as hemlock or belladonna plaster, over stomach. For the Relief of Pyrosis or Water-Brash. — To mention acidity is equivalent to rushmg for an alkali, but a bitter will answer better. Still, patients will persist in their use on account of the immediate relief tbey afford. (^ycerine added to milk; one tablespoonful to half tumblerful, and taken after meals, relieves flatulence, acidity, pyrosis, or water- brash. Usually it is speedily and completely successful, as it pre- vents fermentation and putrefaction. Although glycerine prevents, putrefaction of nitrogenous substances, it does not prevent the digestive action of pepsin and hydrochloric acid ; hence, while it prevents the formation of acids, checks fermentation, it in no way hinders digestion. For the Relief of Gastralgia or Heartburn. — Reject alkalies and try nitric acid in compound tincture of cinchona, or dilute nitro- muriatic acid. If these fail, use hydrocyanic acid dilute. If that does not afford relief, steep gentian and horse-radish in good whiskey enough to cover, and use in tablespoonful doses ; or nux vomica in fluid extract of columbo or cascarilla. If, however, the dyspepsia has been in existence for some time, the stomach needs such a stimulant as the following: Pepper- mint water, eight ounces; tincture nux vomica, three drachms ; tincture belladonna, two drachms; carbonate ammonia, sulphate of magnesia, of each three drachms; tincture of ginger, half an ounce. Mix. One tablespoonful after meals. All microbes in their ingress into the skin ex- Ecthyma. cite irritation, erythema and effusion of lymph, thickening nodules, pustules. Very common on the face of both sexes about or subsequent to puberty. In older subjects they are found on the feet and hands. Ecthyma is com- mon as a result of any ordinary inflammation of the skin, pro- vided the system be somewhat debilitated. BACTERICIDES. 293 In the treatment the general powers of Hfe should be well sus- tained by the best of food. Germicides should be administered : as glycerite of ozone, avena, compound oxygen ; locally, to the affected parts, solutions of boroglyceride, peroxide of hydrogen, creolin, ichthyol should be used. An inflammatory disease of the skin, which Eczema, is not contagious, is polymorphous in charac- Moist Tetter, ter, and may be acute or chronic. Its poly- morphous or multiform character is one of its most marked features. Formerly described as a vesicular affec- tion, but it is erroneous to regard it solely as such. Vesicles, though frequently present, are not the sole elementary lesions met with ; in many cases, indeed, none are discoverable. Any one of the following primary lesions may occur : Simple redness (erythema), papules, vesicles, pustules. According to the lesion present the observer might thus be inclined to term the eruption erythematous, papular, vesicular, or pustular. It will have been noted that, in the classification adopted, eczema appears in several classes, but it will be convenient to refer to its vario is forms in the present place. A typical case is described as commencing as a patch of erythema, passing on to the formation of papules ; the latter then develop into vesicles, some becoming pustules. The bursting of the vesicles and pustules (either spontaneously or as the result of scratching) is succeeded by a serous or sero-puru- lent discharge; this is often very copious and thus justifies der- matologists in regarding eczema as a cutaneous catarrh. The drying up of the discharge is succeeded by the formation of scabs. Many cases, however, are far from presenting this regular course. The lesions are often more or less commingled, thus producing extremely varied appearances. The eruption may be "also more or less entirely confined to one form of lesion. Thus, it may be mainly erythematous, or vesicular, and so on. These different forms have been named correspondingly. Thus we get E, erytlieinatosum^ E. vesicitlosum, E. pustidosuin, etc. The red and moist condition of skin often seen in infants in the groin or between the nates, and beneath the breasts in stout women, is termed E. intertrigo ; in the official nomenclature it is classed as a separate disorder under the heading Intertrigo. In E. riibnnn or E. madidans there is intense redness of the skin, which is ex- coriated, largely denuded of epidermis, and exudes a copious watery discharge ; it is generally seen on the lower limbs. E. paptdosuvi is a form of eczema closely resembling lichen, which latter eruption is, indeed, described by some authorities as merely 294 DISEASE GERMS. a form of eczema. Similarly, some writers include impetigo under eczema, regard it as merely a variety of E, pustulosum. When the surface of the skin is red and inflamed, discharge scanty, but scabs formed in abundance, the resulting condition is termed E. squamosum ; the latter term was also employed by dermatologists to describe some varieties of psoriasis. The eruption may also be named according to the part affected, e. g., E. capitis, E, facialis, etc. Eczema is an exceedingly common affection. Statistics show that from one-third to one-fourth of the cases of skin diseases seen in practice come under this heading. It may occur at any a,ge, but is more common in young children — especially at or about the period of teething ; often (generally erroneously) attri- buted to vaccination. More common in males. May be of local or constitutional origin. Inflammation of the skin set up by ex- ternal irritants differentiated by some dermatologists as dermatitis. In most cases, external irritation is an important factor as, when not actually causing, it often materially aggravates the disorder. Eczema is often hereditary. Gout, scrofula, alimentary disorders, and circulatory derangements are said to predispose to it. Preg- nancy, lactation and uterine complaints are enumerated as causes of eczema, and it may also occur as a " trophic lesion" in various nervous disorders. As there are no specifics in medicine, none in cutaneous dis- ease, each case must be managed on its own merits and general principles ; so in treatment, we can only draw brief attention to the main indications for treatment. The general condition of the patient demands careful attention ; every effort should be made to discover the cause of this trouble- some and frequent skin disease. The diet should be carefully regulated, plain and nutritious, easy of digestion. Shell fish, alcohol, tea and coffee forbidden. Constipation is almost invariably present, and calls for imme- diate attention, as the ptomaines from microbes are always present and greater too if the peristaltic wave is slowed. Kola nut lozenge, better still the cascara sagrada lozenge, which stimulates the liver and aids elimination of excess of uric acid which inva- riably co-exists with eczema. General alteratives and tonics. Tincture of sulphur, alternated with nux vomica, or lycopo- dium do well, better by far than the indiscriminate use of arseni- cal solutions. An excellent formula for general use is : Comp. tincture cin- chona, four ounces; acetate of potass, half an ounce: tincture of nux vomica, two drachms. One teaspoonful in a glass of water after every meal. Another good formula is: Ozonized sulphur BACTERICIDES. 295 water and comp. tincture of gentian, equal parts of each, a tea- spoonful in a little water after meals, alternated with nux vomica. Locally washing to be avoided, but as this must be done, white castile soap should be used and a few drops of the peroxide of hydrogen added to the water. In cases with little secretion, we often meet with great success with a dry dressing, as simply dusting on the anti-microbe powder. To allay itching, a solution of boroglyceride ; or an ointment of ozone ointment and resorcin are excellent. Ichthyol, as an external remedy in the form of a solution or ointment, in strength varying from five to fifty per cent. It acts in three ways : (i) As a Protective. — When a solution of it is painted over the skin surface it quickly dries, forming a thin layer somewhat resembling friar's balsam or collodion, and so protects the skin from the air, dust, etc. (2) As a Reliever of Congestion. — When applied to healthy skin its effects seem nil^ but where there is an active congestion of the part it acts promptly by causing contraction of the arterioles, and so dimin- ishes the vascularity of the part. (3) As a Desiccant. — As it reduces the vascularity of congested skin, the outward flow ot serumi is also reduced, and consequently the part becomes drier. In these three actions are the essentials of the treatment of many skin diseases. Resorcin in glycerine or as a jelly ; ointment of iodoform, iodol, oleate of zinc ; oil of boroglyceride ; nitrate of mercury ; caustic potassa ten grains to the ounce of vaseline ; salicylic acid five to ten to the ounce of vaseline ; siegesbeckie cerate most effica- cious ; all internal and local remedies to be of utility should be changed weekly. The tubercular bacilli appears in a great Elephantiasis, variety of forms in the cuticle, true skin and subcutaneous tissue. In certain cases in which the nerve forces are decidedly bankrupt, and the external surroundings of the worse possible kind, the bacillus excites irritation, effusion of lymph, which form germ nests, great hyper- trophy, and induration. Associated with the hardness, there is considerable pain. Sometimes the parts are dry and mealy, in other cases serum exudes. It usually attacks the lower extremities, scrotum and depending parts, and progressively extends upwards. Before the introduction of so many bactericides, it was deemed incurable, now a cure in the earlier stages is looked upon with more hope. 296 DISEASE G-ERMS. Physicians of undoubted veracity say that the boroglyceride paste during the day, and the resorcin paste during night, are effective in getting rid of the infiltration. The usual internal remedies for the cure of tuberculosis certainly deserve a fair and impartial trial. The presence of the bacillus pyogenes in the Empyema, cavity of the chest — usually the result of pleurisy in debilitated subjects. It is liable to follow scarlet fever in children ; pneumonia and tubercular disease of the lung in adults; the bursting of a hydatid cyst into the pleura, or the bursting of a tubercular cavity of the lung into the thorax. Often it supervenes without any assignable cause. Symptoms. — There is at first pain of a sharp and shooting character in the affected side, and this is generally confined to one spot; the patient cannot cough or take a deep breath with- out increasing this pain. In a few days, when the fluid is poured out into the pleura, the pain may diminish considerably ; but there is more or less distress of breathing, because, from the pressure of the fluid, air cannot enter the lungs on the affected side, and the other lung is called upon to do all the work ; hence the patient lies on his back or diagonally towards the diseased side, so as to give the healthy side of the chest all the room he can to expand. From the first there are the usual signs of fever — a furred tongue, quick pulse, loss of appetite, and much thirst. The temperature, too, of the body rises considerably, and is liable to much daily variation, being high at night and perhaps two or three degrees lower in the morning. When the disease is well .established, the diseased side of the chest is larger in circumfer- ence than the other, and there is bulging of the intercostal spaces ; the veins also are obstructed over the part, and appear as blue lines running over the chest. The dyspnoea is great, and increased on exertion ; each respiration is hurried and shallow; the countenance is anxious, and sometimes pale or livid. Gener- ally the patient is worse at night, and becomes hotter and more oppressed ; at times a hectic flush appears on the cheeks, at others there is much perspiration over the head and body ; rigors or shivering are very usual in the early stages of the disease, but become less frequent afterwards. /// the treatment, the patient must be kept in bed, in a warm, well ventilated room, the air kept moist, and at a temperature of 65° to 75° F. Food of a highly nutritious character adminis- tered, as malted sterilized milk, beef tea, broth; and a moderate amount of stimulants administered. BACTERICIDES. 297 A course of internal bactericides, as the exhibition of the di- oxide of hydrogen, comp. oxygen, ozonized sulphur water. Jackets of bactericides have been tried, prepared of iodoform, and kindred germicides, occasionally a case seems to yield to them, but their uncertainty of action renders them practically useless. The living microbial mass should be removed either by aspi- ration or tapping the chest. The latter procedure is the best. For this purpose an incision, about an inch long, or rather less, is made through the skin, about, the sixth or seventh inter- costal space, and in the line of the axilla or arm-pit. A trocar and canula, about one-fourth or one-fifth of an inch in diameter, is then introduced, and when the trocar is withdrawn the pus will run through the tube most readily. The wound should not be allowed to close, but a piece of tubing of gutta percha should be kept in, so that any more pus that forms may escape at once, and not accumulate again. Even in very favorable cases pus continues to be secreted and to flow through the tube for days and even weeks after the original puncture. The quantity pro- duced dai^y gradually diminishes until at length it ceases. All this while the patient will be easier ; he can breathe more com- fortably ; there is less fever and hectic ; he will recover his appe- tite, and rest better at night ; but in all cases that recover, conval- escence is a very slow process, and tonics, generous diet, cod-liver oil, a visit to the sea-side or country are indispensable aids for regaining health. If the lung cannot expand after the matter has escaped, the chest-wall of the affected side will be pressed in by the external atmosphere, and so be smaller than the other, and in this way such patients often have lateral curvature of the spine afterwards. In time the healthy lung becomes much increased in size, and does in a great measure the work of both. The mor- - tality from this disease is considerable, and it is nearly always fatal when arising from pyaemia, or when the patient's health has been worn down by previous disease. In a few cases the pus has made its way through the skin of the chest, and burst externally of its own accord ; but it is best to tap the chest before such a process has taken place. A morbid state of the blood, in which it has a Embolism, tendency to clot or form fibrinous concretions, ^ which either adhere to the walls of vessels or are carried onward by the current of the circulation, and plug up or impede its normal course. The causes are varied : in-door life, insufficient aeration of blood by skin or lungs ; its imperfect decarbonism by the liver in drunkards; the pressure of the gravid uterus on the liver, and 298 DISEASE GERMS. non-ogygenization by pressure on the diaphragm. It is present in ague, typhus and other fevers ; also in croup, diphtheria, pneumonia, scarlatina, erysipelas, caused by the ptomaines of the germ of each, respectively. It is also caused by diseased vege- tables, fruit, meat, and cereals, such as ergot of rye, ustilago maidis, so that ergot during parturition produces it in mother and child, and is one of the most common causes of death to both. In an examination of the blood after death there is usually a large coagulum found in the heart ; fibrinous specks, patches, plugs can be seen in brain, lungs, heart, liver, and arteries. On an exam.ination of these clots or plugs by the microscope, they seem, in nearly all cases, to be a mass of bacteria interspersed with cadaveric alkaloids. It is often difficult to recognize the disease during life as the symptoms are quite variable, but if any of the above causes exist, it is positively present to a greater or less degree, and particu- larly so if the patient complains of strange sensations about the heart, and has a tendency to fainting. In all diseases in which this is present, or where it is suspected, the patient should be kept as quiet as possible in the recumbent posture, never being permitted to sit up, and nothing allowed to disturb him in any way, and have an abundance of fresh air. The diet should consist of milk, eggs, soups; the secretions attended to. In order to meet the pathological condition of blood, tincture of belladonna, alkalies, and peroxide of hydrogen should be administered. All acro-narcotic remedies have a wonderful effect in causing and maintaining a fluid state of the blood. Belladonna has this property in a high degree. A teaspoonful of the tincture in half a tumbler of water, of which a teaspoonful should be given every one or two hours, never administering it so frequently as to cause dryness of throat. In the sesquicarbonate of ammonia we have an excellent alkali. This either alone or combined with a few grains of bicarbonate potassa soon relieves the condition ; besides, the ammonia is destructive to living germs in the blood. Bromide of ammonia answers well if a deposit of fibrin has taken place. Salicylate soda in acetate of ammonia. Sulphate of soda is also valuable, so is the permanganate or chlorate of potassa. In dis- eases associated with embolism, iron and mineral acids should be avoided in treatment. The term thrombosis is applied to a clot of fibrinous blood causing a partial or complete closure of a vessel. 1 BACTERICIDES. 299 A pouch or air-sac in the lungs. Two Emphysema, varieties. Vesicular and inter-lobular em- physema. Vesicular Emphysema. — Consists of a debilitation, enlargement and coalescence of air-cells, atrophy of their walls and oblitera- tion of their vessels, may affect one or both lungs, or a part of each, especially anterior edges and apices. Its causes are degeneration, a sort of interstitial death, destroy- ing elasticity and contractility of affected tissues, the air-cells and their surroundings, which conditions may be caused or intensi- fied by running, jumping, hoisting, playing base-ball or wind- instruments, singing, shouting, lifting, diggir\^, rowing, running up stairs, or by anything that would cause the patient to take prolonged deep inspirations, or sudden check to an ex- piration ; a sequel of hoop- ing-cough, asthma, chronic bronchitis. Inter- Lobular. — Consist s of an infiltration of air into the interlobular areolar tis- sue, or into sub-pleural areolar tissue. This form is generally caused by rup- ture of the air-cells by vio- lent strain, or fractured ribs, and is generally met at the corners or abrupt angles ot the lungs. The distincti <\\ is important, as the lobular form is very hopeless, and can only be relieved by antispasmodics. Emphysema is often latent, dates back to early years ; an iso- lated spot of the lung weak, which affords an anatomical substra- tum for its occurrence ; a substantive inherent unhealthiness ot lung tissue, which gradually increases with years. This is the true pathological process, which is easily microscopically demon- strated, and is at the bottom of all cases ; gives rise to a predis- position, in an incomplete respiration and retention of air, and in time gives rise to microbiosis of patches in the lung, and lat- terly in the formation of large rarefied air spaces. Symptoms. — The symptoms are the same in both forms. Gene- ral debility, with shortness of breath and difficulty of breathing, increased by slightest exertion, and general distress, that the suf- A beautiful illustration of vesicular emphysenu showing a well-developed air sac in each lun§ with two small ones fully formed. 300 DISEASE GERMS. ferer is unfit for any active occupation ; feeble cough, expectora- tion of frothy sputa, dusky appearance of countenance, weakness of voice, stooping gait; loss of flesh and strength, lowered tem- perature, 85° F'ahr.; very weak and slow pulse, fifty to sixty; re- spiration twelve per minute ; constipation, occasional paroxysms of asthma ; chest barrel-shaped, scarcely any movement of the intercostal muscles in breathing; on percussion, an unnatural clearness tympantis can be mapped out, and to be found there at all times. Ausculation reveals indication of vesicular murmurs as must rule us in bronchitis. Heart sounds are very feeble, and that organ is frequently displaced. Disease of the right cavities of the heart, with venous congestion and dropsy. Diseased side bulging, round or prominent in bad cases. Treatment. — Emphysema is generally regarded as an incurable affection, and that is correct in a large proportion of cases ; still there are few cases that do not admit of much amelioration, and very many of the vesicular form curable. All conditions that would be likely to cause sudden iaspiration or expiration should be avoided, as mental and physical excite- ment, no shouting nor attempts at running, lifting, rowing, etc. Warm flannel clothing, very generous and strengthening diet, and tonics to stimulate the appetite. Some remedies have a re- markable power over the interstitial tissue and stroma of the lungs in atrophy or in sclerosis, such as lobelia, quinine and hyoscyamus ; one grain of each thrice daily operates well, and effects some good cures put up in pill form ; liquor ammonia, sambul, phosphate of iron and quinine, also, are of great efficacy. The lobelia, quinine and hyoscyamus pill is our best combination ; next, bromohydric acid ; warm, moist atmosphere. Quebracho is also a good drug to relieve the difficulty of breathine. It is difficult to define this disease, but it can be Epilepsy, described as a weakness or irritation of a patch of the brain, with an impaired cerebro-spinal centre which leads on the slightest disturbance to an explosion between the positive and negative forces of that organ, which produces the characteristics of sudden loss of consciousness and sensi- bility, power of voluntary motion, with tonic convulsions lasting a few seconds, and followed by clonic spasm of voluntary mus- cles ; cessation succeeded by exhaustion and coma. Attacks recurring at intervals. Without a weakened bulb and neighbor- hood epilepsy could not exist. The causes may be embraced under three general heads : (i.) Centric causes. (2.) Reflex. (3.) Blood diseases. BACTERICIDES. 3OI 1. Hereditary conformation, consanguinity, peculiar shape of skull, depression or excrescence from its walls, tumor, worms ; weakened patches by falls and blows in infantile life. 2. Reflex : caries and overcrowding of teeth, vaulting of the roof of mouth, giving rise to irritation of the trigeminus, the most reflex nerve in the entire body. Irritation anywhere, espe- cially in the abdomen, for of all the regions of the body none reflect more strongly on the brain than the visceral organs ; so we must look well to the stomach and bowels for worms ; if there is great mental depression, melancholia, for a loaded or sacculated colon, the kidneys, bladder and irritation of the gen- erative organs in both sexes, etc. 3. The blood, the living germs of tubercle, cancer, syphilis,, rabies, and even the ovum of parasites will nestle and form colo- nies in patches of the brain weakened by falls and blows, and thus increase the condition of molecular death. Epilepsy is characterized by general languor, debility, lassi- tude ; patient soon acquires a nervous temperament, sharp fea- tures, white skin, with an excess of brain-waste in urine in the shape of phosphates and chlorides. If the fits are about to ap- pear, there are in about two-thirds of all cases what is termed warnings or premonitory symptoms, which consist usually of some nervous sensations, different in duration and character, such as spectral illusion, hallucination of smell, taste, headache, giddiness, vertigo, twitching, confusion of thought, sense of fear, etc. But the aura epileptica occurs in the large propor- tion of cases; some compare this to a current of hot or cold air passing by ; others to a stream of cold water running on the skin, a fulness in head, a sense of burning or tingling or a prick- ing sensation, drawing inwards of the thumbs, a feeling as if insects were creeping, the sensation beginning in some remote part and extending to the head. Usually when aura ceases fit commences. The real symptoms : white or cadaverous appearance or pallor of features, with utterance of a shriek or scream ; and that may not take place, but the patient falls to the ground insensible, with loss of voluntary motion and violently convulsed ; convulsive movements continue violent, usually more marked on one side than the other ; distortion of face, gnashing of teeth, foaming at the mouth ; protrusion of the tongue, which is often bitten ; eyes partly open and suffused ; eyeballs rolling and insensible to light ; skin cold and clammy ; perhaps involuntary micturition and defecation ; vomiting ; breathing laborious, seems about to be suspended ; when the limbs are stretched out a deep sigh is drawn and the fit passes off Patient left insensible and as in a. 302 DISEASE GERMS. sound sleep, with stertorous breathing, from which he recovers with a feeling of stupor and exhaustion and headache, but with- out any knowledge of what he has gone through. Some hours subsequently small ecchymosis often detected on face, neck and chest. « The fit may be very light or very severe; its duration may be a few minutes or extend to many hours. Fits, when slight, often only consist of giddiness, confusion of mind, loss of conscious- ness, little or no convulsion and stupor, and all over in less than a minute. Seizures occur at variable intervals ; often occur at night without being suspected by patient or friends. Repetition of attack impairs memory, may cause cerebral hemorrhage, tem- porary or permanent paralysis, or dementia, idiocy. In all obscure cases, it is well to look for germs and parasites or their spores or eggs. The most hopeless cases are those due to centric causes in the brain or skull, defective nervous organizations, lesions of the meninges. Those due to irritation, reflected or propagated, or to a morbid state of the blood, if not of very old standing, are amenable to treatment. The great increase of epilepsy is due to the vices or defects of civilization, the brain being more susceptible to irritation; abnormal conditions of alimentary canal, uterine irritation, masturbation, venereal excesses, alcoholism, tobacco, syphilis, mercury, etc. Treatment. — The symptoms are those of a sudden explosion of accumulated nervous energy. From the periodical character of the fits, it is inferred that the accumulation of nervous energy goes on for a definite time in the brain and spinal cord until an explosion ensues, which spends itself upon the muscles of voluntary motion, which are thrown into violent action, and by these means the accumulation is exhausted — the explosion being followed by coma or deep sleep. Many measures have been proposed for preventing the gradual accumulation and sudden explosion of the nervous energy con- stituting epilepsy, as improving nutrition, restoring mental and bodily vigor by any possible means, abundance of exercise in open air, daily batliing. Treatment during a fit should be directed chiefly to protecting the patient from violence, and getting him out of the fit. All clothing should be loosened, so that the blood may have free circulation to and from the head and all parts of the body. A piece of pine wood should be placed within the teeth to save the lips and tongue from being wounded by the spasmodic move- ments of the jaws. The patient should be placed on right side BACTERICIDES. 303 on bed or floor, head well elevated, and restrained or guarded, so that no personal injury is inflicted. Cloths wrung out of warm water should be applied to the head ; mustard to the feet. Enemas of some broth, or mucilaginous tea, with half a tea- spoonful of spirits of turpentine, operate very favorably. Tying a ligature around the limb in which the aura is experienced prior to the fit, to ward it off, of doubtful utility. If fit lasts long, a hypodermic injection of one-quarter of a grain of sulphate of morphia in the cellular tissue of nape of neck or over deltoid instantly rouses tlie patient up. Snuff, inhaling nitrite of amyl, etc., rather to be avoided. During the interval, while the fit is off, there must be a vigorous eflbrt to prevent a recurrence or suspend the explosive tendency of the positive and negative forces of the brain with sufficient doses of bromide of potassa and other remedies to diminish or allay the reflex excitability and force of the cerebro- spinal centres. Such a formula as one of the following is efficient : Fluid e^ract of sambul, four ounces; tincture of calabar bean, one ounce ; bromide of potassa, one ounce ; bromide of ammonia, two drachms ; bicarbonate potassa, two drachms ; tincture ot belladonna, thirty drops. Mix. One teaspoonful or more — sufficient to ward ofl'the fits; or the following: Camphor water, four ounces ; bromide of potassa, one ounce; iodide of potassa, two drachms ; carbonate of ammonia, half an ounce. Mix. Dose, from one to more teaspoonfuls, sufficiently often to ward off attacks. The numerous causes of epilepsy have given rise to a variety of treatment, among which that of the bromides deservedly takes the first rank. For many years, bromide of potassium, sodium, ammonium, lithium, calcium, zinc, arsenic, nickel, camphor, ethyl, have variously been employed, but their action appears less reli- able than the bromide of potassium, or a combination of three — potassium, sodium, and ammonium. Lately the author first used bromide of gold, and encouraged by the results, has established a treatment of remarkable activity. The form preferred is the solution, which is of a dark orange color. The least dose for an adult is eight milligrammes in twenty- four hours ; for a child, from three to six milligrammes will suffice. When wishing to obtain a rapid effect in an adult this dose is gradually increased until the effect is obtained. If the dose is increased a persistent headache m.ay occur, which ceases when the dose is lessened. The author has never exceeded a dose of twelve milligrammes. The advantages are the small quantity required, compared to the bromide of sodium or potassium necessary to obtain a good result; and the absence of digestive disturbance renders it pos- 304 DISEASE GERMS. sible to continue the treatment for a long time without inter- mission. No phenomena of bromidism have been noticed ; no cutaneous accidents, nor loss of memory, or diminution in sexual functions. Every one is familiar with the grave result of the bromide treatment upon the general health of epileptics. Bromide of gold is more rapid in its effects, and gives rise to none of these very disagreeable phenomena. Another point worthy of attention is that the effect is lasting, and remains sometimes for many years without other treatment and with no return of the epileptic attacks. Bromide of potassa is a salt of high diffusive power, readily entering and quickly leaving the blood. It should be given freely diluted with water on an empty stomach, otherwise, part of it escapes from the system without being absorbed. Besides, its well-known power in producing anesthesia of the medulla oblongata, thus diminishing central irritation, it has a similar effect on the motor and sensory nerves. Bromide of lithium is a more powerful salt than the potassium, containing %nore bro- mine, but is not efficient in epilepsy. The dose of the bromide of potassa should be from forty to sixty grains per day ; not one grain more should be given than the quantity required. The addition of the bicarbonate of potassa in the one prescrip- tion and carbonate of ammonia in the other, increases the action of the bromine materially ; besides, they are antacid and pro- tect the stomach against brominism. The rule is, bromine enough to act successfully on the bulb, but not to produce a catarrhal condition of mucous membrane with a train of miserable symp- toms in which the remedy must be stopped. Bromide operates best on the heavy fits ; it has less effect on the light. What is really the value of the bromides in chorea and epilepsy due to the germs of tubercle, syphilis, or starved brain areas ? We cannot correctly appreciate. A weakened patch in the brain or bulb, with either of those two disease germs in the blood, will give rise to epilepsy. An imperfect nutrition or weakened patch in brain and cord, with impaired nutrition of the nervous ganglia, or group of nerve cells, with the same or other germs present, will give rise to chorea. Besides, there are the ordinary reflex causes. The two affections demand an alterative and tonic course of remedies, — all the time — with repeated small blisters of about the size of a silver dollar, to nape of neck, for six hours daily, twice a week, as there is always a co-existence of spinal tenderness, greater spinal impressibility and other hybrid ailments. In addition nothing should militate against the use of avcna sativa day by day, as the tissues are starved. It increases the motor power of BACTERICIDES. 305 the heart, tones the nerves, increases the number of nerve cells^ overcomes the want of equihbrium between the grey and white matter of the cord ; reheves insomnia, overcomes mental weak- ness, and incoordination of muscles. If, however, the motor phenomena are peculiarly violent, the patient must have rest — rest from excitement, from noise, from harsh words, from taking an active part in the struggle of life. We do not endorse the use of the bromides in either; it is true they suspend the reflex impressibility of the medulla oblon- gata — the seat of reflex action — but it is also, too true that they diminish nervous energy ; true vital stamina is lowered ; motor and sentient power diminish under their use. They soothe, dis- pose to sleep, but they blunt the intellectual faculties, impair the memory, confuse the ideas, render the individual dull, stupid^ apathetic, with a tendency to somnolence. They impede speech,, weaken special senses, make the body infirm, feeble, unsteady. Its effects on the ovaries and testes are to destroy, or obliterate the secreting cells ; being analogous to castration, so that sexual power is abolished. The bromides devitalize the mucous mem- brane of the stomach, give rise to gastric catarrh (sarcina ven- triculi) nausea, flatulence, etc. It also slows the heart, covers the skin with acne (the bromine rash). Now none of these symptoms are produced by the ozonized fluid extract sambul. It has precisely the same action upon suspending the fits or the choreaic twitching, but never impairs, nor damages, nor atrophies the sexual apparatus. The bromide craze has had its day. Many brilliant minds have been wrecked^ by its indiscriminate use ; it has caused impotency to be very general, and sterility exists from its use to a very alarm.ing degree. Simiilo, for epilepsy, nervous and hysterical cases, has not realized the anticipations formed of it. Its properties are iden- tical with the fl. ext. or essence of hyssop. It is a germicide of some power, but not efficient in epilepsy, and cannot cure it. True, if suitable cases are selected, those due to disease germs, it will da work, but never can make the inroad on the weakened bulb which is effected by the sambul. (Enanthe Crocata, or cowbane, is conspicuous as a remedy m epilepsy, it succeeds in warding off fits by arresting the molecular activity of the brain ; it is worthy of a trial. The tincture of cocculus indicus in ten-drop doses, morning and night, and gradually increased until it produces cerebral conges- tion. The drug keeps the cephalic vessels in a state of relaxation and thus prevents the vascular spasm which produces cerebral anaemia, the fundamental condition of the initial stage of an epi- leptic attack. It is most useful in old chronic cases, in whicli. 20 3o6 DISEASE GERMS. bromine and sambul have failed. The remedy must be carefully guarded. Exalgine possesses some remarkable properties in epilepsy in certain cases ; its action resembles the bromides — that to obtain its effects, it must be given in large doses and persevered with. Osmic acid, alternated with nitro-glycerine, has met with success. Other remedies often of utility are the mono-bromide of cam- phor, valerianate of zinc, cannabis indica,conium, Fowler's solution, bclerotinic acid, Chian turpentine, Calabar beans, lobelia. The elucidation of the germ theory of disease with its bac- tericide remedies has clearly shown that many obscure brain lesions are due to disease germs and uric acid in the blood. Many epileptiform seizures are preceded by hemicrania, and are readily kept in check by peroxide of hydrogen, uric acid solvent, etc. The use of these remedies in epilepsy bids fair to bnng this hitherto stubborn affection within the class of diseases amenable to treatment. It is therefore a good plan in all cases, after ward- ing off the fits either with ozonized extract of sambul or some other remedy, to place the patient upon some efficient bacteri- cide; such a course is attended with most marvellous results. If it is a boy or young man with short hair, an ointment of equal parts of chloral hydrate and camphor dissolved in vaseline should be rubbed into the entire scalp at bedtime ; in case of a lady, well up in nape of neck. It is a valuable help, whether it acts by continuity of tissue or by causing some molecular altera- tion in the periphery of the nerves and occasioning the same alteration in the nerve trunks, or in their nuclei, or by reflex ac- tion, it is impossible to say. The liver and colon should be roused into action by compound licorice powder and colocynth. There is a la*-ge number of cases where the central irritation is kept up by eccentric causes, as a worm, fistula, tight or elongated prepuce, or clitoris, which latter being removed, the central irritation is easily combated by the application of ice to the sympathetic nerve which issues from the last cervical and upper dorsal vertebrae, and by small doses of the bromine. The value of ice is effective in proportion to the youth of the patient and acuteness of the case. It is rarely bene- ficial in the chronic epilepsy of adults. Young children, from one to six years, sleeping in closed rooms, are subject to frequent attacks at night of screaming, with insensi- bility and semi-convulsions, due to the protracted inhalation of air deficient in oxygen and laden with carbonic acid gas. For this the chlorate of potassa is a sovereign remedy, and for the true convulsion and epileptic attacks in children it often proves curative. It is of no utility in the adult, unless combined with bromide. BACTERICIDES. ^O/ While wardiag off attacks, remove the cause if it is admissible. In distinguishing the true epilepsy from the feigned, the follow- ing are good landmarks for a guide. In the feigned, the patient does not fall violently but deliberately, to avoid injury; eyes are closed but pupils contract to the stimulus of the light; tongue and lips never bitten ; face red, congested instead of being pale ; skin healthy ; blow snuff into the nostrils and patient sneezes. A proposition to apply the actual cautery to the spine effects an in- stant and permanent cure. In infantile epilepsy, we must look for falls, blows, teething, irri- tation of the stomach and bowels, worms, and remove by lancing gums, emetics, cathartics and vermifuge remedies. If caused by fright or mental emotion, aconite, belladonna, hyos- cyamus, citrate of caffeine, etc. If caused by indigestible substances, emetics, compound anti- bilious pills, etc. If by worms, the active principle of pomegranate root, valdivine. If by suppressed menstrnation, compound betin pills, warm teas, etc. If by masturbation, large doses of tincture of green root gel- semium, with circumcision and shortening clitoris. If caused by blood disease-germs^ as tubercle, syphilis, etc., iodine, glycerite of ozone and water, nitric acid in compound tincture of cinchona, iodide of potassa, phytolacca, general altera- tives and tonics, as laid down under each ; and in all cases, either repeated blisters or irritating plasters, or the antimonial plasters below nape of neck, an open sore, so as to attract the germs of disease to another pasture-field, away from the vital organ — the brain. The bioplasm of normal nutrition, changed, Erysipelatas. altered, degraded by adverse conditions preju- dicial to vitality into a disease germ. The mi- crococcus erysipelatous is very small, consisting of minute cocci in chains, found in the mouth, breath, blood, kidneys and in the erysipelatous blush. They occupy the lymphatics of the skin and spread along them as the disease advances or progresses. At the margin of the erysipelatous zone, where the microbes are multiplying by millions, marked by the characteristic redness and swelling, the lymph glands are filled with zoogloea of micro- cocci, and the injection of these vessels keeps pace with microbe growth. Artificial culture of the germ succeeds well in almost any nu- trient fluid ; such cultures or even successive cultures inoculated into animals, produce erysipelas. 308 DISEASE GERMS. tl fl '''^ .\''' ' / • ?• ^'. '^'"' A 1/ Streptococcu p erysi ipelas. The presence of this germ in the blood of an individual gives rise to languor, lassitude, debility, pain in the head, back, calves of the legs, tongue coated with a heavy brown bacterial coat, usually constipation, albuminuria, rigors on the sprouting of the germ, and a high grade of fever, either prior or subsequent to the chill an inflammatory blush upon some part of the skin which was accidentally weakened. This inflammation of the skin is thus accounted for by micrographers, the streptococcus erysipelatous, having used up in their own growth, nutrition and multiplication all the oxidizable properties in the blood, and are in danger of starvation, becoming weak and attenuated, seek the cutaneous surface to have free access to oxygen. Here they received an infusion of new life and vigor, and have an unprecedented growth, spreading widely,, but invariably selecting weak or devitalized parts, where the vessels are weak and patulous. The most successful treatment consists in annihilating the germ, overcoming malnutrition, arresting germ evolution. To sterilize and annihilate the microbe : Internally try either brewers' yeast or ozone water ; or resor- cin or compound tincture kurchicine, or lactic acid ; sulphide of lime. Locally, try either satu- rated solution of borogly- ceride or ichthyol, one drachm of the latter to the ounce of distilled water ; painting it on every four hours, forms a complete protection, under which microbes die. Literally speaking, ichthyol is no antiseptic, in itself it cannot destroy the erysipelatous cocci, but it starves the nutrient soil, so that the skin is no suitable location for their multiplication. But the solution of boroglyceride is the remedy which annihilates, and that speedily ; a remedy one can depend on to wipe out every microbe. . This invariably depends on the presence of a Erythema, germ, and is the name given to an eruption of the skin which is attended by a diffuse redness over a larger or smaller tract of skin. This disease is something like Section of the skin in erysipelas. The microbe breeding in the lymphatics in chains ; multiplied looj diameters. BACTERICIDES. 309 a mild attack of erysipelas, and in some cases may shade into it, but it is much less severe in character, and although troublesome, is not dangerous. Unlike erysipelas, it is not confined to the face and head particularly; it is not attended with inflammation of the true skin, nor with any marked pain or fever. When the skin is dry, as in old people, and when it has somewhat lost its elasticity, it is very apt to become erythematous ; the face and neck may become in this condition from walking out in a cold northeast wind. These simple cases may be treated by resting the affected part, keeping it covered up from the air, and bathing it with tepid water several times a day. Another kind, which is more impor- tant, but still very curable, has been styled erythema nodosum. It is generally seen in children, and is found in the form of dirty purplish patches in front of the ankles. These are raised above the surface, and are painful on pressure ; they are worse after walking about. This state is due to blood and serum being effused under the skin, and it is thus different from the other va- riety. With rest in bed^ plenty of nourishing diet, such as milk, meat, strong beef tea or broth, and a little medicine of a tonic character, such as fluid extract of yellow dock, four ounces ; ace- tate potass, half an ounce ; tincture nux vomica, two drachms. Mix. Dose, a teaspoonful every three hours. Dusting the erup- tion with the anti-microbe powder, a cure soon takes place. This form is sometimes met with in cases of rheumatic fever. It more frequently affects young women and girls than the male sex ; yet it is met with in feeble boys. There is slight fever with it, and a feeling of languor and discomfort. Red, elevated spots, oval in form, then come out in a few days, and they are generally situated along the length of the limb or in a vertical direction. The lumps in a short time become purple, as if they were cold, and this in time dies away, leaving no mark behind. The disease, when it occurs, is met with in debilitated persons, and therefore measures should be taken to improve the general health. A cutaneous disorder, affecting chiefly those E>rythrasma. regions of the body where exposed surfaces of the skin are in contact, characterized by ery- thema, rose-shaped maculations, and due to the presence of microsporon missitissimum. The growth is in the superficial layers of the epidermis. The fungus to which this disease is attributed is remarkable for the extraordinary delicacy and fineness of its threads and spores. They are cylindrical bodies of variable size, inextricably inter- 310 DISEASE GERMS. woven. Bacteria and heaps of zoogloea are visible among the scales. It is easily recognized by being encountered only v.'hen op- posed surfaces of the skin come in contact, as in the axillae, groin, cleft of the anus ; by the definitely cir- cumscribed maculations. Color varies, vivid red all over or only the borders ; when old, yellowish or brownish tinge. It does not feel as if there was any eleva- tion, but throws off a fine flour-like furfuraceous de- squamation. Vesiculation and papula- tion do not occur. Color changes frequent, as red, reddish brown, pale reddish The most successful remedies Microsporon missitissimum. yellow and light or dark orange are either the boroglyceride paste or lotion, anti-microbe powder with improvement of the general health. The elements of nutrition, under adverse Fatty conditions to vitality, can be altered, changed Degeneration, modified or degraded into other living m.at- ter, which constitutes a diseased germ, such as cancer, syphilis, tubercula. Independent of this, living matter can be degenerated, the in- fluence of the formative force which builds, maintains existence, and then dies, leaving behind a tissue or structure of an organ, worn out, effete, useless, adds to the general state of general dis- solution. Degeneration is an indicator of advancing age, a necrobrosis, as we begin to live, we begin to die. Another special form of degeneration is the result of disease, slow, certain ; a slight, but continuous failure of nutrition, in which we recognize fibroid, fatty, pigmentary, calcareous, athero- matous degenerations of arteries, glands, nerves, which aggra- vate all maladies. is usually met with in one or other Fatty Degeneration of two forms ; that is, fatty tissue may of the Heart usurp its muscular structure, or there may be an accumulation of fat upon its surface so great as to interfere with its systolic and diastolic action. BACTERICIDES. 3H The causes of fatty degeneration of the heart are evidently those things which interfere with the nutrition of the heart. It is essentially a disease of middle life, associated or blended vvith senile decay, predisposed to by the use of tobacco, fast liv- ing, chronic alcoholism, systemic syphilis, gout, rheumatism ; states or conditions which directl}^ enervate the heart, give it a tendency to degenerative changes. In addition a want of nutri- tion may be the result of atheroma, or calcification of the coro- nary arteries ; embolism, obstruction, or to the use or absorption of phosphorus ; to the action of the yellow fever fungus on the liver. Fatty infiltration of the heart is directly caused by beer drink- ing and various other vices of modern society. In its occurrence, the changes noticed are ^ want of nutrition-; muscular structure becomes pale, loses its contractility, because its nuclei and muscular tissue begin to disappear, become completely granular, anaemic, filled with albuminoid matter ; oil globules obliterate normal fibres. As the muscular structure degenerates it assumes a dirty buff brown or yellow color ; loses its elasticity, power of resistance. Breathing is difficult ; heart liable to be hypertrophied. The coronary .,,^,^ arteries either atheromatous, calcified or obliterated. When the fat accumulates upon the sur- face of the heart, it is liable to cause atrophy with rupture. Fatty degeneration of the heart may go on unrecognized for quite a number of years, a pressing debility, a gradual inability to endure exertion for any length of time; sud- den fits of suffocation, with violent palpita- Teamed fibres from the heart . ' sr r in fatty degeneration. tion not mlrequent ; skm is pale, pasty, yellow color, extremities cold ; oedema not uncommon, espe- cially in old age ; digestion feeble ; perspiration profuse on the sUghtest exertion ; invariably suffering from difficult breathing after exercise ; occasional pain about the heart ; liver and kid- neys become affected, and as this takes place, respiration becomes irregular and feeble. Cardiac insufficiency is progressive ; and simultaneously all the tissues of the body become soft, flabby, affording strong evidence of arterial degeneration; the arcus often present; temper irritable, depression of spirits; disturbance of vision; failure of memory, giddiness, vertigo ; sudden cerebral anaemia during excitement ; syncope, epileptic fits ; pulse variable in torce, but feeble, yet accelerated. Later on angina pectoris ; the apex heart-beat is indistinct; no impulse can be detected. 312 DISEASE GERMS. The prognosis is unfavorable, as the usurpation of the muscu- lar structure of the heart by fat has either a fatal termination by rupture or cerebral anaemia. No plan of treatment can be laid down which is positively curative. No drug or combination of drugs can restore degen- erated muscular fibre, but much good can be accomplished in ameliorating and retarding the disease by improving the tissue- making power of the blood, which is best effected by very gentle physical exercise in the open air, by bathing and persistent mas- sage, by good nutritious food. Our best remedies to increase fibrine are comp. tincture cin- chona and mineral acids ; comp. tincture marticaria ; cardiac stimulants, like digitalis, strophanthus, should be administered with great care. ,^ Tobacco, beer, alcohol, worry, care, should be avoided. occurs either as a general or partial Fatty Degeneration infiltration of the liver with fat, or as a of the Liver general metamorphosis of the structure of the gland into adipose tissue. Associated with this in all cases is a gradual, painless, enlarge- ment of the liver. The victims of this disease are generally in the middle period of life ; men who have been large consumers of fat or other hydro- carbons, as beer, alcohol, wine, with little physical exertion. - The presence of certain disease germs in the blood give rise to fatty degeneration, such as the tuber- cular bacilli; the fungus of yellow fever, the microbe of typhoid, puer- ®\-f^ r^%^ peral, scarlet fever, variola, malaria, pyaemia. The use of certain drugs, as arsenic, antimony, phosphorus, ether, chloroform, tobacco ; old age, ^''"^' ''''^''- etc., produce certain changes in the blood, which give rise to fatty liver. Once a liver is infiltrated with fat, it increases in size, steadily and persistently, and commences to have a peculiar flattened appearance, a smooth surface; a pale brown or light color; a doughy, flabby feel, pits on pressure. Its capsule is tense, shin- ing, transparent ; vessels become enlarged and tortuous. Cutting the liver with a warm knife, the blade is coated with oil globules, BACTERICIDES. 313 very little blood flows from the cut surface. If the patient died in a very early stage, the liver would be reticulated, dotted or mottled, of a dull yellow color. The central veins are intensely congested and pigmented with fat, or the. whole substance may present a yellow appearance. It is not uncommon to meet with both fatty and amyloid de- posits in the same liver. An aggregation of fat in the liver varies considerably ; small deposits the size of a pea, interspersed through the gland, large nodules or patches in the liver of beer drinkers ; seventy-five per cent, of the entire organ is usurped by fat. There is always present in fatty liver, dyspepsia, flatulence, loss of appetite, want of nutrition, splenic enlargement, some pain over the liver, pain in the shoulders, dulnessin the apex of right lung. The slightest indiscretion in eating or drinking causes attacks of gastric irritation and diarrhea. Gradually the patient becomes anaemic, moody, suffers a loss of muscular power with a disposition to sleep. The skin is pasty, and smooth, soft, and flabby. Difficult breathing results from loxaema, enlarged liver, ascites. If acholia be present, with pale, clay-colored stools, the hepatic degeneration speedily proceeds to a rapid termination Fatty and waxy degeneration are often mistaken for each other, the history of the case- when in doubt has an important bearing in diagnosis ; in the waxy form, a history of syphilis, disease of bone, suppuration, etc., are, or have been present; whereas in the fatty form, chronic alcoholism, high living, malaria. The blood is watery in fatty liver; an increase of the white corpuscles in the waxy, a fatty liver is soft, flabby ; a waxy liver is hard. In waxy liver, faeces are pale, deficient in bile ; in fatty liver, faeces are often normal till disease has become well advanced ; with a waxy liver, spleen invariably in same condition ; with fatty liver, spleen often normal. Fatty liver is a disease invariably attended with great danger to life; death may take place at any moment from epileptic fits, apoplexy, or other grave lesion. Treatment can effect much in warding off, even if it cannot cure the disease ; a restricted diet with no fat, sugar or starch ; regular daily open air exercise, with baths and massage. Resi- dence if possible in a temperate region, free from malaria ; stop all alcoholic drinks gradually. A general alterative and tonic course inculcated, as comp. saxifraga, alternate with comp. tincture of matricaria, chionan- thus. 314 DISEASE GERMS. Usually the result of desquamative Fatty Degenerated nephritis, or Bright's disease. If it Kidneys. occurs without the precursory disease, intemperance and bad living may bring it about. Kidneys are usually large, pale, soft, doughy, and fatty. Symptoms. — A recapitulation of all the symptoms enumerated in Bright's disease, but greatly aggravated ; debility increases rapidly ; the uriniferous aspect, pallor, and anaemia much intensi- fied ; the pulse is now irritable and frequent ; there is general oedema ; puffiness of face and hands ; frequent micturition ; dys- pepsia, with attacks of vomiting ; a tendency to inflammation of the membranes of brain, pleura, peritonaeum, pericardium, and amaurosis, due to albuminuria, retinitis, and degeneration ; anasarca of the limbs and dropsy of the cavities. Indications of uraemic poisoning show themselves often in convulsions, coma, etc. The urine in fatty degeneration from the very commence- ment exhibits oil-globules, is very scanty, low specific gravity, and highly albuminous. There are also cast-cells filled with oil, presenting the appearance of dark, opaque masses, besides the oil-globules. When the urine is highly albuminous and presents a large number of oil-casts and cells, the case is to be regarded as a serious one, as they indicate an intractable form of the malady. In aged persons, especially females, con- Fsecal fined to bed or leading very inactive lives. Accumulations, and in whom nervous sensibility is more or less dulled, faecal matter is now and then found to accumulate, and in time to become so hard and large as to resist the natural expulsive action of the bowel. Most liable to occur in the aged or infirm ; still examples of it are often found in young subjects. Enemata of warm glycerine, which is so valuable in constipa- tion, have a most excellent effect in relieving faecal accumulations, a warm thrill is experienced, penetrating through the intestines, followed by vermicular movement which precedes peristalsis, fol- lowed by an urgent call. Enemata form, without doubt, the most efficient means known for dealing with fecal accumulations. The injection should be copious, and should be given, when possible, in the knee-and- head, knee-and- elbow, or lateral abdominal position. The best material is water at a temperature of about ioo°, although some prefer mixtures of soap and water, or of turpentine and water, or of oil. No anesthetic should be used, so that the patient's sensa- BACTERICIDES. 315 tion may afford some test of the amount of pressure employed. If any symptoms are present that raise a suspicion of stercoral ulcers, it is needless to say that the injection should be conducted with the greatest caution. The fluid should be very slowly intro- duced, and should be forcibly retained for ten or fifteen minutes ; and while the colon is well occupied therewith the faecal mass should be gently kneaded. Massage is of great utility, a most potent mechanical tonic and vitalizer. In its application the patient lies upon his back ; the hands of the operator are oiled, and, with the fingers widely opened, both palms are laid upon the abdomen ; the hands are made to pass systematically in various directions ; the pressure exercised is steady and deep, and the movements are slow; the manipulation on each occasion should extend over fifteen or twenty minutes, and should be repeated at such interxals as may be considered advisable. It is a mechanical agent, influencing the stercoral mass and modifying its position ; it is a stimulant, an exciter of the peris- taltic wave through the abdominal nerves which contain both excitatory and inhibitory fibres — a therapeutic measure of great value. A condition in which the vital forces have rect ived Fever, a shock and are struggling to regain their supremacy — an effort of impaired vital forces at restoration. The common causes of all fevers are disease germs and their ptomaines. The mode or manner of ingress of microbes into the body is still an unsettled question. The action of heat and cold, mechan- ical injuries of all kinds, poisons, may so degrade, alter, change elementary molecules into other living matter, or simply depress the vital forces and pave the way for the ready ingress of disease germs from without, such as the germs of malaria. The ordinary symptoms of fever are languor, lassitude, debility, pain in the head, back, and calves of the legs, rigors, high heat, frequent pulse and respirations, with derangement of the secretions. The poison or living germinal matter that produces these symptoms may have gained access to the patient's body through the air, or water, or food, or it may be the degraded or changed living matter of his own body. The salivary glands of the mouth are the most eligible channels of a poison gaining access to our bodies. This is apparent by the disturbance of the stomach. Once the poison has gained admission and found its way into the blood, it grows with great rapidity, and is diffused throughout 3i6 DISEASE GERMS. the entire body, disturbing the vitality of organic living matter with which it comes in contact. The destruction caused by fever or germ-disease involves every constituent of the body. General nervous depression is the characteristic of all fevers. The prostration,, rigors, headache, with pain in the back and calves of the legs, denote a partial death of the nervous system. Pain exists in every sensient nerve in the body, but is experienced most keenly by the patient in the large superficial sensient nerves of the back and calves of the leg. In fever we have a diminution of evaporation, the dormant skin does not act as a refrigerator, destructive metamorphosis is great, the semi-vital chemical changes raise the temperature, — there is rapid oxidation, the passage of organic into inorganic matter, the blood loaded tvith germinal matter; and its growth together with the irritation of brain and the eighth pair of nerves that supply the Hver, causing an excessive secretion of glucose, all of which go to explain the heat of fever. The controlling action of the brain being impaired, the heart and lungs are irritable, and their action accelerated. The brain needs more vital force to hold them in check. All the secretions and excretions are depraved. The termination of fever is either recovery or death ; the former may in some cases be imperfect, terminating in other forms cf disease, as anaemia, paralysis, etc. Some fevers, due to disease germs, a specific contagion, have a definite period of existence in the body, which limits their duration. Nearly all contagious diseases are of this class. Fevers are easily recognized by their symptoms:, languor, pain in the head, back, calves of legs, rigors, with high heat, frequent pulse and respirations, with perverted secretions. If the heat of fever does not exceed 103° Fahr., with favorable surroundings, hygiene, nursing, and no irreparable lesion, good hopes may be entertained of rapid recovery. The treatment of all fevers is based upon certain, well defined rules, viz.: Either sterilize, kill, or annihilate the microbe, the factor of the fever, and to maintain the vitality of the patient. To arrest in all cases, the destructive metamorphosis of the disease germ, bactericides must be administered ; these are the true remedies to lower temperature, reduce the action of the heart, diminish the respirations. In the incipient stage of all fevers, very great benefit is derived from an emetic to unload the stomach, an active or gentle cathartic to relieve the bowels, and an alcoholic vapor bath or some form of bathing to start the function of the skin. The utility of an emetic is apparent ; the living poison that 15ACTERICIDES. ^^j probably caused the fever has been taken in by the salivary glands, swallowed, and lowers the vitality of the stomach. It loathes food, fails to dis^est, and the symptoms are much ameliorated by an emetic. Before administering this, the patient should drink freely of tepid water with a small amount of bicarbonate of soda, so as to neutralize the acid secretion from the walls of the stom- ach. Following the emetic, the alcoholic vapor bath, then the cathartic. Typhoid fever is the solitary exception among all fevers to the use of purgatives ; in that fever they are not admis- sible, except in some rare instances. If the patient is unable to sit up or very young, or pregnant, instead of the alcoholig vapor bath, sponging the entire body should be resorted to with tepid alkaline water. In some cases vinegar is a good addition. Then the regular treatment for the case should be laid down. The room selected for the patient during his illness should^ if possible, be isolated, well ventilated, no draught, abundance of light, free from carpets, curtains, and paper on the walls, as they retain the seeds of disease. If possible, an open fire-place, and if the season permits, a fire, so as to destroy the disease-germs as they escape from the patient. If convenient, two beds should be placed in the apartment, so that the patient's clothing and bed- clothing can be changed daily, and he lifted from one bed to the other. In all cases the head of the bed should be placed to the north, feet to the south, and insulated from the floor with glass castors or pieces of glass, so that the patient may be in unison with the magnetic law of the earth. The greatest cleanliness should be observed. When clothing and bed-clothing are re- moved, they should at once be immersed in water with an anti- septic. No unused food should be permitted to remain in the room. Antiseptics, such as chloride of lime or carbolic acid, buckets of water with bromine, or iodine, or permanganate of potassa, should be exposed in different corners of the apartment. If a nurse is to be selected, let her be young, strong, vigorous ; few" attendants except the nurse, so that the contagion be limited as far as possible. All superfluous matter should be kept away from the patient, even books. Magazines and papers should never be permitted to get out ; after perusal they should be destroyed. In all cases the hair should be cut short and the cut portion de- stroyed or deodorized. The recumbent posture is the true one, it retains the nervo-vital fluid in the spinal cavity and not in the cranium, and gives a diminution of pulse of at least ten or twelve beats per minute, with a corresponding lowering of heat and re- spirations. The entire body should be sponged three times daily with an alkaline wash, such as castile soap and warm water, or 3i8 DISEASE GERMS. bicarbonate of potash and tepid water, well dried, and then rubbed with the dry hand. It is sometimes beneficial to follow this with vinegar and water, which is cooling and grateful to the patient and excites the normal alkaline secretion from the skin. The alkaline bathing removes the disease-germs, opens up the emunc- tories of the skin ; the rubbing with the dry hand dislodges the disease-germs from the capillaries, removes the stagnation in the microscopical circulation, and the reflex effect of it is highly vita- lizing to the medulla oblongata, the seat of reflex action and life. Besides, the inherent vitality of the nurse is in this manner com- municated to the patient, so that instead of elderly ladies being selected for nurses, we demand the young and healthy. The law of reflex emanation is definite : we assim^ilate the vital condition of those with whom we are brought in contact. In exhausting fevers, like typhoid, good results are derived from the inunction of warm olive oil after the sponging and dry- ing off. This aids nutrition, supplies the place of arrested seba- ceous follicles,, and softens the skin, for exhalation attracts the germs to the surface and smothers it. Oil is perfectly compatible in the living tissues. Physiological chemistry explains the imperative necessity of drink in fevers. Water requires to be in excess of the demand ; acidulated drinks of water, with a few drops of acetic or hydro- chloric acid, enable the albumen to be acted on by the gastric juice. All acid substances have the power of increasing the nor- mal alkaline secretions of the body. Apply heat to the feet in all cases of fever, for though the action of the heart is violent, yet it lacks the stamina or power to send the blood to the capillaries ; besides, the nervous system, upon which the circulation depends, is incapable of performing its function in aiding the circulation, and artificial heat aids in a renewal of life. As to the clothing of the patient, cotton and linen should be avoided, and woolen or silk preferred as con- servators of v^ital force and being impervious to atmospheric changes. In fever the nitrogenous tissues are devitalized, drained away, and it is important that they should be replaced, so that small doses of nitrogenous aliment should be given frequently. These pass over the irritated stomach unconsciously, and are taken up by the iacteals in the intestines, requiring very little to make them fit for absorption. The most suitable food is milk. It forms the most appropriate nourishment for fever patients. Two to three ounces should be given every two hours with half a tea- spoonful of lime-water. If it disagrees, substitute beef tea for the milk. If the patient is properly nourished, it renders the BACTERICIDES. 3IQ ■danger much less. Albumen, such as we possess in eggs and oysters, is highly nutritious if quickly absorbed, but if delayed, as they are likely to be by the impaired condition of the stomach, their decomposition is highly injurious — the sulphuretted hydro- gen and other gases evolved are so poisonous that an aggrava- tion of symptoms is the result. A good condition of gastric power is necessary for the digestion of eggs and oysters. Alcohol is a poor stimulant; it has no food or blood-forming faculty ; its only property in fever is an arrester of destructive metamorphosis or change, so with reference to its use in fevers we must be guided by the amount of disintegration going on. If there is great prostration, low muttering, delirium, excessive phosphatic elimination by the kidneys, it should be given. It acts well if there is tremor of the muscles, a sharp, weak, un- equal pulse, or rapid respiration. Sleep is most essential in fever. It is only during sleep that the brain picks up its nutrition or pabulum from the blood. There is no nutrition Avithout sleep. In our pathology of fever, we recognized the microbe as its factor, depressed vital force, as the condition or sphere of exist- ence of microbial life. Bactericides must be administered every hour; just as they kill the germ, temperature is lowered, respira- tions and pulse become normal; if indications exist administer either aconite or antipyrine, or veratrum or antifebrine, or gelse- mium or exalgine. Careful nutrition and nursing. The division of fevers, now that the germ origin of disease is thoroughly established, must be as follows : Simple Fever, Dengue, Gastric Fever, Cerebro-spinal Meningitis, Bilious Types of Fever, Puerperal Fever, • Malarial Fever, Surgical Fever, Relapsing Fever, Measles, Typhoid Fever, Scarlet Fever, Yellow Fever, Small-Pox. One-day fever, the simplest type of fever, re- Fever, suiting from a slight shock to the nervous sys- Ephemeral. tem, rigor and a fever, in which the vital forces, aided or otherwise, react in twenty-four hours, or a few days at most. The cause is usually cold, wet, exposure, overwork, mental de- pression. The usual symptoms are: the patient is seized with lassitude, debility, nausea, want of appetite, chilliness, pain in head, back. 320 DISEASE germs! limbs. After a few hours rigors and fever, high heat, frequent pulse and respirations, headache, thirst, constipation, dry skin, scanty urine, perhaps slight delirium ; symptoms aggravated at night. After a few days a remission ; critical sweating or diar- rhea. Convalescence often somewhat slow. It usually terminates in recovery. It is easily recognized by its cause, mildness, short duration, by its common occurrence in children, persons of feeble vital force, and nursing women. In the treatment general principles are to be followed out ; if there be much nausea or disposition to vomit, a very mild emetic may be useful, and open the bowels with some saline. A warm or a Turkish, bath, or alcoholic vapor bath, or one or two doses of fluid extract jaborandi should be resorted to to excite the action of the skin and stimulate the periphery of nerves. Patient must remain in bed, recumbent posture, then one or other of thefollowing remedies should beadministered: aconite, an- tipyrine or exalgine, in doses sufficient to lower temperature, pulse, respirations. Whichever one is selected, it should be alternated with a bactericide, as a few drops of peroxide of hydrogen or compound oxygen. This latter is essential, as the breath, saliva, tongue, are loaded with a conglomerated mass of micro- organisms. Just as soon as fever abates a good tonic should be adminis- tered, as compound tincture of cinchona or matricaria. As recovery progresses, diet should be more liberal ; compli- cations guarded, every symptom promply relieved. So called, because induced by some agent Gastric Fever, which irritates and weakens the stomach, and causes a perversion of normal nutrition, and the appearance in the mouth, saliva, breath and coating of the tongue, the bacteria as seen in this illustration. It is almost exclusively peculiar to children, and its origin can be traced to eating pastry, cabbage, nuts, candies ; alcohol. There is a period of prostration, during which the child suf- fers from languor, lassitude, debility, nausea, vomiting, followed by rigors and a fever, in which the predominating symptoms are nausea, vomiting, pain over the region of the stomach ; acid or fetid breath, white-coated tongue are always present. Its duration is from seven to fourteen days, and if properly treated terminates in recovery. It is easily recognized by its history, derangement of stomach,. BACTERICIDES. 321 nausea, vomiting, white coat on tongue, irritation and of brain, and that it is pe- the entire absence of any other type of fever cuh'ar to children. Treatment. — As soon as recognized, give the little sufferer an emetic. The peculiar shape of a child's stomach enables it to vomit easily and effectively. To very young children the wine of ipecac, to those more advanced in years an infusion of lobelia. In all cases precede the emetic with drinks of tepid water with bicarbonate of soda, so as to neutralize the acid secretions of the stomach and permit of an easy absorption of the emetic, and a thorough washing out of the stomach ; follow this with a warm alkaline bath, then give a teaspoonful of the neutralizing mixture with one grain of leptandrin, every hour, until a free movement of the bowels is obtained. While pursuing the above treatment, aconite, veratrum, and sweet spirits of nitre should be given as in the preced- ing fever. Another excellent plan of treatment even better than the above, would be to start in and persevere with one or other of the following germicides. Ten grains of resorcin could be ad- ministered in water every three hours, or a few drops of the peroxide of hydro- gen or salicylate soda in the liquor ammonia acetatis ; or com. oxygen ; or ozonized sulphur water, etc. If there is still a disposition to nausea or vomiting, apply a plaster made of pulverized cloves, allspice and capsicum, moistened with vinegar, over the region of the stomach, and give milk and lime-water in very small quantities every two hours, for diet. Gi\ e the stomach all the rest possible ; as a drink, boiled water on toast or crackers, or barley-water. Several days after the fever has entirely disappeared is the proper time for tonics, as the wine bitters, elixir cinchona, sul- phate cinchonine. Otherwise, the treatment should be the same as for fevers generally, especially insisting upon rest in the recumbent posture, and sponging the body thrice daily. 21 rhe bacteria— the degraded bio- plasm of nutrition — the prevail- ing microbe of mal-nutrition — ■ gastric fever. 322 DISEASE GERMS. A fever induced by some shock to the Simple liver. Bilious Fever. The common causes are blows, articles of dress irritating the liver, microbes in the blood, as syphilis, and mercury, eating and drinking excessively of carbonaceous articles. The ordinary symptoms are prostration, in which we have lan- guor, lassitude, debility, nausea, vomiting, brown-coated tongue, yellow skin, pain perhaps over the region of the liver or in the shoulder, constipation or diarrhea, with rigors and fever, the yellowness of the skin increasing and heavily tinging the white of the eye, with dulness, stupor, coma, and itching of the skin. This simple form of bilious fever should be managed with great care, and a most active treatment in gU cases resorted to. Exalgine should be adniinistered in proper doses to lower temperature and equalize the circulation, the surface should be bathed thrice daily ; stimulants should be applied over the region of the liver. The bow^els should be opened by some remedy calculated to stimulate the liver, as either phosphate of soda and chloride of ammonia ; or euonymine and caffeine. Those remedies act well as liver stimulants. As a rule the case progresses well under these mild remedies. Just as febrile action is effectually controlled, the following acts most efficiently : Comp. tincture cinchona and simple syrup, of each two ounces; nitro-muriatic acid, two drachms; water, half pint. Dose, a tablespoonful every three hours. Other cases again can be managed by the administration of exalgine, and small doses of either the kola-nut paste or cas- cara sagrada lozenges. This latter remedy is of great utility in all states in which the liver has suffered damage. Diet, malted sterilized milk, arrow-root, and other simple articles. Intermittent fev^er or ague, whose chief character- Malarial istics are that it has febrile paroxysms, coming on at Fever. a definite specific time, usually, but not always, ushered in with a chili, followed by a fever, ending in a critical sweat, and during the intermissions or remissions, there is an interval of apparent good health, and at the end of a certain interval, tlie phenomena of rigor, fever and sweat are repeated again and again, until a cure is effected. The cause of this peculiar type of fever is the spore or germ of decaying vegetable matter, acted on by solar heat ej^ceeding 75° or 80° F., becomes active. The germ or spores may come from any decaying matter whether it be on the ground, in a marsh, in the soil or ground, stagnant pool, or water we drink. BACTERICIDES. -^23 In all countries whose temperature exceeds 80° F., and decay- ing vegetable matter present, there is a bacillus evolved which, under favorable circumstances, enters the body either by air breathed, or water drank, or by endosmosis through the skin. Once the germ enters the blood, if vital force is normal, it will be repelled, ousted out; but let vitality be depreciated, the bacillus will grow, sprout, seed, evolve spores, cause grave changes in the blood and vital organs. The bacillus is found in the blood of the patient during the rigor, as in the annexed cut, while during the sweat or decline only spores are found. The same microscopic organism is found in malarial sections in a strata of air which floats above the ground. The microbe is pathogenic, capable of cultivation, the cultures injected into animals produce the dis- ease, the microbe being found in the spleen, lymphatics and pink marrow of the bones. The fact that the bacillus and its spores are successively found in the blood explains the intermittent type of the fever. Vegetable decomposition is the source of the germ. From the ponderable character of the spores, they lie close to the e^round, so that ^^ ^ .„ , , } , ^, . . r J n ^ The bacillus of malaria. those who sleep m the nrst rioor lower rooms of dwellings are easily contaminated with it. Fires destroy them, hence the denizens of large cities, as a rule, are exempt from their attack. Certain trees which evolve ozone, as the willow, magnolia, eucalyptus, pine, are, by the pungent, grateful odor emitted, inimical to germ and spore, causing their destruction. The germ of malarial feyers is an organic germ floating in the air we breathe, and capable of introduction into our bodies through the food we eat or the w^ater we drink. The pathologi- cal effects of the germ upon the human organism are protean in their forms, varying from the intense saturation of the system to the slightest degree. No organ in the body escapes the influence of the germ. The characteristics of the bacillus are its periodicy, the com- plete evolution may demand twenty-four, forty-eight or seventy- two hours ; the access, the rigor corresponds with the greatest ac- tivity of the bacillus, and which precedes the emission of spores. When the paroxysms occur at the same hour every day, the fever is called quotidian ; w^hen every other day, tertiaii ; and when absent for two whole days and then recur, quartan. In the quotidian^ the interval is twenty-four hours ; in the tertian, forty- eight hours, and in the quartan, seventy-two hours. The period between the termination of one paroxysm and the commencement 324 DISEASE GERMS. of the next is the intermission. In the quotidian form, the paroxysms occur for the most part in the morning; in the tertian, at noon ; in the quartan, in the afternoon. Besides these forms, we meet with cases occurring once a week, once a month, once a year. Any type may be double, that is, occurring twice during- its specified time. Once the sprouting is effected the newly-formed or full-fledged bacilli imbed themselves in the red corpuscles and cause crescen- tic pigmentation of the blood, with segmentation of the germ ; if vital force be high, even normal, they will be repelled. The blood of man and do- mestic animals in whom the micro-organisms of malaria have entered, have the disease germ enter the interior of the red discs, in which they un- dergo changes, sprout, develop, grow. In their first attack upon the red corpuscles, they are of an amoeboid form, cause cres- centic pigmentation, as seen in the annexed wood-cut. As they grow older they assume the flagellated form, which is the adult condition of the germ. Any one can readily verify the fact by drawing a drop of blood from any part of the body ; place it in the field of a microscope of 2500 diameters ; take a drop in the cold stage, and the amoeboid pig- mentation will be seen ; take a drop in stage of decline, and the flagel- late protozoa are present in millions in a case of ordinary quotidian. The germs crowd the capillary vessels of the brain and the blood- forming glands, as the spleen, suprarenal capsules, pink marrow of bones, lymphatics. These, in chronic cases, are filled with dark granules, flagellate A beautiful microscopic illustration of the microbe of malaria. It is seen as a pigmented proto- plasmic body boring into the red corpuscles of the blood and destroying them in their process of growth. Invariably present in all forms or stages of the disease. Truly diagnostic. This illustration exhibits the amoeba pigmented bodies in the red corpuscles, numerous free circular forms, a few crescents and several flagellate organisms. The adult form of the germ. BACTERICIDES. 325 organisms, with an undulating fin-like membrane, highly poly- morphic. In the tertian, quartan type, and in the comatose pernicious forms, the germs are most numerous and most destructive to the red corpuscles. An interesting practical point is still unsolved, which is, whether the micro-organism from decaying vegetable matter, when it enters the blood, coalesces with and destroys the red discs, or whether the microbe produces a special degradation of living matter, rhancrpQ if into the mirrohe Typical example of the germ in the blood-forming ClldUUCb IL niLU UlC IxUClUUC, glands, as the spleen, pmk marrow, lymph canals. CaUSinP" destructive meta- in the pernicious form the capillaries are literally , "-^ . r 1 1 Stuffed with micrococci and microbes. morphosis 01 the red cor- puscles. One thing is certain, that the micro-organism is patho- genic of the disease, capable of culture ; cultures injected into animals produce the disease. Symptoms. — This fever may set in suddenly, or it may come on gradually with a feeling of general indisposition, which at the end of a few days may culminate in a regular paroxysm. An ague fit is composed of three stages, the cold, hot, and sweating. The cold stage is ushered in with feelings of languor, lassitude, debility, headache, pain in the back and limbs, chiUiness. There are sensations as of cold water running down the back ; shiver- ing ; the skin is shrivelled and the papillae rendered prominent, the skin assuming the appearance of a plucked goose (cutis anse- rina), resulting from irritation of the nerves that supply the microscopical muscles of that gland, which are called arrectores piloriLin. The teeth chatter, the nails turn blue, and the whole body is shaken ; there is exhaustion, often urgent thirst ; the countenance is anxious ; the features contracted ; eyes dull and ' sunken ; pulse feeble ; respiration hurried or oppressed ; mental irritability. The duration of this stage varies from a few minutes to several hours, and is succeeded by the hot or febrile stage. Then all the symptoms of fever are well defined : increased respiration ; more frequent pulse ; elevated temperature ; parched mouth ; excessive thirst ; painful sense of fulness in the head ; great restlessness ; irritability ; delirium. This stage may last a short time or for some hours. Then follows the sweating stage, beginning with a slight moisture on the forehead, then over the entire body. After its decline, all the symptoms become ameliorated, and the patient to all intents and purposes seems to be in perfect health until another paroxysm takes place. 326 DISEASE GERMS. Sometimes one or two of the three stages are absent. The general effects of this microbe are : 1. More or less irritation of the brain, according to the amount of germs present and power of vital resistance. 2. A blood-disease is engendered ; that fluid is loaded with bacteria and malarial germs, and as they increase in number it becomes fibrinous or clotty, and dark colored. Such blood coagulates readily in the fine, delicate interstitial structure of the brain, in the granulated structure of the liver and kidneys, in the very vascular structure of the spleen, and even adheres in masses to the walls of arteries. When this condition has lasted months or years, a white-cell condition or leucocythemia is brought about. 3. This white-cell disease of the blood is properly the third stage, and is brought about by the malarial germ using up in its own nutrition the ele- ments of the red cor- puscles, aided by the mor- bid condition of an en- larged, indurated, or caked, or hypertrophied state of the spleen or an amyloid degeneration of other glands. This fever is easily recognized by the parox- ysms occurring with pe- riodicity, being ushered in with rigors, followed with fever and a sweat. During the remissions an interval of apparent good health, but at the end of a cer- tain interval the phenom- ena are repeated. The morbid conditions are irritation of brain, liver, kidneys, spleen, with blood loaded with living disease-germs, creating an embolism of the blood. In all forms of shock there is a deter- mination of the capillary circulation to the internal viscera ; the spleen, the safety-valve of the heart, suffers most, as the blood is driven inward. True, the congestion subsides during the inter- mission, but repeated attacks with the peculiar bacterial blood give rise to hypertrophy, induration, thrombosis. In the treatment of all forms of malarial fever, the great object in view is to maintain the vital forces by nourishment, bathing, comfortable clothing, and rest in the recumbent posture in bed. Destruction of the red corpus< les of the hloocl in the spleen by the microbe of malaria. BACTERICIDES. 327 During the different stages of the fever, the patient should be nursed and tided over as gently as possible — cold stage, diffusable stimulants ; febrile stage, aconite ; during the sweat or decline, cooling drinks. During the interval, the bacillus, if possible, must be completely annihilated. There are several preparations of great value, in use for this purpose, they are either Warburg's tincture ; or the concentrated tinct. of kurchicine; or eucalyptol. Each of the three remedies is equally good. One is to be selected, and administered according to the following directions: • In any given case of malarial fever, of either the quotidian, tertian or quartan type, first open the bowels with an antibilious purge; then^ three or four hours before the chill or paroxysm, administer either half an ounce or one large tablespoonful of the tincture, without any water; then follow just a little before the chill with another dose. It should be given undiluted, and no drink allowed between the doses. If the profuse perspiration and disintegration of dead germs prove exhausting, beef essence should be freely given. For ordinary fevers, much smaller doses are admissible. The remedy selected administered in smaller doses for seven consecutive days. (For additional formulae see Cinchona.) This occurs in the form of continued fever Remittent characterized by remissions. There is no cessa- Fever. tion of the fever, simply an abatement or diminu- tion. The period of remission varies from twelve to twenty-four hours, at the end of which time the feverish excitement increases, the exacerbation being often preceded by a chill. The cause is the malarial germ, acting upon vital forces already exhausted. It varies greatly in its severity, according to the number of microbes present in the blood the peculiarities or type of the patient. Symptoms. — Usually commences with languor, lassitude, de- bility, mental depression, headache, shivering followed by high fever, vomiting, sometimes jaundice, often accompanied with delirium; pulse frequent and full; tongue dry and furred; nausea, vomiting, generally of bilious matter ; sense of pain at the epi- gastrium, and tenderness on pressure, with signs of pulmonary congestion, great difficulty of breathing, a feeling of oppression at the chest, cough, and a livid color of the countenance. The urine is usually scanty, high-colored, and loaded with lithates. 32! DISEASE GERMS. but passed in increased quantities during the remission. Length of remission varies from six to twelve hours and from twelve to twenty-four hours; at the end of which time the feverish excite- ment increases and the exacerbation is usually preceded by chilliness and a rigor. Remission usually occurs in the morn- ing ; the principal exacerbation is generally towards the evening. The disease may run on for some fourteen or fifteen days and end in an attack of sweating, or merge into typhoid or cerebro- spinal meningitis. The period of convalescence is usually short, except some organic mischief has occurred, in which case con- siderable time may elapse before a restoratiou to health is effected, the debility being kept up by night-sweats, sleeplessness, dyspepsia, neuralgia, jaundice, and dropsy. Complications. — The extreme severity of some cases, the de- pressed condition of the nervous and vascular systems, with defective secretions, the great exhaustion at the termination of a paroxysm, collapse, convulsions, or delirium, passing into drow- siness and coma, cerebro-spinal irritation, with gastric irritability, or with bronchitis, pneumonia, or with hepatitis, jaundice, diarrhea, or typhoid symptoms. The chief causes of the com- plications are great depression of vital power, with epidemic influence and improper treatment- As a rule the fever terminates in two weeks in recovery or some of its numerous complications. Th.e diagnosis is important ; a continued fever with remissions, when complications arise, other morbid states taking place, the points of recognition may be varied. In the treatment of remittent fever, general principles must guide us ; the state of the stomach, bowels and skin merit imme- diate attention. It must be borne in mind that the febrile exacer- bation is of longer duration and of greater intensity than in in- termittent, so there is more danger of structural lesion of brain, liver, spleen, stomach and kidneys, and our first great object should be to effectually equalize the circulation and mode- rate the excitement with a mixture composed of four ounces of water, to which is added one teaspoonful of tinctures of vera- trum viride, aconite, green root tincture of gelsemium and sweet spirits of nitre, one teaspoonful every half-hour until all febrile excitement has become ameliorated and the pulse down to seventy. Then begin with remedies to destroy the germ. For this purpose it is best to resort to a combined treatment of the two classes of remedies, so as to break it up. So that it is well to give quinine, eithernvith prussiate of iron, or in the form of a bisulphate, that is, dissolving it with aromatic sulphuric acid in from one grain to several, every four hours. Give the two reme- BACTERICIDES. 329 dies alternately; if the above does not meet the indications. Then try either Warburg tincture or concentrated tincture of kurchichine, in half or one-teaspoonful doses every three ho*urs.' Bathing the entire body has a magical effect in procuring sleep. The diet should consist of beef tea or farinaceous food. Com- plications looked for and carefully guarded. If there seems to be much cerebral disturbance, active purgation, mustard to feet, head shaved and evaporating lotions of camphor-water and am- monia applied. If there is low delirium or exhaustion, or cere- bro-spinal irritation, dry cups followed by mustard poultices to nape of neck. Haematuria or a hemorrhage of blood from the kidneys is often present in both intermittent and remittent fevers. The general treatment of the fever must not be interfered with, but the patient promptly placed upon as large doses of the green root tincture of gelsemium as he can b^ar, with dry heat over the loins, and a few drops of peroxide of hydrogen given. The bilious type of intermittent and remitterft requires very nearly the same treatment. In these the force of the malarial and bacterial germs seems to be spent upon the liver, so that in those cases the tongue is heavily coated brown, there is nausea, vomiting, jaundice, diarrhea and other bilious symptoms ; a state that will require special attention in addition to the treatment being carried out for the fever, such as the following : five drops of nitro-muriatic acid every four hours in water, or an infusion of leptandra, drunk freely, or phosphate of soda. Some remedy to act efficiently upon the germs that block up the liver, managing the fever in the manner already indicated. A peculiar type of fever, iatermediate be- Remittent tween malignant intermittent and dengue. Bilious Fever, occurring in individuals whose vital force is Malignant. low. The temperature runs high, action of the heart violent, skin jaundiced, stomach very irritable, tongue very heavily coated with a brown coat and black at the root ; there is often delirium from the brain suffering from the ingress of microbes. Treatment here must be most energetic, large doses of bacter- icides must be administered, such as resorcin or creolin ; the circulation controlled with exalgine, and either Warburg's tinc- ture or concentrated tincture of kurchicine administered freely. The case must be carefully guarded, and general principles will guide the selection of drugs. 330 DISEASE GERMS. Sometimes termed enteric or nervous fever, is Typhoid essentially contagious and infectious, owing to its Fever. origin in a disease germ. Various theories are set forth by nearly all authors, as to the origin of the microbe of typhoid fever. A certain class advocate the idea that its pristine condition is in sewage, that the contamination of our drinking water by sewers is one of the chief means of propagation ; others believe in the theory of the origin being in a low degree, as a spirillum placatile, and that by certain series of progression, passing through various stages qf growth and development, it reaches the perfection of a full fledged microbe ; others believe that under adverse states, the bioplasm of the nervous system is degraded into other living matter, a disease germ, that in even very slight nervous depression, or shock, the change in the nutrition of the nervous system* into a disease germ can be detected. But when there is great depression of the sympathetic and ganglionic nervous system, typhoid fever by this class of observers is re- garded as the climax of all nervous depression. They assert that the microbe, the factor of the fever, is simply the degraded bioplasm or living matter concerned in the nutrition of the nerve cell ; that any condition of nerve-depression may cause the change from normal nerve bioplasm into a disease germ, which, when once evolved, is capable of prodigious powers of growth and development ; that the germ is so light (aerobic) that it will float in the atmosphere long distances, penetrate our wells, springs and brooks ; that the excretions of individuals so affected, passing into the earth either by cesspools or sewage pipes, con- taminate everything within its reach. Milk, raw or even cooked meat of animals or fowls, coming in contact with the germs in the air, may communicate the disease. The microbe of typhoid fever has a power, a potency which is incomprehensible. Whence this microbe originates, it is undecided. TJie predisposing causes are nervous prostration, mental strain, worry, exhaustion, overwork, depressing climatic states, solar heat, chills, damp exposure. The exciting cause is the microbe in the blood, which gives rise to those mysterious headaches, lassitude, goneness ; which are unclassified, unnamed, often unpitied, which distress the patient, puzzle the physician ; for the microbe only finds its abode in the weak, the feeble, the shattered. Symptoms. — Usually a period of incubation or germ-growth varying from ten to fourteen or even twenty-one days, in which languor, lassitude, debility, insidiously make their appearance, with headache, white face, sharp features, pain in back and calves BACTERICIDES. 33 1 of the legs, nausea, diarrhea, and chilliness. The rigors reeur from time to time at uncertain intervals, with an aching all over. The rigors increase, and the patient is much prostrated. There may be vertigo, deafness, or epistaxis ; great headache ; intoler- ance of light ; thirst ; loss of appetite ; great nervous irritability ; restlessness ; nostrils pinched ; often a marked, circumscribed flush on each cheek; tongue at first white, with red edges and tip, later red and glazed, buff dry or brown ; sordes on gums, pulse small, wiry, frequent, lOO to 120 or higher; temperature from 101° to 104° Fahr., higher in the evening; breath offensive and ammoniacal. These symptoms slowly become aggravated ; emaciation is great from the destructive action of the germ and imperfect renewal of ti=;sue ; continuous destruction ; defective supply. The solid constituents of the urine increase ; the ten- dency to diarrhea becomes greater ; great interstitial death ; rapid metamorphosis of the entire body. At the commencement of the second week, or a day or two earlier, the typhoid rash appears ; rose-colored spots on the chest and abdomen, few in number, circular, disappearing on pressure, and fading away to be replaced by a fresh crop. In ten or twelve per cent, of cases, no rash. It is a true petechia. After the mid- die of the second week, tympanitis, gurgling in the right iliac fossa on pressure, diarrhea, stools alkaline, of a pea-soup appear- ance. If there is extreme debility with profuse sweating there may be sudamina, or small watery blebs on neck, chest, or abdo- men. There may be other symptoms present, as violent delirium, spasmodic contractions of the muscles, picking at the bedclothes, subsultus, hiccough, tinnitus aurium or deafness, muscular pains, prostration, bed-sores, and attacks of hemorrhage from the ulcer- ated patches in the ileum and perforation of the bowel, with fatal hemorrhage and peritonitis. Congestion of the kidney, cerebral or pulmonary complications ; the latter is the most common and most to be dreaded, and is easily recognized by the flush on right cheek ; cough, rusty sputa, dulness on percussion at the base of the right lung. During convalescence a venous murmur can be detected in the neck, and an inorganic systolic bruit in the heart, same as in anaemia, which quickly disappears on giv- ing nourishment. Duration should be from two to three weeks ; still, some cases are prolonged to the fifth or sixth week. It may terminate in recovery, paralysis, or death. Death is usually due to exhaustion from the protracted fever, or from diarrhea ; sometimes to pulmonary and cerebral complications, or to perforation of the bowel and peritonitis, or to hemorrhage ; occasionally to uraemia. In some cases the patient seems to be 332 DISEASE GERMS. overwhelmed by the poison-germ and dies easily with cerebral symptoms, dehrium, and coma. When recovery takes place with paralysis, it is generally due to anaemia, which, in nearly all cases, can be overcome with good diet. A persistent rise in temperature over 105° Fah. is very un- favorable, and several degrees above, an almost fatal result. Typhoid fever is easily recognized by its insidious mode of attack, by the nervous prostration, by the ringing in the ears or deafness, bleeding at the nose, rapid emaciation, white, sharp- pointed features, sunken eyes, and pinched nostrils ; dry, buff- leather tongue, red tip or edges, or smooth and glassy ; sordes on teeth and gums ; small wiry fre- quent pulse, irritation, inflamma- tion, and ulceration of the glands of Brunner and Peyer of the small intestine ; with tympanitis, gurgling in right iliac ; diarrhea, petechia, sudamina. It bears no analogy or resem- blance to typhus — in no single point. Pathologists are agreed upon one point, that there is nothing in common. In typhus fever the poison or fever germ is bacteria ; in typhoid, the disease-germ vibrios — a specific disease-germ, a true contagium vivum, having properties as dis- tinct and powers of reproduction as perfect as any germ or species known to botanists and zoolo- Microscopical diagram of the vibrios, the mi- crobe of typhoid fever, magnified looo diam- eters ; magnified 2500, they look like feathers. 'J'he diagram from the stools. A, bowel threads stage of incubation (germination) prior to ch;ll ; B, at the period of rigor ; C, the seventh day, now curved ; D, the fourteenth tl'^Y) germ swollen at the spore-forming end ; £, various stages of the developing germ from the twenty-first to the twenty-eighth day. The most recent observations and experiments show that, owing to adverse conditions in- imical to nerve nutrition and development, such as worry, grief, struggle, disease, insanitary states, the bioplasm of nerve nutri- tion is altered or degraded into other living matter, which is a disease germ — capable in or out of the body of independent existence with prodigious powers of growth and reproduction. The disease germ thus evolved is pathogenic of all nervous diseases, as headache, neuralgia, chorea, epilepsy, brain lesions, insanity and typhoid fever; all contagious and infectious diseases owing to the presence of the microbe. The above diagram represents the vibrios in different stages of growth or evolution. BACTERICIDES, 333 Feathers, rods, threads bowed or bent. They bear a flagellum at each end ; as they grow from the bowed feather rods, or "P>'u'::'?%' m >^; Tiif^aMM. ^issa-^ii^^/li Diagram of the microbe on the mucous coat of the ileum, first week of typhoid ; hype- rsemia attending the germ, planting itself in a Peyer's patch. The vbros at work, second week of germ evoluuon, same location, clumps of micro- cocci are seen very extensively on the ulceration of the bowels, and in the mucous membrane surrounding the ulceration, and may even be traced into the mesenteric gland and spleen. itfS| threads, they cease to move, become swollen at their extremity and sprout out into spores ; immense spore formation. Provided vital force be Kf/^=r. low, when this germ is evolved in the blood or re- ceived by contagion and in- fection, it will go through regular stages of sprouting, growth and development, limited by days and weeks. These stages of microbe growth correspond to seven, fourteen, twenty-one and tzuenty- eight days or four weeks in all. Although the tears, breath, tongue, gums, urine, stool and blood are germ-laden, the natural abode of the germ is beneath the ganglia or little brains of the great The germ at work three weeks, shows Peyer's patch deeply ulcerated, loaded with germ ; at D, eats through, causing perforation of the bowel. sympathetic in the glands of the bowels. Corresponding with the rigor, the germ in localizing excites irritation, inflammation, 334 DISEASE GERMS. a catarrhal state of Payer's patches ; these become soft, spongy, later on hard and smooth. Germ growth is greatest at the ileo- caecal valve. This state of hyperaemia, due to the germ burrowing in the gland follicles, causes the agminated and solitary glands to become more elevated ; rapid growth takes place. The various coats of the bowel become infiltrated with germs, necrotic changes are established and ulceration definitely commenced. The third week exhibits the peeling off of the dead germs from each colony, leaving the characteristic typhoid ulcer, which sloughs some in order to remove the necrotic tissue ; a loss of tissue which extends to the deeper layer of the mucous mem- brane. In or during the fourth week inflam- matory action ceases, and the process of cicatrization com- mences,which usually with care progresses on until they are entirely healed up. The mesentery,one of that class of blood- forming glands like the pink marrow and spleen, often becomes invaded by the mi- Sketch showing enlargement of the mesenteric lymphatic glands Crobe, and B. prOCCSS in typhoid fever; ^, y4, portion of small intestine; ^, mesen- r .-,„o1/-vrr/-Mic rrArm tery; C, glands enlarged ; at i? a gland is shown in section. Ol anaiOgOUS gerul colonizing and growth takes place same as in the intestine. The enlarged glands vary in size, from a hazel nut to that of an egg, most numerous over the ileo-csecal valve. The habits of the microbe teach us best its mode of annihilation. The evidence as to the poison of typhoid fever being a micro- organism is : all observers have found it in enteric fever, in the mouth, gums, blood, urine, fseces, and after death in the brain, Peyer's patches, mesentery, spleen, suprarenal capsules. It is constantly and exclusively present; it is never found only in bankrupt states of the nervous system; capable of culture in a nutrient fluid. Independent of the bacillus in typhoid fever and grave nervous BACTERICIDES. 335 <^3»<^g Microbe of typhoid fever as found in the mesen- teric gland during the two weeks of fever. -affections, there are in fifty per cent, of all cases other germs, peculiar short bacilli, rounded at their ends, constricted in their middle, some of them containing spores. They stain freely with methyl-violet. It is very doubtful whether these bacilH have any significance, as they are only present in one-half the cases, and do not bear cultivation in any nutrient fluid outside of the body. The following conclusions have been formulated relating to typhoid fever : 1. Typhoid fever is caused by the introduction of a specific germ into the alimentary canal. 2. This specific germ multi- plies in the alimentary canal, and in turn is thrown off in the stools of the patient. 3. Its vitality is much greater than at first supposed, resisting a variation of temperature rang- ing from even below the freez- ing point to 133° F. 4. The germ may be communicated from one person to another, by water, milk, food and air 5. To prevent its spread, all the dejecta should either be burned at once (which is preferable), or thoroughly disinfected, by throw- ing them into a pot of boiling water and thoroughly cooking them, or using some effective germicide, such as a strong solution of the bichloride of mercury in suf^cient quantities to insure their destruction before they are buried, which should be at a sufficient distance from any neighboring water-supplies to insure their freedom from contamination. 6. If the water-supply is of a suspicious character, thoroughly boil it before using, and then place it where there is no possibility of its becoming infected. If ice is used, pack it around the water- vessel, not allowing the melted ice in any way to enter your drinking-water. The appearances after death are most significant ; the blood and all the tissues and glands are loaded with the microbe in all stages of evolution, congestion of the brain or its membranes, ulceration of oesophagus and stomach, enlarged or friable condi- tion of the spleen. The two lesions that are invariably present are inflammation and ulceration of the glands of Brunner and Peyer. The alterations in the agminated . glands or Peyer's patches are the most marked in the group of glands which are nearest to the ileo-csecal valve and in the corresponding glands 336 DISEASE GERMS. of the mesentery. Frequently the patches have undergone ul- ceration. If the case has terminated at an early stage through prostration, we may simply find congestion, or a swollen condi- tion of the mucous membrane over the patch or gland. Death, as a general rule, occurs at a later period, toward the ninth, tenth or eleventh day, or at the end of the third week, and then we find the true condition of ulceration, in ulcers or sloughs varying in size. These ulcers are often the cause of death, either by hemorrhage or perforation. Mesenteric glands in the neighbor- hood are generally enlarged and softened. The enlargement of spleen and left kidney is decided. The following are good rules to observe in the diagnosis of a case : Peyer's patches an.d the solitary glands of the lower part of the small intestine are always affected in typhoid fever, and the solitary glands in the large intestine in about one-third of the cases ; that ulceration is perfect on the seventh, eighth or ninth day of fever; that cicatrization begins in from two to three wrecks, but may be delayed indefinitely or prolonged by disturbance, as movement and diarrhea. To prevent typhoid, our population must guard against over- work, privation, sorrow, and maintain a high grade of vital force. All insanitary conditions avoided, good drainage, the excreta in cesspools destroyed, and above all good water supplied ; no sewage to enter drinking water, or any cesspool deep in the earth nearer than a mile to a well, and care exercised during convales- cence. The patient should not for three months be permitted to go among his fellows, as he is liable to disseminate the disease. Ti'eatment. — The very instant this fever is recognized, the affected individual should be put to bed, and caused to maintain the recumbent position, and treatment commenced at once. The apartment in which he is placed should be well ventilated, and, if possible, not connected with others ; there ought to be an open fireplace, and if the weather permits, a fire; there should be no bed or window-curtains, no carpets, no superfluous furniture in the sick-room ; a disinfectant of some kind should be freely used and exposed in the apartment. Two beds are of great utility, so that the patient can be lifted from the one to the other, and the bedclothes, as well as the body-linen, changed daily, and strict quarantine maintained, itw but the nurse and physician admitted. No food left uncovered. Patient should be sponged off thrice daily with tepid water and castile soap, well dried and rubbed with the dry hand of a young vigorous nurse. After the midday sponging, the patient should be rubbed over with warm vinegar, to which some peroxide of hydrogen is added ; this form of germicide bathing excites the BACTERICIDES. ^^^7 normal alkaline secretion from the skin and destroys all microbes^ on the surface. Heat to feet, hot poultices every three hours over the ent're abdomen ; these poultices should as far as pos- sible be medicated with resorcin, or naphthaline, or creolin, used- all through the fever. The diet should be attended to with great care. In typhoid, and other fevers due to the presence of a disease germ, the abnormal salivary and pancreatic secretion interferes with digestion and assimilation of all starchy matters, and if given, irritate the iatestinal tract, so that the best diet is sterilized milk, alternated with beef tea. Stools when passed should at once be disinfected or destroyed with a solution of bichloride of mercury or sulphate of iron. Febrile action should be controlled either with antifebrine, exalgine or aconite ; suitable doses administered at stated inter- vals to lower heat, pulse, respirations ; in other words, to retard germ evolution. Small doses of quinine in aromatic sulphuric acid should be given all through the fever. Diarrhea in all cases must be controlled by drinking freely of a tea of kaki ; or a pilL of opium and tannic acid, or boiling milk with cinnamon sticks^ subsequently adding lime water. Sleep is of vast importance. All through the fever the patient must have sleep, because there is no nutrition without it — no vital force gained to fight the on- ward growth of the microbe. For this purpose various remedies should be tried. Sulphonal might be tried first, in thirty or forty grain doses ; if it fails, try urethan in fifteen-grain doses ; bromide of potassa and chloral hydrate in camphor water ; all failing, sul- phate of morphia. Thirst in typhoid must be appeased by a decoction of kaki, or wild indigo, or peppermint, or a few drops of glycerite of kepha- line in water. If emaciation is great, there can be no doubt of arresting the rapid metamorphosis of tissue by the administration of suitable doses of brandy in milk, otherwise it is of no utility as a stimu- lant. Nitro-glycerite is incomparable as a stimulant in all cases of typhoid. After guarding all points carefully, the legitimate treatment of the fever should begin. This consists in the administration of bac- tericides to kill or sterilize the bacillus, the factor of the fever, as fast as it is evolved. The febrile action in typhoid is in propor- tion to germ growth ; the coma, delirium, diarrhea, correspond to the ptomaines excreted. Completely annihilate the microbe with the proper germicide and all goes well. Some twenty years ago, we published the following germicidal formula for sterilizing and killing the bacillus of typhoid, which has been in very general use throughout this country : 22 338 DISEASE GERMS. Tincture of iodine and carbolic acid ; one drachm of the car- bolic acid to one of tincture of iodine, added to fifteen ounces of distilled water, in which oil of lemon and a little muriatic acid has been dissolved. The addition of the acid and oil of lemon dis!:^uises the smell and taste, and obviates any gastric or sensorial disturbance. A tablespoonful should be given every hour until heat, pulse, and respirations are normal ; then three times a day, and continue for three or four weeks after recovery. Since that time numerous, most efficient bactericides have been introduced into the materia medica, and most extensively prescribed, such as salicylic acid and acetate of ammonia ; benzoate of sodium; peroxide of hydrogen ; resorcin ; salol ; creolin, naphthaline and many others. Turpentine, five to fifteen drops, in mucilage of gum acacia flavored with peppermint, when diarrhea persists and convalescence is retarded. Serpentaria relieves the delirium ; nitro-glycerine an invaluable stimulant. All through the fever the infusion of kaki merits the attention of the physician; it keeps up a healthy state of the alimentary canal, keeps the tongue clean, controls the diarrhea, helps the patient to resist the adynamic effects of the microbe. Baptisia, yeast, and other vegetable antiseptics are much in- ferior to the above. The treatment of typhoid with bactericides is the correct one, the sure method of mitigating the febrile symptoms and neutral- izing the action of the ptomaines in the intestines. Every point must be carefully guarded ; for prostration, mut- tering delirium, and irregular pulse, brandy should be given. Antiseptics act best on the ulcerated glands of the bowels. At least three times a day the mouth should be washed out with a little wine and water. The bladder must be seen to, lest any sup- pression of urine take place. Complications should be watched and met vigorously. Guard carefully against pneumonia, which is the common sequel. Great care should be taken during the period of convalescence, lest the cicatrizing ulcers be irritated ; tonics, and a return to general diet to be very gradual. No solid food allowed until all symptoms have disappeared. A tonic course of treatment, aro- matic sulphuric acid and quinine, port wine and Peruvian bark, or glycerite of kephaline administered for some months, and the recumbent posture rigidly maintained. Before the introduction of anesthetics, the shock Surgical incidental to the operation invariably gave rise to im- Fever. perfect reaction, fever. As a rule this form of fever is met with under five different types, a simple type of surgical fever, irritative, intermittent, hectic, typhoid. BACTERICIDES. ^oq General symptoms of fever are present. The treatment of those different types of surgical fever must be •carried on on general principles. In the simple form, rest, bathing, nourishment, exalgine. In the irritative type, anodynes, sulphonal. In the intermittent form, Warburg's tincture, kurchicine. In the hectic type, stimulants, tonics, aromatic sulphuric acid and quinine. If typhoid symptoms appear treat same as in typhoid fever. The most constructive form of treatment should be resorted to in all cases. This fever has a spontaneous origin in the dam- Typhus aged bioplasm of our own or others' bodies ; the Fever. result of crowding a large number of human beings together ; hence it is described as putrid fever, jail fever, plague, pestilence, malignant, ship or hospital fever. Like .all microbial maladies, contagious and infectious, often prevails epidemically. Very rarely do we see this fever in the United States, the :slightest precursor of it consists in the occasional appearance of purulent ophthalmia among the children of our public schools, which is due to the same micro-organism as the fever. The usual symptoms are a period of incubation or shock, or sprouting of the germ in the blood from a few days to ten or twelve, during which time there is often bleeding from the nose or deafness, with great languor, lassitude, debility, headache, pain in the back or limbs. Then rigors, headache more intense, dry, heated skin, flushed face, suffused eyes, dull, heavy aspect, stupor, thirst, constipation and prostration. Towards evening, irritability and restlessness, with sleepless nights. A measly-looking rash makes its appearance about the •fifth day, consisting of irregular spots of a dusky or mulberry hue, at first disappearing on pressure, later forming stains, which are not obliterated on pressure, generally very copious ; seen best on abdomen, chest and back, but especially over the breasts ; spots are often seen on back of wrists. When the rash is very dark colored, the blood has become the prey of the typhus germ, and is disorganized by the abstraction of its oxygen. Skin generally dusky, and besides the rash, subcuticular mottling, rash often remains permanent to the end of the fever, and may be accompanied by or become converted into petechia, sometimes ■mild, in other cases altogether absent. During the first week, bleeding at the nose, or deafness, or noises in the ears, conjunctiva injected, often constipation, never 2^0 DISEASE GERMS. diarrhea. Pulse from 80 to 100 to 160. Temperature 100° to 105° Fahr., steady, not variable like typhoid; tongue coated, brown and dry ; dulness or stupor, looks like sleep but not re- freshing. Urine very scanty in quantity, retention common ; often albuminuria ; occasionally total suppression of urine, and uraemia. In the second week, great prostration, muscular twitchings, delirium, coma and convulsions. The danger is greatly increased by an attack or supervention of acute bronchitis, pleurisy and pneumonia. Often a critical sleep, or sweat, or an attack of diar- rhea, or greatly increased flow of urine. Convalescence is very rapid when it takes place, beginning generally on the fourteenth day. The fatal period is from the ninth to the twelfth day. Duration is from fourteen to twenty-one days. This fever is easily recognized by its history ; the bleeding from the nose and deafness, the stupor or dulness, constipation, dry brown tongue, congestion of eyes and face, measly eruption when present. The blood is loaded with bacteria, thick, black and clotty, and when thoroughly disintegrated becomes fluid, and is effused into the brain, heart, lungs ; besides, the liver and spleen are alive with bacteria. In order to prevent this fever, the people should be supplied with wholesome food and properly ventilated dwellings ; over- crowding in ships, sleeping-rooms, lodging or tenement houses prevented ; smaller school-houses and fewer children congre- gated together. All houses, or ships, or almshouses, to be kept thoroughly cleansed and whitewashed every three months. The clothes and bedding of any one tainted or affected should be dis- infected. The patient kept scrupulously clean ; if just convales- cing he should not enter a street car or public conveyance. No room or house, or public place in which an affected person has been, should be reinhabited or occupied until purified with fumes of burning sulphur and whitewash, and its walls and floors tho- roughly deodorized. The diet of the class of individuals, victims of overcrowding, should be improved in every possible manner. In the treatment of typhus fever, the patient should be kept in bed, in the recumbent posture, disinfectants kept in saucers in each corner of the apartment. The most rigid quarantine main- tained, none but nurse and physician permitted to enter the apart- ment. The body should be bathed morning and night with a warm alkaline wash. An effort should be made to lower temperature by retarding germ evolution, for that purpose a dose of exalgine should be administered morning and night, and during the day the peroxide of hydrogen should be given every hour. BACTERICIDES. 34: The primary action of the microbe of typhus is on the red corpuscles of the blood, they abstract the oxygen from them, and render the blood unfit to stimulate the nervous system ; the secondary action of the germ is to throw off spores, excrete ptomaines, and thus thoroughly overcome the vital forces. The destruction of the microbe is the great aim of the scientific physician. For this purpose, in addition to the two remedies already mentioned, there should be an effort made to crowd in all the bactericides possible to completely sterilize the blood. A selection from some of the following : Carbolic acid and tincture of iodine, creolin, resorcin, naphthaline. Malignant remittent or recurrent fever is highly Relapsing contagious and infectious. At all times a fever, Fever. but the remission and relapse take place every five or seven days, at which period there is a great aggravation of all the symptoms. Epidemics of this fever have appeared at different times, which have led authors to describe it under various names. The real cause of the fever is a dual organism, derived from malarial and decomposing animal matter. Symptoms. — There is generally a latent period of three or four days, during which the patient suffers from prostration, headache, languor, lassitude, debility, followed by rigors and a high grade of fever. The frontal headache and muscular pains, with pains in the back and bones, are so excruciating as to cause great rest- lessness and irritability. Temperature often 107° Fahr., with a pulse over 160, urgent thirst, often nausea, vomiting, pain in the stomach, jaundice often present. A very great aggravation of symptoms at night, giving rise to much irritability and sleepless- ness. As the disorder advances there is constipation, scanty, high-colored urine and increasing prostration; but just as the fever seems to be assuming a threatening aspect, about the fourth or fifth day, a profuse perspiration breaks out over the whole body, a complete subsidence of fever takes place, the patient ap- pearing quite well, but weak or suffering from rheumatic pains. The patient, and often inexperienced physicians, imagine the trouble is over, when all of a sudden, about the fifth or seventh day, there is a relapse, a repetition of all the symptoms in an aggravated form. Graver, more alarming, week by week this goes on, each attack leaving the patient weaker and weaker, till on the sixth or seventh week he either succumbs to the poison or the case terminates in recovery. Troublesome complications often arise which delay recovery, such as petechia and purpuric 342 DISEASE GERMS. spots, muscular weakness, oedema of the legs and feet, prostra- tion. When it occurs in pregnant women, it has a greater ten- dency than any other disorder to cause premature labor: It is a very fatal form of fever, death taking place at any period from sudden prostration. No special lesion can be detected upon making a post-mortem examination. The liver seems to suffer most from enlargement and congestion ; in other cases the spleen is found considerably increased in size. The treatment is in all respects similar to that laid down for typhoid and malarial fever. Large doses of either Warburg's tincture, or comp. tincture of kurchicine, or eucalyptol have been successful in breaking up this type of fever. An endemic, and often an epidemic fever, highly Dengue, contagious and infectious, due to the presence of a micrococcus in the solids and fluids of the body. During the stage of incubation or hatching up to the rigor, the micrococcus has the appearance as shown in Fig. i. After the • •' v. , #«;': % • < ? , •«• .♦.. • •**• /.•;':•••;. ^- .^ The appearance of the microbe of Dengue at the time of rigor. Fig. 2. The germ as found in ihe blood seventy-two hours after rigor. rigor which precedes the fever, the micrococci grows very rapidly,, both in number and size, and have the appearance as shown in Fi^. 2. The germ is pathogenic of the fever, is easily cultivated in any nutrient liquid ; cultures injected into animals produce the disease in all its intensity and malignancy. This fever prevails in the East and West Indies, in all tropical and semi-tropical countries on the coast. It receives quite a variety of names, such as break-bone fever, eruptive rheumatic fever, dandy fever, etc. Its cause is undoubtedly the same as yellow fever, to wit, malarial and paludal poison, probably modified by acting upon persons of a strong rheumatic diathesis. It is fully as contagious, as yellow fever and requires the same attention to quarantine BACTERICIDES. 343 and sanitary surroundings to prevent its spread. Jf due care is not exercised, a most extraordinary epidemic may be developed. The symptoms as seen in the rice-fields are an eruption resem- bling scarlatina, with rigors and a fever combined, with the most intense rheumatic pains in the limbs and joints. There is also a strong biliary train of symptoms : nausea, brown-coated tongue, glands of the throat often implicated ; lymphatic glands of neck, axilla, and groin swell, and the testi- cles become enlarged. The pains in the joints of shoulders, arms, legs, and in the muscles, and, indeed, in all the bones of the body, are very great. The duration of the disease is about eight days. The treatment to be successful must be highly germicidal ; to prepare the way for that class of drugs it is an excellent plan to cleanse out the stomach with a copious emetic, followed by a saline cathartic and an alcoholic vapor bath. These preliminary proceedings should be followed with one or other of the following remedies : Either concentrated tincture of kurchicine, or Warburg's tincture, or eucalyptol ; at least a tea- spoonful to the dose every three hours ; whichever is selected should be alternated with peroxide of hydrogen. If the case does not yield, try salicylic acid in liquor ammo- nia acetatis and tincture of the green root of gelsemium, and then fall back on the eucalyptol. The case must be carefully nursed, and an abundance of beef tea used as a drink. Bilious remittent yellow fever, accompa- Yellow Fever, nied with acute inflammation of the stomach, liver, spleen, kidneys, with severe headache, vomiting of black matter, and jaundice, is a fever caused by a fungus, produced by the malarial germ, acted on by the mias- mata from the sides or beds of rivers. The evolution of this germ is limited to tropical countries and not of infrequent oc- currence in our Southern harbors. The fungus may be carried on ships, clothing, merchandise, etc., but when a temperature of 75° Fahr. is reached, the microbe becomes dormant, incapable of growth. This fever prevails in tropical countries endemically, epidemically, or sporadically, and when it occurs is highly con- tagious and infectious. Much more common in males than in females ; very prevalent among the unacclimatized. One attack affords no protection. The cause is the malarial germ, mingling with paludal emana- tions, giving rise to a dual germ, or fungus ; so far the most emi- nent bacteriologists have failed to isolate it. 344 diseasp: germs. Some have isolated a microbe very similar to that of dengue, but all attempts at culture have so far been attended with failure. Insanitary surroundings, imperfect drainage, uncleanliness add to its malignancy. The true victims of the microbe are those addicted to intem- perance, excesses, overwork, out at night. Preventive measures consist in the removal of all nuisances or insanitary states ; every fence, court, alley, cellar, liberally white- washed with lime and bichloride of mercury ; thorough ventila- tion of all passage-ways, warehouses, holds of ships; the greatest possible cleanliness, removal of all garbage ; no one, non-accli- matized, should expose himself; diet of all should be plain, nour- ishing, avoiding alcoholic drinks, sexual excesses, and should have abundance of sleep ; a healthy action of the liver, skin, kidneys, bowels ; flannel clothing. Symptoms. — Often ushered in quite suddenly with languor, las- situde, debility, loss of appetite, giddiness, headache and mental depression. At other times begins with coldness of the surface and distinct rigors, followed by fever which continues a few hours, then remits. In another class of cases there is prostration from the first, without any febrile reaction ; stupor, coma, convulsions, soon following. When there is decided fever, we have an aggra- vation towards night; pulse becomes quite wiry and frequent, skin hot and dry, eyes congested and painful, face flushed. Dis- tressing headache, often confined to one temple, intense pains in large joints and limbs. Nausea, great irritability of stomach, vomiting, first slimy, then greenish, then black ; constant vomit- ing and retching. Tenderness on pressure over the stomach, liver, spleen, kidneys ; a sense of tightness or constriction across the chest. Thirst is intolerable ; great desire for cold drinks, only to be taken to be rejected. Urine diminished in quantity, highly albuminous, of a dark red color. Constipation, owing to an entire absence of bile in the stools. The restlessness is in- cessant ; extreme mental anxiety; sleeplessness, prostration, active delirium. At the end of a few days severity of symptoms gradually diminishes, patient feels relieved ; face becomes slightly jaundiced ; skin becomes moist and there are copious biliary stools. In favora- ble cases convalescence is firmly established. More frequently the improvement is of short duration. After a respite of twenty- four hours, epigastric tenderness is aggravated ; jaundice increases and spreads over the entire body ; tendency to stupor ; pulse be- comes feeble, irregular, slow, often as low as thirty beats per minute ; tongue becomes very foul and dry ; respirations em- barrassed ; hiccough, thirst, nausea, vomiting, are constant. Unless symptoms remit, grumous blood is vomited ; black vomit; BACTERICIDES. 345 urine is suppressed or simply retained ; skin becomes of a dark brown hue ; dark-colored blood is effused in patches under the skin, or exudes from the nose, mouth, gums, ears, anus, vagina. Most offensive, tarry-looking stools. There are now all the symptoms of a malignant fever ; almost imperceptible pulse, slow or stertorous breathing, involuntary evacuations, difficulty of deglutition and articulation, suppressed or bloody urine, with formation of buboes or patches of gan- grene. Death takes place preceded by coma or convulsions, or in some cases the patient retains his consciousness to the last. Its ordinary duration is from three to nine days. Death may occur from the overpowering effect of the poison on the system, exhaustion, uraemia, or apoplexy of brain, liver, spleen. From the beginning to the end of an attack the general indi- cations for the treatment of a malignant type of fever should be carried out and rigorously enforced : recumbent position ; thor- ough ventilation, greatest possible attention paid to cleanliness ; bathing and disinfectants. Diet very plain ; arrow-root, barley water, broth, iced lemonade. Seltzer water. Watch case closely, guard the patient in every particular. Mustard to nape of neck and feet ; cloths wrung out of hot water, often relieve that ter- lible headache. General bathing as frequent as possible; occa- sionally the application of turpentine over spleen and liver is good. The factor in yellow fever is the germ or fungus ; with a high temperature it breeds by millions per hour ; lower the tempera- ture in any way, active microbe evolution ceases. The high temperature produces dreadful complications; reduce heat by cold packs, by an active refrigeration of the body, the germ dies or becomes inactive. To lower temperature, exalgine is a drug of rare value. It is indicated here ; a dose morning and night works wonders, low- ers temperature, cuts off germ growth, changes the entire aspect of the fever, prevents complications. Its use should never be overlooked, as it holds the patient in the best possible condition for treatment. No direct line of treatment can be laid down, no doses given, the physician in attendance must be the judge in all cases. We shall enumerate a few of the leading remedies in use. Sulphate of quinine is "the great stand-by. There is no doubt about the propriety of using it at proper intervals and in suitable •doses. Warburg tincture, or eucalyptol is worthy of consideration. 346 DISEASE GERMS. Metria is a term which includes a num- Puerperal Fever, ber of affections, which are classed to- or gether under the name of puerperal fever. Metria. The pathology of metria is still far from being perfectly understood. Two facts- alone are admitted by all who have studied the subject carefully : namely, first, that puerperal women are liable, under certain cir- cumstances, to be inoculated with septic matter conveyed to, and deposited in, the vagina by the hands of the attendants, as well as by other agencies, when, either through carelessness or ignor- ance, proper precautions have not been adopted to prevent such an occurrence ; and that the disease produced by such inocula- tion is not an unfrequent. source of one of the forms of metria ; secondly, that puerperal women may be self-inoculated by pois- onous matter originating within their own bodies, from the de- composition of blood-clots formed within the uterus after partu- rition, or of portions of the membranes or placenta which have been retained in titero. That this state is predisposed to by a depression of the great, sympathetic, as struggle for existence, grief, worry, blighted affections, shocks of all kinds. The exciting causes are numerous (contagion and infection), the former carried on the clothes, hair, person of the physician from one person to another, etc. ; the latter, hurried labors, re- laxed uterus, which is liable to follow a too rapid evacuation of the contents of the uterus ; imperfect uterine contractions de- pendent upon nervous bankruptcy which interferes with recupera- tive powers. Auto-infection, self-inoculation, in their own bodies from the decomposition of blood clots found within the uterus after partu- rition, or of a portion of the membranes, or placenta retained in the uterus, owing to imperfect uterine contractions. These are the main factors in its production. The mouths of the vessels at the denuded site of the placental attachment, keep up a slight oozing, which becomes fetid by lying in the uterus and along the genital tract. Imperfect uterine contractions are due to hard work, struggle for existence; sexual congress during pregnancy; and anything which would be likely to exhaust the uterine plexus of nerves. Symptoms. — The general symptoms are rigors, succeeded by fever ; a full, hard, rapid pulse ; occasional vomiting ; distress of countenance ; great debility ; suppression of the secretion of milk ; usually, not always, pain and tenderness in some part of the abdomen, most frequently about the umbilicus, which is in- creased by pressure. BACTERICIDES. 147 Some patients complain of great pain, great tenderness, with great constitutional disturbance. These coming a few days after delivery, in some high fever, in others a peritoneal inflammation preceding the fever. The acute stage continues for a few days ; during this time the rigors are severe ; the skin hot, at some periods clammy ; abdomen be- comes tumid, and susceptible of great pain from the slightest pressure ; the tongue is white ; the respirations short and quick ; countenance anxious; signs of abdominal inflammation. The progress of the disease is rapid, often fatal inside of forty- eight hours. Prophylactic measures are various. The mortality from this fever is specially great among unfortunate women, the depressed sympathetic, mental distress, despondency, seriously interfere with the recuperative powers which should be active after parturi- tion. With a blighted sympathetic, the muscular fibres of the uterus do not contract well, the lochia lies long in the genital organs, germs are evolved which enter the blood, either slowly through the open mouths of the vessels, or are absorbed through some crack or fissure. Patient should be re-animated with a new life^ new hopes, new aspirations ; uterus stimulated to contract and at the same time disinfected by injecting it with solutions of boroglyceride, or resorcin. The rigid enforcement of all antiseptic precautions, the avoid- ance of sewer gases ; all physicians and nurses should be forbid- den attending such cases who perform post-mortems, or have been for six months previously in attendance upon a similar case, or one of boils, or erysipelas. Morbid anatomy. — On examination after death, the vessels of the omentum and peritonaeum are found to be turgid with blood \ there are usually adhesions in many parts of the abdomen, which is distended with gases, and effused serum, with flakes of lymph floating in it ; and sometimes Ihere is seen on the intestines, the puerperal micrococci in the form of zoogloea ; also in the lungs, spleen, kidneys, brain, chains of micrococci. The uterus in par- ticular is literally covered with a thick coating of the germinal matter. The essential and most obvious fact is that the entire body has been the victim of the most deadly of all microbes, the most tenacious, as it is six months before it disappears from the hair of the physician or nurse ; the most deadly, as it often de- stroys life in forty-eight hours. In its origin, it usually declares itself within ten days after delivery. In metria, or so-called puerperal fever, micrococci liave been found in the blood in the form of zooglcea in all irritated organs, as the mouth, lungs, spleen, endocardium, Hver, uriniferous tubules 348 DISEASE GERMS. of the kidneys, and in emboli of the blood-vessels and brain. Precisely the same state of microbe evolution exists in all cases ot puerperal mania ; zoogloea and chains of micrococci are met with in the brain, associated with clot. The present illustration is taken from a necrotic patch of the lochia, which affords most energetic cul- tivation in beef tea. Indications of treatment are: if we possibly can without injury to the or- ganism, introduce into it a sufficient quantity of a drug Chains of micrococci found in a necrotic patch of the lochia. Precisely the same state of evoluiion exists in brain and heart clot. to the life and reproduction of the micrococci or microbe (pathogenic) that may either prevent the devel- opment of the disease ; destroy or sterilize the microbe ; or change it, we may possibly limit its growth, and thus retard the pathological process to such an extent that the germ may be incapable of destroying life. Treatinent, — The treatment of metria must to some- extent be governed by the predominant symptoms of each case, and depend larcfely on the prevailing type of the fever. Under all circumstances must the temperature, pulse, respira- tions, be kept normal, whatever the type of the fever, for if the germ is not sterilized or destroyed in a week, it will kill the pa- tient. It must be treated boldly ; no time must be lost. Select one of the following remedies, either anti- pyrine, thallin, opium, Dover's powder or pul- verized asclepias. Administer in such doses and so frequent as to maintain an equalized circulation. To the abdomen either concentrated ozone or ozonized turpentine, or a mixture of the two. Kept applied until erythema of the skin is produced, then follow with fomentation of poppies and resorcin, and repeat the applications persistently for several days. The entire surface to be bathed with hot water to which some peroxide of hydrogen is added ; this should be done thrice daily. M \ ' The pathogenic microbes of pueperal fever. BACTERICIDES. ^^g The next important steps is to administer half a drachm of leptandra with one grain of opium, pulverized, and five of quinine, this is to be followed in two hours by drinking an infusion of senna, and if it does not operate freely, repeat inside of three hours, so as to produce five or six evacuations from the bowels daily, until the germs are annihilated. Chionanthine, leptandra and opium must be repeated every six hours, both have a power- ful germicidal influence on this microbe ; a directly destructive remedv to the germ. Should violent purging come on, the dose of the leptandra can be reduced. As soon as the symptoms of germ evolution subside, and the recovery of the patient is secured, withdraw the drug. Chlorine or ozone water to be given as a drink. In addition to these remedies a germicide is to be selected suffi- cient to destroy the microbe and adminstered every hour ; resor- cin is excellent, carbolic acid and tincture of iodine (as in typhoid fever). Whatever treatment is carried out, another thing is essential, and that is three times daily a copious, warm, intra-uterine injec- tion of a solution of boroglyceride or resorcin, or chlorinated soda, creolin ; some one is essential. The use of these for wash- ing out the germinal matter from the cavity of the uterus is self- evident. They are of great utility and should be used with great caution. One of the most eminent physicians in our country says of Metria : "The most decided results are obtained by a rigid germi- cidal treatment, under which the microbe disappears from the blood and tissues. Thus, the most careful antiseptic precautions, anti-pyrine in sufficient doses to keep the pulse at 70 ; wash out the cavity of the uterus thrice daily with warm solutions of boro- glyceride ; concentrated ozone with chloroform over the entire abdomen, or ozonized turpentine till erythema appears. Resor- cin jelly one-eighth of an inch thick over the redness ; when it disappears, a re-application of the germicide. Bowels in all cases freely opened with large doses of leptandra and jalap ; then tea- spoonful doses of concentrated tincture of kurchicine every three hours. In a very few hours no microbe can be detected either in the breath, saliva, blood, or lochial discharge." Country physicians may say, we cannot procure such remedies, appropriate in such cases. Turpentine is always at hand ; in all states and conditions it is a good ozone generator and stimulant in metria, one which from its action on the microbe, on the skin and kidneys, materially aids in the annihilation and elimination of the germ ; it is a valuable germicide in puerperal septicsemic fever. 350 DISEASE GERMS. A peculiar form of coryza, to which a Hay Fever, certain class of individuals are liable each Bacillus Subtilis. year, at a particular season ; the disease is of frequent occurrence among highly civilized Caucasians, as the American and English. It occurs much more frequently among those who have their nervous systems very highly developed, the highly educated, or those who perform much mental work. People who live in cities are much more obnoxious to the disease than those who live in the country. The nervous temperament, or neurasthenia has an undoubted influence in predisposing to the complaint. The predisposition is often the result of a neurotic inheritance, can be traced back for generations in the same family, but more commonly acquired under great mental toil, care, worry, strug- gle. The liability to the disease is at any period of life, but most commonly between twenty and thirty-five years of age. The exciting causes are numerous, micro-organisms and irri- tating agents in the atmosphere which are much more commonly in the summer and autumn months, as the pollen of flowering grasses and cereals coming in contact with the periphery of nerves in the delicate mucous membrane ; that the rise and fluc- tuation of the malady during the summer months corresponds with the varying amount of pollen in the atmosphere. Grasses most productive of hay fever are clover, timothy ; of flowers, roses and violets ; of cereals, rye and buckwheat ; ragweed and grapes being most productive of the autumn form. No doubt pollen or aroma in the air, annually recurring, acts as an exciting cause, but hay fever properly includes a much larger group of cases, in which vaso-motor and secretory disturbances in the- nasal passage, or along the whole naso-bronchial tract are excited by a variety of causes. The symptoms usually present are those of languor, lassitude, debility, with pain in the back, calves of the legs, rigors, fever with coryza ; sneezing ; nasal obstruction ; watery discharge from both eyes and nose ; the lachrymation is accompanied with smarting. There may be irritation of the throat, tightness and soreness of the chest, cough, and definite attacks of bronchial asthma. In persons with the typical nervous conformation, a train of symptoms identical with those of hay fever are extremely com- mon, and may be excited by dust of any kind, as the powder of ipecac, linseed; or the exhalation from animals, as cats, dogs, horses, rabbits, pigs ; or the odor of violets and perfumes ; vio- lent exercise ; sudden exposure to great extremes of heat and -cold, impressing the sensory nerves of the skin, together with BACTERICIDES. 30 other psychical causes. Some persons with the pecuHar nerv- ous idiosyncrasy are liable to attacks of sneezing coryza at all seasons of the year. The factors at work are a hypera^sthesia of the terminal nerve filaments in the nasal mucous membrane, and an undue activity of certain nerve centres. Both conditions combined give rise to .a degradation of bioplasm, the evolution being the bacillus sub- tihs. This micro-organism, combined with prolonged irrita- tion, the result of pathological states, leads to hypertrophy of the nasal mucous membrane. This bacillus is very common, and widely distributed, as it occurs in all nitrogenous compounds which are left to the atmos- phere to decompose. The best of all material is hay, ragweed, roses, grapes. Hay is the best. Infusion of hay, filtered and covered, and left to -Stand in a warm place, speedily swarms with this bacillus. This microbe consists of cylin- drical rods of variable length and breadth. Single rods grow to double their length and then un- dergo division. They at first form threads, which become developed into rods and cocci. They are mobile and are provided with a flagellum at each end. Their multiplication in any nourishing fluid speedily impoverishes it, and their growth by division soon ceases. Spore formation, however, will again become active if exposed to the air, as they are aerobic ; the deprivation of oxygen causes the growth of the bacilli to cease. The bacilli from the other nitrogenized bodies mentioned are identical in all respects with those from hay, consisting of elemen- tary rods of various lengths, with a flagellum at each end. After division the individual bacillus remains, as then the germ divides and separates, spore formation being independent of nourishing material. The hay bacillus bears a strong resemblance to the giant bacteria of anthrax, a zoogloea, a swarm, being a special characteristic. The microbe is pathogenic of hay fever, bears culture admira- bly and will grow in almost any nourishing medium, and when inoculated into any animal will give us hay fever or asthma. Hay fever and allied forms of coryza are in a large number of Hay tiaciUu^ . Baciilus Sidytilis), The microbe of hay, grape, ragweed, rose and other fevers. 352 DISEASE GERMS. cases associated with abnormal stites of the intra-nasal structure, and an improvement or complete cure of the coryza may be looked for from treatment directed to the destruction of the micro- organism in the nose. Irrespective of the microbe, or often associated with them, outgrowths from the nasal septum, hyper- trophic rhinitis ; enlargement of the inferior or middle turbin- ated bodies, mucous polypi. Remedying these pathological conditions, and the removal of the microbe, invariably affjrds substantial and durable results, the removal of redundant erectile tissue or otherwise, removing or excising nerve filaments. In the management of all cases, the neurotic element must ever be kept in mind, and. remedies like kephaline, avena sativa, should be pushed. The principal indications are to strengthen the general nervous system, soothe local irritation, and remove the microbe. The most hopeful remedies are those which give tone to the nervous system, kephaline combined with quinine and nux vomica; the bromide of potassium or ammonia and hydro- bromic acid, glycerite of ozone. To allay the irritability of the mucous membrane, various drugs have been tried with varying success, as atropine, morphia,, aconite, cocaine, peroxide of hydrogen, etc., by spraying in the nose, and over the eyes. Of these remedies, cocaine is of the greatest value, it may also be administered internally. Locally a solution, four per cent, is sufficient. While thus meeting the more urgent symptoms, we should select some germicidal remedy with which we should literally saturate the system, sterilize the blood, so that no microbe can live in it. Peroxide of hydrogen, sulphide of lime, comp. oxygen, Chian turpentine, one or other administered, will so sterilize the blood that no microbe will grow, the patient becomes invulnerable to either contagion or infection. Even inoculation is futile. Bi- chloride of mercury produces the same effect, thus: Bichloride mercury, gr. i or ii ; bicarb, soda, half an ounce ; distilled water,, eight ounces Mix. Dose, one teaspoonful every four hours. Boroglyceride both locally and internally ; begin early before the expected attack. The ozonized witch hazel charged with ten volumes of perox- ide of hydrogen, administered internally and locally, diluted, does good work in sterilizing the micro-organism and lessens the hyper-excitability of the nasal and respiratory mucous mem- brane. The distillation of the pine, of the eucalyptus, are exceedingly useful for internal use and also for inhalation ; the pine prepara- BACTERICIDES. ?>S^ tions are superior to creosote ; the pinol preparations, rich in natural and artificial ozone, are always of the greatest efficacy. Syrup of tolu, to which is added con. ozone and resorcin, has a magical action. The effervescing citrate of caffeine is not to be despised, as it will often ward off an attack ; and a w^arm douche of sulphate of quinine will kill the entire brood of germs. Euphorbia pilulifera, when taken internally, has the effect of sterilizing the germ. It has a slight narcotic action, but relieves the nasal, laryngeal, bronchial symptoms, and invariably affords a good night's rest. As this plant is toxical^ great care should be taken in its administration. As it yields its properties readily to boiling water, a decoction of the dried plant in the proportion of a half an ounce to a pint of water, and when cold a teaspoonful of chloroforrn added. This may be administered in doses of a wine-glassful three times a day. If case does not improve rapidly, medicated bougies should be tried, composed of cocaine, resorcin, naphthaline, and butter of coca. Local cauterization to the special sense of sensation, the sup- posed seat of the microbe entrance, is being practiced. In all cases of hay fever the diet should be liberal, as the dis- ease is of a depressing and exhausting character. Daily exer- cise, early hours, very moderate indulgence in alcoholic liquors should be advised. A certain amount of moral courage on the patient's part is also a desideratum, for the more the affection is resisted the less trying does it become. Moreover, as a previous unhealthy condition of the mucous membrane is necessary for the development of hay fever, it is very advisable, during periods of rest, and when the disease lies as it were dormant, that the mucous membrane should be maintained or restored to a healthy condition. I therefore, as far as possible, treat patients before the annual attack shows itself. By this means, in many cases, it has been warded off. Careful syringing with alkaline lotions and sprays, the use of inhalants and of interrupted currents of elec- tricity, with, of course, attention to diet and general medicine, will often enable patients to tide over the trying months of spring, without any manifestations of the malady. As to electricity, I am not aware that it has been tried in the treatment of hay fever on any extensive scale. In many cases I certainly have seen much benefit derived from mild interrupted currents, adminis- tered daily or every second day — act beneficially by exhausting the irritability of the part. 23 354 DISEASE GERMS. An irritation of the brain and cerebro- Spotted Fever, spinal axis, by the presence of a disease Epidemic germ, resembling the streptococcus in diph- Cerebro- Spinal theria, and having also its pathogenic Meningitis. characteristics. In all conditions of the human body in which the vital force is at a very low ebb, shattered almost irre- parably, and this is aggravated by diminished electrical or per- verted meteorological states, a degradation of normal bioplasm takes place. It attacks persons of all ages, with broken-down or devitalized constitutions. It is prevalent all over the world, and corresponds precisely to the blight in the vegetable kingdom ; contagious and infectious. It comes on slowly and insidiously, preceded by an undeter- mined period of incubation or germination, followed by rigors and a fever which last from five to seven days. The prostration and coma are ex- treme ; head and heels thrown back ; often livid or purple spots on the body, some- times absent; otherwise the 5kin is re- markable for its pallor ; flush on cheeks. Often convulsions. Streptococcus in cerebro- j^s duratiou is fivc days ; recovery in all spinal meningitis. i i r i cases very doubtiul. There is a tendency for the different types of remittent to ter- minate in cerebro-spinal meningitis. Its recognition is easy ; its insidious mode of attack, the coma, high fever, head and heels thrown back, livid spots on the skin, violent and short duration of fever. If the case is seen early, the general indications of treatment of fever should be observed, as bathing, beef-essence for diet, exal- gine in doses sufficient to equalize the circulation. Active stimu- lants over the cervical portion of spinal cord, with galvanic cautery or ice, followed by hot poultices or a liniment of tincture of belladonna, chloroform, and aqua ammonia, equal parts. Se- cretions kept active. An effort should be made to destroy the streptococcus in the blood. Internally, the microbe is annihilated by the presence of the ozonized glycerite of sulphur. This remedy is administered in teaspoonful doses every three hours, and the results obtained are rapid diminution in the pulse rate and temperature ; a speedy alleviation of all the symptoms ; its duration is shortened ; the dangers are overcome. It is one of the most remarkable germi- BACTERICIDES. 355 cides, greedily taken by any child, and can be utilized in every case, and effectually roots the brood of germs from the body. Dose after dose can be administered, and so long as there are microbes to kill it will not disturb the bowels, but when all are exterminated, then it will excite peristalsis, and the fre- quency of administration as well as the size of the dose must be lessened. Hydrogen peroxide should be administered internally in alter- nation with the sulphur to sterilize the blood, kill the spores ; neutralizes the ptomaines, and thus anticipate the sequelae of that dreadful microbial disease. In the absence of these two remedies, it should be borne in mind that the microbe can be killed by the administration of sodium salicylate in acetate of ammonia, by zozodine, chlorinate 5oda, pyridin, etc. A class of continued fevers characterized by a Eruptive rash. The principal diseases of this class have Fevers. certain features in common. They are each due to the presence of disease germ in the blood, and each of the respective microbes have a definite period of germina- tion, of fever, rash and decline. The germination of the microbe corresponds to the old stage of incubation, which terminates in each case respectively with a rigor; then the microbe is fully developed, actively at work, sprouting, breeding in the blood ; using up in its own nutrition all the oxidizable properties, which, when completed, the germ seeks the skin for the purpose of obtaining free oxygen ; here, it produces various pathological changes, according to its peculiari- ties and protoplasmic wants. Microbes on the cutaneous surface appear in scales, in peeled-off colonies ; in vesicles, pocks or scales. The microbes, wrapped up in the dead or effete tissue of the body, if not burned up, have an independent property of life, unless destroyed by some bactericide. The special microbe of each type of eruptive fever, once in the body, appropriates to its own use, nutrition and growth, cer- tain elements in the blood and nervous system which never, except in some rare instances, appear there again, hence the patient is subject through life to but one attack ; his blood being sterilized to that special microbe ; and this rule holds good, even if the germ is killed on the first day of its entrance. So that each species of germ can be killed by germicides, and all the uncertainties of fever, rash, etc., wiped out, the child's life oq5 DISEASE GERMS. saved, yet impregnable ever afterwards to the ingress of the same microbe : Disease. Measles . . . Scarlet Fever Small Pox . Gerniinalion. Eruption appears. lo to 4 to 8 days.; 2d day of fever. 12 days. 3d day of fever. Eruption fades. 4 days. 4th day of fever. 17th day of fever. 5ih day of fever. / Scabs form on gth day. \ fall off 14th to 22d day. This continued, highly infectious and often fatal Measles, fever is due to a micrococci and dipiococci in the or blood, brain and fluids of the body, found most Rubeola, abundant in the watery discharges from the eyes and nose ; not quite so abundant on the tongue, sweat. The germ is pathogenic, bears culture v/ell ; cultivations fed to animals reproduces the disease perfectly, even to its different stages, in the most perfect manner. Symptoms. — After a period of germination, varying from ten to fourteen days, there is pain in head, back, calves of the legs ; lassi- tude, shivering, fever and catarrh, the eyes are suffused, lining membrane of the nose congested ; mucous membrane of the fauces, larynx, trachea and bronchi become much affected; eyelids swollen, keep water- ing, intolerance of light Micrococci of measles. runnmg water ; dry cough, hoarseness ; difficulty of breathing ; drowsiness ; great heat of skin ; tendency to delirium ; fre- quent, hard, rapid pulse; tongue white-coated. The eruption comes out on the fourth day of fever, usually first on the face, then the body, and lastly the limbs, fading on seventh day ; it consists of patches, rough, irregular, elevated above sound skin, often of a round or crescentic or horse-shoe shape. Between the crescentic blotches the skin is of the usual color. Fever does not abate on the appearance of the eruption. There is no peeling or desquamation of the cuticle, which is a characteristic in scarlatina. Diarrhea often sets in on the declining of the rash. It is usually salutary. The contagion of measles is strong, being powerful through both its latent and active form ; often pulmonary complications, especially in winter and spring months. BACTERICIDES. 35^ If the patient is tubercular, or the disease comes from another race, there rriay be laryngitis; oancrum oris, severe otitis, epistaxis, acute tuberculosis, or acute desquamatic nephritis. In a malig- nant form, when powers of life are low, the disease is remarkable for its fatality. In the treatment of a case of measles, without any complica- tions, the patient should be confined to bed, in a warm, airy apart- ment either darkened or with buff curtains ; patient must, nay, it is imperative that he should be confined to be bed ; he should be sponged off thrice daily with a warm alkaline wash, and well and carefully dried off Put half a teaspoonful of the tincture of aconite leaves into four ounces of water, and give one tea- spoonful every hour. Half teaspoonful doses of the compound tincture of serpentaria should be administered occasionally to maintain some slight degree of moisture on the skin. No cold drinks to be given. In all cases a bactericide should be given, as there is consid- erable lung, bronchial and nasal irritation from the microbe. The following is most beneficial, and greedily taken by the child : Syrup of tolu, four ounces ; resorcin, three drachms. Mix. Administer frequently, so that one teaspoonful will be given every two hours. If this is not deemed essential, a few drops of glucozone could be given, or the old formula of two drachms each of chlorate of potassa and muriatic acid, added to four ounces of water. Mix. One teaspoonful, added to a glass of sweetened water, taken at repeated intervals, so , one is used every four hours. Diet should be liquid, but very generous, consisting of beef tea, sterilized malted milk, chicken broth. If debility is great, brandy and cream, or brandy and ^%^\ cough troublesome, increase the tolu and resorcin ; any convulsions, delirium, must be carefully managed by the application of mustard to the feet, and rubbed over the entire body, with the internal use of the bromide potassa. ; - Complications .may arise from carelessness on the part of the mother, or a want of recognition of the fever being due to the presence of a microbe. Those are usually congestion of the lungs, bronchi and eustachian tube. In such cases there is danger,; treatment should be on general principles and active. Catarrhal states of the eustachian are often troublesome, and are apt to give rise to impairment of hearing. The coryza and nasal catarrh, with the large mass of germs, swelling of the naso- pharyngeal membrane. A little care and watching are sufficient to prevent any permanent injury. 358 DISEASE GERMS. German or French measles has been supposed Rubeola to be due to a hybrid germ, the union of the or microccocci of measles and the bacilli of scarlatina. Rotheln Bacteriologists assert the existence of a distinct germ, which is pathogenic of the fever, which is essentially contagious and infectious. Symptoms. — There are the ordinary symptoms of languor, lassitude, debility, rigors, and a fever, which often runs high ; tongue is furred ; slight sore throat ; redness of the fauces ; little, if any, coryza; loss of appetite; drowsiness; looks heavy; eyes may be red, but do not water. The skin is full, tense and raised, and a papular rash makes its appearance, which gradually inten- sifies in color and becomes of a bright, rosy hue. These patches become blotches, and gradually spread over the entire body. The rash that comes out first soon fades and other patches make their appearance. The rash is followed by dryness of the skin. In mild cases there is simply the rash without the least con- stitutional disturbance ; appetite good, tongue clean, no languor, rigor or fever — nothing but a few tiny spots ; larger spots or blotches of a rosy hue in one part, at the elbows and knees, and spots and blotches on the hands, arms and legs ; the redness and soreness of the throat scarcely appreciable ; the rash may be gone in a day. Sometimes the cuticle peels, but as the constitu- tional vigor is good, he eats and sleeps well. Between a severe and mild case, rotheln varies much in character and severity. Most frequently it presents no symptoms but the rash, or the patient may be quite sick, and the rash varies much, appearing like measles ; in other cases diffused, or but a few sparsely scat- tered rosy-red minute dots ; in others a perfect aggregation. It is highly contagious and infectious, but its stage of incuba- tion, fever and eruption has not been defined. The worst case seldom lasts longer than three days. One attack protects the patient from all subsequent ones. It is followed by no sequelae, and most invariably terminates in recovery. The treatment consists in the warm bath, rest in bed between blankets, warm drinks, sweet marjoram. Aconite and compound tincture of serpentaria ; aromatic sul- phuric acid and quinine, destroys the germ promptly, and should be given as soon as the skin is moist from the action ot the aconite. The child should be kept at-home a few days, as the affection is even more contagious than measles or scarlatina. No after treatment is necessary. BACTERICIDES. ^^q This continued, highly infectious fever is due Scarlatina, to the micrococci scarlatina swarming in the blood, mouth, throat glands. The micrococcus can be found everywhere throughout the body, in the blood, breath. The germ is pathogenic of the fever, bears cultivation well in beef tea ; cultures injected into animals causes a re-appear- ance of the disease, even to the efflorescence of the skin. Three grades of activity of the microbe are described, which depend solely upon the status of vital force and sanitary sorroundings of the child in which the germ exists. If the micrococci enter the blood of a thoroughly healthy child, with good vital force, all the symptoms of fever and rash will be mild (simplex), but let there be depreciated vitaUty, with insanitary surroundings, the germs in the blood will be very active ; propagation by millions ; rash heavy ; throat badly germ-smitten (anginosa) ; if vital forces still more shattered, germ evolution still greater ; cerebral or malig- nant symptoms of an adynamic type; rash dusky ; purple, with a tendency to general gangrene, ^^ manifested by a suppuration from v^'^ ^ ^^ "•> • eyes and ears (malignant). ^« ^ In Scarlatina Simplex the symp- ^/^ toms are a latent period of from four to six days, with languor, las- -^ ^/^ situde, debility, pain in head, back, ^ ^^ ' calves of legs, and also rigors and a ^ fever. On the second day the erup- ■ws^ ^ tion appears in the form of innu- ^^ ^_^ ~^ jy_^ merable minute dots of a bright The Badiii scariatma rfounlir^re scarlet color, which rapidly diffuses blood before the germ migrates to 1 -11 T^i • the skin. itself over the entire body. Ihis eruption terminates by desquamation of the cuticle, which takes place on the fifth day. It is merely a scurf on the face and trunk, while on the hands and feet large flakes of denuded cuticle peel off. While, or even before the efflorescence is spreading over the entire body, the mucous membranes of the mouth, fauces, and tonsils become affected ; the tongue at first covered with a thick white fur, through which red, elongated papillae project ; as the fur cleans off, the organ presents a strawberry appearance. In Scarlatina Ajiginosa the symptoms are more violent, very much aggravated, and the languor, rigors, and headache very great; fever high, vomiting, delirium, and prostration. The fauces, palate, and tonsils become greatly swollen and covered with coagulable lymph, the nasal mucous membrane, parotid and other glands severely implicated, swollen, and often suppurating. Sometimes there is a diffuse inflammation of cellular tissue of •» % ^ >\ "«» «^ . * ' ■M :• '^ i^ 4^^- =5* *^* -t^- ?!^^*%"' result from artificial cultivations. The micro- "'' -'^'^ cocci of varicella, variola and confluent small-pox ^^lmii"°ox"' ° are identical, thus establishing most conclusively that these are but one morbid state, that the microbe is patho- genic of the disease. Living as we do among distinct races of men, in which every microbial disease is intensified, variola is the great pathogenic and therapeutic question of the day. 3^4 DISEASE GERMS. Themicrobe variola can be detected in the atmosphere for fifty feet around an infected person. All withia that radius are exposed to it, and it enters their bodies ; but in order to take hold and mul- tiply, there must be particular conditions of temperature and chemical media, constituting what is termed receptivity. Just as some seeds will germinate only in presence of certain meteorologi- cal conditions and in certain soils, so organic receptivity is re- quisite, that disease germs be followed by their effects. Once the microbe of variola enters our bodies and produces small-pox, the solids and fluids of our bodies are so altered or modified, that all the essential elements for their further nutrition are used up and never appear again. If the germ of variola enters the human body and finds a medium suitable for its existence, it quickly multiplies, with the celerity peculiar ' to minute bodies, their marvellous facility of ;o I reproduction compensating for their micro- ; ^ ' \- scopic size. During the twelve days of incu- i 'O '^^V ■ bation millions of ova or spores are evolved, i^.r^'^?C'^y-^^ '■'■':^:) so that when the rigors come with the three " ^ ^ • days of fever, the microphytes, having used up all the oxygenizable material in the body, eager, greedy for more, with air and light, accumu- '•^^;^ ' ^^^ near the surface; scattered in groups in "v/v^J^ the skin and mucous membrane, the microbe Section of skin in I'mar- excltcs suppurativc inflammation, which con- pox, showing the mi- stitutes " pustulation.'^ ciococci seekmg the „, ^ r ^i r • ^i ^ a. surface for free oxy- 1 he CaUSC of thc fcVCr IS thc StrCptOCOCCUS ^"""^ variola. Symptoms. — ^^The period of germination in the blood, or latency or incubation, lasts twelve days, during which time there is lan- guor, lassitude, debility, pain in the head, in the loins, and calves of the legs, with persistent nausea and vomiting, tongue not much coated and white of eye clear, and as early as the ninth day a gritty feel can be detected in the skin. FoUowiag these symp- toms a; rigor and fever for three days, during which time pains in the head, loins, and muscles continue, but nausea and vomiting usually cease. When vomiting is severe, pains in the loins in- tense, they may be regarded as precursors of a bad attack. Pe- culiar eruptions of pimples or papulae appear at the end of the third day of fever, appearing in the following order : first on the face, then on the neck and wrists ; secondly, on the trunk, and lastly, on the lower extremities. The papulae have first a hard, shotty feel, then present vesicles on the summit, which gradually expand laterally to about the diameter of a split pea, are flat or BACTERICIDES. 365 depressed in the centre. On the eighth day of the eruption an inflammatory areola or circle forms around the vesicles, and their contents become cloudy and then purulent, the vesicles gradually ripen into pustules, suppuration being complete on the ninth day, at which time finer pustules break and crusts or scabs form. In from five to nine days more, longer or shorter, these scabs fall off. In many instances the rash on the skin is accompanied with a similar one on the mucous membrane of the nose, mouth, throat, eyes, and ears ; in others by a swelling and inflammation of the subjacent areolar tissue; occasionally by marked irritation of the nervous system, delirium, and convulsions. The severity of the disease usually bears a direct relation to quantity of eruption. When pustules are few, and they remain distinct and separate from each other, the disease is not severe ; when very numerous, they run together, coalesce, and lose their regularly circumscribed circular form, it is highly dangerous.* This has caused a division of small-pox into variola discreta and variola confluent. Former not near so dangerous as the latter. Eruption on the face may be confluent, while scanty over the body; still if so, the disease is regarded of the confluent kind. Sometimes the pustules are so numerous that they touch each other, but do not coalesce ; it is then said to be the SQmi-conflu- ent form. Sometimes they are grouped in circles or clusters, and the name corymbose applied. If in either case symptoms of malignancy or putrescence are added, the disease is termed ma- lignant small-pox, a most formidable affection. Occasionally after the early symptoms, as pain in the loins, nausea, vomiting, a rubeoloid or measly eruption, and later minute petechia, which increase in number and size, hemorrhage takes place into the conjunctiva and from the bladder, bowels, etc., and death occurs on the fourth or sixth day ; no characteristic rash, only a few scattered papules or vesicles having appeared, it is called hemor- rhagic small-pox, which is almost invariably fatal. The greatest difference between the distinct and confluent form exists from the beginning. All the symptoms in the con- fluent form are very aggravated, intense, often proving fatal from the blood being surcharged with a living destructive poison. During its course, troublesome complications are likely to arise, as erysipelas, swelling of the glands in the groin and axillae, phlebitis, ichoraemia, glossitis, pleurisy, pneumonia, ulceration through the cornea, and suppuration of eyes and ears. No con- tagion so potent as the living germ of small-pox ; infection lasts all through the case, from the earliest symptom to a little after the last crust has fallen off. One attack exhausts the suscepti- 366 DISEASE GERMS. bility of the system to future attacks, as a rule. The practice of inoculation with the variolous matter is illegal. Small-pox is easily recognized by the history of the case, the period of incubation, fever, and rash ; in the earliest stage by pain in loins, nausea, vomiting, and a white or clear conjunctiva. The success of treatment in small-pox depends upon the early recognition of the disease. With our present bactericides, we are not able to break it up, but it can be rendered very mild. During the twelve days of incubation of the germ, every pos- sible means to allay the irritability of the stomach should be resorted to, as the recumbent posture, stimulants over stomach, peppermint water, and tincture opii, etc. Then select a ger- micide that will take kindly to the stomach, as either thuja or sulphide of lime, or the bichloride of mercury as follows : 15^ Aqua distilled .^viii. Bicarbonate of soda, oiv. Bichloride of hydrargyrum, grs. ii. Mix. One teaspoonful every two or three hours. Either of these three agents — thuja, calcium or bichloride — freely given, and elaborated in the blood, renders the soil unfit for the growth of this microbe. The glycerite of sulphur, with the hydrogen peroxide, has excellent germicidal properties, diffuses itself well through the blood, sterilizes that fluid, combats the invasion of the bacterium of variola. Push germicides as far ^s possible all through the stage of germination, and when the rigor comes and the three days of fever preceding the eruption, do not suspend their use, but perseveringly administer them. When the rigor takes place and fever sets in, it is likely to be very mild if the antiseptic plan has been carried out. After the rigor the patient must be kept in bed, in a well-ventilated room, free from carpets and curtains, and disinfectants freely distributed around the apartment. After his long fast the patient often has a keen appetite, and the diet should be generous — arrow-root, beef essence, milk and lime-water, ripe fruits, warm drinks. Sponging the entire body during the three days of fever with warm mustard water and soda must not be neglected. After rash appears it must be discontinued. All through an attack of small-pox, from its incipiency to its termination, no cold article of food or drink, such as iced drinks, cream, or ice, should be given or applied to the patient. Arterial sedatives, as tincture of aconite, veratrum, and bella- BACTERICIDES. 367 donna, one teaspoonful of each to half a tumbler of water, of which a teaspoonful should be given every hour or two. During the febrile stage it is often advantageous to change the germicide to either lycopodium, ozonized tincture, or to gluco- zane or salicylate soda in the acetate of ammonia. The physi- cian in attendance will be the best judge. Warm drinks are always indicated ; nourishment and stimulants are always of great utility. Tincture of cimicifuga racemosa has an excellent effect in all cases. Aromatic sulphuric acid and quinine is a good tonic in all cases. Much has been written of the bactericide properties of pitcher plant, wild indigo, siegesbeckie, and other vegetable germicides. We might just say that they are of no utility whatever in the destruction of this micrococcus. When the pustules appear, general principles must guide. The germcides should be admin- istered regularly, till every vestige of the disease has disappeared. With regard to pitting, there can be none, even if that simple thuja alone be given. Far less can it take place when such powerful germicides as sulphide of lime, comp. oxygen and gluco- zone are given. If the physician is weak in faith in the action of bactericides, he can bear in mind that under darkness or a yellow light the microbe becomes sterilized in the pustules. Hence there is no pitting. If his faith is still weaker, resorcin. jelly or ointment applied over the face at once destroys every microbe with which it comes in contact. As far as practicable, disinfectants should be exposed all round the apartment ; and if it were possible to move the patient on his cot to another apartment, sulphur fumigation for an hour will destroy every germ with which it comes in contact. The factor in small-pox is the germ. The whole aim and object of all treatment is its careful, persistent destruction, and at the same time keep up by every possible means the vital forces of the patient. We must by all means crowd in germicides with- out offending the stomach. All complications are to be treated on general principles ; convulsions, delirium, with bromide of potassa, belladonna; restlessness, with sulphonal. If the throat is seriously implicated, antiseptic gargles of boroglyceride. We cannot insist too strongly on the imperative necessity of persistent and careful nutrition all through the case ; food often, at proper intervals by day and night. Beef-tea, broths, milk food, cream, finely-chopped meat, chicken, game, are most acceptable. The retrograding action of alcohol on all disease-germs must not.be overlooked. This property alone renders it an agent of 368 DISEASE GERMS. infinite value in the form of milk punch. There is no form of fever that bears such an amount of careful nutrition in all forms as small-pox. Does the modern system of vaccination with the cow-pox lymph sterilize the blood of the recipient ? Does it render the soil unsuitable for the growth of the variola microbe ? Does it exhaust the pabulum ? Most assuredly not. Modern vaccination is productive in creating a deterioration of race, as is seen in widespread neurasthenia and tuberculosis. Bovine lymph has in it the oidium albicans from foot diseases of the heifer ; the bacillus tuberculosis which affects eighty per cent, of all swill-fed and high-bred animals. Actinomyces is more common than what is really known, and all are familiar with the malignant anthrax which is decimating our cattle, pollu- ting our soil. Does a father or guardian desire to implant in his offspring microbes of disease, factors of crime ? In all tropical countries where solar Filaria Sanguinis heat ranges from 80° to upwards of 100° Hominis. F., there are to be found in the human blood during night, millions of ova, of a minute, almost structureless, microscopic parasite, which is the embryonic form of the filaria, which requires the action of the Filaria Sanguinis Hominis in human blood X 280. In this case Irom 2510 100 were found inevery drop of blood between 6 p. m. and 5 A. m. Filaria Sanguinis Hominis, taken from a lymphatic in tiie scrotui mosquito to effect a transition in its scale of being, a sexually mature worm. The mosquito, ever active during the night, feeds upon human blood when those micro-organisms are present ; being a greedy feeder it gorges itself, and once in its body grows prodigiously. The nature of the mosquito compels it to seek water, into which it liberates the developed spores of a trematode. Free in the water, especially if it be stagnant, it undergoes further changes, progressing onward in the water, in the human stomach, in its BACTERICIDES. 369 migration from the gastro-intestinal tract to the lymphatic, where it is found in a mature state, measuring usually about three inches long. The passage of this micro-organism into the human body is chiefly by the water as a drink, possibly by the skin in bathing or by the bronchial mucous membrane. Once the embryonic worm is within the body, it has a selective power, to seek out the lymph canals as an abiding place. Its aptitude in choosing the lymphatics, or lymph scrotum is remarkable. Our knowledge of this parasite is very imperfect, so much so that we are unable to give, its life history, its original mode of development, its duration of life, its habits, its power of repro- duction, or how myriads do exist in individuals during rest or repose. The embryonic filaria in the blood is a microscopic parasite, and will remain or die such, unless he finds an entrance into the mosquito, thence into water, and finally into the human stomach and lymph channels. The mosquito has a peculiar and special affinity for this micro- organism, and will not suck the blood of those in whom they do not abound. . The embryonic filaria are not common in the blood of those who lead an out-door Hfe and enjoy the highest possible standard of health. More is wanting to enlarge our conceptions of the nature of this and other blood parasites. This usually consists of a narrow crack or lacer- Fissure. ation of the mucous membrane, involving the sphincter muscle at its coccygeal border. It is usu- ally situated at the posterior wall, at the external border of the anus, where skin and mucous membrane meet, but it often ex- tends up or across the internal sphincter, and even into the rec- tum. As a rule there is only one, but it is not at all uncommon for two or three to exist simultaneously. The great abundance of sensient nerves in and about the sphincters renders it very sensitive, and when fissured, the pain is indescribable ; severe, agonizing, persistent, after a defecation ; the reflex effect of which is most disastrous to the nerve centres, giving fise to collapse, chorea, epilepsy, nervous disease. It may occur at any age, in both sexes, but most frequently •met with in adult females. Causes. — Scratches, abrasions, lacerations, due to straining at stool, or to excessive stretching produced by passing dry, hard- ened faeces, or to fish bones, or cherry stones, polypus, piles, 24 370 DISEASE GERMS. tumors, diarrhea, discharges, enlarged prostate, prolapsus of uterus and rectum, rectal ulcers, disease germs eating, eroding the tissues, the labor of childbirth. Symptoms. — There is excruciating, intense, sharp, burning pain, at or subsequent to defecation, with mucus or muco-puru- lent matter from the anus, but it needs to be seen, although the pain is an excellent symptom, being of an agonizing character, very de- pressing, owing to the faecal matter lodging in the fissure undergoing chemical changes. Treatmeiit. — The general health must be improved by every possi- ble means, alteratives and tonics. Among the last the following is in- valuable as a rectal tonic : Fl. ext juglans ; fl. ext. Virginia stone crop ; fl. ext. coUinsonia, equal parts of each. Mix. One teaspoonful three times daily. The sphincter muscle must be paralyzed by the local application of belladonna ointment, the bowels evacuated by oil. After a thorough movement, wash out rectum with boroglyceride solution, then wipe the parts dry and expose the fissure thoroughly; then sprinkle it all over with iodol or the solution of nitrate of silver, thirty grains to the ounce of water. By keeping the sphincter thorough- ly relaxeci ; causing copious soft stools with the administration of fl. ext. of juglans, and the introduction of the cocaine suppository, the fissure heals promptly. Another plan is : after the bowels are evacuated, and the parts cleansed, introduce within the fissure a frag- ment of lint, soaked in a solution of chloral hydrate, one to fifty. This should be applied every morning. The action of the chloral is anti- septic, stimulates granulation rapidly. Conium ointment is of great utility in all painful affections of A form of deep rectal fissure commenc- ing two-and-a-half inches above the sphincter muscles, usually met with in persons that suffer from nervous bank- ruptcy, white softening and insanity. U -^'^Wsf Piles, complicated with longitudinal fis- sure, high up as well as low down. BACTERICIDES. 371 the anus and rectum, but it is especially efficacious in fissure with intolerable itching", severe tenesmus, with bleeding; it .affords marked and speedy relief, after every other remedy has failed. If the case resists treatment, sphincter irritable, stretching the sphincter muscles is of great utility. The office of the sphincter ani is to guard the rectum from in- voluntary discharges of its contents in health.; this it does easily, perfectly, without strain or friction. But let disease supervene, ulcer, fissure, fistula, piles— the irritation incidental to which gives rise to thickening ; piles are constantly tending to protru- sion, ceaselessly warring with the muscle, when faeces are passed, they are either protruded, bruised, painful, or agonizing ; whereas in ulcer or fissure the irritation is cumulative. ' In order to effect a cure in the majority of cases, it is impera- tive that the muscle be placed physiologically at rest ; to effect this, belladonna is the drug to be applied ; and this is not at all times indicated, especially if there is fis- sure. While stretching the sphinc- ter ani is neither recognized, nor taught, nor appreciated, but scouted as unsurgical, nevertheless, infinite good is to be derived from it in some cases. Digital stretching is the best, never lacerating, but suffi- cient to destroy its power for a few days until recuperation is effected. Piles and rectal fissures often co-exist — a good illustration. Fis- sures running up are best got rid of either by rectal bougies of boro- glyceride and resorcin, or stuffing them on alternate days with iodol ; the external chronic hsemor- rhoidal condition best smoothed down by painting them once a week with a solution of chromic acid. Another excellent remedy is the ozonized distillation of hamamelis virginica ; by two thirds of the profession it enjoys absolute precedure over all other drugs. This term is applied to a sinus or channel exist- Fistula in ing in the tissues surrounding the anus or rectum. Ano. Anal fistula is a tube lined with a false membrane, which is a secreting tissue and communicates with a cavity. It is met with in three forms ; complete, blind internal, blind external. A complete fistula connects the rectal Fissured rectum, the result of the syph- iUtic microbe, cured by rectal bougies of zozoidol. 372 DISEASE GERMS. cavity with the external skin, by a sinus running outside of or around the sphincters. If the rectal wall be perforated and a sinus extends from the perforation to some point in the tissues, but does not reach the surface, it is called an internal, imperfect External incomplete fistula Internal incomplete fistula. or blind fistula. If the sinus extends from an opening on the outside wall of the rectum, but does not penetrate the rectal wall, it is termed a blind internal. Causes. — Constipation, which distends the lower portion of the bowel to a great extent, and then a weakened patch gives way, or a piece of hardened fasces, fruit seed, fish bone or some other hard body excites irritation, inflammation, ulceration clean through, or otherwise forming a fistulous ulcer. There may be one or more. Fistula does not necessarily co-exist or depend upon the presence of the tubercular bacilli, but may be caused by a germ-eaten rectum, the microbes eating their way through to the external parts. This is frequently the case in ulceration, due to the bacilli of tubercle, or to the vibrios of the insane. The external tissues of such patients are soft, non-vital and disease sperms perforate readily. Symptoms. — The external aper- ture is usually small, and in some cases difficult to find. Generally it is near the anus, although it is not uncommon to find it several inches distant ; it may be concealed in a furrow, or it will be found in the centre of a button-like eminence. Complete fistula is most annoying, because gas, intestinal mucus, and fluid faeces pass along the tract, causing external irritation and painful spasmodic contractions of the sphincter. The blind internal is easily detected by the introduction of a blunt probe, which does not penetrate through, the discharge from this is mucus ; the blind external gives rise to symptoms nearly analo- gous to irritable ulcer. By a careful examination with a bent probe the orifice can readily be detected. Fistula Deverticula. BACTERICIDES. 373 Treatment. — Before enumerating our modern method of treat- ment, which is satisfactory, we will simply enumerate the old methods which have fallen into disuse. The old orthodox and approved treatment for many years has been to cut through the fistulous opening into the rectum, divid- ing the sphincter, and permitting it to heal from the bottom, if the patient has vitality enough, otherwise an imperfect or non- union of the sphincters may take place. This cutting may be done with the knife, or crushed by the chain of the ecraseur, or by a ligature. Even cutting the false membrane lining the sinus has been resorted to. Most encouraging success has attended the treatment of this malady, by stimulating, cleansing, germicidal injections into the fistula. Generally we are successful with this method, but once in a great while we meet with a case in which the ligature or knife might be necessary. Whichever of the methods is deemed best for success should be decided on ; but before it is resorted to it is well to improve the patient's health by every possible means with tonics, fresh air, best of diet. The bowels should be cleansed with oil. If the injection method is selected, we append a few formulae, with which we have had most gratifying success. Before any of those are used, the sinus and rectum should be washed with an anti- septic wash, such as one grain of chloral hydrate to one ounce of water; or one grain of nitrate potassa to two ounces of water; or one grain of bichloride of mercury to four ounces of water ; or a few drops of peroxide of hydrogen in water ; or a solution of boroglyceride. After one or other of those washes have been used, the parts dried, then select one of the following formulae to inject, to destroy the sinus and stimulate effusion of lymph to block up the passage. Carbolic acid, three drachms ; glycerine, one drachm ; sperm oil, one-half drachm. Mix. Heat to 300° F., and evaporate to four drachms ; then use as below. Carbolic acid, twenty grains ; corrosive sublimate, gr. i. ; Mon- sul's solution, one drachm; glycerine, two drachms. Mix. Carbolic acid crystals, forty grains; hydrochlorate of cocaine and of morphia, of each respectively, five grains ; glycerine, two drachms. Mix. An excellent radical cure is as follows: First trace fistula with a flexible probe. Wash out the tract with a five per cent, solu- tion of hydrogen peroxides. Then inject a ninety-five-per-cent. solution of carbolic acid, plus an equal quantity of a ten-per-cent. solution of the muriate of cocaine. Draw from ten to fifteen 3;74 " DISEASE GERMS. minims in the syringe. Push the nozzle of the syringe to the depth of the fistula, and then inject slowly as you withdraw the needle. Within two hours afterwards inject a few drops of equal parts of oil of eucalyptus and glycerine. Let the patient rest twenty-four hours. Lock up the bowels for a few days, and the operation is complete. Stricture of the urethra, when old, and not got Fistula rid of by absorption or electrolysis, is very apt in to excite irritation of the urethra and a gleety dis- Urethra. charge ; the obstruction, however small or large, causes a rebounding upon the prostate, and invaria- bly gives rise to irritation and enlargement of that gland. In bad cases of stricture a drop of urine is hable to lodge behind the stricture, which will, in time, excite irritation, in- flammation, ulceration, and ultimately an opening on the inferior aspect of the penis, through which the urine drops or flows in micturition. There is really only one successful method of treatment,^ namely, placing the patient under the influence of an anesthetic, and carefully dissect out the fistulous tract ; then forcibly intro- duce into the urethra, through the stricture, into the bladder, a No. 12 silver catheter; it should be retained for about eight days ;. the wound should be carefully stitched up. By the time the catheter is withdrawn both stricture and fistula are usually wiped out and a good cure is the result. This may originate from a laceration of the Fistula, perinaeum, which extends back through the Recto-Vaginal, sphincter muscle of the rectum, which has been stitched up, but left an opening between the vagina and rectum ; or it may have arisen from chancre in the vagina perforating through, or from stricture of the lower bowel; foreign bodies ; from the introduction of knitting-needles, whalebones, to induce miscarriage, and like conditions. It is easily recognized by the passage of gas, liquid or solid faeces into the vagina. If very small, and in doubt, empty the bowels from above with castor oil ; after it has operated, put patient on her back, knees drawn up, and a crow-bill speculum into the front part of the vagina ; have a good light, and the index finger into the bowel, and examine it all over for an orifice. They are seldom high up, and by bulging the rectum with the finger, can be easily seen. If very small, so that a pea would BACTERICIDES. 37^ penetrate through, it can be closed up without an operation if care- fully managed. Every second or third day for five or six weeks it can be touched with nitric acid; that is, the edges of the fistula and a little beyond ; after it is raw, it will begin and throw . out granulations that will effectually block up the orifice. It takes time and care, and while it is going on, the patient must keep bowels very soluble and free from gas, by eating a proper diet. If it fails, or if the opening is large, it should be stitched up. Patient's bowels having been well cleansed out, placed under chloroform on her back, a crow-bill speculum should be inserted, and the part exposed to a good light ; its edges should be freely pared, so as to have a good raw surface. If the sore is round, like a three-cent silver piece, it has to be lengthened slightly, to prevent puckering when the stitches are introduced ; then sewed up with lead sutures, and the sphincter muscle on both sides of the coccyx must be divided, so that the patient can have no con- trol of the bowels, that gas and solid matter may pass without disturbing the fistula ; bowels locked up for ten days with opium ; and kept perfectly quiet in bed for two weeks. If the patient is strong and vigorous, all may go well ; the cut sphincter may unite ; if it does not, the patient is a miserable object all her future life, not being able to hold or have control over her bowels. The original fistula, however, unites perfectly, unless there has been some bungling in the paring of the edges or application of the stitches. To obviate the cutting of the sphincter muscle of the rectum, tubes have been tried, with partial success. In all cases the best of nourishment should be o-iven, so that a high standard of health be maintained. A fistulous opening from the bladder Fistula, into the vagina. Vesico-Vaginal. Its common cause is the use of instru- ments during delivery, especially if the bladder has not been emptied. A full or distended bladder, with hurried labor, or with a bad presentation,; or a crooked or de- formed pelvis, may also give rise to it ; and various other like conditions. It is often caused by ladies attempting to commit abortion on themselves by. knitting-needles, whalebones. The dribbling of the urine through the orifice, night and day, gives rise to irritation, rawness of the vagina and renders the patient very miserable, and an object of great distress. It should be treated by getting her into as good health as pos- sible, and then stitching it up ; placing her upon her arms and 3^6 DISEASE GERMS. knees, head down, parts well exposed by two crow-bill specu- lums, a catheter in the bladder. The edges of the fistula should be well pared, and then stitched up with lead-wire sutures; patient put to bed, and a catheter kept constantly in the bladder. All cases are successful. Reflex or functional disorders are Functional Disorders extremely common, and embrace of the Heart. many of the principal organs of the body. We have selected two as an illustration of them all. Functional disorders of the heart are usually brought about in this way : the reflex centre, medulla oblongata, is weak from some cause or other, so are the various nerves that supply the heart. With a weakened bulb, any irritation in the body, such as worms, neuralgia, uterine irritation, or irritation of clitoris, penis, kidneys, bladder, stomach, liver, will be easily and promptly transmitted to the centre, from thence to the heart, giving rise to this functional disturbance ; nervous exhaustion, over-study, anxiety, sexual excesses, weaken the nervous centre. Tobacco, tea, whiskey not only enfeeble the reflex centre, but devitalize the heart. Gout, rheumatism, syphilis, mercury, act on the weakened cardiac nerves, circulating through them, poisoning them. Symptoms. — In the so-called functional derangement, we may have every symptom of organic disease, irregular pulse, palpita- tion, fluttering, with a cardiac murmur and subcutaneous anaemia, in anaemic subjects. Dull, weary ache over region of heart ; occasionally sharp, lancinating, catching pain ; inability to lie on the affected side, owing to tenderness ; very great mental depres- sion ; often dyspepsia, with heart-burn, flatulence, and eructations of gas or acid secretions ; vertigo, faintness, noises in ears, specks or spots before the eyes, flushing of face, violent palpitations, with pulsations in aorta. In women with uterine or ovarian trouble, or young men addicted to masturbation, smothering, difficulty of breathing, globus hystericus. Treatment. — Cases of this kind require fine judgment, long ex- perience and keen observation. Symptoms must be relieved, for they are real, not imaginary, until the cause can be reached. If patient is intelligent, his case should be fully explained to him. He must be told his nerve centres are feeble from some cause or other ; that his cardiac nerves have lost their tone ; that there is an irritation carried to the weakened, but now highly impressible bulb, thence transmitted to the heart ; or that the nerves of the heart are starved from poor, or poisoned by bad blood. Once the cause can be removed there is usually 15ACTERICIDES. 377 little difficulty in the case, but that must be done. Investigations -as to them embrace not a cursory but careful examination of lungs, stomach, liver, bowels, kidneys, genito-urinary organs, skin, blood, for irritation or disease ; and if no cause can be found, the case should be treated with alteratives and tonics, with irritating plaster over region of heart, and treatment persevered with for months. At the same time every means should be adopted to invigorate the nerve centres with cinchona, avena, matricura, kephaline, coca wine. The terms biliousness and torpid Functional Disorders liver are very common, and are ap- of the Liver. plied to a variety of symptoms, such as constipation, sallow and itching ^kin, dark urine, headaches, lassitude, furred tongue, bitter taste in mouth. . Functional derangement of the liver may be due to structural disease, as chronic inflammation ; abscess, acute yellow atrophy, gastric and intestinal dyspepsia, atony of the bowels, organic dis- ease of the heart, lungs, kidneys, to syphilis, tuberculosis, ma- laria, to a faulty diet, too much hydrocarbon, ale, beer, sedentary habits, a deficient supply of oxygen, insanitary state, breathing sewer and other deleterious gases ; poor ventilation, anxiety, pro- longed mental labor. The prominent symptoms which attract attention are anorexia, a bitter taste in the mouth due to taurocholic acid in the blood ; flatulency, acidity, pyrosis. The tongue is large, pale, flabby, with indentations of the teeth along its edges. It may be white, with elongated papillae. The faeces are pale, unless they have remained a long time in the large bowel, when they are blackish. Constipation and diarrhea may alternate ; haemorrhoids very common. There is often a weight, fulness, tightness, burning, or even a sense of actual pain over the liver. There may be obesity, but emaciation is liable to take place from deficient production of bile, or from disarrangement of the glycogenic function of the liver. Bile may saturate the textures of the body, and yet fail to poison, so long as the kidneys are active. A torpid liver, with obstinate constipation, gives rise to a deficient elimination of cholesterin ; lithiates and pigmented bodies in the urine are signs of a dormant liver, and the diathesis lithaemia is usually an ante- cedent state. Renal derangements may be the result of hepatic trouble, and in this way liver disturbance gives rise to congestion of the Icidneys. 378 DISEASE GERMS. After the function of the hver has been interfered with for some time, its granular structure is Hable to become diseased. Amyloid and fatty degeneration is the most common. Senile decay, calcareous, atheromatous arterial changes follow next in order. The lactic and butyric are next, due to the non-de- struction of fibrine in the liver. This modern liver torpor seriously impairs the energies of life. It dwarfs ambition, creates debility, gives rise to pains in the right side, and not infrequently is the cause of numerous diseases, as sciatica, lumbao^o, vertig;o, headache, muscae volitantes, melan- cholia, insomnia, hypochondriasis, irritable temper, moodiness.. It often gives rise to functional disorders of the heart, a variety of skm affections. The treatment consists in regulating the diet. Forbid the use of all starchy or saccharine food ; also all wines and malt liquors. Recommend fresh air, moderate exercise, attention to daily alka- line bathing, and abandonment of all severe mental strain. The bowels should be kept freely opened. Alkalies, as the phosphate of soda, are always of service. The remedies of real value are those which act directly on the liver. Chionanthus virg. is the most efficacious drug in func- tional hepatic disturbance. It increases the biliary secretions ; 'it influences the disintegration of albumen, and thus relieves a weak or overworked organ. Apocynum, podophyllum and taraxacum make a good liver stimulant. The use of iron, mineral acids, ;iarcotics is contra-indicated. In speaking of disease germs, it is not necessary Germs to describe the origin, the growth, the development Disease, of the human species ; neither is it requisite to delineate the process of nutrition, mode of propaga- tion, maturation from the most simple element, a cell, up to the most complex and perfect bodies, nor the ingestion and digestion of food in the stomach, bowels, and its elevation into a vitalizing fluid by the lymph canals and pink marrow of the bones — the blood, which is the life, a complex Hquid that nourishes brain, bone, muscle, gland — a fluid in which infinitesimally flows the sparkling, vivifying elements of the soul. In other words, it is not necessary to descnbe the process of evoltitioii, but suffi- cient it is to say that evolution is simply an ascending develop- ment in a particular order — the passage from the least, the low- est, to the most highly organized ; from the most simple to the most complex ; from the infinitesimal to the giant species ; from a simple cell to the climax of brain development in man's sympa- BACTERICIDES. 3-.Q thetic ganglia. It is a positive process by which the body is built up, put together or constructed ; the negative process is dis- solution, one of undevelopment, of taking to pieces, when the organized, the complex, fall asunder, come back to simple original elements. Man originates in a simple cell or germ, and this body, when of sufficient vitality, with a favorable location, evolves, grows, aggregates from its surroundings, and becomes the most com- plex and highly organized of all created beings — reaches the highest level, the top layer of evolution. Partial or complete dis- solution is downwards, retrogressive ; it is a process of change, of alteration, of living matter resuming its most simple form, and in this process of dissolution normal living matter is changed, altered into disease germs. Disease may be defined to be any deviation from health, a par- tial death or dissolution — a state or condition in which there invariably takes place a degradation of the bioplasm of the blood of some special tissue or gland. Thus, for example, if the shock affects the nervous system — say grief, worry, anxiety — the mat- ter concerned in the nutrition of the great sympathetic will be degraded into the disease germ, the vibrios, and there will probably be typhoid fever or neurasthenia ; if the organs of digestion are impaired or damaged, the nutritive elements con- cerned in its nutrition are degraded into the disease germ bacte- ria ; if the lining membrane of the nose is depressed by colds or otherwise, the nutritive elements concerned in its repair or con- struction are degraded into the disease germ, the amoeba. The degradation may be local, but its pristine seat is in the blood — a fluid in which flows the sparkling, vitalizing elements of our being. There can be no dissolution without pain, without , altered secretion, without disease germs being present. Pain, by what- ever name it is called, indicates a deficiency of life, a partial death, with its changed secretion and disease germs, calls for remedies to promote a renewal ; pain is nature's cry for more stimulus, more pabulum. It disappears the moment a renewal is established. So long 2iS paiji exists colonies of disease germs are being formed or evolved, which are important factors in dis- ease, being the degraded living elements of special nutrition. Pain, even a neurosis, an increased sensibility, whenever and wherever it exists, exhibits a deficiency of life and the presence of disease germs. Pain follows ; nay, is an integer, a factor, in over-work, exhaustion, enfeebled brain, deficient vitality, disease. As a result, the mechanism of the human body is deranged, the appetite leaves; tongue coats, becomes bulky, dry, indented; 380 DISEASE GERiMS. complexion muddy; countenance has the stamp of suffering, of mental depression ; urine deposit lithates ; the stomach, Hver, kidneys work feebly, and the individual feels wretched ; jaundiced in all his acts, thoughts, because he is clogged up with disease germs. True, persons highly and finely organized, feel pain more keenly, more acutely than those of a lower oi'ganization ; the higher the development, the less reserve of vital force, the less the resistance, the more the susceptibility, and less the capacity to bear it. No standard can be laid down as to the degree of pain. Men and women are variously organized and experience it differently. Disease germs may be thus defined : " The blood contains every element, when properly supplied with food, for the proper nourishment of every tissue in the body, as brain, bone, muscle, gland ; here all find their primary elements of nutrition. If the inherent, innate, vital force, that presides over the evolution of each be degraded by any condition adverse to healthy evolution or normal health, those primary elements become degraded into disease germs." Disease germs then consist in the degradation or change or alteration of the primary elements in the blood, into other living matter which is capable of independent existence, noxious, with prodigious power of reproduction if vital force is low, and if much shattered may destroy the individual in whom they are evolved or from whom the degradation springs, or of being car- ried from the seat of evolution and communicated by contagion and infection. The diseases of this class are very variable, being often differ- ent in one race from another, modified by soil and climate, but in all cases giving rise to epidemics, as plague, cholera, small- pox, diphtheria, catarrh, fevers, hooping cough, cancer, syphilis, tuberculosis. Thus disease germs in their varied forms and aspects, influence the fate of individuals, of cities and empires ; they decimate armies, infest the habitations of the poor in our sewage-sodden cities and are direfully fatal to all in feeble health, with insanitary surroundings. They are emphatically the scourges of mankind. The question how microbes act in disease has long been in doubt, but the progress of science tends to clear away obscurity. The first idea was that they were the factors of disease, that when they were evolved or taken in that they acted like parasites, lived upon the blood and tissues of their host. No doubt this is the case to a certain extent, that they swarm in the blood, ab- stract from the red corpuscles the oxygen they require for their nutrition. BACTERICIDES. 381 It often happens that death is so rapid that the bacilH have not time to develop in the blood in sufficient numbers to produce fatal results, such as in tetanus, anthrax, rabies, in cholera ; in the latter especially, death often takes place before the comma- bacillus enters the blood. An explanation of this state of things is necessary. It is this : all disease germs excrete or eliminate in their growth and development a poisonous substance, resembling snake venom, an alkaloid, the ultimate product of putrid fermentation of organic matter, an alkaloid termed ptomaines. The presence of this toxical principle is a natural excretion of all microbes, in the blood, intestines, brain, stomach, etc., gives rise to debility, rigors, fever, pain in sentient nerves, vomiting, diarrhea, hectic, delirium, spasm, collapse. Poisoning by tainted meat, fish, milk, wool, water, is due to the presence of ptomaines. The chief action of all pathogenic microbes, of the most harm- less as well as the most dangerous class, is due to their excretion (in some part of the body) of the ptomaines. This explains the speedy death in snake bite, tetanus, rabies, and cholera ; so rapid, so sudden, that the germ has simply localized, never entered the blood. Although the germ has not been absorbed by the intes- tinal mucous membrane, and carried into the blood, the poison- ous alkaloid or ptomaine which it excretes, is certainly present, and it is to its presence that the symptoms must be ascribed. This alkaloid has been extracted from the faeces. The action of pathogenic micfobes on and in the human body is complex, and may be thus stated. The action of the germ, the factor of morbid action, which is nourished at the expense of the blood ; the formation and excretion by this same germ of a ptomaine, a highly poisonous alkaloid, which acts on the system as an annihilator of vital force. A ptomaine is a chemical compound which is basic in its character, formed either during the putrefaction of animal and vegetable matter, or is an excretion from disease germs, some of which are not very poisonous, whereas others are so highly toxical that they will destroy life almost immediately. Ptomaines are formed in the death of matter, in the transition ; in the activity of bacterial life, which is present when structures are passing from the organic to the inorganic ; they are formed in all microbial diseases as an excretion of the germ ; they are pure alkaloids, and differ in their poisonous qualities, according to the nature and character of the germ which gave them birth. Whereas Leticomaines are altogether different, being a basic substance found in the living tissues, either as the product offer- 382 DISEASE GERMS. mentative changes or of destructive metamorphosis — all basic substances found in animal tissue during normal life. The term is used in contradistinction to the ptomaine, the basic alkaloid of putrefaction. The leucomaines embrace two groups of waste, uric acid and creatine. The excretions of all living things, plants and animals are poison- ous to the organisms which secrete them. These poisons are formed within the body ; they originate in the changes by which the complex organism is split up into simpler compounds, urea, ammonia, water, carbonic acid gas. It matters little how these changes are effected by organized ferments, germs, or by the un- organized ferments of the gastric juices, or by unknown agencies, which will induce metabolic changes in all the tissues; in all cases poisons are formed. At all times, but especially in warm weather, there is a pro- fusion of both vegetable and animal germs in the atmosphere, of which even the most virulent or active cannot find ingress to the blood through the bronchial mucous membrane ; but let the mouth be open, they find ingress there. The human mouth is an excellent culture apparatus, in which too frequently do the broods of microbes enter ; for there they find heat, moisture, nutrient fluids, naturally provided for their nourishment and growth. Besides, the mouth is really the receptive focus, by or through which all disease germs enter the body ; but if there is a lesion, even infinitesimal in its character, they merge in freely. If a few germs enter, they are apt to perish in the blood, but when a large mass enter, the vitality of the blood has not the power to destroy them. Besides disease germs, the degradation of the primary elements of our own bodies, we are liable to take into our blood a giant form from animals, most malignant, such as anthrax, rabies, glanders. The vegetable kingdom also furnishes elements, microbes in themselves, which enter the human blood, produce microbic changes, such as malaria, yellow fever. The degraded bioplasm of fruits, cereals, as borne by the wind or dew drops, give rise to fearful ravages. Races are distinct and antagonistic to each other, so are the degradations of living matter into disease germs as distinct as the body in which they originated. The origin of disease in the Negro, Mongolian, etc., are dependent on the same condition as the Caucasian, but the germs are more active, virulent, if they are passed into an antagonistic race. Not infrequently are animals and plants similarly affected ; all BACTERICIDES. 383 the result of a deterioration of original histogenetic elements. Besides, a special degradation in our own bodies, and that of ani- mals and plants, " disease germs " may come into our bodies from other persons, or from animals, or from plants, if our vital force is weakened in any way, as that condition only permits of the ingress of disease germs from any source. Germ diseases are more common in our country than in any other, mainly on account of the high development of the people, their less reserve of vital force, the necessities of a rising civiliza- tion, mixed races living in proximity, mingling with antagonistic races, our intensely oxygenized atmosphere, our sudden extremes of heat and cold, the mental strain or struggle, or worry, etc. The mortality from germ diseases is enormous, especially at the present time. There is a special degradation of living matter corresponding to each disease. The practical difference in the evolution of those germs turn chiefly upon the amount, kind, degree, quality of expenditures of mental or physical force. Enervation, decrepi- tude, altered nutrition of various parts of the body follow a prodigal waste of the mental or corporeal energies. The quan- tum of germ diseases, contagious maladies, falling to our lot as a nation is in direct proportion to the demand upon the tissues, the character of the food, housing, clothing, and absence of sewage. Taken in the order of their greatest fatality, " germ diseases " arrange themselves thus: Tuberculosis, typhoid and scarlet fevers. Small-pox, hooping-cough, measles, croup, diphtheria, dysentery, erysipelas are the most common. Germ diseases vary with the density of population, the charac- ter of races, location, sewage. Certain trades are very deterio- rating ; whereas others are remarkable for their healthiness. Life is longer, the freedom from care, worry, excitement ; the better the food and clothing, the fresher the air, the more salu- brious and cleanly the house, the less th^ confinement. Animals and plants, when their vital elements are deteriorated by adverse conditions, have also their vital elements of nutrition degraded into " disease germs," as anthrax or cattle plague among cows is simply a degradation of primary elements into a giant disease germ called bacillus anthrax ; and the foot disease of the same animals is analogous to the grape and potato rot, both being identical with the disease germ oidium albicans in the human race. Again, glanders or epizooty (in which we find the giant amoeba) is analogous to the amoeba of nasal catarrh. Every deviation from health, every disease, has its special degradation, its own disease germ, and all are contagious and infectious. As, for example, when nerve nutrition is damaged 384 DISEASE GERMS. there is a special degradation or alteration of neurine into the dis- ease geryn vibrios, the germ of typhoid fever and all nervous dis- eases. When the elementary matter concerned in the nutrition of the air-passages is degraded by adverse conditions we have the amoeba, the disease germ of catarrh, chronic laryngitis, eustachian deafness, asthma, bronchitis ; when the fundamental elements of nutrition are perverted we have the bacteria, the germ of boils, erysipelas, wounds, etc. If the elements concerned in the nutrition of the sexual organs are degraded by promiscuous coition, the syphilic germ is evolved ; if the typical fissures of the brain are partially or completely obliterated by consan- guinity, sameness, isolation, solitariness, reflex irritation or dis- ease, the tubercular germ or bacilli are evolved ; if the vital forces are terribly shattered, a dilapidation, a sterility of vital elements, there may be a rot, and the oidium albicans is evolved, and so with other diseases. The discovery of these and other disease germs has done much to alleviate human suffering, prolong human life. It has created a new system of medicine, a new cure, founded on the presence of disease germs in the blood and the employment of antiseptics in the treatment — a class of remedies to kill the germ, which at the same time tone, invigorate, elevate the standard of vital force, and thus prevent further degradation, which enter the blood, and coming in direct contact with the germ, annihi- late it, without in the least diminishing the vitality of the patient. Bacteriology has completely revolutionized the practice of medicine and the treatment of all diseases. What are bacteria or microbes? simply either the degraded bioplasm of our own or others' bodies, or of animals, or vegetable cells, the lowest forms of existence. All bacteria possess constancy of form, marking its complete development. All bacteria have a cell wall and cell contents, and multiply or reproduce themselves by division or by the formation of spores. The spores are surrounded by a thicker and stronger cell wall than the bacteria from which they spring, they are con- sequently more vigorous than the original bacteria ; can with- stand much greater extremes of heat and cold or vicissitudes of atmospheric influences. In a favorable environment, carefully nurtured, in a proper nutrient material, they grow and multiply with great rapidity, and if introduced into any animal will reproduce the disease to which they are the factor, and in their process of development, in the. vital process so resulting, they excrete a chemical product, an alkaloid (a ptomaine), which in the living organism occasions BACTERICIDES. 385 pathological changes, characteristic of infectious diseases, and which are antagonistic to the life of the microbes themselves and any vital fluid or tissue with which they come in contact. These micro-organisms are cellulose, round globular (inicro- cocci) ; short rods (bacteria) ; long rods {bacilli) ; spherical, twisted {spirilla). The atmosphere, water, and even some articles of food, con- tain both animal and vegetable germs, even the mineral world in which we have the debris of perished creatures. From the vegetable world we have micrococci, bacilli and other forms of the great family of bacteria, spores of other fungi, pollen, seed, parts of flowers. The air of cities is rich in mi- crobes of all diseases, from their sewage-laden emanations. The determination of the thermal death point of disease germs has a very important bearing in prophylactic medicine and cura- tive therapeutics. The following table exhibits the death point of a few of the microbial factors of disease : Organisrr. Thermal Death Point.. Fahr. Bacillus of typhoid fever 132° Cholera-spirillum (comma-bacillus) 125.6° Cholera-spirillum 125.6° Cholera-bacillus 143-6° Anthrax-bacillu> (without spores) 129.2° Tubercle-bacillus 111 ir>.sh sputum 212° Bacillus of glanders. 131° Bacillus of tubercle ) Bacillus of cancer \ 140° Bacillus of syphdis J Bacillus from faeces 143.6"^ Bacidus of green pus 132.8° Bacillus of so-called pneuniocoLC. In 136.4° Bacillus of foul blood ' . 212° Staphylococcus pyogenes aureus 136.4° Staphylococcus pyogenes citrc'us . 143.6° Staphylococcus pyogenes albus 143-6° Micrococcus of osteomyelitis 136.4° (Identical with Staph, aureus) Streptococcus of erys pelas 129.2° Micrococcus tetragon s 140° Bacillus variola 212° The spores of all disease germs require a heat nearly fifty per cent, greater to kill, than the mother germ itself; ptomaines, the excretion of microbes, correspond chemically and pathologically with the cadaveric alkaloids, which are indestructible by any known heat, or process of calorification. The germ theory of disease has, and is producing a complete revolution in the treatment ; it has#reated a new system of medi-^ 25 386 DISEASE GERMS. cine, a new cure founded on the presence of disease germs and their excreta ptomaines in the blood, and the introduction into the materia medica of a class of remedies called germicides. Bactericides are a series of valuable antiseptics and disinfec- tants now becoming of very general use by the highest scientific authorities for the purpose of exerting a detrimental influence on the evolution, growth, and multiplication of disease germs, in either sterilizing or killing them. In order that the remedy be pronounced a germicide, it is ne- cessary to bring it in direct contact with the disease germ for a definite period of time, then remove the germ to a suitable nour- ishing medium; if the germs refuse to grow, the conclusion is, that the exposure has either injured, sterilized or destroyed its life. While thus testing whether the remedy be a germicide or not, we must bear in mind that Pathogenic Microbes do not thrive in an acid medium, neither do they grow well unless there be some degree of warmth about blood heat; a very high heat kills all germs and parasites. In the case of pathogenic microbes, all remedies are to be pro- nounced germicides which have the power, when they are ex- posed or brought in contact with the micro-organism, of perfectly annihilating them. Pathog^enic Microbes * either in the human blood or in a suit- able nutrient fluid, acted on by a germicide, are incapable of pro- ducing the disease, which the same organism, unexposed to the substance in question, does produce. A perfect germicide then must be capable not merely of destroy- ing the micro-organisms and their spores, but also of destroying by chemical oxidation the toxic products which they are capable of producing. The great scavenger of diseased blood is ozone. Ozone exists in the atmosphere and is liberated by friction, it is manufactured in the laboratory of the chemist in a method analogous to that of respiration. This, then, is nature's antisep- tic or germicide, the presence of ozone wards off all contagious and infectious diseases, it vitalizes all animated nature ; without it there is no higher life, without ozonized phosphorus there is no thought, no longings after immortality. * Pathoi^enic Microbes. — The pathogenic microbes are those which are capable of generating disease ; and the evidence on which their disease-producing powers rest is, it must be admitted, sufficiently satisfactory, for no microbe is regarded as the cause of a disease imless it is, in the first place, found to be constantly present in that dis- ease, either in the blood or in the tissues ; secondly, unless when carefully isolated and cultivated, it can, when introduced into the body of a healthy animal, give rise to the original disease, and be again fon^^d in quantity in the body. BACTERICIDES. 387 Ozone, then, chemically pure and in an assimilated form, is the most important agent in nature and in medicine. When intro- duced into the human body it does its work efficiently as a scavenger to diseased blood, it also vitalizes the healthy corpuscle and tissue, it kills disease germs and eliminates them when dead from the body; thus the important factor in disease is destroyed and rendered innocuous. All the eminent medical men of this age and country attest the suprising virtues of the ozone preparations, and it is only a question of time as to its general utilization by the profession. It is of the greatest utility in all diseases to which flesh is heir to ; good in all maladies, acute and chronic, when disease germs are lurking in the blood. We have many and numerous agents that are active germicides, but none so intrinsrcally valuable as C. P. ozone. It is a scandal to our civilization if, with a proper knowledge of the uses of ozone, typhoid fever, scarlet fever, diphtheria, small-pox are permitted to remain the scourge of our day, the terror of any parent, and allowed to run their course by succes- sive inoculations or infections from child to child, from man to man, when our increased knowledge teaches us that here we have an agent able to control and destroy any principle of contagion, every disease germ in any location. Microbes differ greatly in their chemical composition, and in their toxical effects upon the nervous system, and the germicide, organic or inorganic, which is prescribed for their complete anni- hilation, must meet the requirements of a positive strength so that when it comes in contact with the organisms, they ever afterwards are incapable of growing or multiplying, even their very existence is wiped out. Some germicides have a special affinity or chemical attraction to certain pathogenic microbes, and will unite with them more readily, combine with them and destroy them, than others. Witness how silently, how efficiently the glycerite of ozone, when administered in pulmonary tuberculosis, annihilates the tu- bercle bacilli ; and if additional degradation of bioplasm could only be prevented, how rapid the cure. See the utter annihilation of the streptococcus, oidium albicans of diphtheric, the spherical and cylindrical masses making up the diphtheric membrane, the micrococci in the blood and every gland, and the pathogenic microbe of scarlet fever, if the ozonized glycerite of sulphur be freely administered. The microbe variola in or out of the body refuses to grow in the presence of thuja occidentaHs. Such germicides kill the germ and eradicate all ideas of contagion and infection. 388 DISEASE GERMS. The comma-bacillus of cholera will not grow in the presence of lobelia, resorcin, lactic acid, ozone water, peroxide of hy- drogen. The cancer germ, of all microbes is undoubtedly the most difficult to reach by a germicide, although the practical experi- ence of a half of the members of our profession in America clearly demonstrates that the prolonged use of Chian turpentine mixture effectually kills it in the blood and also in the tumor. Administer the glycerite of wintergreen in acute rheumatism, fever ceases, all its symptoms disappear, because the microbe, its factor, is killed. Brush over a diphtheric patch or colony with the ozonized distillation of jequirity and the oidmm albicans die ; sprinkle or dust or apply in capsule, the ozonized powdered jequirity. to an ulcerated neck of the uterus, and the entire brood of bacteria will peel or shell off in the form of a false membrane, leaving normal tissue unaffected. When the bacteria of erysipelas migrate to the skin for free oxygen, if a saturated solution of boroglyceride be applied and kept wet, they entirely disappear. Witness the extraordinary action of sambul on the sugar fungus of diabetes; if administered it thoroughly annihilates it; the re- sult is, the languor, debility, chloroform breath disappear ; every function, appetite, excretion, becomes normal, and the affected in- dividual, with deranged chemical centre in his brain, assumics a new lease of life. Old physicians can scarcely realize the fact that the addition of resorcin to syrup of tolu, and administered in hooping cough, will cause the myceb'a to disappear from the breath and blood, that morbid action will cease ; or that resorcin jelly applied over extensive, burns, will kill the bacteria ; or over the abdomen in peritonitis, inflammatory action ceases the moment the microbe is destroyed. Bring ichthyol close to any vegetable cutaneous parasites, they immediately die. The germicide calculated to do the work most efficiently should be selected ; sometimes it is advisable to use one and sometimes another. The one best suited to the pur- pose is one which will retain the largest amount of positive or negative ozone, without causing the decomposition of the remedy, most of all the ozonized remedies contain from five to ten volumes of C. P. ozone, so that they are capable of yielding when taken on the stomach five times their own volume of nascent oxygen. They are all available for internal administration. The more general use of ozonized remedies exhibits a more rapid cure of a class of diseases hitherto deemed incurable, and a greatly diminished mortality among all contagious and infec- tious diseases. BACTERICIDES. 389 The following table of bactericides is prepared from the most careful experiments. One part in thirty will annihilate the bac- teria. The. highest or germicide of greatest potency at top, weakening as you descend the scale : Peroxide of hydrogen. Corrosive sublimate. Sulphurous acid. Boroglyceride. Chloride of lime. Bisulphate of lime. Chlorine. Iodine and bromine. Chloride of zinc. Menthol. Thymol. Benzoate soda. Creosote. Benzoic acid. Methyl salicylic acid. Salicylic acid, Eucalyptol. Sodium salicylate. Carbolic acid. Oil cloves. Chloral hydrate. Permanganate potass. The above list, classified in the order of their activity. Each of the above, as a remedy, has more or less affinity for a special microbe, the factor of some special disease. The dose of a germicide must in all cases be innocuous to the tissue of the body, and still must be sufficient to either arrest their multiplication or sterilize, or destroy them. Wild indigo infusion. Glucozone. Arsenic solutions. Glycerite sulphur. Glycerite ozone. Glycerite vtantetgreen. Glycerite kephahne. Bisulphate of carbon. Con. ozone. Resorcin. Solol. Chian turpentine. Naphthaline, Quinine. Camphor. Ozone vi'ater. Alcohol. Oil of rue. Oil of thyme. Oil of peppermint. Oil of turpentine. Oil of erigeron. Oil of sassafras. Oil of fennel. C. P. ozone. Siegesbeckie. Essence mustard. Pmol. Ichthyol. Creolin. Sambux. lodol. Thallin. Hydrocotyle. Arbor vita. Saccliarin. Comp. oxygen. Liquid ozone. Chloride of carbon. Simabicidia. - Distillation of jequirity. Distillation of witch hazel. Amoebse. This microscopical vegetable organism, which we find present in all cases of nasal catarrh, oz^ena, eustachian deafness,ulcerated sore throat, chronic laryngi- tis, bronchitis, incipient tu- berculosis, has a most won- derful tenacity of life, difficult to sterilize or destroy. Nasal catarrh and its kindred affec- tions are predisposed to by the presence of the microbe of syphilis, the bacillus of tubercle and other disease creating organisms in the blood, but the active excitin<^ is the amoeba, which is pathogenic of the disease ; bears cul- The amceba of nasal catarrh. microbial factor of nasal catarrh 390 DISEASE GERMS. ture well in any nutrient fluid ; the inoculation of the cultures into animals produces the disease. The amoeba looks like o^o^d^ ' breed by fusion, distension of their cellulose walls, and a shedding off of their embryonic broods, they are aerobic, take a thermal heat of over 212° F. to destroy them. This microbe is sterilized in the presence of ozone et chlorine, boroglyceride, resorcin, creolin, peroxide of hydrogen, myrtol,, glucozone. Bacteria. the stomach, is found on A general term once applied to all disease germs, but now restricted to that present on the •tongue in malassimilation, or disordered states of It is identical with the bacillus megatherium, which spoiled vegetables. It consists of large rods, like small sausages, four or five times longer than wide, usually somewhat curved. Transverse division occurs, each seg- ment attaining the length of the origmal rod. When fresh, they appear non- articulated, but when treated with alcohol, they are seen to be composed of seg- ments. The rods are motile, and form irregular chains of a disjointed appear- ance. They are pathogenic of malassimila- tion, bear cultivation well on nutrient agar and nutrient gelatine. Cultures injected into animals produce profound malnutrition ; tongue coating heavily. Spore formation in the usual manner. If not sterilized or annihilated, it becomes an exuberant breeder, giving rise to colic. This microbe bacteria is the most common of all disease germs, being the degraded bioplasm of normal nutrition in man and plants, changed or altered under some adverse state. It is found in all deranged states of the alimentary canal in wounds, ulcers, and all breaches of continuity. Like all other disease germs, it has marvellous powers of re- production under favorable conditions. It is either sterilized or annihilated in the presence of eucalyp- tol, Warburg's tincture, matricaria, sulphur water, peroxide of hydrogen, and other bactericides. The Bacteria — the degraded hio- plasm of nutrition, magnified 600 diameters, in an active state of growth and nutrition. Spore formation is seen beginning in a single cell, spreading in link-like sausages, which vegetate and divide. These protoplasmic bodies are surrounded by a cell wall or cellulose membrane so thin that they are virtually naked ; they move either by rotation or oscillation. Present in erysipelas, boil, gastric fever. BACTERICIDES. 391 8 \\ \.> >\ ^ i H % Micrococci of the pathogenic ; microbe of the pneumococcus seen in different stages of growth in the prune juice ot the sputum prior to the rigor. consist of short, thick rods, ahiiost eUipti- Bacteria cal cells ; often two to four linked together, Pneumonica forming dark granular colonies. The lanceolate diplococcus represents the only pathogenic microbe or virus of genuine primary pneumo- nia. During the first three or four days of the disease the diplo- coccus is present in the patient's sputa ^^ in an almost pure cultivation; but 0^' later on there may be found, side by ■) "^j side with it, either the amoeba sub- "2 tills, or sometimes various pyogenic micro-organisms, such as staphylo- coccus aureus et albus, bacillus of green pus, streptococcus, etc. The lanceolate coccus, however, is in- variably detected in such enormous masses that a pneumonic sputum cannot possibly be mistaken for that of any other kind — bronchitic, etc. Still, in view of the fact that the staphylococci, micrococcus tetragenes, and such like microbes may stimulate to a certain degree the pneumonic cocci, the differential diagnosis in question should be always settled by means of plate preparations and cultivation experiments, in addition to a micro- scopic examination. The diplococcus loses its virulence and vitality with III ^^^Jjl W f||, characteristic rapidity, both in the It /((^^ w [ill patient's system and on artificial 11 ^--^ ^/^ \^. nutritive media. In the former case I ^ [(\^:\ \'m\-i it becomes less and less virulent day by day, to perish altogether just after the crisis. In artificial media kept at 37° C. the microbe loses its vital- ity in a week; in that at 40° or 40.50° C, even in a few days. How- ever, when the medium is daily renewed, and invariably kept at 32° C, the coccus may survive about three weeks. In lower animals, on inoculation of its pure cultures ob- tained from the sputa or pulmonary juice (in cases ending fatally before the crisis), the diplococcus gives rise to a typical fibrinous pneumonia. We strenuously insist that a bacterioscopic examination of tho patient's sputi Perfect adult form, of the pneumococcus magnified 2000 diameters ; A and B, thread forms : C, D and E, rod forms; G, diplococci; H, cocci; /, streptococci. The pneumococcus consist of cocci, ellipsoidal or round, sma:le or in pairs (diplococci), rocs and thread forms, all enclosed in a cell membrane or gelatinous capsule. 3^2 DISEASE GERMS. should be undertaken ; possibly early. The latter should be collected always after a preceding thorough disinfection of the oral cavity. The microbe is pathogenic of pneumonia; grows vigorously in blood serum or beef juice. Cultures injected into any animal will give rise to the disease. The microbe is most abundant in the prune juice sputum, from Vv^hich it is easily isolated. The microbe is either sterilized or annihilated by inhalations of comp. oxygen, peroxide of hydrogen, glucozone, etc. ; locally by concentrated ozone and chloroform over the microbial- smitten lung, followed by linseed-meal poultices and resorcin jelly. Germicides internally, peroxide of hydrogen, alternated with liquor ammonia acetatis and sulphate of quinine ; Warburg's tincture, antifebrine, resorcin, creolin. Jaborandi, administered before microbes form a colony (red hepatization), will cause the micro-organism to leave the lungs for the skin ; later on, no good. The microbe excretes ptomaines freely, the alkaloid being pro- ductive of embolism, and cardiac and intestinal paralysis. The microbe of all warts, contagium vivtim, a Bacterium minute germ. Porri. Bears culture well in any warm nutrient liquid (is pathogenic), injected into any animal it invariably causes an abundant crop of warts to appear over the entire body. Microbe is at first sterilized, subsequently annihilated, in the presence of thuja occidentalis. Washing them over with salt water twice daily, and then sprinkling them with calomel. The reaction of the residual sodium chloride and calomel produces mercuric chloride, which speedily annihilates the microbe without the slightest pain. Lactic or acetic acid efficacious. The bacillus of butyric acid — the Bacillus Amylobacta. microbe of rheumatism. This micro-organism results as an evolution of fermentation from starchy and saccharine solutions. It takes the form of minute cylindrical rods, rounded at their ex- treiiities, usually straight, and either isolated or united in chains of two or more articulations. They have a gliding motion, and are often curved and present slight undulation, they are repro- duced by fission, and like all other germs, excrete ptomaines freely. They are found most abundantly in cheese, convert the lactic acid in milk into butyric acid. BACTERICIDES. ^qo This microbe, the evolution of fermentation, is pathogenic of rheumatism, bears cultivation well, and its injection into animals produces the identical condition of rheu- matism which we meet with in the human subject. The microbe is anaerobic, in the ripening of cheese, in the fermentation of sauer-kraut, and sour gherkins ; in a case of acute rheumatism, the micro-organisms can be detected for at least twenty feet from the ferment. Ptomaines are excreted freely, and are the cause of the intense suffering. shaped forms inciud Bacillus Amylobacta, spindle shaped fo oval spores. ■ This microbe can either be sterilized or completely annihilated in the presence of the glycerite of winter- green ; uric acid solvent; salicylate soda in acetate of ammonia ; manaca, cascara sagrada tablets ; tine, cimicifuga racemosa. wool-sorters' disease, or malignant pustule, con- Bacillus sists of rods, long and broad, and threads, with Anthracis, spore formation present and ac- tive ; rods are straight, or some- timse curved, rigid and motionless ; vary in size in different animals. The most tenacious of life of ail microbes; and excretes ptomaines in great abundance, so much so that it is probably as fatal a disease germ as rabies. It has a most vigorous growth, literally loads the capillaries all over the body, lungs, liver, kidney, spleen, ^ ^ , , , . skin, mucous {t^ J -^ (3 ^^ J^ ^_ membrane. In a ^■^-^ f-" ^J^^ 'k of^ ^ well marked case .T^nO--., ^J^^ O 'Serous _ as to /7)\.^_^g> G) ^ ©"q"^ ^ cause infraction O G)®^ J (^ Q ''^'^'"x-Pq^ of the kidneys, " Q) ^ ^^3^ ^ G> pN ^- ^^*^ \oQ>k under a '©; -D'?./-;©«l0'o.--'- small power as if / (^ ^^""^--^^^^r- kidney was 'rZ7% ^ (!) '^ (b rZr. ^ an injected speci- ,y f.\C) ^ /^ ° . ^^O men. Amhrax, giant bac- ^nvt,-" .,, r r\ ri.1- leria magnified 6oo i.ucillus Anthracis, as seen lu th3 biuud of a (JnC OI the diameters; from wool sorter. ^ , . foreis-n wool most contagious foreign wool. and infectious of all malignant microbic diseases. . Pathogenic in the truest sense of the term. The sterilization and de.structIon of the germ is most difficult, because when a man, woman, or child, or an animal die and are 394 DISEASE GERMS. buried, the worms bring the germs to the surface and deposit them. The excrementary discharges from infected animals find a nourishing soil in decaying vegetable and animal matter; and their spore formation is active in marshes, rivers, ponds ; inhala- tion of spores, ingress by the pulmonary or intestinal mucous membrane, or direct inoculation are thus being constantly kept up. Various theories have been proposed as to the mode in which the anthrax bacillus causes death — by embolism, by a ferment which decomposes the tissues ; by the evolution of ptomaines. From pure cultures of the bacillus, a most deadly alkaloid is ob- tained. The same in the blood of the affected individual is so toxi- cal that death often takes place before the symptoms of the dis- ease appears. Bacteriological demonstrations on malignant or Bacillus cancerous growths have arrived at the following of conclusions : Cancer. i. The disease is caused by a special pathogenic red-shaped microbe. 2. The bacilli have slightly ovoid outlines, and are arranged most1)^ in pairs and little heaps, their length amounting to one- fourth of the diameter of a red-blood capsule. ^ a\ (ST^Njs^^ \ j/^ 3. In a pure cultivation vSv J^^ J ^ I ^^^ ^^^^ grow best on O £^1^^ ^ if coagulated blood-serum at the body temperature. 4. When inoculated un- der the skin in animals, The microbe of Cancer. .1 • u • ' t. the microbe gives rise to a cancerous degeneration, commencing in the nearest lymphatic glands, and subsequently spreading to the internal organs, especially to the mesenteric glands, omentum, liver and pericar- dium. In all the organs genuine cancerous nodules are formed. 5. Of the lower animals, rabbits and cats prove to be most sensitive in regard to the bacterium. When inoculated they die in one or two months from cachexy, with generalization of can- cerous foci all over the body. 6. All cancers (of any variety and any organ) seem to be caused by one and the same bacillus. The microbe is pathogenic of all forms of cancerous growth. It is sterilized and annihilated in the presence of Chian turpen- tine, saxifraga, sulphate of lime resorcin, thallin, compound saxi- fraga and phytolacca ozonized ; siegesbeckie, hydrocotyle. BACTERICIDES. 39S This microbe consists of very short rods, with Bacillus rounded ends. They are round, ovoid, or spindled Indicus. shaped, and have characteristic granular margins, having a strong resemblance to the microbes of pneumonia and rhinoscleroma, both of which are capable of giving rise to the formation of indigo blue, and to indigotic fer- mentation. It is pres- ent in Addison's dis- ease. This microbe plays an important part, and determines the forma tion of indigo in varioi s diseases. Indigo is a fermen- tation product, due to the action of this m - crobe, and not to sin.- ple oxidation. This indigo bacillus is pathogenic ofvarious affections, due chiefly to non-aeration of the blood, bears cultivation well. If injected into any animal gives rise to embolism, hepa- tization of lungs, cardiac apoplexy, visceral congestion and fibrinous exudation. This microbe is sterilized in the presence of compound tincture kurchicine, eucalyptol, sulphate of quinine, compound oxygen, ozone water, liquor ammonia acetatis, belladonna and acro-nar- cotics generally ; peroxide of hydrogen. Microbe of Indicus, as seen in the liver, magnified 1500 di- ameters ; found in pneumonia, Addison's disease, asph^ xia, cyanosis, valvular heart disease ; excretes ptomaines freely. Bacillus Mallei : The Microbe of Glanders and Farcy : A giant form of bacteria trans- mitted to man from the horse. The nasal discharge placed in the field of the microscope ex- hibits the micro-organisms in the form of fine rods, about the size of the tubercular bacilli. They appear in the form of minute, transparent drops, consisting en- tirely of characteristic bacilli. When this microbe enters the human blood it takes one or other of two forms, either excites by its presence irritation, in- flammation of the lining membrane of the nose, which speedily passes into ulceration, round, scooped-out ulcers, elevated edges,. 39^ DISEASE GERMS. with a central granulation, profuse micro-purulent discharge (glan iers), or the microbe causes a germinal blocking up of the lymph canals, with en- gorgement (farcy). The microbe excretes pto- maines freely. The microbe is the es- sential cause of the dis- y^^y^ ^_^^%^^^ '"' ^y ease, and is pathogenic. Bears most excellent Bacillus Mallei,,he microbe of Gla.clers and Farcy. ^^^^^^^ -^ ^^^^ ^^^ ^^ meal extracts. To Sterilize or Annihilate the Germ.- — It will not grow in the presence of peroxide of hydrogen, glucozone, sulphate of lime and other bactericides. Rods, very fine, like thread forms, mostly col- Bacillus in lected in irregular masses, with characteristic Tetanus. spore-formation. Inoculation of garden earth subcutaneously into rabbits induces tetanus. The bacilli found in their blood is identical with the microbe in man. The germ is pathogenic of the disease, bears cultivation well, and is as active after several generations of culture as in its primi- tive state. Pre-eminently contagious and infectious, it has an un- certain period of incubation, depending upon the status of vital force of the inoculated. Cases occurrino: twenty-four, thirty-six or forty-eight hours >'<*/ ^\ ^':^t ^^ after injury rarely survive the third day, but '%0^*^ ^t 'i'V comparatively few are lost when it comes on % ' \ ^ ^*^'^ the ninth or eleventh day. "•/;^'o« ' The excretion of ptomaines is most active in and around the medulla, death often takes Microbe of Tetanus, place from them before they have time to enter the blood. Sterilized and annihilated by the administration persistently every few minutes of a combination of lobelia, capsicum, valerian, resorcin and sozoidol, aided with con. ozone and chloroform to nape of neck. Three rod-formed organisms, which Caries and Necrosis, give rise to and are invariably asso- Bacilliis saprogciies. ciated with a gangrene of bone and putrefactive processes generally. The microbe is readily procurable from necrosed bone or from otitis media, grows very readily on blood serum. All cultivations BACTERICIDES. 397 yield the microbe with the pecuHar odor of rotten kitchen refuse. The bacillus bears in- oculation well. The microbe becomes sterilized in the pres- ence of either of the fol- lowing remedies: Peroxide hydrogen ; glucozone ; chloride of gold et soda; baptisia ; siegesbeckie ; distillation' of jequirity \ m Bacillus Saprogenes, the microbe of Caries and Necrosi etc. Caused by a tissue-starved brain ; hot Caries Dentalis. and cold fluids; indigestion, formation of lactic acid degrades the elementary mole- cules into a polymorphic bacillus, which is pathogenic of the dis- ease, bears cultivation well in beef tea to which some phosphate of lime is added. Inoculation into animals gives rise to tooth caries. So infec- tious is it that one carious tooth will contaminate a mouthful. The microbe becomes sterilized in the presence of the anti-microbe powder ; concentrated ozone ; distillation of je- quirity ; solutions of boroglyceride ; soap-tree bark and hydrogen peroxide ; infusions of wild indigo ; fennel ; rue ; and nearly all the aromatics. Microbe of tooih caries. consists of rods, occasionally long, very thin, Bacillus and rounded at the ends. They are both Tuberculosis straight or curved, and frequently beaded ; occur singly, in pairs, or in bundles. They are found in the cells of tubercles, especially in the interior of giant cells. Propagate by spore formation. A tubercle bacillus consists for the most part, of a very deli- cate sheath, with protoplasmic contents which have a great tendency to be broken up, or coagulated into little segments or roundish granules. 398 DISEASE GERMS. The best medium for cultivation is solid blood serum of cow or sheep, with or without the addition of gelatine. The most favorable temperature for their development is 98^ F. They grow slowly in cold latitudes. The bacilli are found in all tubercular deposits of man, animals, and birds. The bacilli can be detected in the sputum and excretions. Strictly contagious and infectious ; food, such as milk, flesh- eating, inhalation, close contact ; the bacilli or their spores are inhaled from the air, or taken in with food, find ingress by the pulmonary or intestinal mucous membrane. Morphologically identical bacilli are seen in lupus, tabes, etc. The tubercular bacilli is pathogenic of all forms of tubercular li% ^Viiix ^4i: .{('.:->, ^:".: Bacillus tuberculosis in the blood. Bacilli tubercle in lung structure. disease, its inoculation into animals, reproduces the diseases, and vice versa into man. Ptomaines excreted give rise to fever, diar- rhea, and other symptoms. The microbe is both sterilized and annihilated in the presence of germicides, of which the glycerite of ozone is the most reliable and definite, but distillation of pine, tar, creosote, chlorinated soda, comp. oxygen, creolin, peroxide of hydrogen, are of utility. The great difficulty in tuberculosis is, there is a nervous blight or wreckage, which keeps on degrading normal bioplasm into new crops, and until this is overcome the cure is difficult. Bacillus in Typhoid Fever and Nervous Diseases. Rods, broad and forming filaments, rounded at their ends, and constricted in the middle like small feathers or yarrow leaves, exhibiting spore formation. These bacilli are found in the sordes on the gums, in Peyer's glands, the spleen, mesenteric glands, lungs, in typhoid and in the insane. BACTERICIDES. 399 Spore formation occurs at the ends of the rods, and is most active. The microbe is pathogenic, bears cultivation well in any nutri- ent broth. Inoculation in all cases reproduces the disease. The germ is sterilized and annihilated in the presence of either of the following germicides : mixture of carbolic acid and tincture of iodine ; or resorcin ; iodol ; lactic acid; creosote, salol ; sozoiodol; creo- lin ; kaki ; siegesbeckie. The microbe of typhoid breeds, ex- cretes its ptomaines in the intestines, found abundantly in' the stools. Dur- ing its growth and multiplication in the intestines, the ptomaines are thrown off, which form the poison that gives rise to fever. The toxi-ptomaine is termed typhotoxino. The viiality of this germ is so great that freezing will not destroy it, and it takes a high heat to kill it. Communicated by contagion and confection, also by air, food, water, milk. Stools of the germ-stricken should be destroyed by fire, as they live in earth, water, etc. t, c 4^ The bacillus of typhoid fever. Hay Fever or Asthma. Bacillus Subtilis. of cylindrical rods of variable lengths and breadths. they appear as threads, The bacillus of hay, rag-weed, roses, grapes and other nitrogenous bodies, resembles the giant bacteria of anthrax, the microbe consisting Originally, which become developed into rods and cocci. They are motile, and are provided with a flagellum at each end. They are easily obtained from any infusion of hay, and will grow prodigiously in almost any nourishing medium, by spore formation and division by The microbe is pathogenic of hay fever or asthma ; bears cul- ture well in any vegetable infu- sion. The inoculation of the BaciUus Subtilis, the microbe of hay fever. ggj-m into aoy animal produces the disease. The excreted ptomaines often give rise to violent constitutional disturbance. 400 DISEASE GERMS. To sterilize or annihilate the microbe, a combination of lobelia, stramonium and belladonna (crude) inhaled, or administered in tincture form, will sterilize; glonoin, nitrate of amyl ; sulphate sparteine, have the same action ; euphorbia piluliform. The microbe is annihilated in the presence of pyridin. Bacillus in Syphilis consists of rods, very minute. Two or more ovoid points are visible in the course of the rod, which are spores. They are best observed from the secretion or discharge of the indurated chancre, or from the uldfers in the mouth. When the blood is searched for them, they are, when present, found in the interior of the nucleated cells. The microbe is pathogenic of systemic The bacillus in syphilis as seen in the blood. syphilis. Bears culture well ; reproduces itself in all red-blooded animals when injected subcutaneously. The ptomaines excreted by the syphilitic germ are peculiarly toxical to skin, mucous membrane, bone, brain, lungs, etc. When the atmospheric electrical influences are low, germ breeds most actively. Thence the nocturnal pains in bones, etc. The micro-organism is annihilated in the presence of saxi- fraga, kalmia, phytolacca, stillingia, irisine, sulphur water ozonized, sozoiodol. BACTERICIDES. ^01 appears in the form of a rosette of pyriform. The Microbe or club-shaped elements. The little masses Actinomycosis are arborescent, pure white, of a yellowish tinge, visible to the naked eye. The microbe effects an entrance to the mouth through an abrasion, wound or carious tooth. Then the living organism sets up an inflammation, which results in the formation of a neoplasm, composed chiefly of round cells, resembling a tuber- cular nodule. These may break down or go on increasing in size. Fibrous growths may develop between the nodules, and these latter into purulent excavations or cavities. The microbe has a special affinity for the mouth, gums ; if it does not localize there, it may select the lungs. There it pro- >>^. -.■, completely sterilized and annihilated by the /''^''^v..'"-" same remedies, to wit, thuja, sulphide of lime. The micrococci of dioxide of hydrogen and bichloride of mercury. smaii-pox. This microbe is found in the sputum of pa- Micrococcus tients suffering from pulmonary tuberculosis Tetragonus. and in the walls of the cavities in the germ- eaten lung. They are found in groups of four (tetrads) surrounded by a hyaline capsule. Present invariably when the actinomyces are I ^ in lung structure. They ^ \^ %. I V ^^^ pathogenic of vomica, ^ Vw'>ily,^^\ %% caverns in the lung; bear ^^^^_^f I V^^ML. ^1 cultivation well; reproduce " " *" ^ ^^%w ^^^ disease in animals. Groups of the charac- teristic tetrad are found in the capillaries, lungs, spleen and kidney after death. ^ \^ ^ ^ When present, urine V" i^^-^ I ^ usually loaded with pto- Micrococcus tetragonus; from the walls of a vomica mainCS. Thc prCSCnCeof '" '^^ ^""^- those deadly alkaloids ex- plains the sweats, diarrhea, hectic fever that are present. The microbe is sterilized in the presence of glycerite of ozone, tar syrup, peroxide of hydrogen; completely annihilated by kepha- line and toluene. Actively motile, dumb- Qr^t:!^ t^ Micrococcus bell cocci are found in the o o&«^SB< in blood, lymphatics, in all ^ \^^^^^^ Typhus. cases of typhus, ship or g © ^^j|fo jail fever. /T)!^^^^^ They are isolated from the breath, ;^ ' saliva, sweat, the eruption. They are <> Vo ^ pathogenic ; easily cultivated in any nutri- ent medium The microbe of typhus fever. (Sy o J^J* 410 DISEASE GERMS. An injection of the cultures into animals reproduces the disease. A course of ordinary germicides effects a destruction of the micro-organisms in the blood. The same class of remedies, act also as prophylactics, by steril- izing the blood. Micrococcus Urea. *=»C!,, "^Ofl*- The transformation of the urea (the nitro- genous principle of urine) into ammonia and carbonic acid, under the influence of a microbe^ appears in the form of free globules of articu- lated filaments, or of chaplets, resembling those of the lactic fer- ments. So long as the bladder is perfectly empty, that is per- fectly evacuated, no residual urine, there is no microbe in it, but let there be some little retention, probably owing to an enlarged pros- tate, then this microbe is evolved. True it is often carried into the urethra by bougies^ catheters, sounds, but very generally found in the bottom of the chamber. This microbe is the true cause of ammoniacal fermentation and intense uriniferous odor. The germ is positively sterilized and anni- hilated by boroglyceride internally and locally. -e«* ,oo ^m Bacteria of rhinosclero- ma; rods surrounded with their capsules; group of bacteria sur- rounded by a single capsule; bacteria seen from above and resem- bling a coccus. In the culture of the various Dual, Triple and other pathogenic microbes we have found Complex Organisms. by careful culture that the union or junction of microbes in the culture glass gives us most remarkable results. For example, an equal quantity of the cultures of the bacillus of tubercle and the mi- crobe of syphilis will produce the microbe of lupus ; an equal quantity of the micro-organisms of syphilis, tubercOlae and scar- coma, will give us the microbe of leprosy. The bacteria of malnu- trition, the germ of erysipelas and the vibrios of typhoid fever, unite to form the microbe of puerperal fever. 422 DISEASE GERMS. If we take a lupus nest, or a scraping from the skin of a leper's face, or a drop of lochiai discharge, this statement can be imme- diately verified. In neurasthenia in both sexes there is an evolution from the blighted or weakened embryonic elements, which assume various forms of microscopic life. In gynecological practice in the maladies peculiar to women, as a neurosis of the womb or vagina, either affecting the mucous membrane or body, a damaged uterus is followed by a relaxed or altered state (acid), mucous secretions, yeast fungi and other microbes. This natur- ally gives rise to more microbes in women than men, and explains why those latent discharges are so common in men. From puberty to the cessation of the menses the uterus has a rich, nervous, arterial connection, and the organ is liable, from very slight causes to suffer a neurosis or get out of gear. Can we wonder at the number and variety of female disease when we look at modern society, and our women, with this maundering, wandering activity and great fluctuations of animal spirits, gay, fascinating in society ; brisk, orderly, thorough in business, but at home dejected and fretful ; a small eater, light sleeper, worn worker, an heir of any true neurosis, from insanity to toothache; perturbations of intermarriage, with great mental power, with eccentricities agonizingly painful, when affected with any disease, instead of single disease germs being present, we have them dual and complex, as in peritonitis we have both the bactarian and vibrios. Microbes of all Cutaneous Diseases. There is no lesion of the skin without a degradation of its living matter into a disease germ. No damage done, no depression of its vital elements, without some fungi, or mould, or vege- table parasite appearing on its sur- face. All skin diseases are indicative of poor health ; all have their special microbe, which is pathogenic of each cutaneous affection, which bears cul- ture in some nourishing broth. As an infallible result, all cutaneous affections possess in their innate ele- ments contagion and infection ; even microbes. the Fungi from Favus. — Patch. sweat is loaded with BACTERICIDES. 423 All cutaneous diseases must be treated with bactericides chemically adapted to the utter annihilation of the germ, as thy- mol, menthol, ozone ointment, . ^ ^ sulphurous water, creolin, per- ^ , _^ / ' L5V"^ / oxide of hydrogen, sulphide of ^^ii^ - -^"-^-^'^^^ lime. f '5pv1_-^*, S. -• . ^- ^ Very favorable results have been 6^ .^-J*^,^ JL^« ,<:^ /\ e ^ ^ obtained by creolin, chrysophanic }-^ I'^Vll^- acid, ichthyol, resorcin. "^^^^Vj^^^^T ^ " ^^ All vegetable parasitical skin ^-^^ - ^J^^^i affections should be treated with ^^^i ^ ^ s^ " ^"^ a course of internal germicides, ®^o " > such as the peroxide of hydrgen, - ^ compound Saxifraga and phytO- Photograph of the micrococcus versicolor ^ '-' , '■ / — small COCCI which are seen form irides- laCCa, CaSCara Sagrada, lyCOpodlUm. cent colomes-growing in the form ot yellowish beads. Cocci, singly or in pairs, seen in the roots 01 Bacterium the hair in cases of alopecia areata. Microbe is Decalvans. pathogenic; bears cultivation in rich soup ; in- jected into animals, reproduces the disease. It is completely sterilized either in the presence of ozone oint- ment or turpeth mineral, gr. i. to xv. gr. benzoated ointment ; ozonized boroglyceride. Trichomycosis nodosa, a peculiar condition, nodose in char- acter, affecting the hairs of the axilla and scrotum ; due to the evolution, growth and encapsulation in the cortical layers of the shaft of a small, red-shaped bacterium. In the various forms of bacteria occurring in sweat, there exists in the secretion numerous granular bodies, the number of which is increased according to the hairiness of the part, the arm- pit and between the thighs. They are micrococci ; they attack the hairs, causing small, knotty swellings. These are composed of bacterial elements, cause clefts, spindle-shaped projections; hairs are friable : affect the hair shaft. of sumac, ivy, poisoned vines, stings of The Microbe wasps, bees, gnats, are pathogenic. or Living Poison The bacterial germs can be annihilated either by solution of chloride of ammonia or concentrated ozone. 424 DISEASE GERMS. The oidium albicans (rot) often attacks the Onychonycis. roots of the nails of man as well as the hoofs of animals, as the horse, ass, mule. The par- asite fungus is readily transferred from one person to another, introduced into the cracked, superficial layer of the hoof through the fissures. Pathogenic of the disease; bears culture well in any nourish- ing broth. The cultures injected into any mammal produces the original disease. Germ sterilized and annihilated in the presence of ozone oint- ment and resorcin, or resorcin jelly, hydrogen peroxide, and the use of comp. saxifraga ozonized, avena sativa, glycerite of kepha- line ozonized. In the three different stages of burns, The Microbe of erythema, vesication, ulceration, we have Burns and Scalds, a degradation of the primary elements of the different coats of the skin in a bacterium, so that whatever application is made to a burn of any degree should be a powerfully stimulating application, as car- bolic acid and olive oil, glucozone, creolin, resorcin, thymol, sul- phide of lime, balsam of fir, tolu, siegesbeckie in ozone ointment, or in olive oil, or oil of boroglyceride, resorcin and cocaine in olive oil. A malignant, very contagious, microbial disease, Glanders, which appears in the nasal organ of the horse, ass, mule, or in the lymphatic glands. It is termed glanders, when in the nose ; farcy, when the lymphatics are infil- trated by the microbe. The predisposing cause of glanders in animals is depressed nervous and physical energy, such as is produced by hard work, overcrowding, isolation, sameness of diet, exposure to air cur- rents, privation, depressed and vitiated states of the atmosphere, endemic conditions, air loaded with germs, abnormal meteoro- logical ■ states, dispersion of germs over large areas, very fatal to man and animals, destroying the red discs of the blood, and is death to that fluid ; besides, it causes immense hypertrophy of spleen, starchy degeneration of liver and kidneys and general dropsy. Like all germ diseases, it is propagated by contagion and infec- tion. It is very prevalent in all sections of the country, and it exists to such an alarming extent that it is becoming a serious and growing evil. It makes occasional epidemic attacks under a form named epizooty. BACTERICIDES. 425 The gathering together of several hundred horses in one stable is not conducive to their health, and the slightest catarrhal condi- tion when present is likely to be disseminated. It is well known that the disease-germs are not only abundant in the nasal dis- charge, but that the breath, sweat, urine and other excreta are loaded ; and where have we the least sanitary arrangements made for its suppression ? In the stalls, blankets, feed boxes, water troughs there is the living contagion. The public drinking troughs are a source of danger to animals, as the germs pass into the water and the glandered horses are allowed to quench their thirst at those valuable conveniences. In the act of drinking by the horse, a certain amount of saliva and nasal discharge always escapes into the trough, so that one glandered horse may infect all that drink subsequently from the same trough ; for, although the discharge is heavier than water, and as we would naturally suppose, sinks to the bottom, the fact of its being alive and the germ growth increased by water, myriads and millions .are grown light enough not only to float in the water, but also to float through the air. ^ A microbe communi- cated from horses to man caused by the presence of a giant bacterium, the " Badiius of glanders. degraded bioplasm of nu- trition of the Schneiderian membrane of the horse, evolved by in- sanitary states, exposure, over-crowding, bad or meagre food and other adverse states. The microbe as found either in the dis- <;harge from the nose (glanders) or from the contents of a lym- phatic (farcy) appears in the form of very fine rods, about the size of the tubercular bacilla. When this germ is cultivated either on blood serum or extract of meat, it affords magnificent results, appearing in the form of minute transparent drops, con- sisting entirely of characteristic bacilli. Pure cultivations, after several generations, when inoculated into horses, asses, rabbits and other animals, give us genuine glanders. It takes place as follows : a spreading ulcer with an indurated base first makes its appearance at the site of inoculation, while a crop of smaller ulcers break out in close proximity. There is a general state of languor, debility, rigors, fever ; lymphatics be- come engorged with the microbe ; general infection follows, nodules of microbes are thrown out on all internal organs, and on the inner lining of the nose, these eminences of the nasal sep- tum break, form characteristic ulcers, round, sCooped-out, with granulations in the centre. 426 DISEASE GERMS. Glanders is fortunately a very rare disease, and is met with, almost exclusively, among grooms, coachmen and others occu- pied with horses. The salient feature of the disease is the forma- tion of pustules, followed by ulceration of the skin, nasal cartilages and bones. The earliest symptoms are secretion of a thin, tough mucus, followed by swelling and redness. The mucous mem- brane is covered with scabs and ulcerations. There may subse- quently be ulceration of the throat, larynx and tongue. The discharge from the nose, which is sometimes limited to one side, only, becomes, sooner or later, sanious and fetid. The majority of cases go on to perforation of the septum, necrosis, glandular enlargements and death from pyaemia and exhaustion. The com- plaint may run a very chronic course, but in the acute form may terminate life within a week. If the history of the case is clear, the diagnosis is easy ; if not the microscopical examination of the nasal discharges will decide it. The ulcerations bear a strong resemblance to those of syphilis, and are apt to be mistaken for them. The microbe is pathogenic of the disease, bears cultivation well ; cultures injected into animals reproduces the disease in all its malignancy. It is resident in the nasal secretions of the infected animals and in the ulcers which form upon their mucous membranes, also in the so-called " farcy buds " and in the large lymphatic glands of the infected animal. There seems some probability, also, that it is occasionally present in the urine. The rod itself bears a strong resemblance to the ordinary tubercle bacillus, but it is more uniform in size. It can be readily seen when stained with fuchsine or methyline blue, and certain appearances have led people to believe that spores are present in the bacilli. The infective material does not appear to be capable of living for any great length of time outside the body, and never develops after the bacilli have been exposed to a temperature of 130° F. for ten minutes. Exposure for five minutes to a five-per-cent. solution of carbolic acid, or to corrosive sublimate of a strength of one in five thousand, is quite sufficient to destroy all possibility of infection. Practically there seems not the smallest doubt that any suspected article can be readily disinfected by being boiled for, say, a period of half an hour in ordinary water, whilst any article that will not stand boiling can be readily disinfected by carbolic acid or corrosive sublimate. The exposed parts of the stable should be thoroughly disinfected by burning sulphur in them, with all the doors and windows closed, after which the walls should be thoroughly washed down with carbolic acid of BACTERICIDES. 427 the above strength or with perchloride of mercury, and the vari- ous troughs, etc., should be thoroughly scrubbed out, so as to remove all trace of the disinfecting materials. After the walls are carefully lime-washed there seems to be no possibility of in- fection taking place. TJie treatment of glanders, either in the horse or in man, is the same. Remedies calculated either to sustain the vital powers, or sterilize the blood or allay pain, should be given internally. Either the sterilization or destruction of the germ should be effected by either peroxide of hydrogen or sulphide of calcium in the form of an aqueous solution internally and locally ; these two remedies kill the microbe, stimulate the blood currents and have a special vitalizing action upon the mucous membrane and lymphatics. Other bactericides which have met with success are resorcin, creolin, pyridin, creosote, naphthaline. The nostrils should be douched out thrice daily ; all enlarged or painful lymphatics immediately opened. Exalgine is a good remedy for both pain and fever. General principles as to bathing, diet, nursing, hygiene, should be carried out. Scrupulous cleanliness, immediate destruction of all dress- ings and discharges. The Epizooty, the epidemic form of glanders, is due to insani- tary states existing in stables, to overcrowding, to a sameness or meagre or insufficient food. Pink Eye is simply the same disease germ colonizing in the eye instead of the nose or lymphatics. A form of blindness, attended with disorgani- Glaucoma. zation of the various tissues of the eyeball, in which objects are surrounded by various colors, especially blue and green. Causes. — It seems to depend upon extravasation of blood in retina and choroid ; serous effusion between retina and choroid ; retina raised in folds ; and clots in vitreous humor, and changes in the optic nerve. What induces such changes, aside from shocks, jars, concussions, it is impossible to say. Symptoms. — It may be acute or chronic, that is, it may come on suddenly, or more slowly ; take months to do so. In both there is a rapid and irreparable loss of vision ; begins with in- tense pain in the ball of eye during night, with throbbing in both eye and temple. Pain continues, and the eyes become congested. Iris of a dusky hue, and motionless ; cornea becomes dim ; pupil widely dilated, and sometimes of an oval shape ; eyeball ^28 DISEASE GERMS. unusually hard. Everything looks as if surrounded with pris- matic colors ; often bright flashes of light before eyes ; both eyes are affected. In the chronic form the symptoms are the same ; perhaps more congestion of iris and cornea, and more fulness of eyeball. Opacity of the lens is comfmon in chronic form, as a result of deranged nutrition. Treatment. — So far there is no known mode of treatment that avails. The improvement of general health and relief of pain is about all that can be done. Any depressing treatment, anything that weakens the patient, aggravates the trouble, so that the care- ful administration of sulphate of quinine, ozonized glycerite of kephaline, and other elements to invigorate the brain, should have a trial, with change of scene, and a sea voyage, etc. At the present day, when science is slowly ferreting Gout, out the secrets of nature, both under normal and ab- normal conditions, it is a matter of great interest to trace out the origin of uric acid and the presence of urate of soda in the blood of gouty patients. What gives rise to the liberation of vast quantities of this salt in the blood has never been clearly explained. Special typical conformations of the body which are hereditary give rise to it, and an excess of certain kinds of food, by supply- ing an over-abundance of nitrogenized material, for the blood creates an excess of urea and uric acid. Besides certain special agents as malt liquors, wines, sedentary habits, want of exercise, irregularities, lead poisoning, excessive mental strain, worry, give us urate of soda or uric acid and soda, which exist in the blood in a separate state, but a depression of the nervous system causes their union. The morbid state is aggravated by gastric and intestinal disorder, impaired appetite, furred tongue, acid or bitter eructations. The disease cannot be developed unless the blood contains a considerable quantity of uric acid and soda in some form. They never exist in the blood in combination before an attack of gout, but the moment they combine the disease is produced. Nerve force in health keeps them separate, so that they can be elimi- nated by the skin, kidneys and bowels, but as soon as nerve force is lessened or impaired these two unite. Good nerve force keeps them apart, but in shocks or debility they unite and crystallize as urate of soda. In lessened nerve force the uric acid seizes the urate of soda, and this is deposited in the tissues generally most remote from the heart and brain. This union generally arouses BACTERICIDES. 429 the nervous system, and a febrile effort takes place and it is warded off, but in subsequent attacks the febrile effort fails. In youth, before care, anxiety and disappointment have well-nigh worn out the brain, the nervous system is active, and in spite of dissipation and indulgence, gout is rare, but as soon as age and care stamp their mark upon the great nerve centres, gout too often appears. In the gouty diathesis, without local manifestations, are to be found neuralgia, dyspepsia, palpitation, syncope, congestion of liver, piles, anaemia, pains in head, toothache, tonsillitis and asthma ; besides it is a common cause of disease of heart, arte- ries, kidneys, and, indirectly, of apoplexy, etc. Gout presents itself in so many different forms that it is often difficult to recog- nize it when we meet with it, and many cases are overlooked be- cause the disease is not found in its accustomed seat. One patient may suffer from bronchitis, another from psoria- sis ; one may have gravel, another asthma, or, again, neuralgia of the face. One may be alarmed by his having to be treated for an apparent gonorrhea, while another may have piles or tenes- mus ; all of which are but local exhibitions of the constitutional affection. The morbid anatomy of gout shows the brain cells to be feeble, exhausted, the red blood discs greatly impaired by the presence of the urate of soda, and the de- posit of that substance on the cartilages of joints, and valves of the heart, or wherever vitality is lowered. This consists of the urate of soda in the form of needle-shaped crystals. In the early stages the articular surfaces are granular, form a thin incrusta- tion, which, as the uriates increase in the blood, becomes thicker and thicker, the deposits becoming large concretions. Symptoms. — The attack may be preceded by debility, heart- burn, flatulence, dull pain in left side of chest, irregularity in heart's action, dry skin, urticaria, urine loaded with phosphates and urates containing albumen. It may come on suddenly in the night with acute pain in the great toe, heel, instep or wrist ; rigors, followed by fever with great irritability and restlessness^ The appearance of the cartilages of a gouty subject, showing a deposit of urates of soda— dense deposits of uric acid. 430 DISEASE GERMS. tenderness and swelling of the affected part. The attack passes off, an interval elapses of length proportionate to the care taken, and then another attack follows. The local affection takes place in weakened parts, then the in- flammation and exudation take place, so there is liable to be a change of location according as the vital forces of a part are strong or feeble. In this manner a metastasis occurs from the joint to some internal part, as the heart, stomach, lungs, brain, etc. When the kidneys act imperfectly, and there is a retention of the urate of soda in the blood, it is taken up and deposited in other structures to which it has an affinity, as cartilage, bones, fibrous tissue, forming topha or chalk formations, or stones con- sisting of urate of soda. . They are found in innumerable situa- tions in chronic gout, in the eyes, ears, heart, joints, etc. Treatment. — The general principles of treatment consist in per- fect rest between blankets, attention to the condition of the skin, kidneys and bowels ; to the forrfier, warm baths, to the latter, with salines, so as to relieve the overloaded heart and blood vessels. For any irritation about the heart, mustard ap- plied and to be repeated. The following is to be given at re- peated intervals, so that the sensorium experiences no sensation of pain : Pulverized opium, ten grains ; Dover's powder, thirty grains ; pulverized nitrate potash, sixty grains. Mix and make twenty powders. Dose, one, as indicated. If there is fever, aconite and veratrum viride. To cut short an attack, nothing excels the phosphate of quinine in alternation with the wine of the root of colchicum. These two remedies act quickly and meet the indications most promptly. As to the dose, from one to three grains of the quinine every three hours, with colchicum enough in alternation to slightly move the bowels, the dose necessary being usually from fifteen to thirty drops. If the evacuations from the bowels are too frequent, diminish the quantity, but do not discontinue. As soon as the acute stage is over, the same remedies may be continued, although it is often advisable to change to some of the following drugs : The uric acid solvent, highly ozonized, has a marked effect in causing the urate of soda to disappear from the blood, and a dis- solution of the incrustations in the joints. This remedy has per- manently cured the most aggravated form of the disease. In the present state of medical science there is no longer obscurity about what gout is ; a bankrupt brain and a perversion or mal- assimilation of the secondary process of digestion, with deficient elimination of waste products through functional disorder of the BACTERICIDES. 4^ I l' locality it finds a proper pabulum for Micrococrof hooping-cough. growth and reproduction ; although the germ is constantly present in the blood, it is also found in the breath, expectoration, saliva, urine and faeces, and it can be detected within a radius of fifty feet on the furniture, walls, carpets, etc. The germ consists of elliptical cocci or their mycelia, and looks like the annexed cut, with figure 8 interspersed. 460 DISEASE GERMS. Like all other living poisons in the blood, it has a period of incubation, sprouting, fecundation, growth, activity, and death, depending greatly on the vigor of vital force of the patient. The pathological effects produced by the micro-organism are embolism, and as it is a free excretor of ptomaines, toxaemia of the brain — convulsions. Its duration under the old treatment, from six to eight weeks. Symptoms. — The earliest is a common cold or catarrh, accom- panied by a cough ; there is also a slight amount of fever, rest- lessness, and sometimes running at the eyes and nose. The cough in a i^ssi days becomes more troublesome, and some glairy fluid may be brought up from the chest ; in a week or ten days, but oftener later, the child will begin to have the characteristic hoop ; the cough comes on in paroxysms, and is more frequent by night than by day ; each paroxysm begins with a deep and loud inspiration, followed by a succession of short and sharp ex- pirations, again followed by a deep inspiration, and the repeated expiration ; this may go on several times, and last one or two minutes, according to the severity of the case. Just before each attack comes on, the child clings to its nurse or mother ; it sits in an erect position ; during the paroxysm the face is flushed, the veins in the head and face prominent, the eyes suffused and watery, and generally there is some glairy fluid expelled from the mouth, or vomiting may come on. After the paroxysm the child will rest for a time and appear pretty well until the next attack comes on. In bad cases there may be twenty and thirty paroxysms a day, and several fits of coughing besides, without the hoop being heard. In ordinary cases there are from four to ten spasmodic attacks in the twenty-four hours. These symp- toms last for three or four weeks, and then the cough abates in severity and frequency, and finally ceases altogether; even when there is no hooping, the child may continue to have a trouble- some cough for some time. In most cases there is some bron- chitis attending this complaint, and this is shown by the hurried breathing, rise of temperature, and by hearing rattling noises over the chest. The more mischief there is in the lungs, the greater is the danger to the child. Convulsions are a sign of ptomaines being liberated, and this is generally the way in which such cases die. Hooping-cough cannot be made out until the characteristic hoop appears, with microbe in breath, and then there can be no difficulty in recognizing the disease. Complications, as measles, small-pox, bronchitis, pheumonia, disordered bowels, as cholera infantum, tubercular meningitis, always render it fatal ; cough, accompanied with hemorrhage from nose, mouth, ears, effusion into the conjunctiva are bad BACTERICIDES. 46! complications. It may prove fatal from exhaustion, marasmus^ convulsions from embolism, or thrombosis in heart or large arteries. Renal complications are extremely common, if the physician fails to recognize its germicidal origin ; stasis of blood in the kidney, albuminuria, suppression of urine. When disease is permitted to run its course, emphysema, dilatation of ventricles of heart and glucosuria are common. In the treatment, child should be kept as quiet as possible; if the weather is fine, it can be taken out, but if stormy, it must be kept within its room, which should be of an even temperature and protected from draughts. Warm clothing should be worn, nourishing diet given, and well bathed morning and night in an antiseptic bath ; all complications, as diarrhea, carefully guarded. In all cases, the reflex impressibility of the medulla oblongata and spinal cord must be diminished by the administration of some one of the following remedies : comp. syr. lobelia, musk root; bromides of potass and ammonia; tinctures of calabar bean ; black cohosh ; belladonna, etc. Such a formula as the following : comp. syr. lobelia, six ounces ; fluid ext. sambul, one ounce ; tinctures of belladonna, calabar bean, each one drachm ; bromide of potass, half an ounce ; bromide of ammonia, two drachms. Mix. Dose, from a few drops to half a teaspoonful or more every three or four hours. The action of this can be aided by applying local stimulants to the back of the neck, as concentrated ozone and chloroform ; or thymol dissolved in chlo- roform ; or an ointment of eucalyptol and iodol. Children, as a rule, do not bear inhalations well, but if they can be used, in an atomizer or otherwise, the best are distillations of jequirity, pine, eucalyptus, creolin, naphthaline, glucozone. The little patient should be taken off some distance, a mile or two, twice a week, and while absent the apartment in which it is domiciled should for one hour be fumigated with burning sul- phur, doors, windows, and every crevice carefully closed ; this has a salutary effect in destroying every germ in the apartment, on the walls, floor, playthings, etc., so that when the patient returns it will breathe a sterilized atmosphere. This sulphur fumigation is most beneficial, exercises a marked effect on the future evolution of the germ. Having attended to those preliminaries, then the correct treat- ment of the case should begin. The patient, as far as possible, should be surrounded with an antiseptic atmosphere ; tincture of iodine, or distillation of the pine or solution of carbolic acid, etc., should be exposed in the apartment in saucers, so that they mix freely with air breathed, and thus paralyze the activity of the micrococcus. 462 DISEASE GERMS. Internally, the true curative treatment consists in administering persistently some efficient germicide that will either completely sterilize or annihilate the germ. For this purpose, one of the fol- lowing formulae may be selected : Syrup of tolu, iour ounces ; resorcin, half an ounce. Mix. One teaspoonful every three hours while child is awake. Liquor ammonia acetatis, six ounces ; salicylate soda, four drachms. Mix. Dose, as above. Hydro- gen peroxide (ten volumes strength), six drachms ; glycerine, four drachms ; distilled water, three ounces. Dose. One table- spoonful thrice daily. Syrup of benzoin, four ounces ; drosera rotundifolia tincture, two drachms ; tincture belladonna, thirty drops. Mix. Dose. One teaspoonful every three hours. Other germicides often used. Salicylic acid, pyridin, exalgine, chloral hydrate, benzoic acid, boroglyceride, bromohydric acid, etc. All complications should be carefully guarded and treated on general principles, holding on to germicides as the agents to destroy the factor of the disease. Warm clothing, moderate exercise ; some mild, efficient tonic should be given. are watery vesicles in whose fluid are found the Hydatids larval elements of the tape-worm. These hydatid sacs may occur in any part of the body of man and animals. They are generally enclosed in an external sac, which is attached to the tissue of the organ in which it is situated ; ^",^.^9' -. .^^ ^^^y rapidly grow, young broods sprout- ^^.*.. -t, V .^^ forth, with distinct envelopes peculiar to each. The fluid in the interior of the hydatid contains millions of larvae, and is almost colorless and limpid, but the fluid in the common cyst in which the hydatids float is often of a yellow color. Two species of echinococcus are usually noted, that which is peculiar to man, met Showing the growth and bud- with in thc brain, eye, liver, intestines, ding of hydatids. kidncys, and that which is common in animals, but it is by no means certain that they are distinct. Whenever any of the hydatids are swallowed by man or ani- mals they proceed under favorable circumstances to be developed to a higher stage of existence, the tapeworm. These echinococci do not become developed into tapeworms unless they reach the intestinal canal of some animal by being taken in as food or drink. In ordinary cases of hydatids, consisting of echinococci, the cysts and their contents undergo a species of degeneration, be- BACTERICIDES. 463 >coming changed or altered in some cases into fatty or calcareous matter, while in other cases the contents become granular. The peculiar hooklets which occur in them, and which remain unal- tered for a long time, reveal their true origin. The common globular hydatid or acephalocyst, which sometimes attains quite a large size, is merely a degenerated or abnormally developed echinococcus. Hydatids sometimes oc- casion so little inconvenience that persons in whom they are discovered after death have not even suspected any disease in the organ in which they were found. On other occasions they grow rapidly and cause so much irritation that suppuration occurs in and around the common sac. In such a condition it is very liable to either burst externally or into a mucous canal or serous cavity. When discharged into any of the natural outlets, all is well ; recovery may take place, but if it ruptures into a cavity, a shut sac, like the chest, abdomen or brain, fatal inflammation will follow. False hydatids are simple serous cysts, either occurring alone, or in clusters, com- mon in the choroid plexus of the brain ; constituting the fluid of ovarian dropsy. These false hydatids are comparatively common in the uterus, where they cause great enlargement of that organ, simulat- ing pregnancy. Most remarkable cases of epilepsy, chorea, be cited as due to the presence of those larva formations in brain and cord. Even the eye becomes affected by bathing it in water from a pond in which animals have drunk. Hydatids, i, Coenurus eerebralis, natural size; 2, one head magnified; a, oval circlet of hooks ; b, suckers; 3, Cysticercus tenuicoUis, natural size; 4, head magnified; a, circlet of hooks; b, suckers. A bright elastic tumor of a translucent appearance on neck of the womb ; wheu punctured, its serum yields myriads of echinocerons. might 464 DISEASE GERMS. Hydatids of the Brain. — Parasite cysts of the brain are very commonly found in sections of the country in which the inhabi- tants live chiefly upon pork. Chiefly two parasites, the taenia echinococcus and the taenia solium, are found in the human brain in the cyst condition, and it is of some importance to distinguish between them more defi- nitely than has hitherto been done. Where dogs are admitted freely to human dwellings and have access to sources of drink- ing water, the echinococcus will be the more common, as, for instance, in Iceland. In our Western States, the cysticercus cellulosae is the more common parasite, and it has been shown that it has a special tendency to affect the brain in man. Out of eighty-seven patients in Cincinnati, Ohio, who were affected with this parasite, it was found that in no less than seventy-two the cyst was situated in the brain. Two cases have been reported where the cysticercus acanthotrias and the coenurus respectively were discovered in the brain, but these were isolated instances. It is not surprising, seeing that the male sex is more liable than the female to cerebral tumor, to find that a much larger proportion of men than of women are attacked by hydatids of the brain. The proportion is greater than that of their general tendency to hydatid disease. The echinococcus forms in the brain a much larger tumor than does the cysticercus cellulosae. A case has been recorded which weighed eighteen and one-half ounces, and contained eighteen ounces of clear fluid. In regard to the anatomy of these cysts, it is curious that in a large number of the cases collected, the tumors consisted of the parasite pure and simple. In other organs, as, for instance, the liver, the echino- coccus cyst has around it a fibrous capsule, derived from the tissues among which it lies. In most cases the brain cysts appear to be devoid of this coating. A consideration of the seat of the parasite brings forth some facts which may become of some practical importance. In more than half of all cases, the cyst was in one or other hemisphere of the brain, and more com- monly in the right than in the left side. Again, in only four out of the ninety-seven cases collected was the cyst situated in the cerebellum, or " the ratio of cerebral to cerebellar echino- cocci was about fourteen to one.'' One naturally turns to the symptomatology, hoping for further practical guides, but the signs have been so various in different Cysticercus as seen in the eye. BACTERICIDES. 465 cases as to give no very definite clue. Headache, blindness, and convulsions seem to be the symptoms which is most common to such cases. Hydatids ^ of the Liver. — The essential cause of the development of hydatids is the entrance into the stomach or intestines of the taenia echinococcus. If they remain in the intestines they be- come tape worms ; when they pass into the liver they develop hydatids. They are chiefly met with between thfe ages of thirty and fifty, rare in children and the aged. They are most com- monly met with among the poor, the filthy, and those that are surrounded by insanitary states. The percentage of people affected is quite large. Dogs, sheep, pigs, cats, rats, are victims to tape worms, and as the ova of those parasites are discharged in the excrements of those animals, they can only gain access to the human stomach through polluted drinking water, or un- c3oked food. The method of growth is as follows : an ovum of taenia echi- nococcus, either during mastication, or from the action of the digestive juices, has the envelope containing the echinococcus removed, and then by its hooklets it bores its way from the stomach or intestine into the liver. It there becomes encysted ; the cyst consists of an external laminated cuticular layer, and an internal parenchymatous lining. From the internal layer numer- ous little heads bud forth in the form of vesicles, and these in turn bud out into others, and so on, the mother-sac keeping en- larging to accommodate the young broods. Successive genera- tions or broods of embryonic taenia, immature scolices, form upon the internal surface of the mother-sac, while the young crop cling to the mother, pushing the older ones forward into the fluid of the sac, which keeps on enlarging. Proliferation is excited by pressure of the surrounding tissue, which developes into a cyst. During the process of enlargement, a hydatid tumor loses its spherical shape, and becomes indented, the fibrous capsule be- comes thickened, rough, cartilaginous, and in some cases ossifi- cation takes place. There are various contingencies that may arise that may de- stroy the echinococci, such as, bile may enter the cyst and destroy its living breeding contents ; inflammation from numer- ous causes may arise, that may cause the disappearance of the mass. They may suffer fatty degeneration, or they may die from over-growth and other forms of degeneration. They are liable to rupture in every direction, and cause grave organic changes, even death, consequently they are dangerous in proportion to their size and the direction of their growth. The symptoms of hydatid tumor in the liver are those which 466 DISEASE GERMS. belong to liver disease. There is the presence of a tumor in the region of the liver, weight, dragging, difficulty of breathing, cough, bronchial catarrh; pain in the right shoulder; brown- coated tongue ; constipation ; jaundice ; ascites ; hemorrhoids. Prophylactic measures consist in preventing the drinking of water contaminated by the evacuations of animals, and in not permitting dogs to feed upon the offal of sheep ; chloride of sodium, resorcin, naphthaline, iodide of potass; ^'t*A ^fe aspiration if the tumor is superficial. - 'C^.^^:*^-feV' Hydatids are found in every organ of the .:,'^V&^3)°° ' body, and are to be seen in v^rious micro- k**'C'/*(?l^'^^ scopical conditions. gv4^,ov»*t%Vo Hydatids of the Kidney. — Every disease '^W^^>^4 germ, and nearly every parasite incidental to "^ ^ * the human body is to be found occasionally Hydatids of the lung;; {*, fUg kidnCVS the appearance cf the "^ ^^^^ KlUIlCyb. elements found in the As a rulc, whcn the kidncy becomes the sputum. -.,.,,, •' 1 !• seat oi nydatids it becomes enormously dis- tended or enlarged. A tumor is usually the first noticeable sign, and an examination of the urine may reveal echinococci hooklets. If the case can be made out c'early, aspiration should be practiced, and iodine injected into the cyst. Dropsy of the scrotum may be a result of Hydrocele, inflammation, or disease, as enlargement of testis injuries, or dependent on general dropsy. Symptoms. — The scrotum becomes gradually distended with serum, which forms a smooth, pear-shaped, elastic and translucent swelling. The spermatic cord can usually be detected free at its neck, and the testicles can be detected lower down. There is no impulse on coughing. To take patient into a dark room and hold the scrotum between you and a lighted candle is an absurd proceeding ; for the serum in the scrotum is often grumous, turbid, and it may not be transparent, although in a good number of cases it is of a pale straw-color. In quantity, it averages about twelve ounces, less or more. If it is allowed to become chronic it may lose its pear shape, become thick, and almost invariably opaque. In some cases, instead of the water being in one mass or volume in the scrotum, it is found in cysts, resembling a honey- comb ; it is then called encysted. Little boys may be born with this accumulation, and the communication between the peritoneal cavity and scrotum may not have been obliterated ; it is called cono;enital. i^ACTERICIDES. 467 Treatment. — In the early stages or in acute form, such as in scarlet fever or from testitis, try treatment for dropsy — diapho- retics, diuretics, hydragogue cathartics, preceded with digitalis, then iodide potass, and back on those remedies {^See Dropsy), using the lotion of muriate of ammonia over scrotum. If medi- cinal means fail, then tap the scrotum about three-fourths of an inch from the median line at the base, boring gently in with tro- car and canula until the serum appears between the fingers ; then withdraw the trocar, leaving the canula in, through which the fluid oozes out. After it has been entirely drained away, insert the trocar again, and push it through the walls of the scrotum high up. After perforating, withdraw the trocar, and insert up through the canula a strand of seven threads of saddler's silk, and holding the upper end, withdraw the canula, and then tie the ends of the strand together ; undo this knot every morning, and remove one thread every successive day till they are all withdrawn. By this method the secreting faculty of tunica vaginalis will be destroyed, and a perfect cure is the result. There is no deceiving the patient with this manner of dealing with the case, as the result is always most Tapping the scrotum for hydro- satisfactory. Some tap without using the seton ; others tap, withdraw the fluid and inject tincture o iodine ; while another class aspirate ; all such measures are un- certain and inappropriate. In the encysted form each sac must be punctured, one by one, and their contents drained off, and then the seton. In the con- genital form a truss must be worn, so as to irritate a little, and thus close up the vaginal process. Usually the muriate of am- monia lotion to scrotum is sufficient. Dropsy of the brain may be congenital, Hydrocephalus, and associated with cerebral malformation. When it does not originate in that way it is a result of tubercular meningitis. It is rarely met with after two years of age. In dropsy or effusion of serum from the membranes of the brain, the head often attains a large size ; the unossified sutures yield readily to the pressure of the fluid. It may be equal all round, or one side may be larger than the other ; bones thin and trans- parent ; meninges thickened. Serum, in quantity, varies from a few ounces to as many pints; if in large amounts, the lateral ven- tricles are expanded in one large cavity. 468 DISEASE GERMS. The predisposing cause is tubercle bacilli irritating the mem- branes of the brain, causing the effusion. The exciting causes are falls, blows, cradle rocking, or reflected irritation, as teething, worms, cholera infantum, etc. Symptoms. — General symptoms of tubercular meningitis to a greater or less degree, followed by extreme wasting of the body. Although the child may eat ravenously there is no nutrition. The appearance is remarkable ; skin very white, body emaciated, face small, with a large globular cranium and overhanging fore- head ; head drops helplessly on one side. Th^re may still exist a little inflammation; if so, there will be headache, irritability, rest- lessness sleeplessness, and a susceptibility to noise, light, motion. Intelligence very feeble; great prostration and muscular weakness; rolling movement of head, eyeba'Us, perhaps squinting and blind- ness ; great li ability to epileptic convulsions; nausea, constipa- tion, with dark-colored, offensive stools; grinding of teeth, screams on awaking. As the case progresses there is more pallor of the surface, a great deal of stupor, very slow pulse, dilatation or contraction of pupils, picking of nose and lips. In favorable cases the headache and irritability subside ; the skin assumes a better color, there is more energy, appetite becomes more natural and the body nourishes. If there is great prostration, rapid pulse, paralysis, coma or convulsions, it is very apt to end in death. Treatment. — Infants of a tubercular diathesis, with a tendency to any irritation of the brain, should be well cared for, and their constitution strengthened by every possible means. Nourishing food, abundance of good milk, beef juice, country air ; seaside in summer; daily bathing, followed by inunction of iodized oil; and when they become older, great precaution should be used, espe- cially against any mental strain or irritation. To get rid of the effusion, its cause must be removed, that is,, all irritation. Then the principles of treatment are the same as effusion of serum or dropsy. Small doses of infusion of digitalis,, with infusion of parsley or asparagus, with nitrate potassa. Bowels to be opened freely with leptandra and compound licor- ice powder, given as often as necessary to keep the bowels free. Other diuretics, if it is possible, should be crowded in, as. hair- cap moss, squills, etc. In the hospital for the treatment cf children's diseases, lactose or sugar of milk is recognized as a standard and reliable diu- retic, and so administered with great success in hydrocephalus. Whatever remedies are administered to get rid of the effusion, they should invariably be alternated with two grains of the iodide potass in simple syrup thrice daily. Warm alkaline baths invariably do good. BACTERICIDES. 469 A peculiar tubercular form of disease of Hydrocephaloid the brain in children, under two years of Disease. age who suffer from insanitary states, over- crowding in cities, with meagre or insuffi- cient or deleterious food. Often the result of reflex irritation, as teething, worms, summer diarrhea. It has a close resemblance to tuber- cular meningitis, although pathologi- cally different ; the surface of the fontan- elles are depressed, instead of being raised as in hydrocephalus. There is great prostration, heavi- ness of head, drowsiness, languor, chop-spinach stools; wakes from sleep in alarm, screams, dread of strangers, freaks of temper, irregular breathing, no fever, skin white and cool. The main point in treatment is to make an effort to destroy the tubercular bacilli by the administration of the glycerite of ozone, kephaline and avena internally ; locally, into the scalp an ointment of sozoiodol should be rubbed daily. Prolusion of a hydrocepha'oid brai An effusion of serum into the cavity of the Hydrothorax. chest may be either the effect of pleurisy or organic disease of the heart; in pleurisy, a result of the expectorant treatment ; in organic disease, obstruc- tion and exosmosis of the serum of the blood takes place. The presence of serum in the cavity of the chest is usually easily recognized, by the history of the case: the great difficulty of breathing when the patient lies down, in which position if the lungs are clear, there will be resonance from top to bottom, as they float on the top of the water ; then set the patient up, on percus'^ion, dulness will extend up as far as the water level. If the patient is of a spare habit, a splashing sound will be detected by shaking the patient in the sitting posture. This form of dropsy admits of removal without operation in the large percentage of cases when due to pleurisy. The microbe of rabies is communicated to man by the inoculation of the saliva of a rabid animal. Period of latency or dormancy of the germ varies with the grade of vital force. With strong vital force it may remain quiescent indefi- Hydrophobia. {Rabies.) 470 DISEASE GERMS. nitely, whereas, in a weak and impaired constitution the germ may take on vigorous growth and use up vital force in a few days. In the dog there can be Httle doubt that the degradation of Hving matter which gives us the germ rabies, may be due to filth, want of natural grasses and water, over-exhaustion, heat, and probably from other anim.als. The fact that a dog only per- spires by its mouth may have something to do with it, in render- ing it more obnoxious to its development. Licking the hand, bites, scratches are the ordinary forms of inoculation. As a latent germ or slightly active one in the human blood, it gives rise to a number of obscure nervous affections, as epilepsy, asthma, neuralgia, hysteria, special conditions of irritation of the brain, chiefly around the pons, spinal cord and great sympathetic. If the germ becomes active, or, in other words, if hydrophobia is about to appear, there is great nervousness and irritability, a mental condition of profound despair, haggard appearance of countenance. If from an old bite or inoculation, the cicatrix be- comes painful, sharp lancing pains radiate along the course of the nerves up the limb, and in a freshly bitten part the same sen- sations. Slight spasms come on, very light at first, and long intervals between, but they gradually become more violent, increase in length, and the interval between grows less and less with each occurrence. During these attacks the features become livid or purple, eyes protrude from their sockets ; thick, viscid, ropy saliva is secreted, which keeps him constantly hawking and spitting ; spasmodic action of the muscles of the throat and pharynx and diaphragm, and latterly, of the entire body. Dur- ing these paroxysms the patient is wild and delirious. In the interval between, nervous impressibility is intense; thus, dread of movement so great that even the moving of a curtain or door, the undulation of water in a glass, will excite a spasm. Still, there is a real dread of fluids. They are more difficult to swal- low than solids, as they bring all the rings of the oesophagus into active exercise. Great delirium, violent spasm, exhaustion, death. It is a disease that is easily recognized by the great mental irritability, by a total absence of fever, by the character of the spasm, very light at first with long intervals, by the fits gradu- ally becoming longer and more violent, with less time between ; the face, during paroxysm, livid or purple, eyes protruding, hawking and spitting thick, viscid saliva ; while paroxysm is off, conscious. The Microbe of Rabies, " canine,'^ consists of small globular cocci, single or united into characteristic colonies. They are not BACTERICIDES. 47 1 met with in the blood, but are found literally swarming in the cerebral secretion, in and around the medulla oblongata and spinal cord. One hundred and twenty drops of brain juice from about the medulla yields three-fourths of a grain of a distinct crystallizable (ptomaine) alkaloid, one thirty- second of a grain of which injected into a mule, gives rise to all the symptoms of hydrophobia, and in a short time collapse, convulsions and death. The exceptional virulence of this microbe is due to its vital and reproductive energy, to the rapidity with which it multiplies, and the excessive amount of ptomaines excreted by the germ directly in the nerve centres. The microbe is pathogenic of the disease, bears culture well in a neutral menstruum. Inoculations of the cultures, or better still the ptomaines, give rise to the disease. From these cultivations new ones can be made, and carried on through successive generations, all cultures, behaving in the same manner, showing exactly the same changes as in the parent culture. The most minute droplet of any of those cultivations produces the disease in animals. Treatment. — After a bite ligate above the wound, then resort to free incision into it or apply wet cups over it ; encourage free bleeding with fomentations of hot water ; then either cauterize the wound freely with caustic potash or wood ashes, or if none of these are handy, chop a number of red onions very fine, and crush or beat into them pulverized muriate of ammonia, and apply for several hours ; if a large wound, fresh application every hour, then poultice with lobelia and slippery elm. At once the patient should be placed on small doses of lobelia, and if indica- tions of a spasm, larger doses, just enough to nauseate well, not to vomit. Keep on with it several days. Lobelia has a retro- grading action on the germ rabies ; it will not cure, but prevents its activity and development. The living germ will only die under a condition of quasi-suspension of the nervous system. This is to be obtained if commenced early, when the patient can swallow freely, by very large doses of fluid extract of sambul, a strong infusion of skull-cap and sesquicarbonate of ammonia. Administer often ; repeat one after the other in as large doses as the stomach will tolerate, and not let up until a condition resembling general paralysis is induced, with a sleep like coma. If this condition can be brought about the germ will die. The rate of growth of the germ rabies is determined solely by the debility of the affected person, and there is no way left, no time for anything but cutting off the pabulum by partially suspend- ^'j2 DISEASE GERMS. ing nerve force. The power of growth is great, but if this quasi- suspension is induced, there seems to be no nutrient matter for the germ. It must be performed early. None of the remedies are in any way poisonous, so there is no danger from an over dose ; and there must be no stopping until the most profound anesthesia is produced. Never be satisfied with a sensation of pins and needles over the entire body, that feeling must be followed by profound narcotism. Anesthetics, chloral hydrate, opium, bromide of potass, are no good, neither are the general run of acro-narcotics, as aconite, belladonna. More recently practitioners of repute and trustworthiness in Asia have introduced hoang-nan (strychnos gautheriana) as a germicide which will destroy the microbe. The effects and physiological action of this drug are, general indisposition, with extreme fatigue, vertigo, tingling of the hands and feet, with involuntary movement of the jaws, and a partial sus- pension of nerve power. If these symptoms are not present while the drug is being administered, it is a certain sign of the presence of a microbe imbibing the remedy. In such cases, the treatment must be continued, the remedy increased every dose, until the microbe is destroyed, which is known when the above symptoms appear. If the remedy acts too violently, either because the microbe or its ptomaine is absent, or to the administration of too large a dose, it is easily counteracted by administering fluid extract licorice. Energetic, repeated doses, either in the stage of sprouting (incuba- tion) or upon segmentation (violent rabid stage) should be the rule. The passion of rage in any animal, even man, evolves a special living principle, a disease germ ; for the bite of an angry man free from the anesthetic influence of alcohol, is highly danger- ous and often fatal, causing bacterial poisoning, erysipelatous in flammation of cellular tissue, and death. The principle might be carried further. Are not there living principles in all our emotions, desires, affections, passions, which render them contagious? Have we not special epidemics which are catching, religions excitement, suicidal mania, seasons when special crimes seem to be propagated ? Enormous enlargement of the breast is often Hypertrophy met with in both single and married women ; of sometimes one gland, in other cases both The Breast, glands slowly increase in size. It is not at- tended by inflammatory symptoms ; no heat, pain, induration ; nothing but progressive enlargement, which becomes burdensome and unsightly. The affected glands may BACTERICIDES. ^^-> point right out, but more generally they hang, loose, flabby and pendulous, reaching, in some cases, well to the navel or knee. Causes. — Rather obscure; in some cases we can see its con- nection with goitre ; in another class with masturbation ; while in still another, uterine and ovarian irritation, chiefly from imper- fect sexual intercourse ; impaired health, etc. Treatment.- — -Alteratives and tonics ; every possible means to improve the general health and activity of the uterine organs should be resorted to. As a rule, however, all means are very unsatisfactory and unavailing. Amputation of breasts is most invariably f:)llowed by tetanus. Enlargement of the heart is much more Hypertrophy common than atrophy. The weight of an of adult male heart is about nine and a half, and The Heart. the female eight and a half ounces, but in en- largement it often weighs several pounds. Hypertrophy may take place in various ways. It may be gen- eral, that is, its walls increased in size or thickness without any change in its cavity, — this is called simple hypertrophy ; the walls may be thickened and the cavity enlarged, — called eccentric hypertrophy, or enlargement with dilatation ; or the increase of thickness of its walls may be accompanied with diminution of cavity, — concentric hypertrophy. In cases of valvular disease and other forms of obstruction, hypertrophy is of utility in over- coming the impediment to a free flow of blood. Hypertrophy of left ventricle is usually due to aortic valvular disease, or to Bright's disease, in which there is resistance to the passage of the blood through the arteries and capillaries. Hypertrophy with dilatation of right ventricle generally due to disease in the mitral valve, causing obstruction to the pulmonary circulation, or to some chronic disease of the lungs. Causes. — Enlargement of the heart may be predisposed to by the use of tobacco, tea, alcoholic stimulants, great mental strain, worry, disease of brain, blood, etc., although the common excit- ing causes are over-stimulation, excitement, violent muscular exercise, as running, jumping, rowing, hoisting, lifting; excess, use of malt liquors, sexual excitement. Symptoms. — There is usually vertigo, muscae volitantes, tin- nitus aurium, redness of face or plethora ; heat, respiration and pulse are up. The sounds of the heart are not only frequent but loud, audible at a distance ; there is a fulness or bulging, often a wearing away of the ribs ; instead of the area of dulness on per- cussion being four square inches, it is increased to more than 474 DISEASE GERMS. double; there is also numbness in left hand extending up the arm, caused by a distension or stretching of the recurrent branches of the subclavian nerve over the heart reflected to the brachial plexus, thence to the hand. There may be bleeding at the nose, cough, difficulty of breathing from enlarged heart pressing on lungs ; often palpitations ; difficulty in walking quickly ; uneasiness, and sense of fulness and pain about cardiac region. In the treatment of an enlarged heart, all mental and physical excitement must be rigidly avoided ; strictly forbid the use of tobacco, tea, coffee, whiskey, ale, sexual congress. Diet very nutritious but as little animal food as possible, unless there is debility, warm flannel clothing, and abundance of fresh air. The action of the heart must be carefully regulated with tinc- ture of digitalis, alternated with strophanthus. Possibly it may be necessary to keep the patient upon those two drugs for two or three years, slightly lessening the dose all the time. As the case improves, begin with a general massage of all the superficial muscles of the body, morning and night. Then other drugs, as dioxide of hydrogen, comp. oxygen fucus vesiculosis, etc., could be administered with advantage. A visit for a month or more to some mountainous region is of great benefit. There are a variety of forms of enlarged Hypertrophy liver ; it may be increased in size and weight of in chronic inflammation, with effusion of The Liver. lymph in fatty or starchy degeneration, and from the presence of tumors, but those are not conditions of true enlargement. Hypertrophy of the liver proper is characterized by an increase in size as well as the number of the secreting cells, causing gen- eral enlargement of the gland. It is usually the result of long- continued congestion, such as takes place in all tropical climates from the irritation of malaria, and whiskey. It may be looked for in the indurated spleen, or leucocythaemia, in or after dysen- tery, and very common in the glucose diathesis, or diabetes. It is often met with in a lobe or portion of the liver. It is then said to be partial. It is brought about by the healthy portion having to do the work of a portion diseased ; its cells become enlarged, new ones are developed, and in this way the developed part compensates for that which is diseased. It gives rise to gastric catarrh, etc. Treatment same as for chronic inflam- mation. BACTERICIDES. 475 Muscles may suffer enlargement by exces- Hypertrophy sive use. The muscles on the arm of a black- of smith or prize-fighter are enormously devel- Muscles. oped. In the former it is quite common for the right side to measure four or five inches more than the left. This can only go on to a certain extent — to a degree of growth in which there is an adequate nerve-supply ; when that limit is reached, and exercise still continued or per- sisted in, fatty tissue will begin to take the place of muscular fibre, and the muscle will lose its contractility and become use- less, because it has undergone fatty degeneration. The treatment is rest and alteratives. About two-thirds of the male population Hypertrophy of this country, about the middle period of of life, suffer from some unsuspected urinary The Prostate, trouble, as well as partial or complete im- potency, while the other third, from puberty up, are either victims of self-abuse, a perversion of the sexual act, or a neglected or imperfectly cured gonorrhea, etc. These are the most prolific sources of generative weakness, and in themselves are productive of irritation, inflammation, effusion of lymph, and enlargement of the prostate. It is doubtful, when once this gland is damaged by masturba- tion, by dalliance in the sexual act ; by withdrawal in the act of ejaculation ; by the wearing of condums ; or by a gonorrhea, if ever it regains its pristine condition of health ; and those and other causes plant the foundation of future trouble. Chronic inflammation, brought about by these and other like causes, invariably terminates in enlargement of the gland, with either tubercular or calcareous induration. The degree of trouble from an enlarged orhypertrophied prostate varies greatly. For example, the lateral lobes may be consider- ably enlarged without causing much inconvenience ; whereas, if the middle lobe, which forms the floor of the prostate urethra, is only slightly enlarged, there is difficulty in micturition. The symptoms of hypertrophy of the prostrate, even in the slightest degree, are in all cases well marked, and consist in some difficulty in emptying the bladder, dribbling after micturition ; inability to pass water, which frequently proceeds along to a> state in which he cannot hold his water at all ; the irritability becomes intense, the desire to urinate imperative, and still withal partial retention of an ounce or two of urine; which speedily undergoes decomposition, and there is evolved in its ammonia- 4^6 DISEASE GERMS. cal products, the micrococcus urea, which gives rise to cystitis. The micrococcus migrates up the uterus to the kidneys, giving rise to grave anatomical changes in those glands. The sufferer from irritable, then enlarged prostate, is an incessant victim of pain, uneasiness, aching in the hips and thighs, a feeling of weight and heat in the perinaeum, and all around ; pains in the limbs,' and extreme irritability; besides he is liable to severe complications, even from the slightest indiscretion in diet, or from cold, or wet, and the residual urine in the bladder loaded with the micrococcus urea, excreting ptomaines gives rise to pain and fever. The spasmodic contractions of the bladder to void its germ-laden contents are irresistible. In the early stages, noc- turnal emissions, two or three in a night are not uncommon, with urine very cloudy, with a copious deposit of muco-purulent matter. A thin, transparent discharge at stool invariably pres- ent, or, if not present, a gluing of the lips. This moisture or discharge, if placed in the field of the microscope, will be found to be prostatic, often mistaken for semen. A rectal examination in all such cases, reveals the prostate, large, hot, indurated, tender to the touch. Enlarged prostate means complete physical and nervous bank- ruptcy, as is seen in the partial or complete impotency, in the wasted testes, in the blighted state of the organs, loose and patulous vesiculae seminalis ; in the gleety discharge, or weeping penis ; in the cold, clammy state of the parts. What does modern therapeutics offer for the alleviation of this affection, and anchoring its unhappy victim to the earth a little while longer ? One essential element in the treatment of such cases is, the bladder must be emptied; there must be no residual urine in it to give birth to the micrococcus urea and fungus ; it must be evacu- ated daily, and either injected with a germicidal fluid like boro- glyceride, or else a bougie of thallin or resorcin used to kill every microbe in the viscus. An effort must be made to control and wipe out all irritation and inflammation of the prostate, and establish a renewal of life in it For this purpose a selection of some of the following methods or modes of treatment should be tried, with some of the special remedies enumerated. It is unnecessary to state that the appetite should be stimu- lated, the diet should be the best and abundant; daily bathing inculcated ; the bowels regulated, so as to have one free motion after the morning meal, and an injection every evening, an hour or two before retiring to bed, this should consist either of witch hazel or infusion of uva ursi, or a like remedy, with occasional hip baths. BACTERICIDES. ^yj All cases of enlarged prostate are much benefited by a general alterative and tonic course of treatment. The best alteratives being saxifraga and phytolacca ; and preparations of cinchona our best tonics. Then the attending physician will select some special remedy to meet the peculiar outcroppings of each particu- lar case. If there is great irritability in a chronically inflamed and en- larged prostate, with either continence or incontinence of urine, there should be no delay, but large doses of green root tincture of gelsemium should be administered, with belladonna suppositories. The ozonized uric acid solvent is of inestimable value, it con- tains a large percentage of pichi, a most efficacious drug in breaking up fibrinous and calcareous deposits in this gland ; its power of disintegration on this gland is immense, in effacing all conditions of hypertrophy. Once the gland becomes soft, patulous, the action of ergot and damiana are of signal efficacy in inducing contraction. Unquestionably, the most efficient drug in hypertrophy is the salix nigra, being a tonic, vitalizer, sedative and anesthetic. It entirely supersedes the different preparations of bromine upon the prostate, possessing all the good properties, with none of the bad. The ulterior action of a long continued persistent adminis- tration of the black willow has a most marvellous action in de- creasing the size of an enlarged prostate. The introduction daily or every other day of the salix nigra bougie will effectually get rid of all leakages or emissions. This is an important point gained. Besides the black willow bougie those composed of ergotine, quinine, damiana, papoid, iodol, have an excellent effect, their use rouses up the vital energy of the gland ; they diminish its size ; contract the ejaculatory ducts ; change the whole sphere of morbid action. If the bougies fail, then suppositories of the same ingredients should be used. The cocaine suppository ; one prepared from ergotine and cocaine ; another composed of the glucosides of the black willow and stone crop. AH have an excellent action in contracting the motor cells in the vesiculae seminalis and cord. This method of treatment is good, direct, energetic, often effective, but in all cases it must be aided with a course of medical treatment to increase their efficacy. We attach the greatest importance in all cases to a careful rectal examination, as it determines the status of the case. When we feel the prostate soft, yielding to the touch, it indicates that muscle still prevails, that a complete restoration of function, is possible under good treatment, aided by the stimulating ab- sorbent action of electricity ; again, when we feel a hard, modu- 478 DISEASE GERMS. lated prostate, and there is evidence to the touch, that fibrous tissue preponderates largely over the muscular ; the power of the bladder seldom returns, unless electrolysis is resorted to. Electrolysis of late years has been brought to bear upon such cases with wonderful success. The medical electricians of the United States are scientific men of rare culture, arduous study and extensive experience. The plan they adopt in electrolysis of the prostate is, they place the positive electrode in the form of a plate over the region of the bladder, and the index finger guides into the disinfected rectum the negative pole in the form an insu- lated needle, with its point clear for half an inch. This, by a gently rotary motion, is inserted into the prostate. The two electrodes are switched on and the current gradually increased to ten or twelve cells, for five minutes. The needle is then withdrawn and reinserted the same way in another direction. This is repeated three times. Taking in all fifteen-minute sitting. The results in the hands of the following eminent savans have been pre-eminently satisfactory. No dan- ger, no unfavorable symptom, and no doubts can be entertained of its wonderful efficacy.* Every means failing, either to ameliorate or cure, and life being in imminent danger, suprapubic and perineal prostatectomy have been resorted to with great success. There is no gland in the entire body, more frequently the seat of irritation ; the tubercu- lar, the syphilitic, the gouty, the lymphatic, the sensualist, the sedentary, the bicycler as well as the rider on horseback are its victims. No matter what the irritation be, it invariably gives rise to fibrous excoriation, calcareous deposits, ulcerations, fistulous openings, ante- rior and posterior, vesical thickening, catarrh, and necessitates special illustration. This cut shows the external appearance of the middle lobe when the vesiculae semi- nales and the vasa deferentia under which it is situated have been removed. Although it is connected firmly on each side with the lateral lobes, it is distinct from them at the posterior part, and evidently a separate lobe of a rounded form. *We would enumerate the names of medical electricians who have met with brill- iant success in electrolysis of the prostate and subsequently effecting a radical cure ; C S. Hastings. M. D., Los Angeles, Cal. ; R. PI. Randolph, M. D,, Portland, Ore- gon; I. C. Hewes, M. D., Omaha, Nebraska; J. J. Jones, M. D., Philadelphia, Pa.; S. M. Piatt, M. D., Waterbury, Conn.; Frank L. Tuttle, M. D., Springfield, Mass.; E. T Skelton, M. D., Bloomfield, Iowa. BACTERICIDES. 4/9 The prostate gland varies more in its size in different men, than many other parts of the human body ; and this middle lobe is liable to do so in a still greater degree than the body of the gland, being frequently smaller than it is here re- presented, and sometimes of a larger size. This illustration represents the middle lobe of the prostate gland in an incipient state of its enlargement, putting on a nipple- like appearance, and pushing the internal membrane of the bladder before it, which everywhere adheres to the projecting parts, and forms a covering to it. In this view the fundus of the urinary bladder is removed, so as to expose the orifice of the bladder. This in a natural state resembles the narrow part of a funnel, but here the pro- jecting middle lobe is so situated that whcn^^ver th'e bladder contracts to expel its contents, the middle lobe is pressed for- wards directly upon the orifice; and although it could not completely shut it up, must form an obstruction to the pas- sage of the urine. This diagram is taken from the same parts, but the enlarged lobe is seen in relation both to the bladder and the ure- thra. The membrane covering it is put so much on the stretch, as to drag down the orifices of the ureters towards the tumor, so that the intermediate space forms a double projecting ridge, instead of a concave surface. In the opposite direction the loose membrane of the ure- thra, as far as the verumontanum, is so much elevated as to form a bridle of some breadth and considerable strength, by which the enlarged lobe and the verumontanum are drawn nearly close to each other, and the hollow between them is rendered much deeper than it is in its natural state ; this hollow is considerably increased by the lateral lobes having also become enlarged. In this state of the parts, there is some difficulty in passing a catheter into the bladder, unless it is a large metallic one. The best instrument is a silver No. 12, which should be well warmed and oiled, introduced with the greatest care and gentleness ; as it is being inserted it should press against the superior aspect of the urethra ; it will thus readily slide into the bladder. With such a sized instrument there is no danger in making a false passage or doing any damage to the parts. It should be inserted at least thrice daily and retained a short time. 48o DISEASE GERMS. In this representation the bladder had been for many years disturbed by the passage of the urine being obstructed in conse- quence of strictures in the urethra; so that before the enlargement of the middle lobe took place, the muscular coats of the bladder had acquired great strength, and an un- common degree of thickness ; the internal membrane had been formed into sacculi, and was so much thick- ened, that its fibres were unusually distinct. The opening of the ureters had become so patulous, as to admit of regurgitation of the urine. Under these circumstances many of the pathological effects had taken place. The stretched state of the mem- brane of the bladder over the middle lobe is remarkably distinct. In this illustration the middle lobe of the prostate is more prominent than the last. The internal membrane of the bladder has a sacculated ap- pearance ; at the fundus there is a sac formed by the internal membrane, protruding between the fasciculi of muscular fibres. There is a cavity be- hind the ridge formed by the enlarged lobe, and the transverse fold of the mem brane ; and another on the opposite side between it and the verumontanum. It is evident, that, when the disease has arrived at this stage, the bladder can never empty itself completely, since, before any urine can pass out, the cavity behind the ridge must be full ; and the pressure of the liquid which it contains must force the tumor forwards, so as to shut the orifice of the urethra; but when a larger quantity of urine is collected in the bladder, the internal membrane being put upon the stretch, and the tumor pulled backwards from the orifice of the urethra, a certain portion is al- lowed to flow. The same ridge, which prevents the bladder from emptying itself, forms an obstacle to the point of the catheter when an attempt is made to pass it into the bladder to- draw off the urine. In the middle line where the lobe itself is BACTERICIDES. 481 situated, there must be great art in directing the end of the in- strument over it ; but laterally, v/here there is only a folded membrane which can be pressed before the instrument, and which does not rise so high, the catheter may be more easily di- rected into the bladder. The bridle extending from the veru- montanum to the lobe being only a narrow band, the end of the catheter cannot rest upon it, but descends into the space on one side of it, and is conducted into the bottom of the cavity before the lobe, where it is very probably entangled, so as with diffi- culty to be extricated, unless the catheter is curved at the point. The middle lobe is in this instance still larger than in the last ; the lateral fold of the membrane on each side is very distinct, and as the prostate gland itself is increased to a great size, the cavity before the middle lobe is very deep, and the left portion of the gland having swelled more than the right, it has put on a convex form towards the urethra while the opposite surface is concave, so that the canal of the urethra through that part, instead of being straight, forms a curved line ; wherever this is the case, there is great difficulty in conducting the point of the catheter into the bladder, for when it arrives at the prostate, the handle of the instrument is always turned round, and the point forced downwards and to one side, and goes on in that direction till it is en- tangled in the fold of the membrane close to the root of the projecting por- tion of the middle lobe. To counteract this it is difficult to insert a catheter. In this cut the middle lobe is not very prominent, but it extends laterally, and the transverse fold of the mem- brane of the bladder is unusually thick, so that they form together a very com- plete valve to the orifice of the urethra; the lateral portions of the gland are not much elongated but are consider- ably swelled, so that the hollow be- tween the middle lobe and the verumontanum is of unusual depth. The resistance to the passage of the urine was so great in this instance that not a drop could be passed, and the efforts 31 482 DISEASE GERMS. of the muscular coats of the bladder to expel the contents were so great, that they occasioned the inner membrane to protrude just between the openings of the ureters, and a large cavity or reservoir was fo.rmed there capable of containing above half a pint of urine, while the cavity of the bladder became preternaturally con- tracted. In this case every attempt to pass an instrument into the bladder was ineffectual. In this representation, the middle lobe has acquired a larger size than the lateral lobes, so that it appeared at first to be a tumor of an irregular form belonging to the body of the gland taking this par- ticular direction ; but after having been examined more accurately, it was found to be an enlargement of the middle lobe only ; the transverse folds of the inner membrane of the bladder connected with it were dis- tinct when the parts were examined in a recent state. In this specimen, the increase in the size of the lateral lobes was more in the direction towards the bladder, which produced an effect the reverse of what has been met with in the former representations, since here the distance between the verumontanum and orifice of the bladder is increased, and the canal of the urethra is lengthened. The appearance of the middle lobe in this illustration is quite hypertrophied and extremely difficult to introduce an instrument. In such cases the use of papoid works in a marvellous manner as a digestive solvent. The difficulty has been to get it in con- tact with it. This has recently been overcome by mixing the papoid with butter of coca into a bougie. An instrument made in all respects like Lallemand's porte caustice, size No. 1 2 catheter into this ; after it is inserted right up against the prostate, this papoid bougie can be continuously pushed up as it melts ; it dissolves the hypertrophied tissue and makes its way into the bladder. Repeated several times it does most excellent work. BACTERICIDES. 483 In this instance the middle lobe itself has not acquired so great a size as in some of the others, but the left lateral lobe is very much enlarged, and, what is unusual, forms a prominent tumor in the bladder, by which the middle lobe is thrown to- wards the right side. From the mode in which the enlargement has taken place, the orifice of the bladder and urethra is enlarged to an uncommon degree, as is also a portion of the urethra itself, so that instead of being a canal, it has at this part the appearance of an oval cavity. This is a very unusual appearance, and is principally produced by the left lobe in its enlargement having extended itself to the same length in the direction of the membranous part of the urethra, as it has done towards the bladder in the opposite direction, and also in an equal degree laterally. This engraving exhibits great enlarge- ment of the prostate in the middle and lateral lobes ; the lateral lobe of the left side projecting into the urethra, and into the bladder, the middle lobe being pushed to the right side, and the left considerably more prominent. In this case the retention of urine was complete, and was only relieved by the introduction of a very large-sized catheter and sub- sequently cured by the persistent use of a papoid bougie. This represents the middle and left lobe of the prostate gland in a state of ulceration. This is of rare occurrence. In this instance the left lateral lobe forms so large a tumor, projecting into the bladder, that the mid- dle lobe is pushed on one side, and forms a less complete valve over the orifice of the urethra, than it would otherwise have done, which probably is the reason that the patient was less 484 DISEASE GERMS. liable to retention of urine in the earlier periods of the disorder .than in some other instances where the acual enlargement was less, and where there was less difficulty in the introduction of the catheter. The enlargement of the left lobe also extends further into the bladder. This cut represents the substance of the lateral lobes of the prostate gland, in which suppuration and ulceration had taken place with little or no increase of their size, and no apparent affection of the middle lobe. This state of the prostate is very common when the microbe of syphilis localizes itself in the prostate, giving it that germ-eaten appearance. In speaking of the operation for the removal of the hypertrophied prostate, we would say : /. That prostatic enlargements zvhich give rise to urinary symp- toms are intravesical and not rectal. It has been long recognized that the severity of the symptoms in a case of hypertrophy of the prostate bears little or no relation to its apparent size as felt through the rectum, and it is also well known that a considerable number of men, aged fifty-five and upwards, have prostates of an abnormally large size, though of these only a certain proportion, sayfiftypercent, suffer from urinary symptoms. This strange difference depends on the position at which the organ is enlarged. Prostates of immense size which project towards the rectum and perinaeum cause no urinary trouble, while severe symptoms may supervene when the prostate on rectal examination is apparently of normal dimensions. There are many varieties of the intravesical growth. We find (i) a pro- jecting middle lobe, pedunculated or sessile, (2) a middle lobe with lateral lobes forming three distinct projections, (3) the lateral lobes alone, (4) a pedunculated growth springing from a lateral lobe, and (5) ** a uniform circular projection surrounding the internal orifice of the urethra." This last variety, described by ' Brodie, has in recent years escaped notice ; it is better seen i7i situ than in museum specimens, and is of not infrequent occurrence. It surrounds the urethra like a collar, and projects for a variable distance into the bladder, //. That retention is caused by a valve-like action of the intra- vesical prostate^ the urethral orifice being closed more or less com- pletely by the contraction of the bladder on its contents. When the bladder contracts on its contents the contained fluid BACTERICIDES. 485 is forced on to the projecting prostate, and the urethral orifice is closed. The mechanism is the same, with one exception, what- ever may be the variety of the enlargement. Whether there is a middle lobe or lateral lobes, or a collar, the same valve-action occurs ; and the more violent contraction the more complete is the action of the valve. A patient finding that he is unable to relieve himself soon ceases his violent efforts ; the pressure on the valve is then lessened, the urethral orifice is released,' and the urine flows away in a feeble stream. If he attempt to expel it more quickly the outflow again stops, and it is only after several attempts that he is able to obtain an incomplete relief A time comes when, though the bladder still contains urine, no more can be forced from it. This residual urine varies much in quantity in dif- ferent cases, sometimes amounting to a pint or more. Its pres- ence, and the consequent frequency of micturition, are accounted for by the fact that a more violent contraction of the wall is re- quired to completely than to partially empty the bladder, and that its muscular coat acts to a greater advantage, and consequently with greater force, in its partially contracted than in its distended con- dition. This greater force, pressing on the outside of the valve, more completely closes the urethra, and the urine that remains is unable to escape. An exception to the general rule is found in cases with a small sessile middle lobe, situated partly in the blad- der and partly occluding the prostatic urethra. When this is the case the passage is blocked by the projection, and no valve action occurs. The urine is expelled by a violent contraction, and the bladder wall is much hypertrophied, and its cavity conlracted. The cuts show instances of this condition. The explanation I have given of the mechanism of the residual urine is not that generally received, but want of time prevents me from discussing the various hypotheses that have been advanced. ///. That in many cases self-catheterism is the only treatment required. This prosposition does not require discussion. We have all seen patients who with little discomfort have, by a passage of a catheter, kept themselves in good health, sometimes for years. We would none of us think under these circumstances of advis- ing a patient to submit to a radical operation. IV. That when the catheter treatment fails ^ or is unavailable, more radical measures are necessary. I am unable to prove the assertion, but my belief is that a large proportion of the cases treated by the catheter sooner or later break down ; in other words, that evenually the prostatic enlarge- ment is the cause of death. The breakdown may come soon, or it may come late, but in many cases it ultimately supervenes. 486 DISEASE GERMS. The urine becomes thick and ammoniacal, the desire to micturate is continuous, the passage of a catheter reHeves but for a (ew minutes, the suffering and discomfort are constant; day and night ; life becomes a burden, and death a happy release. The greatest care cannot prevent this result, and the greatest carelessness does not always induce it. 1 have seen a patient who daily for years passed a gum- elastic catheter, which he carried in his hat, which he never washed ; the urine was acid, and he was in robust health. I have also seen many in the last stage of prostatic cystitis who had previously taken every care. Not only does catheter treatment fail, but it is not infrequently, especially in hospital patients, unfavorable. The patient has suffered from frequency of micturition and general discomfort for some years ; he has probably consumed large quantities of herbs to cure a supposed attack of " the gravel," and has not sought surgical assistance till, from some cause or other, complete retention has occurred. The surgeon passes a catheter with difficulty, there is much hemorrhage, the bladder is full of blood, and the patient's life is in jeopardy. If he gets over the acute attack it is found that he cannot learn to catheterize himself. The constant attend- ance of a surgeon is impossible, and the catheter treatment can- not consequently be tried. Even in cases where there is ap- parently no difficulty it is sometimes impossible to teach a patient to pass a catheter for himself In these various cases, cases of frequent occurrence, it is plain that a radical operation is required. It is, indeed, absolutely necessary. V. That this treatment, to be effectual^ should (i) for a time thoroughly drain the bladder, and (2) permanently remove the cause of the obstructio7i. It is now some ten or twelve years since perineal drainage was introduced for the relief of cystitis in patients suffering from prostatic breakdown. The relief obtained in this way has been most marked, and the practice is well recognized and established. As soon as efficient drainage is effected the bladder ceases to be a receptacle, urine sweet from the kidneys flows through it, pu- trefactive changes are prevented, and acute symptoms cease. The relief is, however, only temporary. Either the patient must sub- mit to the discomfort of permanently wearing a urinal, or the artificial fistulse must be allowed to close, with the probable result of a recurrence of the symptoms. It is necessary, if we desire permanent relief, that our measures should be more radical. We have seen that the cause of the mischief in the intravesical pros- tatic outgrowth must consequently be removed. This can only be done by leaving a raw surface in the prostatic region of the bladder, and as mischief would undoubtedly result from stagnant BACTERICIDES. 487 urine accumulating in this position, another and not less import- ant reason for efficient drainage presents itself. VI. That these two indications are best fulfilled by a suprapubic rather than by a urethral or periiteal operation. There are three ways in which it is possible to perform a radi- cal operation for the removal of prostatic obstruction — the ure- thral, the perineal, and the suprapubic. Of these the urethral appear to be in every way unsatisfactory. It is founded on faulty anatomy ; it is supposed that the cause of the retention of urine is a bar at the neck of the bladder, and that the division of this bar will effect relief. We must next compare the perineal with the suprapubic operation. I prefer the latter, for the following reasons : — 1. It is more generally applicable. 2. It can be performed with greater precision, and completed with greater certainty. It is, I believe, impossible to diagnose the nature of the intravesical growth till the finger is in the blad- der ; we may suspect an enlarged middle lobe, but we cannot be snre that it exists alone. In no way can a bladder be explored with the same completeness as through a suprapubic wound. All projecting portions can be felt with ease, but often are re- moved with difficulty — a difficulty that has made me certain that attempts at removal through the perinaeum must often of neces- sity fail. 3. It ensures complete and most efficient drainage. It may possibly be argued by some that the position of the suprapubic wound will prevent drainage, and that the urine will naturally escape more readily through a dependent perineal wound than through one above the pubes. Experience shows that this is not so. Drainage takes place more easily through the soft ab- dominal than through the hard perineal tissues. This was shown in a case already published. In a patient with fractured pelvis and ruptured urethra, I opened the bladder above the pubes, and also cut into the infiltrated tissues in the peri- naeum. A tube was passed through the bladder from above, and brought out below. On its removal all the urine escaped above, and continued to do so as long as the wound remained unhealed. 4. It is equally safe. While making this assertion it is right to draw attention to the fact that it is merely an opinion, and does not rest on a statistical foundation, there being no statistics available for the purpose. In looking over a few cases we shall find that the mortality of the suprapubic operation has been lower than might reasonably be expected. Of ten patients, DISEASE GERMS. all old men, three were above sixty, while seven were upwards of seventy. It is unnecessary to describe fully the operation of suprapubic prostatectomy, but a few special points about its technique, founded on an experience of thirty-seven suprapubic cystotomies of various kinds, may not be out of place. 1. The quantity of water injected into the rectal bag, espe- cially in cases where the prostate is abnormally hard, should be smaller than is usually recommended. Profuse rectal hemor- rhage may occur. 2. The bladder should be irrigated till the antiseptic borogly- ceride solution used is perfectly clear. The quantity left in the bladder varies much from ten to twenty or more ounces. The hand placed on the hypogastrium will show when the distension is sufficient. 3. In cases where the bladder is contracted with thick non- distensible walls it will usually be unadvisable to perform this operation. 4. It is better to leave a catheter in the bladder till its cavity is opened, as it is a guide that expedites the operation. Care must be taken not to hook the peritoneal fold (superior false ligament) into the wound with the point of the instrument. 5. The linea alba is best divided by incising it immediately above the symphysis, and then dividing upwards on a director. 6. Care must be taken to secure the bladder before proceeding to remove the prostate. This is best done by inserting two sutures through each lip of the wound, and fastening it securely to the deeper part of the abdominal wall. When the operation is completed a third suture, passed through the lower angle of the wound, is an additional security against urinary extravasation into the retropubic space. 7. The prostrate should be removed as far as possible by enu- cleation with the finger, and not by cutting. The mucous mem- brane over the projecting portion havjng been snippors 6 to 8 Lateral incisors 7 to 9 1st bicuspids . 9 to 10 2d " 10 to II Canines II to 12 2d molars 12 to 14 3d " 17 to 21 Difficult Dentition. — Permature decay of the teeth is in a great measure due to the want of vegetable phosphates in the mother's blood ; to her neglect of the daily use of oatmeal, corn-bread and boiled fresh fish ; and the use of bakers' bread as diet. This also predisposes the mother to nervous diseases, which correlate to the deterioration of the teeth, each influencing, and, in a mea- sure, causing the other ; besides, the modern system of over- stimulating the nervous system by early precocity, causing a defective process of assimilation and tissue- formation, especially in teeth. Symptoms, — Difficult teething exhibits itself in a variety of ways, but the great bulk of the symptoms are reflex — irritation transmitted to a weakened bulb and cord. The child becomes fretful, its skin white ; nutrition is impaired ; the gums swell, spread, become hot, tender; the child is continually working with its mouth, desiring to bite something; irritable, restless, peevish ; some fever ; increased heat in the head, or pallor, with dilatation of pupils ; there is often a hectic flush on the cheeks, with erup- tion on the skin, especially on face and scalp ; a looseness of the bowels, with griping stools, of a green, pale or leaden hue, BACrERICIDES. 52Q sometimes mucus ; and the child becomes very peevish ; starts in its sleep ; eyes partially open ; rolls head, and throws its arms about, and seems convulsed in particular parts of the body. It exhibits great indications of brain-irritation ; in some cases screaming, throwing head back, thrusting its fingers into mouth; in other cases there is cough, difficulty of breathing, emaciation, marasmus, great fever, thirst, convulsions and a bad train of symptoms. When the child is properly cared for, its secretions and excre- tions kept natural, and elements supplied in its milk from which nature can make teeth, very few of the violent symptoms attend- ant on such a condition occur, and we need not apprehend any bad symptoms from teething. Infants cut their teeth more easily and readily in winter than in summer ; boys more difificult than girls. What is to be apprehended is the reflex condition, which affects all children to a greater or less degree. Treatment. — The irritation of teething causes the gums to swell and become tender to the touch ; there is fever, with irritation of nervous system, with occasional convulsions. In such cases, where the gums are conside-'ably swollen, and the child seems to suffer much from the irritation of the tooth in working its way out, and when the tooth is near the surface, it will be exposed by the retraction of the gum, then it may be advisable to relieve it with a lancet; when no such appearances present themselves, and the child is very restless and uneasy, we can do little more than attend to the different symptoms. In the mildest forms of dentition, sedation is very useful; bathing twice daily; put thirty drops of tincture of aconite in half a tumbler of water, and give a teaspoonful every one or two hours ; if there be strong nervous symptoms, with a tendency to convulsions, add a few drops of tincture green root gelsemium. If the breath is very acid, lime- water and milk, or the neutralizing mixture, or ozone-water ; if there seems to be griping, open the bowels with cascara, and fol- low with infusion of anise-seed. The above also will relieve the bowels if constipated. In some cases a grain of leptandra rubbed up in pulverized licorice is very efficient. If there is restlessness, violent startings, with screamings and twitchings — precursors of convulsions ; bromide of potass and ammonia in lavender or cinnamon-water. Opium, or laudanum, or paregoric, should not be administered to teething infants for the purpose of keeping them quiet. It is a most injurious practice; dries up their secretions, and whittles down their vital force. Mothers, and especially nurses, are prone to resort to that drug iii some soothing syrup, so as to have their own rest undisturbed. The only drugs of real merit are lime- 34 t^Q DISEASE GERMS. water in milk, compound hypophosphites of lime and soda in juice of raw meat, and ozone-water ; two of which could be given at alternate periods, say, every two hours ; otherwise the treat- ment must be upon general principles. If there is fever, aconite and asclepias should be given ; urine scanty and high-colored, parsley-root tea and sweet spirits of nitre. Watch convulsions ; let mother have tincture of lobelia on hand, and if she sees twitchings or throwing head back, alternate pallor and redness, administer a few drops as occasion demands. A free action of the bowels during dentition should not be stopped ; not unless the motions are very frequent, and then guardedly. Any other symptom that arises should be managed upon general principles. The practice adopted of giving infants toys made of hard rubber or ivory to suck and hold in the mouth, upon which they can press their gums during teething, is highly improper, as it has a tendency to harden the gums. Aphth(£, or Nursing Sore Mouth, is most common in ill-fed children, and the parasite present often makes destructive ulcera- tion of the gums. (See Aphthce.) Pure air, proper exercise, wholesome, nutritious milk ; flannel clothing, regular bathing, secretions, and everything that is calculated to promote good health, will greatly contribute to the safety of dentition. At the same time guard the reflex centres, by keeping them well stimu- lated by proper means. In all cases of tardy, difficult, or painful dentition, we must never ignore the main defect — a want of histo-genetic material in the blood ; provide in all cases material from which the sys- tem can elaborate teeth. Weaning Brash is a term applied by mothers and nurses to a disorder that takes place upon being suddenly deprived of the mother's milk by disease, pregnancy, or death, or where children are reared artificially with bad milk. The use of the milk-food has stamped this disorder out. It consisted in derangement of the stomach, vomiting and purging, with green stools ; and if it occurred during the hot weather, speedily merged into that fatal disease, cholera infantum, with its sequel, tabes mesenterica. A quick transition from one kind of food to another should never take place ; it should be progressive, and adapted to the age and condition of the child. Malformations and Deformities. — SomiC attribute them to im- pressions made upon the mother during pregnancy, and there is no doubt but this is a fruitful source ; others attribute them to defects, or deficiencies, or absence of certain histo-genetic mate- rial in the body; and others, to a variety of causes. But there can be little doubt that by far the most prolific causes of deformi- i BACTERICIDES. ^oj ties are incompatibility of temperament, close consanguinity, in- and-in breeding. Although this is the main source of the trouble, it would be well in our present state of civilization, where the nervous system is developed at the expense of the physical, where the brain is alive, vivid to external impressions, to guard pregnant mothers from theatre scenes, deformities, animial or fowl killing, choreaic movements, fits, appalling accidents, death, or anything of an unfavorable nature that would be likely to impress her keenly or acutely. Defects or mutilations may also be classed under the same causes. Imbecihty, an abrogation of the facial angle of forty-five, or idiocy, is likely to be due to the use of whiskey and tobacco by the father, the former causing true imbecility, the latter wiping out the typical convolutions of the brain. As a rule, all extra fingers, and toes, and other malformations, should be rectified at birth. To7igue-Tie. — The tongue may be unnaturally adherent to the sides, or to the under surface of the mouth, so that nursing may be prevented. The adhesions must be carefully and cautiously divided with a bistoury and the bleeding controlled by the perchloride of iron. Genuine tongue-tie is when the bridle of the tongue is so short as to reach nearly to its tip and interfere with its motions. This is to be remedied by dividing the edge of the bridle with the scissors. Hare-Lip, — The simplest degree of this deformity is single hare-lip, in which the lip is fissured on one side ; it may be com- plicated, with partial or complete fissure of the palate. The greatest malforma- tion of this kind is double hare-lip and fissure of the pal- ate. The arrest ^ * . Diiferent forms of hair-lip. curs only m the upper lip ; the fissure never occurs in the median line, but always under one or both nostrils, and the deformity may vary from a notch to a complete fissure, extending into the nostrils. The only point of interest is the treatment. The operation for the relief of this difficulty should be performed immediately after birth. The child, after being properly nourished, should be wrapped up in a sheet ; the edges of the cleft should be liberally pared, and then hare-lip-pins inserted two-thirds the thickness of the lips, from its anterior face. A sufficient number of pins should be used, and over each the figure 8, formed of lead wire, which should have the preference to silk. »#^S^ ^-,2 DISEASE GERMS. Cleft Palate is often associated with hare-lip, and frequently closes when the lips are healed. The operation for this has generally to be delayed till patient becomes ten or fourteen years of age, or even older. Wry-Neck. — A distortion in which the head is drawn to one side, and the face to the opposite ; due to contraction of one sterno-mastoid muscle. Paralysis of one muscle allows the other to overpower its fellow. Causes, — Blows on neck ; caries of cervical vertebrae ; enlarge- ment of cervical glands on one side ; to the cicatrix of a burn or ulcer ; rheumatism ; gout. Treatment varies much, generally embraces alteratives and tonics, with shampooing, friction, electricity of the paralyzed side. Try every means to improve general health ; all failing, the muscle on sound side to be divided. Knock-knees y due to a relaxation of the internal lateral liga- ments of the knee-joints, allowing femur and tibia to become separated, so that an angular obliquity of the bones results. It is common in tubercular children ; may be noticed before beginning to walk. The best plan is to treat for tuberculse, and resort to every means to build up the general health. Massage, locally, twice daily. Bow-legs belong essentially to rickets, and is generally due to starch-feeding of infants. It can be overcome by a better diet, one containing vegetable phosphates, as corn and oatmeal mush, boiled white-fish, animal food, etc.; keeping patient off his feet, and in addition, using locally, massage, salt-water baths, and general treatment for tuberculae. Perseverance is essential, as many months are indispensable for a cure. Club-Foot. — A gradual change in form and positions of tarsal bones, chiefly owing to undue action, or paralysis of certain mus- cles, or their atrophy, or want of development, or to contraction of tendons. Usually congenital, and dependent on same causes as other malformations; or it can be acquired' by conditions affecting either the circulation of nerves, or growth of muscles. There are quite a number of varieties, but for all practical pur- poses they may be embraced under four principal heads. (i.) Talipes Equinus : This is the most common form, and consists either in a rigid contraction of the tendo-achillis, of the muscles of the calf of the leg, so that the heel cannot be brought to the ground, and the patient walks on the metatarsal bones. When this is not congenital, it is h' able to occur during dentition, from worms, acidity and other reflex causes of irritation. The patient, either from incompatibility or other causes, is very tuber- cular; and the slightest irritati^m in the body is transmitted to BACTERICIDES. ^33 the weakened nerves. A cure is easily effected by a division of the tendo-achillis under the skin. (2.) Talipes Varus : The heel is raised, the inner edge of the foot is drawn upwards, and the outer edge rests on the ground. In extreme cases, patient walks on dorsum of foot and outer ankle. There is contraction of the muscles of the calf and ad- ductors of the foot. Every tendon that aids in producing the deformity should be freely divided under the skin, and, last of all, the tendo-achillis. (3.) Talipes Valgus : This is the direct reverse of the talipes varus. The outer edge of foot drawn upwards, so that patient rests on inside of instep and inner ankle. All the tendons that are concerned in producing the deformity are to be cut under the skin. (4.) Talipes Calcaneus : Elevation of the toes and falling on the heel, so that the patient walks on the latter. This is usually brought about by loss of nerve-power, or degeneration of the muscles of the calf, which affords the opposing muscles a chance of drawing the foot into the abnormal position. Every tendon to be divided subcutaneously, so as to bring the foot into its proper position. The principle upon which the tendons of the various muscles are divided is very simple : A cut, or incision, is made under the skin, so as to prevent any suppuration ; the cut surfaces, or ends, although stretched apart quite a space, heal by connective tissue or lymph, which lengthens the tendon the amount desired. It is necessary to wear a boot if performed at birth, as it ought to be, or a week after. When not congenital, but coming on during childhood, many cases can be cured without operation by the removal of the source of the irritation, by good food, fresh air, sea-bathing, tonics and by shampooing, friction or massage, with oil, and a proper use of bandages, splints, boots, adhesive plasters and the like. Rheumatism and gout should be carefully guarded against. We cannot too strongly insist upon a most constructive treat- ment as the best means of overcoming the true cause of the difficulty. Flat Foot. — A sinking of the sole of the foot from relaxation of the supporting ligaments. Walking is rendered awkward, slow, painful, and in bad cases, lameness and deformity. It is usually the result of debility, and can be remedied by the mother when the child is quite young, by bathing, friction and good nutrition. Webbed Fingers and Toes. — In rectifying this malformation, the best plan is to make a small incision at the junction of fingers 534 DISEASE GERMS. or toes, through which introduce a piece of lead ribbon which should be permitted to remain about ten days, so as to give ample time for healing. Then remove and slit up the web its entire length, and dress with the lead ribbon, or otherwise. If the above method is not observed the webbing often returns. The Nutrition of the Infant. — Milk is the natural food of the infant up to the period when it is supplied with teeth for masti- cation. Its stomach is adapted solely for its digestion, and it is the only proper element for building up the body. Milk, if healthy, supplies everything for the whole organism, from which bone, muscle, brain, gland, etc., can be constructed, repaired and renovated. Milk is pre-eminently suited for the rapid oxidation, increased temperature, accelerated respiration and circulation, the only diet for building up infant organization. The milk taken by the child represents so much potential energy ; but before that energy can assume a vital form, the food must be converted into tissue, and in that conversion a large amount of energy must be expended. All the constructing and repairing powers in the in- fant are more active than in the adult. The infant requires, over and above the wants of the man, not only food for flesh laid on, but also for the energy used in making up that living, sculptured flesh out of materials that serve for food. In the growing organ- ism- there is a greater instability in the nutritive process, and this instability, must be guarded against by having good milk, else we will have defects in blood formation. American mothers have been accused of being bad nurses. Now, this is both true and false ; true, she is highly civilized, quick, excitable, and often, in the act of nursing, allows care, worry, to distract her attention ; will hastily lay her little one down before it has even partially emptied the breast, which act of all others causes the milk to dry up ; trne, she is absorbed in lectures, theatres, balls and other frivoli- ties, which engender late hours and irregularity, which has a de- pressing effect upon her; and her literature is not good ; true, her diet is not the proper kind or quality for a nursing mother, her ices, ice-cream, iced drinks, candies, pastry, etc., are pernicious and highly detrimental to the secretion of milk ; but let her re move these and other defects, she is as good a nurse as any other mothers of her race. Take the American mother, free from toil, care, struggle for existence ; free from the vices and depressing influences of city life, with a good diet of beef, mutton, poultry, game, eggs, milk, oatmeal porridge, corn-bread, carrots, parsnips, fruit and other vegetables, she is a good nurse. Excess of feed- ing, alcoholic or malt liquors, wines and sloppy food, never should be recommended ; neither is tea nor coffee of any utility. The nutrition of the child is of the greatest importance, be- BACTERICIDES. 535 cause in all our large cities we lose two-thirds of our entire infantile population during the first two years of existence, chiefly By bad milk, careless or improper nursing, insufficient food, and insanitary conditions. The mother's milk is too often deteriorated by fashion, theatres, improper food, worry, work, and other causes, and the want never can be supplied by artificial means, for there is no substitute for the life-giving mother's milk. If we could only teach mothers how much suffering they could save, how many valuable lives they could prolong, by seing that their children have proper food, it would be a holy task. Many modern mothers can only nurse their children partially,* or not at all. Their milk is often deficient through improper diet, and not emptying the breast properly; besides, the secretion decreases by care, worry, struggle, work, or her health may be feeble or delicate ; or her vital energies taxed by some latent condition, that she may have no milk. In this condition the infant must have nourishment ; if rich, a wet-nurse could be provided ; if poor, the cow's milk, or milk-food. As regards wet-nurses, there is always great danger to be ap- prehended from them in a moral and physical point of view. They are generally unfortunate women, women with hidden vices, uneducated, full of prejudices and disease, and the irregularity of their past life has a bad influence on the rnilk and moral well- being of the child ; and it is doubtful, rather than run risks of moral and physical degradation, whether artificial nutrition, administered by its own mother, or some other intelligent person, properly adapted to its age and development, is not the best. Artificial nourishment is often better than run the risk of wet- nursing. The great trouble of late years, in this particular, has been that parties, by advertisements and certificates of ignorant physicians, have foisted upon the people an immense array of infant food, all chiefly composed of starch. Indeed, starch-food is forced upon the mother wherever she goes, as a diet for her child. Now, our infants cannot digest starch, their stomachs are not made for it, neither have they the means of converting it into sugar, like an adult ; so children fed upon starch, as rice-flour, farina, Liebig's food, arrowroot, starve ; they have no teeth ; their bones and brain are destitute of phosphates. God never made a Caucasian infant to eat starch ; there is not a trace of it • in the white mother's milk. A Mongolian or Negro, without cerebral convolutions, may thrive on it, but never the white race. So, if there must be artificial feeding, let us have cow's milk or milk-food ; and with greater care, more fresh air, rigid cleanli- ness, abundance of sleep, an avoidance of insanitary states and contagious diseases, we may be able to raise the child. 536 DISEASE GERMS. The proper food, then, of all infants, is milk. That gives everything wanted — development and growth ; on it they are healthy and thrive. The first two months of life, cow's milk* two-thirds, water, one-third, with very little sugar, comes very near, that of mother's milk. There is still a difficulty here: if a cow is fed on pasture alone the milk is very poor ; but if they are fed with corn-meal and bran, in addition to abundance of good pasture, the milk is excellent; and besides, it must be seen that the cow is free from foot-disease, or tuberculosis, and the milker not affected by syphilis. In all our large cities there is much impure milk — milk loaded with diseased germs ; besides, nearly all the high-bred cows are affected with tubercle ; so if matters are not of the purest kind, condensed milk should be used : for in the process of manufacturing, the diseased germs are destroyed. About the third month nourishment should be more substan- tial ; for that is the period for true, rational nourishment to be given for the future welfare of the child. The Racine Malted Milk Co., Wis., has placed bef -re the American parents a nour- ishment for children at this period that is unsurpassed, and satis- fies all the phy.'=iological and chemical demands. It consists of the best milk, the wheaten phosphates, no starch, best cane-sugar, and a normal quantity of saline matter. The combination is perfect, and the most appropriate for infant-food, and of immense value as an article of general nutrition. It is highly nourish- ing, its composition is pure, fresh, superior to anything ever introduced ; it is very easily digested ; keeps well, never fer- ments or sours ; and is better than city milk, because it is free: from all diseased germs. Besides, it nourishes brain and bone well, consequently teething is easy; excellent for debility ; chil- dren and invalids never tire of it, but rapidly increase in flesh and strength upon it. It is so excellent in teething that they come easy, regular, without suffering; no diarrhea, or vomit- ing, or skin eruptions. It supplies a long- felt want, to wit : a per- fect form of artificial nutrition — the best that has ever been offered in the world. The milk-food is intended to be used when the infant is about from two to three months old. Its superiority consists in its containing no starch, which has been so detri- ■ mental to the digestion of children ; and to the fact that bone and brain elements in it are abundant. As soon as the child has completed its dentition, the mouth, salivary glands, stomach, and pancreas become gradually adapted to digest solid food, and a change or transition from milk food should be very progressively made. Modern children are per- mitted by both parents to take the ordinary course of the house, BACTERICIDES. -37 Avhich is a great wrong on the part of the parents. For exam- ple, the use of tea and coffee by children is very injurious, as it overstimulates and exhausts their nervous systems ; gives rise to catarrh of the stomach in their period of infancy, and pre- disposes them to dyspepsia and cancer of stomach in more mature years. The use of sweets, ice-cream, pastry, dumplings, is also improper food, because the gastric juices are not strong enough for their dissolution; so also with pork, veal, cabbage, nuts, salt fish, and corned beef, totally unfit for the diet of a child. Children should be early taught the injurious effects of drinking at meals. Whatever fluids are necessary should consist of milk or water. A new system of dietetics should be inculcated, or rather, an old method revived, among the children. All, irre- spective of sex, or condition in life, should, from weaning, up till twenty-one years of age, have a special diet — one of brain and bone-elements ; one hearty meal daily of oatmeal porridge and milk or cream. This should be a daily meal from September ist to May 1st; during the very hot months of the summer, better to discontinue its use, as it is somewhat heating. Corn-bread, made without baking-powder, should be a daily and staple article of diet ; boiled white-fish and home-made bread. Bakers' bread, with its noxious compounds of soda, tartaric acid, alum, sul- phuric acid, etc., is unfit for child-food, as the phosphates are destroyed in the process of whitening. The oatmeal, corn, and fish diet should be insisted on, as calculated to promote the nutri- tion of brain and bone. No baking-powders should be tolerated in the culinary department of any family, as their use is destruc- tive to the phosphates in all our cereals. To the toothless babe starch diet is starvation, but after dentition is completed they can digest starch ; but in our climate, with its highly oxygenized atmosphere, our children do not require much starch-food, such as potatoes, arrowroot, tapioca, rice ; there are no brain elements in them — not of thought ; they are converted into sugar, and thus into calorification — a process not very essential to the pre- cocious American ; so, as a rule, they should be sparingly fed. Carrots, parsnips, onions, vegetables, and ripe fruit generally are conducive to health and longevity in the child. The Child — its care and cidture, warding off and curing its dis- eases, must be carried out on physiological principles. In look- ing at the dawning intellect, we must remember that mind is brain-function, just as locomotion is one form of muscle-function. The brain, as it matures, acts, thinks, reasons, judges, and forms purposes. As the size, weight, form, and development of the bony skeleton, with its muscular apparatus, determine the limits and nature of physical power and activity, so do the size, weight, 538 DISEASE GERMS. form and development of the brain, with its apparatus of sense- organs, determine the Hmit and nature of intellectual power and activity. Its personal characteristics are passed down from the parents ; so that there are mental and moral qualities offering themselves for care and culture. The aggregate qualities of the parents, embodied in the child, are subject to surrounding influ- ences. It is essential to recognize this initial fact, so as to develop the good, and repress the evil elements of its nature. Every child is charged with potential energies that need to be stimulated for good, trained and taught in a manner and upon a principle peculiar to her or himself; the influences brought to bear upon it ; the tasks imposed ; the exercise of its body and mind — its regime, selected and graduated to its undetermined nature, and its special needs. A partial death of a portion of the body, Inflammation, and involves a condition of vital depression, and degradation of the bioplasm of the part. The causes are very numerous, and embrace everything that diminishes, damages, or tends to destroy any part of the body, such as heat, cold, wet, poisons, depressing passions, mechanical violence, etc. The permanent symptoms of inflammation are pain, heat, i^ed- ness, swelling. Pain is a symptom of partial death, of deficient vitality, or vital depression. It differs in structures and tissues according to their physiological function, chemical composition and anatomical structure. The nerve-tissue being intrinsically the most valuable, most highly organized, and vital, is the most resisting, the most diffi- cult to depress, and when once devitalized the most tardy of all structures to regain its vitality. The pain also, when it suffers a partial death, is out of proportion to all other pain, especially so if the brain has suffered the shock ; here it is frontal, and aggra- vated by noise, light, heat and motion. If the skin suffers a partial death or inflammation, the pain is burning, tingBig ; if the cellular tissue, throbbing ; if the serous membranes, like pleura, sharp, lancinating ; if the mucous mem- branes, sore, raw ; if in bone, dull, deep seated ; if in cartilage, more intense. Pain may not be experienced in the inflamed part, but reflected by recurrent nerves to a part at a distance, as for in- stance, in inflammation of the liver the pain is in the shoulder ; of the kidney, at the orifice of the urethra ; of the ovary, in the BACTERICIDES. cog front of the thigh; of the uterus, in the sacrum; of the hip-joint, at the knee. The heat of inflammation is caused by the semi-vital chemi- cal change, the passage of organic into inorganic matter, the per- version of nutrition, rapid oxidation, molecular excitement and general metamorphosis of structure. The congestion and redness are due to the lost contractility of the walls of the blood-vessels, whereby their walls become loose and lax ; the blood rushes in and the minute capillaries being also relaxed, i^ed blood circulates where white only passed through, and the walls being so relaxed the more watery portion passes through their walls. The blood-vessels owe their con- tractility to the nerves that supply them, so the vitality of the part or its nerves being so weakened permits of the changes ; indeed, its chemical character is altered ; in health neutral or alkaline, it is in inflammation intensely acid. Besides a change in secretion, there are important changes in the structure of the part, as degradation of living matter into disease-germs which cause it to spread. Inflammation has but one genuine termination ; resolution or recovery; the subsidence of the inflammation and the restoration of the part to its original condition ; but besides this legitimate termination, there may take place from various causes the follow- ing effects, viz.: Effiisioii of serum, effiision of blood or hemor- rhage ; effusion of lymph ; the breaking of lymph and formation of pus ; ulceration ; gangrene, or mortification. Inflammation miay be either acute or active, sub-acute or pas sive, and chronic. It is called acute when it sets in and runs its course rapidly, when the symptoms are all well defined and are accompanied with rigors and fever; sub-acute, same as the acute, with the exception that there is no fever. Chronic may be either a sequel of an acute or sub-acute attack, or it may come on per se. ■ It is liable to occur in patients of low vitality. It usually progresses slowly, insidiously ; symptoms not well defined ; no fever, and has a tendency to terminate in eff'usion of serum or thickening. Each form of inflammation is characterized by a special microbe of its own, which renders all inflammations to a degree conta- gious and infectious. The permanency of the pain, heat, redness and swelling is the best point by which to recognize inflammation. The correct treatment of all inflammation is powerful local and internal stimulation. A stimulation so powerful and so effective that will run the case in resolution. The local stimulants should be of such a character that they will stimulate to the point de- 540 DISEASE GERMS. sired and still not impair or destroy in any way the future in- tegrity of the tissues ; induce contractility of the blood vessels and overcome partial death. The class of internal stimulants of most utility are exalgine, aconite, veratrum ; these tend to lower tem- perature by checking the chemical metamorphosis, vivifying and toning the vessels. No case of inflammation can be treated with success without the use of bactericides; even ordinary bacteria of malnutrition require to be killed. If the largest dose of an arterial sedative, warranted by the nature of the case and good judgment of the physician, does not ameliorate the pain, then the impressibility of the sensorum must be blunted by anodynes to secure an entire freedom from pain. General attention should be directed to hygiene, rest, diet, sponging and secretions. If it is impossible to secure resolution by these means, then the case will terminate in either one or other of its six lermina- tioiis or effects. Effusion of seruui may occur during inflammation of any tissue, but by preference from serous membranes, as the periosteum, membranes of the brain, the pleura and peritoneum ; the cellular tissue is also obnoxious to serous effusions. When effusion of serum takes place, whether it be from membranes of the brain, pleura, peritoneum, or cellular tissue or other structures, it con- stitutes what we term dropsy, not a disease, a mere mechanical effect. Serouseffusion, however, often gives rise to much trouble, especially if within the cranium, chest, or abdomen ; in the extremities it constitutes what we term oedema or dropsy, pitting upon pressure. Although not a disease, its presence is liable to bring about grave complications, and it must be got rid of at the very earliest moment the inflammation can be overcome. The serum effused in the process of inflammation is a fluid of pathogenic microbes, of which neither the origin, kind, nor quantity can be accurately ascertained. These microbes exercise a morbid effect on the adjacent tissues, and constitute a febrile element in the body. To get rid of serous effusion, the appetite should be stimulated with tonics, as teaspoonful doses of compound tincture of cin- chona, before meals, and the very best of blood-elaborating diet given. Before making any decided attempt at the removal of the dropsy, place the patient upon an infusion of digitalis for a {^^ days. To half a pint of water, boiling briskly, add one or two grains of fresh pulverized digitalis, boil for five minutes, then cool and administer one wineglassful every two or three hours ; continue from day to day till the patient becomes quite BACTERICIDES. 54 1 melancholy or despondent, then administer less frequently and in smaller doses. Now is the opportune moment to commence with diaphoretics, diuretics, and hydragogue cathartics, just as the digitalis has unlocked the flood-gates of the body. Then take of Pulverized mandrake, thirty grains ; pulverized nitrate of pot- ash, one drachm ; cream of tartar, one ounce. Mix. Make ten powders, and let the patient take two or more daily, so as to cause at least three watery evacuations from the bowels in the twenty-four hours. In addition, a teaspoonful of the fol- lowing mixture should be taken thrice daily, in a glass of water : Camphor water, four ounces ; nitrate of potash, half an ounce ; muriated tincture of iron, one ounce. Mix. At the same time an alcoholic vapor bath should be given every other day. As a drink, to encourage free sweating, an in- fusion of jaborandi or pleurisy-root. Patient kept moderately warm and clothed in flannel. If the above means fail, discontinue the mandrake mixture and substitute a pill, one-twelfth of a grain of elaterium. If the patient is unable to bear such active remedies, five-grain doses of iodide of potassium should be given in a tablespoonful of fluid extract of saxifraga. Other remedies, as infusion of hair- cap moss, buchu. Treat effusion or dropsy in the extremities in the same man- ner, with the addition of rest, elevation, compression by rollers, friction, shampooing, steaming with medicated vapors, elec- tricity. (See Dropsy}) Effusion of Blood. — Hemorrhage, as a result of inflammation, may take place prior to or during its activity; or the inflamma- tion may so terminate. Organs that are freely supplied with blood-vessels, when they suffer a partial death are more liable to have hemorrhage occur in them than others, as the lungs, stomach, bowels, kidneys, bladder, urethra, uterus. In the treatment of hemorrhage as a result of inflammation, the main point is more thorough arterial sedation, more active local stimulation. If from the lungs, large doses of veratrum viride ; if from the stomach, rectum, kidneys, or uterus, the green root tincture of gelsemium, and digitahs. If the hemorrhage is violent, styptics may be resorted to, but the true principles of treatment of inflammation should never be lost sight of. Salt, iron, gallic acid, digitalis, matico are useful if from the lungs ; capsicum, salt, gelsemium, if from the stomach ; r^2 DISEASE GERMS. erigeron, gallic acid, ergot, corn smut, if from the kidneys or uterus. In surgical operations, the vessels should be ligated ; still there are often minute capillaries that bleed. Then carbolic acid spray, exposure of the bleeding surface to the air, pressure by bandages, cold, perchloride of iron, matico, spider web. Effusion of Lymph. — This is a very common termination of chronic inflammation, still there can be little doubt but that it is present in all forms. When it takes place, it causes induration, thickening, adhesions, mechanical obstructions. In surgical practice, the greatest ingenuity has been exercised to procure effusion of lymph for the purpose of cementing or joining parts. For this purpose all foreign bodies are re- moved. Catgut ligatures are used. An antiseptic spray flows upon the wound to destroy degraded matter or bacteria. Me- tallic sutures and antiseptic dressing are extensively employed. Effusion of lymph for the purpose of repair can only take place when there is total absence of pain, and when the vital forces are normal. Lymph is often effused in general inflammations ; in pleurisy, where it forms adhesions ; in inflammation of stomach, thicken- ing ; in canals, forming strictures ; in glands and tissues, form- ing swellings. It is highly desirable to get rid of effused lymph, because if permitted to remain it is liable to break down at any time the vital forces of the individual become impaired, and form an abscess. To cause an absorption of effused lymph our best internal remedies are iodide of potassium, iodol, bromide of potassium, saxifraga, phytolacca, blue flag, mandrake. Our local remedies are green plantain leaves, phytolacca, stra- monium, belladonna, ozonized clay, iodide of potassium, iodo- form, potassa, ammonia. Shampooing, friction, and electricity are very doubtful in their utility. When adhesions have taken place, the continuous application of the irritating plaster is a powerful resolvent, and aids in the breaking down or absorption of the adhesions. The effused lymph, like the serum, contains the spores of the pathogenic microbe of pus. The presence of these spores in the effused lymph may for many years be innocuous, but when softening comes they are capable of provoking septicaemia, which may prove fatal. The Formation of Pus. — Lymph or plasma from the blood is effused to a greater or less extent in all forms of inflammation, but especially in the chronic, and is liable, at any moment there BACTERICIDES. r ^^ is the slightest nervous depression, to break down and become pus — become the bacillus pyocyaneus. This event is invariably ushered in with rigors, but when it occurs during acute inflam- mation, simultaneously with the rigors the pain changes to a tftrobbing or beating, the heat diminishes, congestion and red- ness disappear. When it occurs during chronic inflammation or after inflammation has ceased, it is also invariably preceded by a rigor. The broken-down lymph constitutes pus, an active living deadly microbe, and a collection of pus anywhere forms an ab- scess. The precursor or rigor is followed by the lymph break- ing down in the centre and gradually enlarging, perhaps point- ing, and a sense of fluctuation is experienced to the touch. There are numerous varieties of pus, as, healthy or laudable, when it is thick and creamy ; serous, when it contains water ; sanious, when it contains blood ; curd-like or cheesy, when it contains tubercle ; muco-purulent, when it contains mucus mixed with " purulent matter ; lardaceous, if like lard ; specific, when it con- tains a special living germ or poison ; and putrid, when dark or offensive. The division of abscess into acute and chronic, superficial and deep-seated, explains itself. The moment pus has formed, there should be an assiduous effort made to aid the vital forces of the part in its further pro- gress by the application of heat and moisture in the form of a well-made poultice, which should be continued until the lymph has entirely broken, when a free opening should be made into the part and the poultices continued for a day or two, then dressed with an ointment of vaseline. Simultaneously with the evacuation of the pus and breaking down of the entire amount of lymph eflused, nature begins to throw out lymph anew at the bottom of the abscess or cavity ; this is at once permeated by blood-vessels and nerves ; then another layer which becomes similarly organized, and so on un- til she reaches the surface, when around its edges can be seen a white milky scum, which gradually covers the entire surface. The process of effusion of lymph, its organization or permeation with blood-vessels and nerves, is called the process of cicatriza- tion ; when it is covered over with a new skin or cutis it is called a cicatrix. In order that the effused lymph may exhibit vital elements, the process may be devoid of pain, the pus laudable, and the granulations neither pale nor red. During such a pro- cess of repair the vital stamina of the patient should be well sus- tained with good food. Gangrene^ or Incipient Mortification. — When the vital forces of a part are so shattered that the salutary effort of nature fails in CAA DISEASE GERMS. obtaining resolution, then the process of dving is liable to set in. If it is an internal vital organ, the sudden cessation of pain fol- lowing a high intensity of symptoms, with a typhoid condition supervening, features becoming small and contracted, breath and extremities cold, intermitting wiry pulse, indicate the approach of mortification or complete death. If the inflammation occurs in an extremity and it is about to terminate in gangrene, pain suddenly ceases, the redness be- comes of a livid color, the congestion soft and flaccid. It crepi- tates when pressed upon, from the fact that it contains gase'=;, the productions of putrefaction and a train of typhoid symp- toms. In gangrene, when the parts yet retain a certain degree of vitality, the object should be to arrest the occurrence of morti- fication. Internal stimulants and antiseptics, as brandy and quinine, yeast; and locally poultices of charcoal, yeast, capsicum, wild indigo weed with carbolic acid, changed frequently. If this poultice does nothing in arresting the condition it will at least stimulate a line of demarcation between the living and dying part. Such a line usually makes its appearance in the form of a red blush, which soon rises into a blister; this soon ruptures, forming a line of ulceration with a furrow. In the treatment of all forms of inflammation, the most decidep and energetic measures should be resorted to ; internal and local stimulation should be the rule, in order to prevent the process of dying (gangrene) or complete death (mortification) from tak- ing place. Partial death of bone may arise from injuries; Infiammation poisons, as phosphorus; from the microbes of Bone. of rheumatism, syphilis and the tubercular bacilli, etc. The usual termination is effusion of lymph, in which we find the spores or seed of the saprogenes blended with other germs. Spores may be absorbed or break down, giving us caries and necrosis — ulceration of bone. Symptoms. — There is a deep-seated, severe, dull pain, with swelling of the soft parts, rigors and fever; if acute, the parts slowly enlarge, tenderness increases, with weight and pain. If it proceed to ulceration (caries or necrosis), there are rigors, and pain changes to a throbbing. The treatment embraces rest; control fever with exalgine, keep bowels open, and skin active ; local stimulants in the form of hot packs during the day, and the chloroform liniment at night. As soon as fever is controlled, iodide of potass in compound syrup BACTERICIDES. 545 stillingia ; keep patient under it for some months. If rigors and a throbbing have taken place, poultice, and as soon as indica- tions of pus formation are clear, free openings. If an opening, or several openings, have taken place, run them into one, so as to give nature as little work to do as possible. Inject with various solutions of peroxide of hydrogen. Abscess is rare, the condi- tion being a breaking down of lymph in the substances of the bone, giving us caries or necrosis. Either of these conditions can be easily detected by a gritty or sandy feel of the pus. In all cases general alteratives and tonics ; best of diet, with an ex- cess of phosphates, as oatmeal porridge, cream and boiled white- fish. The periosteum being fibrous tissue Inflammation of the is liable to suffer a partial death from Covering of Bone. various microbes, as bacillus of syphi- {Periostitis.) lis, tubercle, rheumatism, and from injuries. Whether it be of microbial origin or not, there is invariably a disease germ present. It is easily recognized by the history of the case, and the sharp, lancinating pain present. By killing the microbe, resolution may be effected before the streptococcus pyogenes appears. Any powerful germicide, which will not destroy the tissues, should be applied, as the oil or fluid extract of lobelia ; resorcin in ozone ointment ; iodol. No class of diseases are so interesting as Inflammation the various affections of the brain. The fact of the Brain, that the brain wears out sooner than it used Acute. to do, under what is termed civilization, and that its health and vigor, and even the pro- duction of disease in it, depends on the development and healthy condition of the great sympathetic, are highly suggestive. In women, children and all races outside of the Caucasian, the ab- sence to a great extent of cerebral disease can only be accounted for by the rudimentary condition of the sympathetic. The effects of isolation and sameness, or monotony, in causing contraction of its convolutions, thus causing epilepsy and insanity, and the action of blood poisons, are also of great moment in reducing the angle of longevity of our race. The study of brain diseases is not suffi- ciently advanced to enable us to elucidate all the points clearly ; neither are we yet able to distinguish correctly between inflam- mation of the substance of the brain and that of its membranes. 35 546 DISEASE GERM^. Indeed, they cannot be really separated, although it has been attempted. A partial death of the substance of the brain may depend upon two general conditions. It may be due to causes within the body, such as depressing emotions, desires, affections, passions, the struggle for existence, or excessive mental strain, religious excitement, blood poisons, or it may be due to blows, falls, shocks, concussion of the brain or fracture of the skull. In the former case it is said to be idiopathic ; in the latter, traumatic. As brain substance is intrinsically the most valuable tissue in the body, it is the most difficult to depress and the hardest to establish a re- newal of life in ; so that in the idiopathic form, the stage of Section of brain : horizontal section through the brain to show the mode in which the two hemispheres, a, a, are joined together by the transverse band of white matter called the Cor- pus Callosum. In front and behind this the longitudinal fissure b sepa- rates the two hemispheres; b, b, is the sect. on of the cortical substance; a, a, of the medullary ; the section also shows the depth of the suki be- tween the convolutions. The brain : upper surface of the brain of man, showing its subdivision by the longitudinal fis'-ure into two lateral hemispheres, right and left, also the chief sulci and convolutions. The fis- sures of Rolando are the oblique fis- sures which commence near the mid- dle line and proceed outwards and forwards, marking off the frontal lobes, a, a, from the parietal lobes, which lie behind those fissures The occipi- tal lobes forming the posterior extrem- ity of the hemispheres completely con- ceal the cerebellum. shock or incubation is often for a number of years, and in the traumatic form, quite a good while ; even in ba;i fracture, with compression, a week or more often elapses before active symp- toms of inflammation set in. After the brain has received the shock, there is then an inter- vening period before the rigor and active inflammation, and dur- ing that time the patient is irritable, restless, peevish, sleepless, complains of heats and colds, burning in the skin, secretions are arrested, great lassitude, peculiar idiosyncrasies, great disturbance of the mental faculties, and there is a characteristic pain in the head, usually frontal, aggravated by noise, light, heat and motion. There is also intolerance of light, slow pulse, want of appetite, tongue dry, with white and brown coat, skin white. BACTERICIDES. ^.-t These premonitory symptoms , become more intense daily, when, if the inflammation is about to take place, the patient is seized with the most violent rigors and a high fever ; pulse hard and frequent, strong pulsations of the carotid and temporal arteries, headache intolerable and throbbing, eyes suffused, face congested, tongue dry and brown, bowels obstinately constipated; stomach rejects everything, secretion and excretion arrested; besides, there is apt to be violent delirium, coma, convulsions, paralysis, pupils contracted to a pin's point, articulation difficult or indistinct. If not relieved at this point, then pupils become dilated, the eyelids drop (ptosis or squinting), or paralysis of muscles of eyelids, frequent twitching of muscles, ghastly coun- tenance, sordes on gums and teeth, cold sweats, relaxation of sphincters, convulsive paroxysms, paralysis, profound coma, which usually soon ends in death. In some cases, the first symptom of an attack is convulsions, preceded by very slight premonitory symptoms that are often unnoticed. Convulsions, strong and severe, may be followed by coma, which is soon fatal ; or it may recur frequently at short intervals, and pass into coma at the end of twenty-four hours. When nausea and vomiting are the earliest symptoms, inflamma- tion has its origination in the cerebral pulp. When attacks begin with convulsions, the affection has started from the arach- noid or pia mater ; or, to be more explicit, if the inflammation involves the cortical substance and membranes, early derange- ment of the intellectual faculties, irritability, constant agitation ; if the medullary substance, chills, headaches, convulsions, great lassitude. The medullary substance of the brain is merely the passive servant of the cineritious substance, the conductor of its de- mands to the muscles. The gray presides over intellect ; the white, over movements. Rigors taking place during the active inflammatory stage, with squinting or dropping of the eyelids, palsy ; contraction of one pupil and dilatation of the other, indicate extravasation of blood into the brain and an unfavorable termination. Acute inflammation of the brain may terminate in any of the ordinary results of inflammation, but its common termination is effusion of blood or extravasation of blood on or in its substance, or recovery by the slow process of chronic inflammation. The hemorrhage is termed red ramollissement. In the recognition of acute inflammation of the brain, its his- tory, all the symptoms prior to and after rigor, the fever, intel- lectual condition, eyes, face, arrested secretions, and especially the headache, must be noted. True, there may exist compli- 548 DISEASE GERMS. cated phenomena during life, according to what extent the vari- ous structures are involved, but the leading symptoms are a good land-mark. Treatment. — At the earliest possible moment energetic treat- ment should be resorted to, to aid a renewal of life in the brain. For this purpose the patient should 6e placed in the recumbent posture in bed, head and shoulders well elevated, and in an apart- ment away from noise, heat, and pretty well darkened ; head to be shaved and towels kept constantly wet with hot water to be wrapped around it. The back and sides of the neck, down the back and over the shoulders should be dry cupped ; a roller, eight yards long and three inches wide, saturated with mustard of the consistency of cream, should be applied from the great toes to the knees, wet occasionally with fresh mustard and re- applied. Two to three drops of tincture veratrum viride should be given every fifteen or thirty minutes until pulse is seventy, and then continued at longer intervals of one, two or three hours, as indicated. Free purgation must be resorted to. For this purpose, twenty grains of compound powder of jalap and senna, with one drop of croton oil rubbed into it, should be given, and the same dose repeated every one or two hours, or often enough to keep the bowels open twice or three times a day — the croton oil to be left out after the third dose. Another important indication is sleep. It is very likely the patient has not slept for a long time. Then take twenty grains of the solid English extract of hyoscyamus with three grains of pulverized opium, ancf rub both up in a mortar until a fine powder is pro- cured, then add a drachm of sugar of milk ; mix well and divide into twenty powders, and give one every hour until the patient sleeps. If, after three or four are administered, there is no sleep, double the dose for three times, and if that fails, increase still, but very carefully, never to exceed five to one dose. If this fails, try sulphonal in twenty-grain doses and increase. If sleep and a pulse of seventy can be reached, by further good management, the patient is safe. On no account resort to chloral hydrate, opium, hypodermic injections, as they are totally contra-indicated. If arterial sedation and sleep can be procured, still persevere for some time with the above. Give little or no diet for several weeks ; barley or cracker water ; oatmeal gruel and the like will suffice. As the patient improves, other remedies to aid the salutary effort of nature may be tried, as bromide of potass, aconite, belladonna, lobelia. The bromide does good work given in the following manner : Camphor water, four ounces ; bromide of potass, one ounce ; BACTERICIDES. 549 bromide of ammonium, two drachms; bicarbonate potass, three drachms. Mix. Dose, one teaspoonful thrice daily. Just as the fever subsides is the best time to commence with the aconite and belladonna. A teaspoonful of the tincture of each in half a tumblerful of water; a teaspoonful ev^ery one or two hours. Belladonna, like bromide of potass, has ah anesthetic action upon the cortical substance, the quadrigemina tubercula and the membranes which aid in the removal of congestion. It will also be found advantageous in many cases to alternate them with lobelia in full form, as often as every two or three hours. Pills of pulverized green lobelia are slower in absorption, and less likely to induce nausea. Lobelia is a depressant and sedative, has a decided influence in all cerebral engorgements ; it dimin- ishes respiration, heat, pulse, and abates inflammation. With these and other means that the peculiarities of the case will sug- gest, we try to aid nature in controlling inflammation of this vital organ. The general principles of treatment of fever must be carried out, as to bathing, recumbent posture, heat to feet, great quietness, etc., and run the case into one of chronic inflam- mation in which our remedies are more numerous, and embrace alteratives and tonics, rest, change of air and a very cautious use of food. Is a condition in which we have a low Inflammation grade of irritation. It is apt to follow an of The Brain, acute attack, but more frequently it is an in- Chronic, dependent primary disorder. Its causes are very various : shocks, jars, concussions, blows, falls, railroad traveling, action of the sun, mental strain, worry, struggle for existence, study, depressing passions, as grief, sexual excesses, whiskey, tea, coffee, tobacco, quinine, opium, chloral and other drugs ; besides, the blood poisons, as rheumatism, gout,' syphilis, tuberculae, may, with numerous other conditions, be enumerated as causes. The vices or defects of civilization operate disastrously upon the brain, as well as insanitary states and diet. Its symptoms are much diversified : pain in the head, aggra- vated by noise, light, heat, motion, with irritability, restlessness, sleeplessness, with heats and colds, with mental depression, dis- turbance or idiosyncrasy, pallor or whiteness of the skin, anxious expression of countenance, arrest of secretions. There is often vertigo, specks or spots before the eyes, ringing or noises in the ears, unsteadiness of gait, hesitation in speech, stammering, stiffness of muscles, loss of appetite, irregularity of pulse, delu- 550 DISEASE GERMS. sions ; subsequently symptoms become more marked ; memory fails, senses become impaired, paralysis, general breaking down of health. Its duration is very indefinite and it has a marked resemblance to insanity, once fairly established. In the treatment we must insist upon rest, freedom from care and worry, and an avoidance of all the causes, such, as jars, mental work, sexual indulgence, the use of tea, coffee, tobacco, alcohol, opium. The secretions should be stimulated, bowels moved twice daily with mild but efficient remedies, as cascara, neutralizing mixture, daily tepid bathing, followed with the shower-bath ; hair short, head cool, feet warm. Bitter tonics to promote an appetite and ameliorate the more prominent symp- toms. Sleep should be procured, and, if possible, prolonged to ten or twelve hours in the twenty-four, by the repeated and per- sistent use of hyoscyamus, thus : Solid extract hyoscyamus, English, thirty grains ; powdered opium, five grains ; powdered licorice, sixty grains. Mix. Make twenty powders. At least three or more daily, beginning in the afternoon and continuing on one or two hours apart until profound sleep is induced. Three times per week two small fly blisters, size of an ordinary visiting card, should be applied below nape of neck, top of each shoulder blade, for six hours at a time; or the irritating plaster or tartarized antimony in basilicon ointment. The idea being, as our people are affected with tuberculae to the extent of seventy-five per cent., and syphilis to the degree of fifty per cent, of our entire population, to attract or draw those two germs from feeding on the brain. There can be little doubt but that tuberculse and syphilis are at the source of at least seventy-five per cent, of all cases of chronic inflammation of the brain and insanity. An invaluable remedy here is the bromine, as already laid down. But the best plan is, to keep the patient upon a general alterative course with bitter tonics until all vestige of inflammation ceases, such as compound syrup Phytolacca ozonized, or saxifraga, glycerite of ozone, and when pain has ceased and natural repose is obtained, then such remedies as ozone-water, preparations of cinchona, com- pound hypophosphites of lime ; soda should be given in small doses. The diet should consist, as much as possible, of the chemical elements of the brain, as oatmeal, boiled fish, rare beef-steak, etc. Change of air of utility. Other remedies sometimes used with advantage. After the pain in the head is relieved, and the patient sleeping for ten or twelve hours every night, appetite returning, then the glycerite of ozone or kephaline should be administered persis- BACTERICIDES. 551 tently. Those two preparations promptly relieve the prominent symptoms, as the dizziness, mental depression, loss of memory and impaired intellectual faculties. They invigorate rapidly and remove that feeling of nerve-tire or exhaustion which is so dis- tressing. Induration of the Brain. — Effusion of lymph — one of the effects of chronic inflammation. The indurated portion of small extent presents the appearance of wax, or white of ^^^ boiled hard. The symptoms are often obscure, but it causes loss of memory, confusion of thought, derangement of mental powers, loss of appetite, desires, affections, passions, and paralysis. Abscess of the Brain. — May be the result of the induration or" some injury or disease of the ear and temporal bone. It may be acute, and severe cerebritis may be present, pain in the head, vomiting, fever, delirium and coma; or chronic , ^\\}i\ insidious headache, dulness of intellect, sometimes hemiplegia, which comes on gradually; it may end in convulsions and death, abscess bursting into ventricles of brain. The treatment is general alteratives and iodide of potassa. Softening of the Brain, Red and White Raniollissevient — the word ramollir meaning to make soft. During acute inflamma- tion an extravasion of blood taking place in or on the brain is ca led red ramollissement, and if it amounts to three or four ounces is usually fatal. From obstruction, calcareous disease of vessels, embolism and other causes, it may take place, and be absorbed, or the portion of brain in which it took place may be reduced to the consistency of cream. The most common form is the anaemic or white, that caused by imperfect nutrition or blood suppy, due either to wearing out of the brain by overwork or excess, or arterial or other forms of degeneration. There may or may not be pain in the head ; likely to be sudden and occasional attacks of vertigo ; diminu- tion of intellectual power, slow and hesitating speech, embarass- ment in answering questions, depression of spirits, tendency to shed tears on any excitement. Pricking and twitching in limbs, perhaps pain or numbness ; tendency to sleep, especially after meals ; more or less impairment of senses, mental faculties im- paired, appetite often good, even greedy ; limbs become the seat of painful cramps, stiffness or contractions ; paralysis with spasm not uncommon, general sensibility more acute. In a large per- centage of cases paralysis of one-haif the body coming on sud- denly without the loss of consciousness. Patient easily confused, has great difficulty in answering questions or in making himself understood. Great feebleness, weak and intermitting pulse. 552 DISEASE GERMS. vomiting and constipation, difficulty in emptying the bladder, often retention of urine with uriniferous odor, involuntary escape of stools ; respiration labored, at last becomes stertorous, coma, ending in death. The portions of the brain affected are often of the consistence of cream. In all cases white softening is the opposite of that due to congestion. It is due to a want of nourishment or an insufficient amount of blood in the brain. Softening of tJie Cerebellum is attended with fixed pain at the back of the head, impairment of sight, hemiplegia or paraplegia, tottering gait, vertigo, convulsive agitation, dulness of hearing, aphonia, eccentricities of conduct. Tumors, Tubercular Deposits, syphilitic growths, hydatids, tape worm ; cysticera are often found in the brain, and their existence is very obscure ; headache, sickness, giddiness, mental depres- sion, confusion, partial paralysis, epileptic convulsions. As to the location of softening, it is thought that the corpus callosum, septum lucidum, formix and cerebral substance around the ventricles are more frequently affected with red softening ; whereas, white softening attacks the gray matter of the convolu- tions at base, optic thalami, corpora striata. Treatment. — It is useless to disguise the fact that we have little to hope for in any kind of treatment; still, some cases are greatly ameliorated or their progress is arrested by judicious use of means. The treatment is very similar to chronic inflammation of the brain : daily bathing, flannel clothing, abundance of sleep, feet and extremities kept warm, blisters or plasters to nape of neck, bowels and kidneys cared for, diet pre-eminently of phosphates, oatmeal, boiled fish, wheaten grits, otherwise generous. Altera- tives and tonics. There are two remedies of undoubted utility — iodide of potassa and ozone water. We must never shut our eyes to the fact that by far the greater number of cases are due to affections of the blood; hence the very remarkable success ot those two preparations. Indeed, so convinced am I of the fact of their great efficacy in softening, that I could fill this volume with cases that have made wonderful improvement; memory, good judgment and the senses being washed, as it were, free from germs of tuberculae, syphilis, etc. The alterative saxifraga is the best as the case progresses ; glycerite of ozone and kepha- line alternately will effect a good cure. We have in sulphonal an invaluable remedy ; by its use in all damaged states of the brain we can regulate sleep — an impor- tant factor in the treatment ; besides, it is a germicide of some power. \ BACTERICIDES. ^r^ Inflammation of the membranes Inflammation of the brain may arise in children of the Membranes from a very trifling cause, as a of the Brain. blow or fall on the head, or exten- {Aczcte Simple Meningitis}^ sion of disease from the ear or nose, or by exposure to the sun. The fact that children have only one table in the bones of the skull, no middle or diploetic structure to resist shocks, renders them, up to puberty, very susceptible to irritation of the mem- branes from falls or concussions. Independent of violence, it may be caused by rheumatism, gout, syphilis, tuberculae. Sympioins. — The ordinary symptoms of languor, mental irri- tability, sleeplessness, headache aggravated by noise, light, heat, motion; intolerance of light; rigors and a fever; pain in the head becomes aggravated, irritability increases, delirium, frequent flushings of the face, followed by pallor, rapid pulse, muscular twitchings, prostration, coma. In distinguishing its locality in children observe carefully the following: Membranes covering the convexity of the brain. — In the child, first a rigor, then a convulsion, fever, skin hot, dry; pulse hard and rapid, vomiting, bowels constipated, intense headache, aggra- vated by movement, light, etc., face alternately flushed and pallid, eyes injected and staring, noisy and violent delirium sets in early, great restlessness, muscular twitching, squinting ; after three or four days a remission ; the pulse fags, tongue becomes heavily coated and dry, pupils sluggish, dilated ; the delirium passes into coma, and in a few days more intense prostration. If treatment be successful, improvement is very gradual but progressive. Membranes confined to base of brain. — Convulsions at com- mencement, fever, contracted pupils, frequent pulse, clenching of teeth and retraction of head, coma. In other cases, pain in tem- ples, vomiting, constipation, wry neck, loss of appetite, a desire for repose ; after a few days, vacant look, dejection, intelligence clear, pulse and skin natural. Headache unrelieved by remedies, coma, death. Inflammation of dura mater. — Often the result of violence, of disease of the cranial bones, chronic affections of the ears and nose in children, regarded as trifling, may end fatally by an ex- tension of morbid action to dura mater. Treatment. — In the treatment of this affection in children, it must ever be borne in mind that the law of reflex impressibility is strong in those born of highly civilized parents, so that the active measures used in adult cases must be laid aside when we have a delicate, impressible child to deal with. We want a quiet 554 DISEASE GERMS. room, tree from noise, and heat and light excluded ; no cradle ; the hair on the head should be cut close, and cloths wet with either of the following applied : Liquor acetate ammonia, one ounce ; alcohol, two ounces ; camphor water, eight ounces. Mix. Or, camphor water, ten ounces; muriate of ammonia, one ounce; nitrate of potassa, half an ounce ; chloride of sodium, half an ounce. Mix. Strength varied to age. To the feet, dry mustard in socks. Bowels opened gently with compound hcorice powder or one or two grains of leptandra rubbed up in pulverized licorice or cascara. To control the circulation, tinctures of aconite and belladonna should be given in a tea of asclepias, and sleep procured with suitable doses of the bromide of potass, as under inflammation in adults ; and if not powerful enough, give the hyoscyamus, but in smaller doses. No cupping, blisters, or other cuuter-irritants on account of the reflex impressibility. In case of wandering pains, bryonia is often of great value. As soon as the fever is controlled, iodide of potass is of great utility, otherwise it must be treated accord- ing to the cause, taking the greatest care to procure a large amount of sleep, if possible ten or twelve hours out of the twenty-four. The diet here must be more generous, milk and lime-water, and beef tea. Convalescence established upon cin- chona and aromatic sulphuric acid, ozone-water, more nutritious food and change of air. An acute form of inflam ma- Inflammation of the Brain tion of the brain and its mem- and its Membranes branes, with effusion of tuber- in Children. cle from the blood in and on (Tubercular Meiiingitis}^ the membranes and superficial surface of the brain proper. Common among tubercular children under two years of age, and seldom met with over that period of life ; is, next to cholera infantum, one of the most fatal maladies among city children during the summer months. The mortality from this source is very great, and were moth- ers and health care-takers more efficient in their duties, infant mortality might be. reduced to a minimum. The predisposing cause is tuberculse. This may be an heredi- tary condition in the child, or the child may be entirely free from tuberculae at birth but acquire that cachexia by bad food, insanitary conditions, drugging with soothing cordials, retarded dentition, hence irritation of the gums. BACTERICIDES. 555 stomach, bowels, acidity, cholera infantum, etc., which irritation is transmitted to the seat of reflex action ; the centres of life are depressed, and in consequence normal living matter is changed into the living germ tuberculse. Cradle-rocking, blows, slaps, falls, jars, shocks are simply ex- citing causes. City life and solar heat act as powerful depres- sants, and in some cases the irritation of dentition, cholera in- fantum, burns, etc., are sufficient in themselves to cause tubercu- lae and give rise to the inflammation. It usually comes on slawly and insidiously, marked by debility and whiteness of skin, mal-nutrition, loss of flesh and other signs of a tubercular diathesis ; short, dry cough, great peevishness, restlessness, irritability, attacks of headache aggravated by move- ment, light, noise ; giddiness, skin often hot or cold, pale or flushed, appetite capricious, tongue furred and breath offensive ; sickness and constipation, child drowsy, yet restless ; rubs head with hand, rolls head in sleep with eyes partially open ; wakes in alarm and screams, and other warnings of cerebral congestion. These symptoms may last for weeks ; if they occur in early sum- mer, before the hot weather sets in, they may last the entire sea- son ; if late in the fall, they will disappear on the approach of cool weather, or if the patient have proper treatment applied, it may disappear at any time. But suppose the case progresses onwards, all the above symp- toms become aggravated and the child lies very quiet, its coun- tenance expressive of anxiety and alternately flushed and pale, the eyes listless, eyebrows knit, pupils contracted, and is greatly annoyed with light and noise; retching, bowels variable. If old enough, will complain of head; often delirium. Fever high, pulse, 1 80; temperature, 107°. After a few days the pulse be- comes irregular and diminishes, although the slightest exertion will cause its increase. Stupor and heaviness may come on, squinting, patient lies on back, head and heels thrown back, insensible, probably picking his nose and lips with tremu- lous fingers, convulsions, paralysis, urine and faeces passed in- voluntary. If there is no effort at recovery, the drowsiness passes into profound coma, from which it is impossible to rouse the child. Pupils are dilated and insensible, pulse becomes very feeble and frequent, extremities become cold, a clammy sweat breaks out over the entire body. Paralysis and convulsions follow, which soon end the scene. If the case is complicated with cholera in- fantum, these symptoms become modified to a greater or less degree by that condition. As to its duration little can be said. ' Some children will sue- 556 DISEASE GERMS. cumb in two or three weeks ; others, again, will struggle on the entire summer and finally terminate in hydrocephalus, from which they will recover in a few months. The growth of tubercle on membranes or brain, carefully scraped off after death, seldom amounts to from three to five ounces. There is always a great quantity of fluid in ventricles and frequently softening of brain substance. In the treatment, the highest possible medical skill, nice dis- crimination, and good management are required. The little patient is literally crowded out with the tubercular bacilli, and no depleting plan of treatment is at all admissible. The child should be placed in a large airy room, away from noise, heat, light, motion. It should be bathed thrice daily, be- ginning with tepid water, and gradually permitting it to be colder and colder. Dry mustard in socks should be constantly worn. One grain of euonymine and one of salol, well triturated in sugar of milk should be administered at bedtime. The hair cut close, and lotions of ammonia, and potassa in camphor-water kept applied. Nourishment, either mother's milk or juice of raw beef, or sterilized malted milk. Aconite is the best drug for fever to lower temperature and soothe the patient. The nature of the prevailing symptoms will indicate the best bactericide to administer to kill or sterilize the tubercular bacilli. For example, if there be diarrhea, creosote or naphthaline in mucilage acacia, does splendid work. Resorcin in syrup of tolu ; glycerite of ozone and iodol ; if there be convulsions, bromide of potassa with pyridin. Sulphonal must be administered in sufficient doses to insure sleep. We can lay down no definite rules to follow, the great point is to nurse it along, keep up nutrition, and push germicides. Partial death or inflammation of the Inflammation small intestines may be caused by both of The Bowels, local and internal irritation, and varies {Enteritis^ much in its severity, in some cases being very slight, in others very active. Symptoms begin with pain around the umbilicus, aggravated by pressure; nausea, vomiting, rigors, and a fever; great head- ache, features pinched, tongue buff-leather coated, heat high, pulse wiry ; great restlessness, prostration, anxiety of counte- nance. If the mucous coat alone is involved, there will be a muco-enteritis, or acute intestinal catarrh, and diarrhea, with BACTERICIDES. 557 mucous, bilious, or serous stools. When the peritoneal and muscular coat is involved, there is obstinate constipation.' The patient assumes the position on back, with knees drawn up so as to relax the abdominal muscles ; often delirium ; vomiting be- comes more persistent, and vomited matter highly offensive, sometimes stercoraceous. In the treatment, perfect rest in bed, stimulants applied over entire abdomen, as either turpentine or con. ozone, followed by compresses of hot bran. Aqua, four ounces ; tincture of aconite, thirty drops; tincture white bryonia, one drachm. Mix. One teaspoonful every hour until relieved. If these fail, substitute tincture of the green root gelsemium, in alternation with opium.. It is a good plan to empty the rectum with copious warm water enemata, medicated with tincture of opium. Drinks, infusions of Enteritis : colon laid open. Acute enteritis : small intestine, very heavily loaded with microbes. Deep-perforating ulcers of the ileum, following chronic enteritis. coUinsonia, or stone crop. Later on, aromatic sulphuric acid and quinine; simple Hquid animal food, malted sterilized milk, raw eggs. A chronic jorm of Enteritis corresponds exactly to intestinal catarrh, has the same sarcinae in the mucus of the stools. When chronic it has very limited areas of distribution in most cases. It can usually be localized by the soreness, and \{ near the duodenum, by some jaundice ; if near the rectum, by the tenes- mus or bearing down, while the pain or soreness enables us to locate it in some particular spot. The significance of the stool is of great value — mucus. Pure mucus indicates a disease of the sigmoid flexure; scybala or hardened lumps of faeces in mucus, an affection of the colon. The stools may be large and covered with mucus, and no pain ; or the stools may be soft, and incor- porated with mucus of a pulpy, thick consistence, or full of mucus. If there be unaltered food in the stools, fat or starch, the pancreas is at fault. 558 DISEASE GERMS. In the treatment of the chronic form, a flannel roller should be worn around the abdomen. The best of all remedies is the Virginia stone crop, which should be administered persistently for several weeks, in alternation with aromatic sulphuric acid and comp. tincture cinchona. Collinsonia is also of great utility. A partial death of the bladder may Inflammation of the arise from the use of such drugs as o Bladder. cantharides, turpentine; from mechan- [Acute Cystitis.) ical irritation, as calculi ; introduction of instruments ; or by ignorant use of forceps during parturition; external injuries, or blows, falls, con- cussions ; from diseases of the rectum, vagina, uterus, prostate, especially inflammation of those organs ; to gonorrhea and other microbes ; to the use of injections. . Symptoms. — Commences with rigors and a fever ; heat, pulse and respiration greatly increased ; wiry pulse ; pain over region of bladder ; intense heat of urethra and base of the bladder, where inflammation is most intense ; constant desire to make water, which comes away in little dribs ; great mental depres- sion, and constitutional disturbance becomes greater; nausea; vomiting. Bladder can be felt as a small, rounded, tender tumor. Severe pain, extending to perinaeum and down the thighs ; in- creased by pressure, rectal or vaginal examination. Tenesmus, unless patient is relieved pain becomes unbearable. The calls to micturate become constant ; urine is expelled drop by drop, or there is retention ; urine becomes fetid and alkaline, containing shreds of lymph, fibrine, entangling pus, and blood-corpuscles; great prostration ; cold, clammy sweats ; cadaverous appearance; low muttering delirium ; fatal exhaustion. Its duration is from one to two weeks. Gangrene of bladder liable to occur. When well managed the symptoms subside, and the inflammation terminates in resolution or recovery. Treatment. — Patient is usually found on back with knees drawn up — a most convenient position for the application of stimulants ; apply over region of bladder, first mustard, and then hot linseed meal poultices, made with glycerine. If possible, empty bowels with oil ; if not, with enemata of infusion of marsh- mallow and opium. If vomiting is persistent, apply mustard over stomach, and begin at once with pretty large doses of tinc- ture of green root of gelsemium and pulverized opium ; admin- ister in small doses until there is a perfect alleviation of pain, and if necessary push to narcotism. If that takes place, patient BACTERICIDES. 3-g must be turned over on right side. Incorporate tincture of opium in poultice, and introduce suppositories of opium and belladonna per rectum. Drinks to consist of infusion of linseed or marsh-mallow, with nitrate of potassa and cream of tartar, enough to keep urine alkaline. If indications are bad, dissolve one or two grains of sulphate of morphia in one ounce of tepid water, and inject into bladder. If exhaustion is predominant, cream, raw eggs, essence of beef, etc. As soon as symptoms of inflammation have subsided, put patient upon compound tincture cinchona and nitric acid, or aromatic sulphuric acid and quinine, with an infusion of one or other of the astringent diuretics, as buchu, uva ursi, queen of the meadow, pareira brava, cleavers, pipsissewa, as a drink ; the idea being to restore the tone and vigor of the bladder. If convales- cence is slow, alteratives. The greatest possible attention should be paid to diet; let it be most nutritious, avoiding fat, sugar, starch, malt or spirituous liquors, or anything likely to cause acidity. T,he skin should be well stimulated by alkaline spong- ing daily, and the constant use of flannel. Chronic inflammation ot the bladder is Inflammation of the most common form met with. Some the Bladder. term it catarrh of the bladder. It may be {Chronic Cystitis), the sequel of an acute attack ; but most generally it is due to the crystals of gout ; the amylobacta of rheumatism, the microbe of syphilis, and other germs; venereal excesses, disease of the prostate, damp, cold, ex- posure ; foreign bodies, as calculi in the bladder ; ammoniacal urine ; uric acid crystals ; excessive beer drinking ; certain drugs, as the indiscriminate use of balsam copaiba, cantharides, turpen- tine ; to the metastasis of inflammation from other parts, as rec- tum, prostate, uterus ; to the natural decay of old age. The symptoms which are most prominent are a general feeling of languor, lassitude, debility, with an urgent, irresistible desire to void urine frequently, with pain in the urethra. Great tension, and increased sensibility of the walls of the bladder, after disten- sion from an accumulation of urine ; mucus in urine greatly augmented, and of an unnatural color ; first it is gray, then yel- lowish, or greenish (owing to the predominance of each species of microbe present), thick, viscid, ropy, often streaked with blood. When decided ulceration sets in, urine becomes loaded with pus, the quantity of this being immense, owing to the fact that the bacillus pyogenes has such room and nutrition for growth, often averaging several pints daily. 560 DISEASE GERMS. If there is no treatment resorted to, or but an inefficient one^ the case may progress onwards to a fatal termination; whereas^ under a thorough bactericide treatment, a good recovery will take place in the large proportion of cases. Indispensable to a successful medical treatment, the patient should partake of the best of food, of the most nourishing kind; daily bathing ; flannel clothing ; external warmth ; bowels to be regulated to one motion per day. An alterative and tonic course all through the treatment, such as compound saxifraga, phytolacca compound, in alternation with compound tincture of cinchona and nitro-muriatic acid; or aromatic sulphuric acid and quinine. While pursuing this course special remedies should be used to sterilize and annihilate the microbial family in the bladder, to wit : the micrococcus urinea and bacillus of yellow and green pus. Some one of the following bactericides should be administered internally to sterilize the blood and cut off, if possible, microbe nutrition in the bladder: sulphide of lime, dioxide of hydrogen, salol, naphthaline, creolin, sulphur water, uric acid solvent. The bladder should be injected daily with either a solution of resorcin or creolin, or iodol, or naphthaline. Patient should drink a tea daily made from one of the follow- ing herbs : either buchu, or uva ursi, or pareira brava, or queen of the meadows, or couch grass, or pipsissewa, or cleavers to astringe the walls of the bladder. General principles should guide ; every symptom promptly relieved Irritation of the mammary gland Inflammation of The is rarely met with unless the gland Breast. is in a state of activity. The state (yMannnitis) of development of the male breast is simply rudimentary, and it is rarely afflicted with inflammation. Infants, at birth, both sexes, often have one or both the breasts engorged with a secretion of milk. Highly organized sensitive ladies, during menstruation, and also from the period of conception until the birth of the child, suffer from a swollen, engorged state of the breasts. We are, however, safe in stating, that it is only during active lactation, that we meet with acute inflammation of the mammary gland or its nipple. In most modern ladies, there is a great development of the sympathetic, which is reflected chiefly over the left breast ; hence violent emotions, desires, affections, passions, grief, worry, give rise to a weakness or a predisposition, a debility. I BACTERICIDES. 561 The common exciting causes are cold, wet, exposure, blows, violence of all kind, irritation of corsets, all forms of external injury. The gland suffers re- flexly from the uterus, with which organ it is in direct sympathy ; besides, ovarian, gastric, hepatic, renal, intestinal irritation. It is met with in either the acute or chronic form. Symptoms. — In the acute form there is the shock, with pain, swelling, and induration of breast, rigors and a fever, with prostra- tion, rapid pulse, arrested secre- tions, often slight delirium. Ar- rest of secretion of milk and sup- puration soon follow. In the chronic form there is enlargement of the gland and in- duration ; milk is either wholly or partially arrested. It may follow an acute attack, or come on by itself. It is more likely to occur at other periods than pregnancy and lactation. It may also terminate in abscess. In acute inflammation of the breast, active treatment : fifteen grains of exalgine, twice daily ; open bowels with repeated doses of salines ; apply over the entire breast equal parts of the fl. ext. belladonna and glycerine. Milk to be drawn off at regular inter- vals by breast pump ; if skin is dry, administer comp. tincture serpentaria. If it is deemed best to arrest the secretion of milk altogether, then the following should be spread on linen and applied over the entire breast : belladonna ointment, two ounces ; iodide of potass and chloride of ammonia, of each four drachms. Mix. Gentle compression by means of a roller round the chest not to be overlooked. Subsequently tonics and nourishing food. If it is the chronic form, the best possible results are to be ob- tained from the boroglyceride paste applied to the entire breast over night, with fomentations of hot vinegar and nitrate of potassa during the day. In this form the internal use of phytolacca is most efficacious. The arm in a sling, compression of the breast with a roller always of utility. If rigors, softening or other evi- 36 Breast : A, lactiferous duels dissected out and injected; B, nipple, with bristles insected into the orifices of the lactiferous ducts. 56: DISEASE GERMS. dences of suppuration can be detected, poultice freely, open in the most depending part as soon as fluctuation can be detected, so as to permit the escape of the bacillus pyocyaneus. Inflammation of the Nipple ^ whether it be from some irritation, or from some germs of amylobacta, burrowing and causing fis- sures, or cracks, or from disease germs from the child's mouth. The most common of these microbes which infest any crack or abrasion of the nipple is the oidium albicans. Any good bactericide, as resorcin oint- ment or jelly ; boroglyceride paste, creolin, etc., is effective in destroying this mi- crobe. '^t^:^^^,^^- Other germs are to be found in this re- atitis in the child of the gion, duc to microbcs carried there by the mouths of other children. Inflammation of the Cellular Tissue. The tissue between the skin and the muscles, termed the cellular tissue, is one of the very best absorbing tissues in the entire body, and it is quite extensively util- ized for injecting pure alkaloids, so as to obtain their action upon the organic tissues of the body. Inflammation of this tissue may arise from the microbe of ery- sipelas, from the germs of the cadaver in post-mortem examina- tions, from the bites of venomous reptiles. In addition to general erysipelatous inflammation of the skin, which gives rise to burning, tingling, we have, when the cellular tissue is affected, throbbing ; the swelling is stiff, brawny ; the absorbents are implicated, the nearest lymphatics take on the irritation, doughy swellings form on the chest and abdomen. The adenitis proceeds to rapid suppuration. There are violent rigors, fever, a low type of typhoid fever, with abscesses in lungs, liver and other parts. Perspiration is very offensive ; stools fetid, jaundice, stupor, delirium, difficulty of breathing, fatal exhaustion. In the treatment of such cases, free incisions, suction, cups, everything to encourage free bleeding from the part ; then the boroglyceride paste should be applied all over the affected part, or solutions of the paste in hot water applied by cloths ; the BACTERICIDES. 563 moment any swelling is detected it should be opened and boro- glyceride solution applied. Internally push bactericides and nourishment; peroxide of hydrogen, brewers' yeast, salol, resorcin, iodol. The indications, as they arise, are to be actively treated. Pelvic cellulitis is mostly met with Inflammation of the in connection with some tubercular Cellular Tissue disease ; it may be a result of blows, of the Pelvis. falls or other violence ; abortions, tedious labor, or some uterine or other disease. Symptoms. — Local pain, throbbing and tenderness, with pain- ful swelling, usually appreciable at lower part of abdomen, or by vaginal examination. Simultaneously with the local pain, there is nausea and vomiting ; great constitutional disturbance ; rigors, and a fever, with some pain in the head, back and aching pains in the limbs; difficult micturition and tenesmus. If case progresses to suppuration, the above symptoms increase in severity, with additional rigors, throbbing and tenderness ; neuralgic pain down the thighs, and if within reach, fluctuation can be detected. Pus channels may form in different directions, into bladder, vagina, rectum, colon, rarely into peritonaeum, generally finding their way externally. Nature is most provident of herself in these cases, by the formation of those sinuses almost invariably reach- ing the surface, and thus providing an egress for the staphylo- coccus pyogenes. Treatment. — Those cases require great tact and good judg- men ; the rectum and vagina should be injected daily with lin- seed-tea ; hot poultices should be applied ; fever controlled with aconite, opium, or morphia, to relieve pain. Belladonna and opium suppositories every night at bedtime. Quinine and aro- matic sulphuric acid and carbolic acid and tincture of iodine in- ternally; the patient regularly sponged ofl*. Most nutritious food, milk, raw eggs, beef-tea, juice of meat and animal food as soon as the stomach can bear it. If abscess point anywhere, it can be opened with advantage. As soon as the pus has been thoroughly evacuated, alteratives and tonics. The greatest possible care should be exercised during the stage of convalescence. Rest is an indispensable condition, to- gether with well-regulated secretions ; tonics, and the very best of blood-elaborating food. 5^4 DISEASE GERMS. The portion of the covering of the Inflammation of the eye ball next to the conjunctiva is Cornea. called the cornea, from its fancied re- (Acute Corneitis) semblance to a horn, transparent and ^ nearly circular, forming the anterior sixth of the globe, a structure of exceeding low organization, very difficult to depress, by violence or contiguous inflamma- tion, unless the vital forces are greatly shattered and the bacillus of rheumatism, gout, tubercle or syphilis be present in the blood. Acute inflammation may be the result of injuries, cold, wet, exposure in depraved subjects, or inflammation from other parts. When it takes place, it renders the polished and transparent sur- face of the cornea hazy, dim, and rough, or to look like ground glass. Symptoms. — Dull, deep-seated pain in the eye ; intolerance of light ; abundant secretion of tears ; no muco-purulent discharge of any moment ; a concentric plexus of minute vessels can be seen passing from edge of cornea ; a zone of pink vessels in adja- cent sclerotic ; haziness of cornea, with opacity. Patient affected very tuberculous ; disease runs a very chronic course, lasting for months, leaving cornea permanently cloudy ; sometimes ends in suppuration, and softening is liable to take place, with perforating ulcer into cornea. One or both eyes may be affected. Treatment must consist in the administration of exalgine to reduce temperature and equalize the circulation. Stimulate the liver actively with leptandra and phosphate of soda ; apply two blisters to nape of neck just as soon as the active symptoms are controlled ; comp. saxifraga and phytolacca, the best of food and everything calculated to build up the vital forces, as avena, kephaline, cinchona. The same ideas must be followed in the chronic form, whether it be gout or the syphilitic germ which is giving rise to intersti- tial degeneration. Beyond all question, the diseases of Inflammation of the the auditory apparatus, which occur Middle Ear. m.ost frequently and possess the great- {Oiitis Media}) est interest, are the inflammatory affec- tions of the tympanum and middle ear. The middle ear properly consists of the membrana tympani, the tympanitic cavity, the mastoid cells, the chain of ossicles, and certain muscles, vessels, and nerves. In a small, confined space, we have a most delicate, intricate structure, performing impor- tant functions ; easily disturbed by the standard of health, by a variety of causes, and attaining increased importance from their BACTERICIDES. 565 ■contiguity to such vital parts as the labyrinth, the internal jugular vein, the internal carotid artery, the dura mater, and several venous sinuses of the brain, so when we look at the parts impli- cated, there should be no apathy in our treatment, no ignorant, officious meddling. Causes. — It may arise from cold, damp, exposure, rheumatism, gout, boils, injuries, or accidents, injudicious tampering with the ear with hair-pins. It may also be due to extension of inflamma- tion inwards, or upwards from the pharynx, carrying the germs of scarlet fever, quinsy, diphtheria, measles, small-pox, hooping cough, catarrh, pneumonia, bronchitis, influenza, syphilis, mer- cury, tuberculse, and the use of nasal-douches. When the inflam- matory action reaches the throat, it travels along the eustachian tube, which is the channel designed by nature for maintaining a due equilibrium between the atmospheric and tympanitic air, and for draining superfluous mucus from the tympanum. When all is well it serves those purposes admirably, but when disease exists it serves as a channel for carrying diseased germs up from the pharynx. The tube is short, being one-and-a half inches in the adult, but its continuity of mucous membrane permits an easy road for the germs to travel, and more so if it is a young child, in whom the tube is much shorter and more open than in the adult. Dentition, first and second periods, are productive of inflammation of the middle ear. The vaso-motor impressions are readily conveyed from the inflamed gums to the correlated membrana tympani by the dental nerve, and the nervi-vaso- rum of the tympanitic branch of the internal carotid artery. There can be little doubt that the difficult or retarded dentition, due to a want of phosphates in the modern mother's milk, is a common cause of inflammation of the inner ear. It is impossible to doubt it when we look at the troubled little face, the resting of the head on the nurse, the thrill of agony that passes over its features, accompanied with piteous cries or shrieks when its posi- tion is moved, especially if done suddenly ; and, more than all, the constant raising of its little hand to the side of the head : all indicate the agonizing sufferings of earache. Of all living diseased germs, those of scarlatina are most de- structive to the ear, give rise to hopeless chronic affections, or drift into deafness. The ear, in scarlet fever, is about as obnox- ious to irritation as the kidneys, and we should bear in mind that every congestion of the lining membrane of the ear is a true periostitis, and every ulceration a caries of its osseous walls, so that, with better care, a true appreciation of germ-diseases, a more thorough antiseptic course, many lives might be saved, useful ears spared, and deaf-mutism become a rare exception. ^66 DISEASE GERMS. Symptoms. — General symptoms of inflammation, headache, pain in back, legs, rigors, and a fever ; uneasiness in ear, followed by sharp, lancinating pain in the inner ear, increasing in severity ; there are also impairment of hearing, giddiness, a sense of fulness in the head, and an increase of pain in moving jaws, mastication, or swallowing, moving the head, or blowing the nose. On ex- amination of the membrana tympani, it is found red and con- gested. Beating noises in the ears : eyes become injected \ countenance anxious ; fever greater ; function of skin, kidneys, and bowels disordered. There may be delirium or convulsions. There is always great depression and despondency. If case is not seen to there may be facial paralysis, from a spreading of the inflammation, which is overcome when morbid action ceases. Should the attack be a slight one, or the vital force vigorous, and treatment appropriate, perfect resolution may take place \ but if powers of life are low, suppuration may take place, pent- up pus bursting on discharging itself, if in inner ear, by perfora- tion of membrana tympani ; or in more grave cases the inflam- matory process spreads into the mastoid cells internally, or by bony meatus to the periosteum, covering the mastoid process externally. In external otitis, perforation of the membrana tympani may take place, owing to the extension of inflammation from within outwards. The disease usually runs a very rapid course, suppuration often taking place in from twenty-four to forty-eight hours from its inception — a significant fact for rational and active treatment. Treatment. — The cause, if it can be removed, should be done promptly. Then patient should be put to bed in a warm room, 70° F., moist atmosphere, well ventilated, comfortable, and free from all noise, no talking, the greatest quietness ; dry heat to the ear and side of head, such as hops, camomile flowers, bran, or salt, in bags or pillows, made hot in oven ; and permit no food requiring mastication, for moving the jaws interferes with the rest of organ. The fever, as well as the local inflammation, must be regulated by arterial sedatives. To do this effectually administer a saline purge, or cascara, or both, and enemata, if not soon moved; heat to feet; aconite, belladonna, and sweet spirits of nitre freely. If the skin does not become moist, com- pound tincture of serpentaria, so as to cause free diaphoresis ; hot drinks ; near night either chloral or Dover's powder, so as to get a long sleep. The dry heat is of primary importance, and should be watched with care. Never poultice either an eye or an ear is an injunction to be obeyed. The idea of this line of treatment is, if possible, to prevent the formation of abscess, or BACTERICIDES. 567 suppuration, as that is a result to be dreaded, as we never can know how, when, or where it may terminate, or to what it may- lead. Case otherwise should be placed upon alteratives and tonics. If there is a manifestation of gout or rheumatism, col- chicum, quinine, iodide of potass ; if upon teething, lance the gums ; as soon as fever, pain, etc., are relieved, alteratives and tonics. Inflammation and suppuration of the middle ear is one of the most common, dangerous and neglected of all- maladies. Bac- teriological investigations have revealed and unravelled its pa- thology and demonstrated that the streptococcus pyogenes is ever, though not exclusively, present in all cases. From what- ever cause the otitis has arisen, cold, germs of scarlatina, measles, etc., there are invariably present one or other of two kinds of discharges ; fetid and non-fetid; in the former both cocci and bacilli are found together ; in the latter cocci alone are present. In the offensive secretion, full-fled bacilli ; in the odorless dis- charge, cocci alone. The discharge is pathogenic of the disease, and is of special interest, as both forms are not devoid of danger ; the inner ear being largely infested with rapidly breeding microbe is a fact of great significance. The oil of mullein sterilizes and completely annihilates this microbe. This oil when properly prepared contains eight volumes of peroxide of hydrogen, and is a powerful bactericide, etc. Two or three drops introduced into the ear once or twice daily, imme- diately kills the bacilli and cocci, the entire microbial family, and keeps the ear free from all disease germs. To effect a radical cure the daily use of the oil must be fol- lowed up with tonics, alteratives and germicides, compound saxi- fraga, oats, kephaline ; and the blood kept in such a condition of purity by the daily administration of some ozonized preparation that no microbe can live in that vital fluid. Inflammation of the mucous Inflammation membrane of the eye-ball and of the Mucous Membrane lids is one of the most com- of the Eye. mon affections of every-day life. (^Ophthalmia.) From its very essence and char- acter it divides itself into distinct varities, each one having or acquiring its own special pathogenic microbe with peculiarities of each other ; all essentially conta- gious and infectious, they have, however, some symptoms in com- mon, as intolerance of light; a sensation of sand in the eye, a muco- or sero-purulent discharge, 1 oaded with microbes. 56S DISEASE GERMS. Infantile Ophthalmia, so called because it occurs in infants from two to four days after birth. It usually commences at the eds^es of the lids and proceeds over the entire conjunctiva. The causes are often cold, light, irritating soaps, or some of the sebacious secretion from the skin of the child, by inadvertence of the nurse, got into the eye ; or it might arise from the entrance of either the leucorrheal or gonorrheal discharge from the mother's genitals. Symptoms, — A spasmodic closure of lids ; lashes stick together; hard crusts form at the edge of lids, which are red ; the redness and swelling increase, lids more swollen; the conjunctival sac be- comes filled with transparent, yellowish-colored serum and mucus; engorgement continues ;. then pus, or thick muco-purulent mat- ter makes its appearance ; the tumefaction of the conjunctiva is so great that the lids will scarcely close, and the discharge so copious that it runs down the cheek of the infant; the cornea of the eye looks depressed, or retracted, or hid; the surrounding conjunctiva fleshy and elevated, owing to its infiltration with red blood, serum, etc. This swollen condition of the conjunctiva, looking elevated, while the cornea looks depressed, is called chemosis. As the dis- charge is so loaded with bacteria and other diseased germs, if great care is not observed it may contaminate the other eye, or that of nurse or mother. If not actively seen to, the symptoms will increase in severity. The mucous membrane of the conjunc- tiva possesses a lamellated epithelium, and has the faculty, when so inoculated, of a proliferation of its epithelium, which is trans- formed into pus cells, which process of shedding gives rise to an enormous discharge, and a continual thinning or peeling of the conjunctiva of the ball of the eye, which becomes soft, and liquefies, and ulcerates, and contents of eye are liable to escape. Perforation is very liable to happen if allowed to run two or three weeks, especially if the lids are swollen and tight on ball. Should the eye escape disorganization, there is often opacity of the cornea left behind, or an opacity of lens, or some defect in vision. The greatest care is necessary in opening the eye ; it must be done with great caution and care. In the muco-purulent discharge are to be found quite a number of pathogenic microbes, as ordinary bacteria, bacillus, pyocyanes and micrococci of various kinds. In the treatment, examine carefully to ascertain if any piece of sebaceous secretion remain, if so, oil it well and have it removed ; then darken the room in which the patient is to remain ; open its bowels freely with oil ; control fever with aconite and sweet spirits of nitre. Administer one-eighth of a grain of quinine in fl. ext. licorice BACTERICIDES. 569 every four hours as the great eye tonic. Locally, wash out the eye with a saturated solution of boroglyceride, keep the same remedy applied all the time to the eye, and if matter accumulates between the lids, inject it underneath them. After dressing the eye, drop into the inner canthus of the affected eye a few drops of a solution of atropia — strength, two grains of the sulphate to one ounce of distilled water. Atropia has an antiphlogistic effect on the inflamed surfaces, dilates the pupil and relieves the tension of the eye-ball. Precautions taken lest the other eye be- come affected. Other bactericides sometimes used instead of the boroglyceride, lotions of aromatic sulphuric acid ; creolin, naph- thaline, resorcin, etc. Common acute ophthalmia is usually the result of colds, wet, foreign bodies, as sand, lime, changes of temperature, usually mild, often of a catarrhal form, involving the conjunctiva and meibomian glands. Symptoms. — Intolerance of light, pain in the eye, a sense of soreness or scalding, stiffness, dryness, a feeling of roughness about the eye, as if there was sand in the eye. This sensation is caused by the congested condition of the vessels of the lid and globe. They are tortuous, swollen ; red blood circulating where only white blood was wont to circulate ; roughened, and by rub- bing over each other, carry this sensation to the mind. These vessels can be seen, of a light scarlet color and irregularly ar- ranged, and can even be moved by the finger. In bad cases general congestion. The discharge is puriform at first, and then becomes muco-purulent. Exceeding microbial, and contagious and infectious. In some cases headache, rigors, fever. The treatment is the same as the following : Purulent Ophthalmia, a severe and dangerous form, due to bacteria ; more contagious and infectious than the former. Overcrowding of large bodies of men, women, and children in workshops, jails, reformatories, refugees' schools, and other in- stitutions. The emanation or miasma of our bodies is prejudicial to others, degrades the normal bioplasm -of the conjunctiva into a microbe of extraordinary power, vitality ; with great power of re- production in the mucous follicles of the conjunctiva. A school, a refuge, or shop, once infected, must be thoroughly disinfected by burning sulphur before the germs can be destroyed. Symptoms. — All the symptoms are well defined : the soreness or redness ; the intolerence of light ; the sensation of sand ; the copious or profuse muco-purulent discharge, with other severe symptoms, intense, with prostration, rigors, and violent fever ; the pain in head and eye agonizing ; and the amount of 570 DISEASE GERMS. discharge of thick, yellow, purulent matter immense. The con- junctiva of both lids and globes swell, so that it is with difficulty that the cornea and iris can be seen (cJieinosis) ; and the discharge flows on cheek. If disease does not yield to proper treatment, the inflammation will increase, spread to the cornea and deeper structures of the eye. When the internal textures become involved, constitutional symptoms are still more aggravated ; extensive sloughing takes place, and the sight, and often the eye, is lost. Sometimes one eye, in other cases two are affected simultaneously. Patient to be kept in bed, in a well ventilated, dark room ; with disinfectants exposed in the apartment ; bowels should be freely opened with comp. ext. colocynth and copious enemata of beef-tea ; surface to be bathed thrice daily ; exalgine in fifteen- grain doses, to keep pulse 70 ; hypodermic injections of pilocar- pin to keep up diaphoresis ; quinine ranging from three to five grains every four hours ; sulphonal in sufficient doses to procure sleep every night at bedtime ; two blisters to nape of neck, free suppuration from nape of neck. Wash out the eye carefully with either a lotion of borogly- ceride ; or creolin ; or resorcin ; naphthaline, or some other germicide. The eye itself should be carefully washed out with the boro- glyceride solution three times daily, and after each cleansing the atropia solution should be dropped into the corner of the affected eye. If the case yields to the above plan of treatment, the best plan is to hold the patient on those remedies for a few days, pushing nourishment very strong. By and by a general alterative and tonic treatment should for two or three months be resorted to, the best alteratives being saxifraga and phytolacca, and of tonics, cinchona and kepha- line. Whenever more than sixty children are congregated for five or six hours daily in a school-house, the microbe of this form makes its appearance at the roots of the eyelashes, and in the minute oil glands, excites an irritation, inflammation, causing a peculiar incrustation on the edge of the lids ; even in this slight form it gives rise to impaired vision in city children. Keeping a child at home, improving its general health by every possible means ; washing the eyes three times a day. Boroglyceride wash is usually sufficient. Gonorrheal opJithalmia is usually caused by the gross careless- ness of the affected individual, either by bringing the gonococcus from the orifice of the urethra to the eye by the finger, or a BACTERICIDES. 571 The gonococcus as seen in gonorrheal ophthal- mia. towel, or otherwise ; or it might be from a fellow boarder who has a running. The discharge from the eye contains the gonococcus, which is pathogenic of the dis- ease. The symptoms are about the same as the purulent, a trifle more intense. Treatment must be very prompt, even more active than the purulent ; the dose of quinine should be increased; more rigid nutrition; leeching must not be resorted to here, it is of no utility, spreads the microbe, being simply a zoological humbug. The all-prevailing idea is the destruction of the germ before it can cause disorganization of the eye. Tubercular ophthalmia is common from the period of dentition up to the tenth year, and even older in some cases. In such cases the entire body is literally eaten up with tubercular bacilli. The tubercular cachexia is usually present in a high degree ; the skin white and thin ; muscles soft and flabby ; hair as dry as tow ; torpidity of all the great secreting organs. Symptoms. — There is no sore- ness or rawness, no sensation of sand in the eye, no muco-puru- lent discharge ; but the intole- rance of light is very great, with spasmodic contraction of the lids ; there is a copious lachry- mal secretion ; irritability of the nasal and buccal mucous mem- brane ; fleshy redness is absent, but there is a very slight conjunc- tival and sclerotic redness, with formation of pustules or ulcers on cornea. Both eyes are usually affected. Hot tears profusely flowing over cheek cause an excoriation. There are often the thick lips, long eyebrows and eyelashes, eruption behind the ears, with disordered intestinal secretion, so often present in tuberculae. Treatment. — Eyes must be protected with a green shade ; and when not exercising for health in the open air, to lie down in a well-ventilated room, and a lotion or wash of common salt and water kept applied. The strength of this wash will depend on Bacillus tuberculosis in the blood in cases of tubercular ophthalmia. Usually in those ca^es the blood is so charged with the germ that its spores excrete through the eye coats. 572 DISEASE GERMS. the age ; it must be strong enough so as to barely feel it, not to cause the least smarting. It is the best of all local applications. This wash is to be kept on as much as possible, and changed every little while, as it becomes dry ; and cloths either washed or destroyed ; never allow it to become dry ; an emetic twice a week for six weeks, of wi^e of lobelia; encourage child to drink freely some tepid water with bicarbonate of potassa, and then follow with half teaspoonfuls of the wine every five minutes till free vomiting takes place. The reflex effect of this emetic on the eye is really wonderful ; it acts like a charm ; benefits at once, and the whole aspect of the disease changes for the better. Besides, in that class of children the mucous coat of the stomach is relaxed, sarcinae are present, and there is a large accumulation of mucus in that viscus, which, when thrown off, lets the natural appetite for food return, and more perfect digestion takes place. Bowels to be regulated with cascara ; bathing morning and night ; flannel clothing ; patient placed upon a general course of alteratives and tonics — saxifraga, phytolacca, in alternation with glycerite of ozone, avena, etc. The diet to be most nourishing, consisting of abundance of animal food, beef, mutton, poultry, eggs, milk, cream, oatmeal porridge and cream, boiled white-fish. Granular ophthalmia is often a result of the preceding forms of inflammation, or may come on of itself from the same causes, and consists in a low form of irritation of the conjunctiva, with effusion of lymph, which forms nodules or granules, rendering the conjunctiva uneven and granular. These granulations look like grains of sago, and consist of inflamed mucous follicles and papillae; they cause a good deal of irritation, and opacity of the cornea is the result. In the treatment, the patient should be placed upon comp. saxifraga, phytolacca, in alternation with tonics, as sulphate of quinine in glycerite of kephaline. It is rare for internal remedies to remove cleanly all the granu- lations, they do much good, but their action must be aided by introducing remedies into the eye that will strip off the granula- tions. Among recent remedies for this purpose infusion of the ground decorticated jequirity bean has been tried and proved effective. Eight beans, ground, infused for two hours in half a pint of distilled water, percolated, when sufficiently cooled dropped into the eye, will often in one application cause all the granulations to shell or peel off If it does not effect this at once, let matters rest about a week, try it again, when it can be made either BACTERICIDES. 573 stronger or weaker, to suit the case under observation. If this is not procurable, brushing over the eye solutions of iodide of potassa, variable strengths, from five to twenty-five grains to the ounce of water, as frequent, so no irritation be produced, or aro- matic sulphuric acid, according to age ; bowels regulated; best of nourishment; warm clothing. Rheumatic Ophthalmia consists in the bacillus amylobacta lodging itself in the white fibrous tissue of the eyeball (the sclerotic coat) and giving rise to organic changes. Symptoms. — Severe, sharp, lancinating pain in the eye and side of head. It is so agonizing that it depresses nerve centres, and there is more or less fever; the white of the eye looks a pale red, its vessels being arranged in a radiated or zonular form, and be- neath the conjunctiva; intolerance of light ; dimness of vision, from haziness of cornea and contraction of pupil ; the discharge from the eye is watery or serous ; there is conjunctiva, no muco-purulent discharge, / ^ f^\\ B i\ no sensation of sand, no fleshy condition of conjunctiva, no muco-purulent discharge, no soreness or rawness ; but a sharp, lan- nating pain, always worse at night. The general treatment for rheumatism must at once be adopted. ^ S 7 cinating pain, always worse at night. t /^ ^ A Exalgine and quinine in sufficient doses to reduce temperature and pulse, then a Bacuius Amylobacta, spindle . ^ rnrii shaped lorms, including selection of some one or two of the follow- ovai spores The patho- ,. 11 -1 .. 1- 1 . genie microbe of rheumatic mg remedies, made by the attending physi- ophthalmia, seen in the cian, and administered so as to kill the :;;Tn\racSttac£.^'' microbe amylobacta : salicylate soda in liquor ammonia acetatis, manaca, salol, casca sagrada lozenges, cimicifuga race., etc. The atropia solution must be dropped into the eye morning and night, and persistently dry heat, bran or camomile flowers warmed, applied to the eye. Several other forms might be enumerated, as the catarrhal^ reflex, or sympathetic, all of which should be managed upon general principles and bactericide remedies. In considering the subject of inflamma- Inflammation tion of an involuntary muscle like the of the Substance heart, we must look at its anatomical of the Heart. relations to the great sympathetic. This (^Carditis)) nerve in the Caucasian man of average civilization is perfectly developed, and is freely spread over the entire anterior cardiac surface, whereas in all other races and in the majority of women this nerve is merely rudimentary. cyA DISEASE GERMS. In the civilized Caucasian, the development of the great sym- pathetic is perfect, and as a result it is liberally scattered over his larynx, heart, lower lobe of right lung, spleen, left kidney, mesentery and abdominal viscera, so that when the vital forces are depressed by solar heat, privation, overwork, exhaustion, struggle for existence, prolonged exposure, grief, sorrow, use of tobacco or other narcotics, the individual is liable to have a weak heart, which is greatly aggravated if either the microbes of rheu- matism, or syphilis, or typhoid fever, or pyaemia be also present. This peculiar weakness of the heart, irritated by some special living poison, gives rise to a degradation of the living matter which nourishes the heart, hence, we have a micrococcus. The first symptoms, aside from the ordinary languor, lassi- tude, debility, general prostration, is a sudden seizure of violent steady pain in the heart, out of all proportion to any other kind of pain ; intense excitement, greatest anxiety ; features change rapidly, become ghastly or cadaverous ; tongue coats rapidly, brown, dry, darkish ; breathing difficult, irregular, labored ; action of heart violent but unsteady ; rigors heavy, frequent ; and a fever of the highest possible kind, with great oppression about the chest ; difficult respiration, dread of suffocation, alarm- ing palpitation, delirium, extremities become cold, fits of syncope, pain in heart all the time increasing in severity. Its duration is from twenty-four to forty-eight hours, invari- abty terminating in death. The proper treatment to try, if seen early, would be wet cups over region of heart, followed by hot poultices in which opium is abundantly diffused. Then there are three drugs that act well on this part of the nervous organ- ism, and they must be given often and in very large doses. Veratrum viride, five-drop doses, often and persistent. Pulverized opium in one-grain doses, but frequently, and Sulphate of quinine, in from ten to thirty-grain doses every three hours. The three drugs act harmoniously together ; the opium pre- vents the veratrum from prostrating, and retains the quinine in the blood. To be successful, case must be seen early. The endocardium, or the Inflammation of the serous membrane which lines Internal Lining Membrane the interior of the heart, and of the Heart. which by its reduplication as- {Endocarditis}) sists in the formation of the valves, and covers them com- pletely, is frequently the seat of inflammation. BACTERICIDES. ^^5 The predisposing causes are the use of tobacco and other stimulants ; over- work, nervous exhaustion, worry, grief, sorrow. The exciting cause is rheumatism or gout, or both, which give rise to the evolution of the micrococcus. Micrococcus Endocarditis. — A pathogenic microbe, a degrada- tion of the complex bioplasm, which nourishes the heart-muscle into a disease germ. It is found as a streptococcus, massed upon the thickened valves of the heart, small chains three or four irregularly linked together. They often assume the form of a zoogloea, and are found congregated together, and form plugs in the vessels of the muscular tissue of the heart. In the detritus of the ulceration which follows, they are found in chains. The microbe and its micrococci are found chiefly in the heart, spleen, liver, kidneys, lymph canals, blood. The micro-organism bears cultivation well in beef tea. The same disease germ is present in acute laryngitis. Sy7nptoms, — In the acute form, there are the ordinary symp- toms of languor and debility, with a deep-seated, sharp, lancinat- ing pain away down deep, as the patient expresses it, in the heart, with great oppression and uneasiness over the region of the heart ; rigors and a fever ; pulse small, feeble and intermit- tent ; patient very restless and anxious ; prefers to lie on back ; great difficulty of breathing; jactitation, cold sweats, fainting fits. If the vital power is greatly depressed, or constitution depraved, there may exist a true typhoid condition, with all its varied train of symptoms. If the endocarditis is of the subacute form, or what is more common, of a low chronic type, the symptoms will be less prominent, milder and more obscure, so much so, that patients attacked with rheumatic fever have endocarditis without being aware of its existence ; nevertheless, it is apt to leave structural changes on the valves that give rise to trouble. That portion of the endocardium lining the orifices and cover- ing the valves most frequently attacked ; the left side of the heart more generally implicated. It is seldom directly fatal ; its effects, effusion of lymph, and its organization into cartilage or bone, or the effusion of urate of soda in gout, and its degeneration into a chalky concretion, most to be dreaded ; invariably gives rise to valvular disease. Place the hand over the region of the heart, it experiences a vibratory thrill ; no increased area of dulness ; place ear over heart, a soft, mitral, blowing murmur can be easily detected. Its duration may be months or years ; but its inevitable termina- tion is thickening of the valves, general loss of tone_, obstructed circulation, impoverishment of blood, dropsy and sudden death. To sterilize, or annihilate the microbe, concentrated ozone diluted with chloroform over region of the heart. 5/6 DISEASE GERMS. Internally, try either digitalis, or- strophanti! us, or ozone water,, or simabicidia, or ammonia, in alternation with quinine; liquor ammonia acetatis and salicylic acid; perfect rest of mind and body ; nothing to fret, worry or cause anxiety ; diet to be good^ light, nutritious ; treatment for rheumatism or gout to be carried carefully out ; convalescence to be established on vegetable alteratives, with iodide of potass and tonics ; guarding against that twin-monster, rheumatic gout, by keeping the body covered with flannel, and avoiding everything likely to debilitate. Forbid tobacco, alcohol, tea, excess, debauchery, etc. The very best of diet should be given, consisting of a mixed animal and vegetable kind ; and if unable to exercise, massage should be resorted to morning and night. The iris, suspended like a curtain, with a Inflammation circular opening in its centre, lies between the of the Iris. cornea and crystalline lens ; and bathed on (^Iritis?) both sides by aqueous humor, serves to regu- late the amount of light that is admitted into the retina. It divides the cavity containing the aqueous humor into anterior and posterior chambers. The iris is composed of delicate bundles of fibrous tissue, or circular and radiating, in- voluntary, muscular fibres, and of pigment cells. In some cases it is absent, or exists in a rudimentary form. In the Albino, the iris is of a rose-color, while the pupils present a deep red appear- ance, owing to absence of opaque pigment. In coloboma, the two halves of the iris have failed to unite, in consequence of an arrest of development, which gives the pupil an elongated form. Inflammation of the iris exists in a variety of forms, and is asso- ciated or dependent on low states of vital power. The different forms of iritis are divided into (i) hyperaemia of iris; (2) plastic iritis ; (3) serous iritis; (4) parenchymatous iritis ; (5) syphi- litic iritis. Causes, — Syphilis, gout, tuberculae, mercury, are the primal causes, but exposure to sudden changes of temperature, cold draughts, or severe drenching, together with grief, anxiety, sleeplessness, may induce it Tf the predisposition exists in a depraved constitution. Symptoms. — There is lancinating pain, situated at first, in the in- terior of the eyeball ; then it extends to the forehead, temple and gums, and other parts of the fifth nerve. Throbbing is an unfavora- ble symptom. Pain increases towards evening and lasts till morn- ing, when it has assumed a dull aching in the eyeball, and oc- casionally it is of lancinating character. The nocturnal attacks BACTERICIDES. 577 of pain are very apt to cause fever and impaired appetite. In- tolerance of light and lachrymation are rarely absent, but very slight. Now examine the eye. Direct your attention to its color ; compare it with the healthy iris, and see if it has not undergone some change, for inflammation changes blue into greenish, brown into reddish, gray into greenish yellow color; and if blood is effused into the anterior part of vitreous humor, it presents a green color. The arterial distribution accounts for those changes. There is also contraction, dryness and irregu- larity of the pupil, dimness of vision and sometimes total blindness. The different forms depend upon the cause ; the syphilitic form is the most common, and is usually associated with other symp- toms, r.s chief distinctive characteristic is that instead of the whole iris being studded over with excrescences, the inflamma- tion is confined to one or two single spots, while the rest is normal. One-fourth or one-half of the iris is changed in color, and swollen. Treatment. — This embraces general principles ; aconite for fever; morphia for pain; free action of bowels and skin; nour- ishing food, etc. Our effort must be directed to the eye to obviate the tendency to adhesions, or break them down ; for this purpose, a solution of atropine breaks them up if fresh, and puts the eye in a favorable condition toward resolution. The solution formerly given should be dropped into the eye thrice daily. Then the eye kept covered with a solution of boroglyceride. Inflammation of the substance of the Inflammation kidneys, or acute nephritis, is a compara- of the tively rare affection. Kidneys. It is predisposed to by debility, or a {Acute Nephritis) tubercular diathesis, poor living, mental depression. Its exciting causes are cold, damp, exposure to vicissitudes of weather, mechanical in- juries, lifting, hoisting, strains, blows ; to the presence of calculi or gravel in the kidneys ; excessive beer or whiskey drinking ; the drastic action of such drugs as turpentine, balsam copaiba, can- tharides, and it is also caused by diseased germs. Symptoms. — In addition to the usual symptoms of languor, lassitude, debility, there is great constitutional disturbance, head- ache, pain in the back and legs, rigors, fever, nausea, vomiting ; hard, frequent, but small, wiry pulse; constipation and a localized pain over the region of the kidneys, increased by pressure and 37 578 DISEASE GERMS. movement ; pain is permanent and severe and often extends down the ureter to the bladder, groin, scrotum, or testicle; besides, there is numbness of the anterior portion of thighs, retraction of the testicle, and tympanitis ; frequent micturition, a desire to void water when there is none in the bladder, or passed in drops ; often suppression of urine, and if there is any passed it is very high colored and contains casts of the kidney tubes, or blood in large or small amount, or pus. If the urine is suppressed there will be uraemia, with coma or convulsions. If recovery follow it is liable to leave the kidneys weak for some time. Besides resolution or recovery, the case may terminate in a vio- lent attack of haematuria, and get well ; or in effusion of lymph and abscesses of variable sizes, which are very destructive to the body of the kidney. These abscesses are likely to lead to ulceration, perfora- tion of capsules and renal fis- tula, and estabHshment of the muco-purulent discharge ; often fatal hectic associated with those abscesses. In favor- pus is evacuated, the kidney heals up and a good cure takes place. Besides being a result of inflammation, abscess may be due to the presence of a stone in the kidney, obstruct- ing and irritating the passages. Treatment. — If seen early, administer an emetic ; follow with aperient and enemata and alcoholic vapor bath ; then put patient to bed, between blankets ; apply mustard sinapisms over kidneys and over stomach ; when a very decided redness is produced, hot linseed poultices ; disturb patient as little as possible in their ap- plication. Administer aconite, tincture of green root gelsemium and digitalis, in small doses, frequently repeated till pulse reaches 60 ; then, at longer intervals. Those three arterial sedatives operate well, and should be given for sometime in smaller doses, at longer intervals. If there is the slightest tendency to ursemic symptoms, hypodermic injections of one-third of a grain of pilo- carpin. Low diet, milk and lime-water, beef tea. No drink, nothing to give kidneys \york. If case progresses favorably, apply irritating plaster over kidneys, and administer either quinine, with aromatic sulphuric acid, or compound tincture of cinchona with nitromuriatic acid. For two or three months patient Renal hyperaemia in acute nephritis. able cases the BACTERICIDES. ^^^ should use, three times a day, either an infusion of buchu, or uva ursi, or queen of meadow, or pipsissewa, or cleavers, or pareira brava, to restore tone to kidneys. Tubular nephritis, or acute Inflammation of the albuminous nephritis, is an afifec- Interstitial Tubes. tion of the kidneys, greatly on {Acute Interstitial Nephritis}) the increase, and forms what is known as acute Bright's disease. Its chief characteristics are excessive proliferation of the con- voluted tubes of the kidneys, with congestion of the malpighian tufts, an exfoliation of the walls, and the white blood escapes. The shedding, or shelling, or peeling of the tubes in the process of proliferation, by which they lose their epithelial lining, chokes up the tubes, obstructs secretion. The morbid process is tubu- lar, interlobular, interstitial, commencing at the surface, and pro- ceeding inwards, leaving the cortex pale. In this process the walls of vessels usually give way, and the serum and white cor- puscles mingle with the urine, rendering it albuminous, the fibrin coagulates in the tubes, and forms casts. The malpighian bodies form bright red points, pyramids, dark and congested ; kidneys much enlarged. Causes.— Yr\v2!aoxi, exposure to wet or cold, but especially when the nerves of the kidney are weakened, and there is a union of the urate of soda with lithic acid from beer or ale-drinking, and especially the germs of scarlatina. Symptoms, — There is a sudden seizure of chilliness, rigors, fever, with headache, thirst, vomiting, restlessness, with pain and tenderness over region of the kidneys ; frequent micturition ; urine scanty; of a dark, smoky color, persistent and highly albuminous, with abundance of fibrinous casts, epithelial casts, renal epithelium, blood casts, and few blood corpuscles; dropsy of the cellular tissue, general oedema, face puffy, hand swells if it hangs down ; dropsy and anaemia ; a strong tendency to effu- sion of serum from membranes of brain, peritoneal coat, pleura. There are cases occasionally met with of general dropsy and albuminuria, without a desquamation or peeling off of the renal epithelium, called ^^t'/^-desquamative disease of the kidneys. This is apt to occur in bad cases of blood-poisoning, owing to a failure of vital power to eliminate morbid material from the system. A favorable sign is free and copious urination without albu- men ; an unfavorable indication is scanty, or total suppression of urine, aggravated dropsy and effusion into the serous cavities, pleura, pericardium, and peritonaeum. 58o DISEASE GERMS. Treatment. — If the result of intemperance, active measures, as cupping over the kidneys ; open bowels quickly with elaterium ; alcoholic vapor bath ; then put to bed between blankets ; mus- tard, followed by hot poultices over kidneys ; very free diapho- resis, with jaborandi or pilocarpin ; try first infusion of digitalis and nitrate of potass ; and if that fail, citrate of potassa in infu- sion of hair-cap moss, and general treatment as laid down under Bright' s Disease. In the little child, whose kidney tubes are peeling off and exfoliating, our treatment must be more gentle, and still effi- cient, but different from the above — warm baths ; confinement to bed ; dry heat to kidneys, in the form of camomile flowers or bran in a bag, heated in an oven ; to lie between blankets, and give most nutritious diet of beef tea, milk, eggs, etc. Try infu- sion of digitalis and sweet spirits of nitre, in alternation with quinine and aromatic sulphuric acid. Open bowels with com- pound licorice powder. The infusion of digitalis is our best remedy ; but if it fail, try infusion of asparagus-tops and nitrate of potassa, or infusion of parsley-root and citrate of potass. Per- severe with the quinine and aromatic sulphuric acid. If those remedies do not avail, then try nitro-glycerine — a two per cent, solution, in one-drop doses, every four hours. Most excellent results have followed the use of the remedy in this form of acute interstitial nephritis ; it relieves every symptom, the oppression, the vascular tension ; the kidneys resume work, peeling is arrested, and we are soon gratified with a copious secretion of urine free from albumen and tube casts. There are no cases but what are relieved, if not cured, by the action of this drug. Im- provement inevitably follows. Chronic desquamative nephritis, or Chronic Interstitial contracted granular, or gouty kidney, or Nephritis. more commonly termed Bright's disease, is a true interstitial degeneration or breaking-down of the epithelium of the convoluted tubes; an ex- foliation, or shedding, or peeling of the walls of vessels, which lose their epithelial lining, owing to a true inflammatory process ^r partial death. This interstitial irritation causes the interior of the kidneys to collapse, become filled up with broken-down debris or rubbish ; choke up the tubes, and obstruct secretion. This interlobular death causes them to contract. Nature makes efforts at revival again and again; but this shedding of renal epithelium continues; and besides blocking up the kidney, appears in the urine in a BACTERICIDES. 581 more or less disintegrated form. The tubes lose their lining altogether, and either collapse or become filled up. This denud- ing process permits the liquor sanguinis, or serum, or albumen of the blood, to escape in the urine, so that the urine is persis- tently albuminous, of low specific gravity, and contains granular casts and epithelium. Varieties, an excellent etiological classication has been pro- posed, to wit, which corresponds to the facts of clinical obser- vation, as well as to pathology. The following are the proposed divisions : 1. Febrile nephritis. 2. Toxaemic nephritis. 3. Obstructive nephritis. The first division includes all those cases of acute or chronic nephritis occurring as a result of acute or chronic febrile disease, as is engendered either by the microbes of measles, variola, scar- latina, hooping-cough, mumps, rheumatism, or the bacillus of tubercle, cancer, syphilis, anthrax, erysipelas, etc., or by the mi- cro-organism of diphtheria, typhoid, malaria, pneumonia, ulcera- tive endocarditis, pyaemia, etc. The second division includes the great group of essential chronic cases due to lithaemia, an irritation of the kidneys by the excessive elimination of poisons of which uric acid is the type. It includes the nephritis of gout, the poisoning by animal, vege- table or mineral poisons, but more especially the toxaemic effects of beer, which gives rise to an excess of uric acid in the blood and its prolonged elimination through the kidneys. The third division includes all cases dependent upon obstruc- tion to the outflow of urine, as stricture, enlarged prostate, cystitis in men, and uterine, ovarian tumors, pregnancy, procidentia uteri in females. Predisposing cause may be enumerated thus: neurasthenia or poverty of nerve force; the intense struggle for existence; vari- able temperature, highly oxygenized atmosphere ; suppression of the perspiration, followed by increased acid of the urine, with diminished alkalinity of the blood, leading to the accumulation of uric acid in the blood. The left kidney being freely covered with the great sympathetic, demonstrates most clearly how over- mental work, or worry, or grief, damages that kidney, and gives it a predisposition, a weakness to any irritating agent. Residence amidst a halo of sewer gas impairs the integrity of the organism, and is often a primary cause. Frequent chilling of the body in- creases the formation of uric acid. Climate, individual conforma- tion, occupation, habits as to food and drink ; the presence of pre-existing disease of the heart and liver ; the failure of the kid- 582 DISEASE GERMS. neys to eliminate, owing to some obstruction, as stricture, enlarged prostate, tumor, pregnancy, ovarian enlargement. Exciting causes. The most common are the presence of disease germs in the blood, and their elimination, dead or alive, by the kidneys. Where there is an inherent weakness of organization, the microbes of malaria, the bacillus of diphtheria, the vibrios of typhoid fever; the amylobacta of rheumatism, the amoeba of catarrh, the germ syphilitica act as exciting causes. The in- discriminate use of such drugs as mercury, balsam copaiba, turpentine, cantharides, juniper berries, acetate of potassa, etc., often give rise to it. Bad living, constant exposure to wet and cold, to atmospheric changes, deleterious trades, and intem- perance, are common causes. Out of every one hundred persons who indulge in beer arid other alcoholic compounds, and thus lay the elements of gout and rheumatism in their blood, eighty per cent, are affected, more or less, with desquamative nephritis. The union, therefore, of the urate of soda, with lithic acid in a weak- ened kidney, or in gout, is the most common of all causes. In this enumeration, previous dis- ease, blows, lifts, strains, etc., are not to be overlooked. The distinction between gout and rheumatism does not essen- tially enter into the exciting cause. In rheumatism we have the uric, lactic, butyric acids, the latter forming or entering the into micro-organism (bacillus amy- lobacta), gout, with the same compounds and urate of soda. The inhibition of lead, phosphorus, mercury, leads to the accu- mulation of uric acid in the kidneys, by depressing the function of the liver or forming insoluble urates. Permanent hardness in drinking water, due to the presence of lime salts, is often a predisposing cause. Beer drinking owes its ill effects more to the acid it contains than the alcohol. Whiskey drinking causes cirrhosis of the liver, organic changes in the great urea-forming organ of the body, indirectly causes the formation of uric acid. The excessive use of animal food increases the raw material from which uric acid is formed, and also by the large amount of salts contained in it. Sudden changes of temperature are a fertile cause of this disease. Prognosis. — The chances of recovery from an acute attack of Section from the cortex of a contracted kid- ney, showing two glomeruH. BACTERICIDES. 583 Bright's disease are decidedly favorable, for we rarely have a fatal termination unless egregiously mismanaged. We cannot speak so confidently of the ulterior result, for once the kidneys are damaged, they are difficult to repair. All circumstances must be well balanced in the mind, if the urine is to be kept well persistently loaded with uric acid (lithse- Section of the cortex of the kidney in chronic interstitial nephritis. Fatty degeneration, the result of interstitial nephritis, due to beer drinking. mic nephritis), such as we have in gout, in habitual beer drinkers, whose blood is inflated, may, actually irritated by the dyscrasia, our prognosis is not good, as we have the prolonged action of the uric acid in paasing through the kidneys. Age modifies this morbid condition. It is rare under twenty ^years of age, indeed not common up to forty, very prevalent after that period is passed, after fifty still more common, so much so that one-third of all persons dying above that age show more or less signs of its action on their kidneys. With reference to sex, all statistics show that the contracting type of kidney is less common in females than in males, being one female to two males. It attacks all classes, but is especially common among workers in lead, miners, brewers, and frequency among females may be due to sympathetic, and to their exemption from avocations of life. Pathology. — As. the mortality from this disease shows a pro- gressive increase, co-equal with civilization, it is interesting and important to note its pathology. During life, uric acid, the normal product of dis-assimilation, plays a most important part. Waxy kidney, common in the tuber- cular, a sequela of chronic inter- stitial nephritis. beer drinkers. Its in- their rudimentary the more rugged 584 DISEASE GERMS. Hypertrophy of the heart exists in seventy-five cases out of one hundred ; atheroma of the aorta, coronary arteries, ossifica- tion of the valves, with evidence of fatty degeneration in all cases. Of 250 cases observed, 176 were men and 74 were women. The cyanotic kidney was found chiefly in young and middle- aged men, and the oedematous form chiefly in old men and in women. Six-tenths of the cases showed a fatty liver, not affected with fibrosis. As regards the general pathological conditions found in the 250 cases, the following may be stated : the alco- holic kidney was found 248 times ; large, fatty liver, 220 times ; chronic and acute cystitis, 170 times; a mammelonated condi- tion of the stomach, 150 times ; excess of blood in the brain and oedema, 1 50 times , simple hypertrophy of the stomach, 90 times ; arterio-sclerosis, 50 times ; acute gastritis, 50 times ; Bright's disease and phthisis, 20 times ; hemorrhage in the brain, 10 times ; and cirrhosis of the liver, 6 times. The changes found in the stomach, liver, and brain are of very great interest. The extreme frequency of fatty liver, with the infrequency of cir- rhotic liver, is certainly very remarkable. In all cases either a waxy or fatty degeneration of the kidneys, with atrophy or hypertrophy. Many complications of chronic interstitial nepJiritis are liable to take place, chiefly due to the presence of an excess of urea in the blood, all embraced under " urcemia',^ these are hyperaesthesia of the skin ; deposits of crystals of urea on the skin ; symmetrical gangrene; vomiting and diarrhea; hiccough; difficulty of breath- ing ; headache; deafness and blindness; hemiopia ; hemi- plegia ; delirium ; coma ; twitchings ; convulsions ; epilepsy ; hemorrhages ; oedema of the glottis ; congestive oedema of the lungs. Symptoms, — General languor, lassitude and debility existing for a long period, even for years, may exist without the true nature of the affection being suspected, but by and by the debility increases, and the weakness becomes associated with loss of flesh, prostration, vertigo ; specks and spots before the eyes ; noises in the ears, and the skin assumes a uriniferous appearance and odor; the conjunctiva becomes a pearly white, the tongue large and flabby with the diagnostic kidney tracts, with feeble pulse, cold extremities. There may or may not be pain over the region of the kidneys ; usually, however, a sense of weight or weakness. Urine is usually free and very copious, pale in color, and of a very low density, but persistently exhibits traces of albumen in large or sma'l aii')ants, and soon becomes loaded with casts from the kidney. BACTERICIDES. 585 Interstitial death or collapse progresses onwards, the above symptoms become more intense, aggravated, then dropsy, more or less oedema, puffiness of eyelids, general anasarca, with effusion into the serous sacs, with some oedema of the glottis and lungs, with symptoms all the time growing worse, degeneration of the kidneys appear, or structural changes in the form of fatty or amyloid usurpation. The blood becomes very impure, loaded with urea ; there is an innate or inherent power of resistance to the circulation of contaminated and deteriorated blood through- out the vessels, whence arises the high tension in arteries ; hyper- trophy of the muscular coat of the arterioles, and enlargement of heart ; often organic disease, especially valvular. This impure blood acts badly on nerve centres ; retinitis and other signs of degeneration often appear. Diagnosis. — The history of the case may exhibit a diathesis inherited or acquired ; if not the presence of some source of irri- tation of the kidney with that terrible feeling of goneness. The skin has a uriniferous aspect ; the saliva and sweat contain urea. The blood is anaemic, haemoglobin and red corpuscles diminished, while the water of that fluid is increased. The truly diagnostic symptoms are, the pearly lustre of the eye ; longitudinal fissures on the tongue ; the persistent presence of albumen in the urine ; the anasarca ; retinitis , polyuria ; dilatation, followed by hyper- trophy of the heart ; tube casts in urine ; of mucus, epithelia, blood; or occasional hemorrhages take place contracting kidney. Progress and Distinctive Features of the Disease. — The presence of albumen in the urine, or an albuminous body, which is coagu- lated by heat or precipitated by neutralization, was once regarded as of primary import, but later observations has caused it to lose its original meaning. The number and variety of pathological relations, under which albumea may appear in the urine are numerous. It is invariably present in inflammation, congestion, changes in the mechanical circulation, microbes in the blood cir- culating through the kidneys ; disease of the heart or lungs, or morbid states of the liver, peritonitis ; pregnancy, abdominal tumors. It is often present in tubercle, syphilis, cancer, purpura, scurvy, anaemia, diseases of the brain and spinal cord, in epilepsy, chorea ; cutaneous affections. It is also present in active or arterial congestion, from a chill to the skin in bathing ; from exposure to cold ; from the elimination of some irritant through the kidney, as alcohol, uric acid, phosphorus, lead, cantharides, copaiba ; but especially are the microbes of scarlatina, variola, diphtheria and erysipelas disastrous to the kidneys, as well as the vaso- motor paralysis which their presence induces. ^S6 DISEASE GERMS. Venous congestion induced by cardiac, pulmonary disease, goitre. Degeneration of the arterioles, changes in the composi- tion of the blood. Besides, there is a common form of albuminuria, which occurs in young men and young ladies, victims of self-abuse, or sexual excess, whose reproductive centre is exhausted ; who suffer from languor, headache, weakness of the back and knees, indi- gestion, neurasthenia, without a sign of organic lesion ; it is re- mittent in type, and named cyclical albuminuria, or that of adolescence. So we meet with albumen in the urine, from innumerable causes, which are not to be regarded as diagnostic of Bright^s disease. The mechanism by which albumen persistently passes in the urinary secretion is essentially one of inherent debility, organic change, permeability in the walls of the glomerule, by or through which the white portion of the blood exudes, by transudation or exosmosis. Next to the persistent presence of albumen in the urine, dropsy is a most striking symptom. This consists in an accumu- lation of serous fluid in the lymph spaces of the subcutaneous cellular tissue and in the three great serous cavities of the body. This fluid is derived from the capillaries, and under normal cir- cumstances is poured out into those spaces, but taken up again by the venous and lymphatic radicle, as fast as it is poured out. For the production of dropsy this equilibrium must be upset, either by an increase in the outflow of the fluid, or in a failure on the part of the veins and lymphatics to take up the effused fluid. A weak or obstructed kidney, with watery blood, increased permeability of the capillaries ; a defective pumping arrange- ment ; organic changes in the brain, blood and capillaries generally gives rise to an increased outflow, a decreased taking up. Albuminuria is invariably present in all states of damaged kidneys, in all grades of renal debility, or irritation, or where the kidneys become clogged up with diseased germs. This state of partial death of the renal organs, existing for some time, soon gives rise to the presence of tube casts in the urine. Casts of the renal tubes are usually one or other of three kinds : blood, epithelial, and hyaline. Blood casts are evidence of hemorrhage from the glandular structure of the kidney, epithelial and hyaline casts, evidence of active inflammation. BACTERICIDES. 587 Nephritic debility gives rise to increased permeability of the glomerular walls and epithelium, and these structures further stunned by the presence of an excess of uric acid, gives rise to ^'polyuria''' where we have increased blood pressure, dilatation of efferent vessels, with destruction of capillary areas beyond the glomeruli. Cardiac hypertrophy is invariably present in all forms of per- sistent albuminuria, even in acute nephritis, but most common in contracted kidney, and is due to stimulation of the heart, to irri- tation produced by the microbes in the blood, to the presence of uric acid or urea in the blood, to increased capillary resistance, due to the density of the blood plasma, and the high tension pulse to the acquired increased energy of the heart, with greater capillary resistance. The chief retinal changes are due to neuritis, which is caused by the disordered state of the blood, and invariably indicates grave organic changes. A partial death of the kidneys always gives rise to an excess of urea in the blood. Uraemia is a generic name given to a large host of symptoms which occur in the onward progress ot the disease, due to a failure on the part of the kidneys to elimi- nate this agent, hence the skin and breath have a uriniferous odor ; the brain is poisoned with it, hence the headache, the ver- tigo, delirium, intoxication, convulsive attacks, chorea and epi- lepsy ; the asthma, paralysis. Indeed such patients present themselves under the most varied semciological conditions, they may complain of bronchitis, asthma, pain at the praecordia, palpitation, epistaxis, vomiting, diarrhea, giddiness, headache, neuralgia, affections of sight or hearing, apoplexies, convulsions, coma. Treatmejit. — The successful management of Bright's disease depends a good deal upon the physician being a man of exten- sive experience, sound common sense, and upon a thorough understanding of the disease. Fortunately for all patients, the true nature of the malady is yearly becoming better appreciated. A patient can do much also to improve his condition, main- tain and preserve his vital force ; in no way, neither with work nor excess of exercise, should he do anything to weaken his con- dition, all his efforts should be directed to adopt a mode of life which will lead to the acquisition of more strength. It is not always in the power of patients to choose their resi- dence in strict conformity with medical advice, but when possible a warm, dry climate should be selected for the winter, and the highlands in the summer. The clothing, day and night, summer and winter, should be woolen. 588 DISEASE GERMS. Tepid bathing should be resorted to daily, followed by brisk friction or massage, cold baths or sponging should never be permitted. Once a week, if the case permits, an alcoholic vapor bath should be taken. This is the most accessible, and for general utility, one of the best forms of bathing, and every family should be familiar with its use. In the first place any tinsmith will make a convenient lamp, like an oyster chafing-dish, with five wicks, each the thick- ness of a quill, and large enough to hold alcohol to burn three- quarters of an hour. In the centre, over the five flames, a deep plate, large enough to hold water to boil for forty-five minutes. The whole, for safety, might be placed inside of an iron pot, which is to be placed underneath the chair on which the patient is to sit. The patient is then to be divested of all clothes, and sit down on the chair un- der which the spirit-lamp is placed. This chair must have a thick, wooden bot- tom, and there must be some protection, either a piece of wood, or blanket, placed in front to prevent undue heat on his calves. The patient, sitting down, must be carefully envel- oped in blankets pinned tightly around his neck, and lying on the floor, and be careful that on crevice, or hole, or outlet exists to let the vapor escape. The patient being thus duly enveloped and covered up, the lamp and saucer which had been previously fixed, the former with alcohol, and the latter with water, the five wicks are ignited. In a few minutes he begins to experience the glow of the burning alcohol, and by and by the steam begins to rise. Some recommend giv- ing a cup of hot boneset, or pleurisy-root tea, but it is unneces- sary — the best drink is abundance of cold water. With this bath there is a determination of blood to the skin ; it relieves cerebral, lung, and visceral congestion ; induces a healthy action of the skin and mucous membrane ; eliminates noxious matter from the blood, and imparts a sense of elasticity and vigor to the system. It is useful in both health and disease, but especially in Alcoholic vapor bath. BACTERICIDES. 589 colds ; congestion of the lungs, liver, kidneys ; dropsy, gout, and rheumatism, neuralgia. No tendency to catch cold after it. It will break up all fevers. It should be given upon an empty stomach, and never to pregnant women, or those who are men- struating. It can also be used for medicated vapor baths, by adding iodine, or other chemical agents to the water in the saucer, so that the patient is exposed to the influence of three agents, heated air, or alcoholic vapor, steam, and the medicinal agent used. After one-half an hour spent in the alcoholic bath, with copious perspiration, the light should be extinguished, and the blankets pushed down, the body well rubbed and dried, and then the lower half; a dry shirt put on, and placed in bed for several hours, or over night. It is much superior to either the Turkish or the Russian bath, and costs little. No family should be with- out it. The duration of this bath should never exceed thirty minutes. Daily exercise, but never so much as to induce the slightest fatigue. Diet is to be generous and nutritious, embracing, as far as possible, fowl, game, eggs, cream, cereals, as oatmeal, wheaten grits; sweet-bread, tripe, calf 's-head ; white-fish; fresh vege- tables and fruit, with farinaceous food. Tea, coffee, chocolate are permissible, but beef, mutton, cheese, saccharine fatty food forbidden ; a liberal diet, but rigidly de- prive the patient of all slops, even milk, beef-tea, soups. Beef- tea is a chemical composition, closely resembling urine, and all soups or broths partake of the same character. Nevertheless, the patient's health and strength must be maintained. Malt liquors forbid, if anything in this line be necessary, let it be good whiskey in ApoUinaris or Vichy water. In all cases the patient should be placed upon a general tonic and alterative course for months or years. Such tonics as matricaria comp., comp. tincture cinchona and aromatic sulphuric acid ; quinine and mineral acids ; ozone water ; glycerite of ozone, or a mixture containing benzoate of soda and digitalis, thus, benzoated soda, five grains ; tinct. digi- talis, eight drops ; infusion of gentian, one ounce. Mix. Take a dose thrice daily. For alteratives, comp. saxifraga and Phyto- lacca, are invaluable ; still, such vegetable extracts as corydalis, stillingia, are not to be overlooked. Over both kidneys, some stimulant should be kept constantly applied; the common irritating or tar piaster is the most efficient. While pursuing the general alterative and tonic course, it is 5Q0 DISEASE GERMS. well to change them once a week, so that the patient does not become habituated to any one drug. An important indication in all cases is to keep the bowels in a soluble condition, the intestines form an important channel of elimination. If the peristaltic wa\^e is arrested, poisons, or pto- maines are formed, which aggravate the existing state of things. If constipation does exist, very gentle, but efficient measures must be adopted. The cascara lozenge should be tried, being a tasteless, tonic laxative ; stimulating digestion, promoting nutrition and assimi- lation, one or two after each meal ; or small doses of the kola- nut, or if very obstinate, a pill containing one grain of euony- mine ; two grains of the extract of aloes, and one-eighth of a grain of belladonna. Mix. Make one pill. Take at a dose. Besides adopting a general treatment as here indicated, there must be a special course of remedies used to meet the three prominent indication* which are invariably present. * To arrest or check the flow of albumen we must be solemnly impressed with the idea that there are no specifics in medicine ; that we profess no drug which has a definite, decided control over the excretion of albumen by the kidneys. The action of any drug upon a diseased organ is always obscure, invariably an element of uncertainty about it. Some of the following remedies should be selected and tried, say, for forty-eight hours ; and if no check, another substituted : Gallic acid, in fifteen-grain doses thrice daily, in a tablespoonful of port wine ; tincture or infusion of digitalis, ten drops of the former, or wineglassful of the latter, thrice daily ; iron in tinc- ture, or iron-alum, oil of erigeron, ergot, matico, mineral acids. Tannate of soda, thus, tannic acid, bicarbonate of soda, of each ten grains ; glycerine, twenty drops ; add to and mix in one ounce of water. Administer thrice daily. Nitro-glycerine, most invaluable drug. A one-per-cent. solu- tion most available, in doses of from one to more drops added to water three or four times daily, is the most effective remedy we possess, it props up the collapsed kidneys, and as we have to deal with heart failure, this remedy while checking the escape of al- bumen gives backbone to the heart, imparts to it increased energy. Oil of erigero7t is superior to terebene, and deserves an occa- sional trial, its use in five-drop doses on a lump of sugar every three or four hours, lessens greatly the amount of albumen, lowers vascular tension, and improves the general condition. It has also a most favorable influence on the headache, nausea and other symptoms of a uraemic character. BACTERICIDES. 591 It is in no sense a curative drug, but it undoubtedly palliates this state in a most admirable manner. Some claim that the glucoside from eupatorium purpureum, combined with chloride of sodium, the former in five, and the latter in ten grains, are successful; we have increased the dose greatly, and have met with no success with the combination. Ballota Suaveolens is of great efficacy where the kidneys are blocked up with uric acid, in itself it is a powerful diuretic, dis- solves the uric acid lodged in the kidney, removes congestion, checks the escape of albumen, and eliminates morbid matter. This is an invaluable remedy. An acetic tincture of the ballota and senega root, makes a most efficient astringent diuretic. Occasionally we have found five grains of the syzygium jam- bolanum, thrice daily, of great efficacy in arresting the escape of albumen, it is the best by far of the class designated astringent diuretics. Iron is a remedy sometimes of great utility. A good formula for its administration is the following : liquor ammonia acetatis, two ounces ; dilute acetic acid, one ounce ; tincture of chloride of iron, four drachms ; water, one ounce and a half. Mix. Teaspoonful for a dose. With regard to all drugs, small doses, frequently repeated, are the best ; do much better than large ones. To remove effusion, dropsy of the cellular tissue, or in the three serous cavities. Infusion of digitalis, or strophanthus, to unlock the absorbents, followed by diuretics, diaphoretics, hydragogue cathartics. An infusion of digitalis, made fresh daily, has a marked action on the brain, the heart, the arteries ; it often arrests the escape of the albumen itself; it unlocks the absorbent system, and is a most serviceable drug. Many are, and have been, disappointed in its action, simply from inattention to its proper mode of infusion. It deserves a fair trial, properly prepared. Strophanthus if tried, must be used in tincture form, one to two or more drops, then follow in with special remedies. Caffeine might be tried thus : citrate of caffeine ; pulverized digitalis; pulverized squills, of each one grain. Make into one pill. Administer one every three hours. Bitartrate potassa, half an ounce, to a pint of boiling water, to be used as a drink, has a most remarkable action in flushing the kidneys ; or it could be administered thus : bitartrate potassa, one drachm ; nitrate potass, ten grains ; pulverized mandrake, three grains. Mix. Make one powder. Give one once, twice, or thrice daily, so as to cause two or more motions of the bowels in the twenty-four hours. 592 DISEASE GERMS. Ulexine, an elegant alkaloid possessing powerful diuretic prop- erties, in doses of one-fortieth of a grain three times a day. An infusion of the hair-cap moss often does good work, it is an efficient diuretic. Hydragogue cathartics, that is the stimulation of the entire serous coat of the bowels, with one-twelfth of a grain doses of elaterin ; or some remedy of a like character. The sonchus oleraceus, or rather the gum obtained from the milk of the plant by evaporation, is the part used, and is best ad- ministered in small doses combined with either manna, anise seed, or carbonate of magnesia. It is quite as powerful as elate- rin, but not so exhausting. It is always safe to promote a dis- charge from the intestinal canal, with due caution that they do not become excessive, so as to pass into a permanent diarrhea. Frequent passage from the bowels rid the intestinal tract of ptomaines, urea, and other toxical substances. Inflammation of the Larynx, Acute. Acute laryngitis is a rare disease, being confined almost exclusively to adult males ; women and children almost exempt from this form of inflammation. A slight inflammation or congestion of the mucous membrane of the larynx is common in all ages and in both sexes, as the result of cold, damp, etc.; symptoms being, sore- ness, or rawness, hoarseness and a dry, harsh cough. But acute laryngitis is a grave, formidable and fatal affection, when it occurs in men whose nervous system has been shattered by worry, care, struggle for existence, and involves the mucous and sub-mucous coats. It is a paltry piece of human mechanism that is attacked, perhaps merely the fraction of an inch, but the inflammation is terrible and rapid in its results; congestion first, effusion of plas- tic lymph obstructing the chink of the rima glottis, preventing the ingress of air. The predisposing cause is, depression of the great sympathetic, whose branches freely cover the larynx in adult males ; the depression being some emotion, desire, affection, passion ; the exciting cause, exposure, fatigue, wet, poisons. Laryngitis, then, being peculiar to persons of a shattered nervous system, comes on very insidiously. At the end of a few hours, violent rigors, fever of a high grade, fauces red, A vertical section of the mucous membrane in acute laryngitis. BACTERICIDES. ^q^ swollen ; pain over the cartilaginous part of the throat ; great difficulty of breathing and swallowing ; patient very anxious ; hoarseness, and complete loss of voice; spasmodic exacerbations, with paroxysms of threatened suffocation ; long inspirations ; peculiar wheezing sound as if air was being drawn through a narrow tube; harsh, brassy cough; difficulty of swallowing; liquids more difficult to get down than solids, as they bring -the circular muscular rings into active exercise. Face and neck first flushed, then livid, subsequently purple ; eyes protruding ; pulse hard and frequent ; great distress. Larynx and trachea move rapidly upward and downward ; all the respiratory muscles brought into powerful action, so the chest heaves violently. Pa- tient grasps at his throat, gasps for breath, gets out of bed, will thrust his head out of the window. He soon becomes delirious or comatose, and dies from non-oxygenation of blood. The duration of the affection is from forty -eight to seventy-two hours. Almost invariably fatal. Treatment. — The importance of active treatment cannot be too strongly insisted on. Immediate relief is indispensable. Rest and quiet; forbid talking. Air of room to be kept at 75° Fahr., very moist, with warm vapor. Extract of belladonna in hot linseed poultices to throat. Inhalation of warm vapor of tinc- ture belladonna and iodine. Diet : cream, raw eggs, extract of raw beef Veratrum viride in three-drop doses every twenty minutes ; from twenty to thirty grains of sulphate of quinine every two or three hours, between which from a quarter to a half grain of sulphate of morphia. If necessary, open bowels with beef tea. No debilitating treatment to be used in acute laryngitis ; make an effort to guide patient over third day and run it into chronic laryngitis, from which he will recover. This is a very common form of Inflammation of laryngitis. Membrane lining laryngeal Larynx. cartilages becomes thickened, ulcerated, {^Chronic Laryngitis}) also involving the fauces and uvula. It may be caused by cold, damp, ex- posure, exertion, inhaling noxious gases, etc., and those condi- tions intensified by disease germs in the blood, as tuberculae, syphilis, mercury, lead, amoeba of catarrh. The ordinary symptoms are, general debility, cough, expec- toration, hoarseness, loss of voice, with ulceration of the mucous membrane of the larynx, fauces. The different varieties are to be recognized by the following landmarks. 38 ^Q^ DISEASE GERMS. Simple chrofiic laryngitis, by soreness, rawness, redness. The syphilitic forrriy by its copper-colored appearance, and dry huskiness, microbe syphilitica. Mercurial form, by its dingy, metallic hue, and peculiar fetor of breath. Tubercular form, by its mottled appearance, bacillus tubercle. The profession or avocation of the patient will guide us as to the variety. Either of the forms may give rise to thickening, warty excrescences, and small polypi on different parts of the larynx, which aggravate the difficulty, cause impediment to the entrance and exit of air, and impairment or loss of voice. The sputum of chronic laryngitis is loaded with amoeba, which would necessarily cause it to be contagious and infectious. Treatment. — General principles must guide us in its different forms. Skin to be attended to by daily baths and friction ; bowels to be seen to, clothing to be woolen ; appetite to be stimulated, and diet to be rich in blood elements and very generous. Mouth and throat gargled with a wash of boroglyceride, chlorate or permanganate of potassa, three times a day. Atomized spray, warm vapor once a day, consisting of terebene, creolin, resorcin, or chlorate of potassa, or some other antiseptic. The use of demulcents, as gum-arabic water, elm water, flaxseed tea, marsh- mallow, white of eggs and common salt are to be recommended. Alteratives, as compound syrup of yellow dock, ozonized saxi- fraga, phytolacca, iodide potassa, and tonics, as cinchona, gly- cerite of ozone, ozone water, nux vomica. Tonics before meals, alteratives two hours after. Two points of suppuration to be kept active by the irritating plaster on side of spine below the nape of neck. Special Treatment as to Cause. — Muriate of ammonia, tere- bene, in the simple form ; iodide potassa, nitric acid and com- pound tincture cinchona, compound saxifraga and phytolacca in the syphilitic ; glycerite of ozone, compound hypophosphite of potassa, tincture iodine in the tubercular; iodide of potassa in the mercurial ; ozonized catarrh fluid, if due to catarrh. If no cause can bf^ ascertained, then a general alterative and tonic course should be inculcated and carried rigidly out; change of air, locality, diversity of scene, every possible means adopted to build up the general health. All cases of chronic laryngitis, irrespective of their cause, are greatly benefited by the comp. oxygen treatment — the remedy being an active microbicide — at the same time a powerful vital- izer of the larynx. It stimulates, aids a renewal of life in the various structures of which it is composed. BACTERICIDES. 595 Inflammation of the Liver. {Acute Hepatitis.) Partial death of the Hver may result from some obstruction through the hepatic and portal veins, as occurs in some forms of valvular disease of the heart, or morbid state of lungs, im- peding the passage of blood through the pulmonary artery ; or in diseases that diminish the capacity of the thoracic cavity ; or from violent exercise, or tight lacing; conditions that lead to diminished excretion of bile, so that the ducts become engorged with it, and thus cause biliary congestion. %^, Suppose this condition to progress, the patient receiving some mechanical shock over the liver, or that some diseased germs in the blood took up their abode there, or that it was subjected to the influence of solar heat, malaria, or to some depressing pas- sion or other nervous influence, or excessive eating and drink- ing of carbonaceous food, as fat, sugar, starch, alcohol, with Section of the liver in passive hypersemia. Hypersemia of the liver in the incipient stage of hepatitis. sedentary habits, a state of active congestion will set in ; other conditions might be enumerated, as the action of mercury, which produces atony of the walls of the vessels of the liver. From these remarks it will be readily seen that the causes of acute inflammation of the liver are varied and numerous, embracing mechanical irritation, obstruction from morbid changes, heat, malaria and other germs, carbonaceous food, drugs, mental depression ; in other words, anything that tends to devitalize. Symptoms. — General symptoms of languor, lassitude, debility, mental depression, loss of appetite or dyspepsia, tongue coated heavy brown coat, skin jaundiced, yellow conjunctiva, bowels constipated or irregular, a sense of constriction and weight over liver at first, it greatly enlarges from congestion, and the area of hepatic dulness increases ; liver extends below the ribs and across the hypogastrium ; headache, pain in back, calves of legs, 596 DISEASE GERMS. rigors, followed by high fever, which sometimes assumes a low type ; pain over region of liver, aggravated by pressure ; cough, deep inspirations, inability to lie on left side ; the coat on tongue becomes heavier, conjunctiva tinged with bile; there is nausea, vomiting, cough, difficulty of breathing, hiccough, pain in right shoulder and clavicle ; if the left lobe of liver suffers there may be pain in the left shoulder, dulness of the upper lobe of left lung ; urine is always scanty, high colored, loaded with bile pig- ment and traces of albumen. The variation and intensity of symptoms will depend a good deal as to whether the peritoneal investment or substance of the gland suffers most. Most gen- erally it is the substance of the gland that is affected. If the inflammation or .partial death is great it may lead in a short time to extravasation of blood into the hepatic tissue, or beneath the capsule, the result of great congestion, as takes place in bilious, malignant, remittent, or yellow fever. The extravasa- tion may be from the size of a pea to that of a duck egg ; in some cases the blood is infiltrated through its entire substance, converting the tissue into a pulpy mass. In less severe cases, even with the morbid action diffused through the entire organ, effusion of lymph may take place, which may lead to induration, with atrophy or enlargement, and ultimately softening or abscess. The formation of abscess is ushered in with distinct chills after the inflammatory stage has proceeded some time, with hec- tic fever, great disturbance of the stomach, with extreme pain and tenderness over both liver and stomach and abdominal walls; feeling of weight about the liver, emaciation, prostration, diarrhea or dysentery. Treatment. — Inculcate the general principles of treatment for fever, complete rest in bed, sponging the entire body three times daily with some aqua ammonia and tepid water, drying and rub- bing well, and then sponging with nitro-muriatic acid water, heat to feet ; first apply a large mustard plaster over region of liver and stomach, and as soon as erythema or redness is produced, paint over the inflamed part with croton oil, and over that a hot flaxseed-meal poultice ; change poultices every three hours. As the stomach is irritable, lime-water and milk ; control fever with very large doses of the tincture of green root of gelsemium with veratrum and aconite ; as soon as pulse is about 70 leave vera- trum and aconite out, and hold on to gelsemium ; as soon as stomach will contain drink, oatmeal-gruel and phosphate of soda, and six-drop doses of nitro-muriatic acid in water every three hours. If stomach is persistently irritable, use small quantities of ipecac and morphia ; if there is dysentery give one or two large doses of quinine, and to render the stomach more tolerant BACTERICIDES. 597 add about a grain of pulverized opium to the dose ; get control of the more acute symptoms, and never mind diet, and even when given it must be greatly restricted. If there is constipa- tion, enemata, or a small dose of compound licorice powder, or a drink of the acid tartrate of potash. Great care and good discrimination are necessary in the selec- tion of the proper remedy and dose. If case progresses favoradfy, establish conv3ilQscence upon com- pound tincture cinchona and nitro-muriatic acid, fluid extract of chionanthus virg., and nux, or leptandra and salines. If suppuration takes p/ace, support the powers of life with most nutritious food, cinchona and mineral acids, quinine ; poultice assiduously. The peritoneal coat of liver becomes adherent to the abdominal wall at points, and, as a general rule, it is best to let it burst spontaneously; they do better than those that are punched by grooved needles, or trocar and canula, or even the aspirator. Chronic inflammation of the liver may Inflammation of be a sequel of either active or passive The Liver. congestion ; it may present itself with {CJironic Hepatitis}) either hypertrophy or atrophy, but in either case indurated or hard. Various names have been applied to it, as indurated liver, interstitial hepatitis, granular liver, gin-drinker's liver, hob-nailed liver, from the fact that the capsule of the gland is drawn in here and there over it, owing to contraction of thickened connective tissue, giving it the appearance of hob- nailed ; and some call it cirrhosed iver, because on slicing it after death it pre- sents the grayish yellow color of impure -J beeswax. The term chronic inflamma- tion is the best. Section of the liver in chronic Caiises. — Solar hcat, malarial germs, ^'^^^^^'^- carbonaceous food, disease of the heart, lungs, etc. ; mental depression, articles of dress, as tight lacing, violent muscular exercise, use of mercury, whiskey or beer, which retards its function, and excites irritation directly in its substance; impure air, inattention to bowels and skin, want of exercise. Symptoms. — There is a general lethargy of the entire body ; skin is sallow — in rare cases sHghtly jaundiced ; the white of the eye tinged with bile ; tongue coated with white and brown coat ; breath fetid ; copper taste in mouth ; usually constipation and clay-colored stools; urine scanty, high-colored, with bile pig- 598 DISEASE GERMS. ment and traces of albumen ; skin is dry and harsh, burning in hands and feet ; often sweaty feet, with pungent odors ; sebaceous glands of nose, axilla, groin, active, giving those parts a greasy feel ; skin not only sallow, but assumes an unhealthy look. After disease has lasted some time, dyspepsia, flatulence, consti- pation, with feverishness by spells and headache. There may be nausea or loathing of food — a sense of constriction and weight over liver ; there is an increase or decrease in size, usually the former, from effused lymph in its interstitial structure. This lymph blocks up, interferes with the flow of portal blood and escape of bile. In enlargement, area of dulness greatly in- creased ; if it contracts and lobules atrophy, the gland diminishes in size ; piles, enlargement of spleen, pain, perhaps, over region of liver ; if not, then it will be experienced in right shoulder and Cells filled with pigment matter, in yellow atrophy of the liver. Hepatitis suppurative, where, the inflam- mation has terminated in multiple abscess. clavicle. Passive congestion of the upper lobe of right lung, and dulness on percussion ; irritative cough. As the case pro- gresses, symptoms become more aggravated, and debility, with loss of flesh, takes place. An increasing contraction or obstruc- tion from effused lymph takes place, and dams back portal circu- lation, and ascites supervenes. Jaundice is now decided ; dilata- tion of the veins of abdominal walls ; hemorrhage from nose, stomach and bowels often present; indeed, a bleeding from nose and stomach might be an early symptom, and often occurs be- fore the disease is suspected. After the disease has lasted from a few months to more gen- erally ten or twenty years, the debility and anaemia become great, dropsical effusions in the abdomen and limbs increase, and death takes place either from exhaustion or some complication, as pneumonia, peritonitis, jaundice, toxaemia, diarrhea. Treatment. — Medical statistics exhibit the fact that nearly two- thirds of our entire population, young and old, men and women, are affected with chronic inflammation of the liver. Now, this is BACTERICIDES. 599 due in a very great measure to our hot, or tropical climate, ma- larial atmosphere, excessive struggle or brain work, whiskey and beer-drinking, hog-eating, starchy and saccharine feeding, tobacco-chewing, mercurial drugging. Our first aim in a cure, therefore, consists in discarding all these agents ; forbid mental anxiety, a total disuse of fat, sugar, starch, whiskey or beer, tobacco, mercury, etc. ; and besides, tea, curry and all high- seasoned dishes. Plain animal food, milk, eggs, white-fish, fruit, and vegetables ; daily bathing, flannel clothing, open-air exercis- ing, horse-back exercise ; well ventilated apartments ; bowels to be opened once or twice daily ; irritating plaster to be worn pretty steadily over liver ; an alterative and tonic course incul- cated ; such alteratives as saxifraga, tag alder, alums, comfrey, dulcamara, elecampane, blue flag, leptandra, podophyllin, stillin- gia, iodide of potassa, and iodide of sodium; and as tonics, cin- chona, mineral acids, hydrastis, columbo, collinsonia. Besides general alteratives, all bearing upon the liver, stimulating a re- newal of life in that gland, the tonics should be selected with the same view, the alteratives administered two hours after meals, and the tonics half an hour before — both freely diluted with water, and changed weekly. Digestion should be looked to, and gentian and pepsin and other remedies to strengthen .the stom- ach. The special remedies that stimulate the liver, break down and absorb lymph, can usually be run in either in the alterative or tonic form, such as Phosphate of Soda : Used in all articles of diet instead of com- mon salt, is invaluable in promoting a free flow of liquid bile ; it should never be omitted in treatment. Nitro-muriatic Acid: One of the very best of liver stimulants, in six-drop doses in compound tincture cinchona ; used for about a week, discontinued for a few days, and then re-com- menced ; its action on the connective tissue of the liver is in- valuable. Sulphur : Always and persistently from one form to another ; an invaluable liver stimulant. Chionanthus Virg., or fringe tree, is superior to all vegetable liver stimulants ; much superior to mandrake, blue flag, leptan- dra, taraxacum ; very mild in its action. Phytolacca is an ad- mirable cholagogue in small doses. Nux vomica is not to be discarded. Iodide potassa, ozonized glycerine, ozone-water, should be given all through the case. In addition to the special treatment for rousing up the liver with special remedies, I have found the use of the white mustard seeds of great value in doses of from one to two teaspoonfuls of the seeds whole — never pulverized— in a little water or muci- 5oO DISEASE GERMS. lage one hour before each meal. It is an invaluable remedy when the liver and stomach are sluggish ; when there is great debility, loss of appetite, failure to sleep, depression of the nerves. The mustard seed gives new life to the liver ; promotes a good biliary secretion. In that form of chronic inflammation of liver due to the use of whiskey, and when the stomach coats are pretty well eaten, it can be used with splendid success. In the malarial form its action is beyond description. Its use should be continued for six or more months after recovery has taken place. Kiirchicine is another remedy of inestimable value in the chronic inflammation of liver due to heat, malaria, and carbon- aceous food or drink. It is extensively used for those terrible forms of bilious fevers so common in the swamps of Hindostan. When degeneration of hepatic cells is suspected, iodoform ointment, instead of irritating plaster, ozonized glycerine and water, nitro-muriatic acid; and if stubborn, apply ozonized clay. If there is hemorrhage, the sulphuric acid and turpentine mixture, gallic acid. For ascites, general treatment for dropsy — digitalis, squills, pilocarpin, diaphoretics, diuretics, etc. (See Dropsy}) Inflammation of the substance of Infliammation of the the lungs is one of the most com- Substance of mon affections that we meet with, the Lungs. especially in the spring, fall, and in- (^Acute Pnenino7tia) deed at all seasons of the year. The predisposing causes are in- tense nervous depression, especially of the great sympathetic, debility, exhaustion. The exciting causes are cold, wet, inhalation of irritants, mechanical violence. The usual point of microbe evolution is just where the branches of this nerve are most numerous, to wit, the lower lobe of the right lung. Inflammatory action and microbe evolution may be limited there, or it may spread in every possible direction. One of the most important micrographic discoveries of the present time is that a microbe is always present in inflammation of the lungs or pneumonia. The microbe of pneumonia is found in the lungs of pneumonic patients, either detached or encysted in the lymphatic cells, and in the blood and sputum. Under a strong magnifying power this micrococcus is seen to be shaped like a lance head, and short BACTERICIDES. 60 I W^^t V-V^i-yX- ^fi^ Interstitial pneumonia rods terminating- in a cone, are found wi h it. The micrococcus is the early form of the microbe, which becomes a bacillus in the adult form. The presence of a microbe in pneumonia explains many facts which have hitherto remained obscure in this disease, especially epidemics, also the remarkable resemblance between that of man and the contagious pneumonia of cattle. The origin of the microbe of pneumonia in man is no doubt due to intense nervous strain, worry, exhaustion, especially neu- rasthenia of the great sympathetic, which is so freely reflexed on the face, larynx, heart, lungs, spleen and internal viscera of the Caucasian ; that owing to some adverse state or condition, the bioplasm, the living matter of nutrition of the great sympathetic is either changed, or altered, or degraded into other living matter, a disease germ, the microbe of pneumonia, which is capable of prodigious growth, and multiplication, an independent existence in or out of the body if warmth and some nutritious pabulum be present. Once it has suffered evolution and become a microbe, it can be propagated by contagion and infection, Uke all germ diseases. The partial death of the great sym- pathetic induces the evolution. Cultivations of the pneumococcus on boiled potatoes and in meat juice yield immense crops, which if in- jected into or are fed to any animal produce pneumonia. The career of this germ does not differ, when it is the sequel of other maladies, such as typhoid, etc. Later on, when the lungs or lobules have become transformed into a solid structure, gray hepatization, masses of micrococci may be found in the air cells, even growing into the blood vessels, in which stasis had set in. Aside from the pathogenic microbe, we find in the sputa, blood, mucus, epithelial cells, granular protoplasmic masses, elastic fibres, etc. None of these bear cultivation. All cases are ushered in with a rigor less or more violent. Pneumonia is met with in the foUowincr forms: Acute, sudden Perfect adult form of the pneumococcus magnified 2000 diameters ; A and B, thread forms ; C, D and E, rod forms ; G, aiplococci ; H, cocci, I, strepto- cocci. The pneumococcus consist of cocci, ellipsoidal or round, single or in pairs fdiplococci), rods and thread forms, all enclosed in a cell membrane or gelatinous capsule. 6o2 DISEASE GERMS. in its seizure, and attended with fever; sub-acute, of the same character, but the vital forces of the patient being vigorous, resist the local irritation, consequently there is no fever ; or chronic^ which may be a sequel of either of the former, or come on of itself from slight irritation in patients whose constitutions are Micrococci of the pathogenic ; microbe of the pneumococcus seen in differ- ent stages of growth in the prune juice ot the sputum prior to the rigor. The appearance of the pneumococcus prior to the rigor in acute pneumonia. The microbe will disappear from the sputum in less than two hours with concentrated ozone ove; the germ.-smitten lung. Inha- lation of comp. oxygen. feeble. It is called lobular, when confined to one lobe ; single, when confined to one lung ; double, when both lungs are involved ; pleural, when the violence comes from without and proceeds in- ward, affecting the pleura first, then the lungs; and typhoid The micrococci, as seen microscopically in the prune juice sputum of pneumonia ; b, d, free or encysted in expectorated lymphatic cells. pneumonia, when the powers of life are low, and the typhoid germ is developed, giving us inflammation of lungs with typhoid fever. A case that is permitted to run its course has three distinct stages, viz. — congestion, red hepatization and gray hepatization. General Symptoms in First Stage. — Great nervous prostration, with pain in the head, back, calves of the legs, with cough, short- ness of breath, rusty, or prune juice sputum, or streaks of blood, or hemorrhage, restlessness and anxiety, violent rigors and high grade of fever, with aggravation of symptoms ; pulse 140 to 160, heat 105° Fahr., respiration 40; flush on cheek or cheeks, nostrils BACTERICIDES. 603 dilated, tongue coats heavily with a brown coat, nausea, great thirst, loss of appetite. Cough becomes worse, sputum viscid and bloody, pain in the affected lung, with frequent but dis- tressed breathing, skin has a dry pungent heat, sometimes delirium. As this is the stage of filling up or engorgement, the affected lung which was clear and resonant gradually becomes dull on percussion, and crepitation to a variable extent is distinctly heard. If the pleura is involved, friction sounds can be detected ; there is exudation into the air-cells and proliferation of their lining epithelium. This stage may last a few hours to a week or longer. General Symptoms in Second Stage. — If the inflammation pro- ceed, it passes into the stage of red hepatization, in which all the symptoms of the first stage are still present and more decided ; there is in addition likely to be blueness or lividity of the skin, delirium or coma from non-aeration of blood. The air-cells are choked ^*§ by coagulated exudation of blood ^ ^ ^ ^ ^ and lymph ; the spongy character ^ o • '^ o O of the lung is quite lost, and it ^ \;) ^ ^ ® a becomes solid as a liver, neither ^ ^ , ^ ^ /^ minute crepitation nor vesicular '^^ ^ ' jf J^ '^s murmur can be heard. There is /fj •*«» ^ 3 perfect dulness on percussion and ^ ^ a ^\ *" no intercostal movement ; bron- / • ^ chial or tubular breathingr, with Some cf the pnt^umococcns in the secon 1 , . ° - stage, surrounded by a capsule. vocal vibration communicated to the walls of the chest by the solidified lung and felt by the hand over the ribs unless there be water in the cavity of the chest. The duration of this stage is from a week to a longer period. General Symptoms in the Third Stage. — If the inflammation still progresses, and the patient does not die in the second stage, then the third or gray hepatization supervenes ; then we have a complete change of symptoms. Fever abates ; heat, pulse and respirations often low ; rigors ; profuse colliquative sweats are common ; the flush .on cheeks and other physical signs disap- pear, and it looks as if amelioration was taking place ; whereas, we have the grave process of suppuration of the substance of the lung ; diffuse suppuration of pulmonary tissue, with parts re- maining dense and impermeable; it is hard to drag through with incessant cough ; thick, ropy, tenacious pus. In some cases the pus liquefies, and is expectorated, air begins to re-^nter the affected lung, and resonance and a healthy vesicular murmur is restored. Often cases will, during the first and second stage. 6o4 DISEASE GERMS. take on a typhoid condition. The tongue will become of a buff leather appearance, very dry and parchy, or it may become red, like a piece of raw beef, or simply red aftip and edges, with elevation of papillae; the char- acter of the pulse changes to small, wiry and frequent ; bowels generally in pneumonia are constipated, but when typhoid symptoms threaten, diarrhea, sordes on the gums, petechia on skin, eyes sunken, nostrils pinched, face white, gurgling in right iliac, and tympanitic state of the abdomen. No definite rule can be laid down as to its duration. About two-thirds of cases run thus: a week of infiltration or filling up, a second week in perfect consolidation, and a third in gray hepatization, which terminates in suppura- tion, extending over a period of months. In any of its stages it is easily recognized ; in the early stage its history, flush on cheek or cheeks, the rapid mal-assimilation, the anxiety or distress, the cough, difficulty of breathing, the rusty sputum or blood, pain in side, dul- ness on percussion at base of lung proceeding up, lack of inter- costal movement, tubular breathing, rigors, fever, purple or livid appearance of skin, delirium, coma, etc. As a very vital organ is smitten, pneumonia must be regarded as a grave affection, if it has passed the first stage ; imperfect Diagram showing; red hepatization of the lung: pneumococcns changing into the streptococcus pyo- genes. % *i^l^^gpp^ Capillary net-work in the human lung. Section of lung, showing a single alveolus in red hepatization. oxygenation of the blood gives rise to so many complications, besides delirium, coma and lividity of the lips, nose, hands, face, as embolism in brain and heart, that render all cases very dangerous, and our prognosis must be guarded. In ppite of the great improvement in modern therapeutics, the death rate of pneumonia has been steadily on the increase. The pathology of the disease must be better appreciated ; we have BACTERICIDES. 605 not only a vital organ smitten by a deadly microbe-infarction ot the lung by the micrococci, non-aeration of the blood the result ; skin, kidney, and other excretory organs, imperfectly, feverishly perform their work; springs feeding the smaller and larger glands run dry ; the feverish nerve centres repel the vital atoms of the great sympathetic, are wrecked by germ evolution. The blood requires aeration, oxygen, ozone. In all cases of acute and chronic pneumonia, there are to be found in the blood, in the infiltrated lung, in the sputum, and all Section of lung in the second stage of lobar pneumonia, showing the pneumococcus aggregated together in patches. Vertical section of the lung as seen in the second stage of pleuro-pneumo- nia. the glands of the body the microbe pathogenic of the disease ; even the sputum in the early stages is loaded with the micro- cocci, which gives it the peculiar characteristic brownish prune- juice tint. This is most common the first seven days from the Lobular pneumonia, alveolus from lung; the capillaries distended with the mi- crobe. Section of lung, second lobar pneumonia ; the pneumo- coccus actively throwing off spores. rigor, later on they decrease in number, until about the four- teenth day when their presence is usurped by vibrios. Treatment. — Perfect rest in bed in a room whose atmosphere is kept moist by steam, and at a temperature of 70° Fahr. If 6o6 DISEASE GERMS. there be constipation, enemas and a dose of castor oil. Having ascertained the extent of the damaged lung, wet cups should be freely and closely applied over the part, and free bleeding from cups encouraged by hot fomentations, and then followed by hot Section of lung, showing a single alveolus in the first stage of pheumonia, with the pneumo- coccus actively sprouting. Section of lung, with the streptococcus pyogenes ; third stage of pneumo- nia. poultices of flaxseed meal. This is a better local stimulant than turpentine or mustard. Poultices shoulci be changed every three hours, spread about half an inch thick, and in size to cover a little beyond affected part, so that if both lungs are affected it will form a regular jacket. Poultices should be covered by oiled silk. Over and above all, there should be a firm flannel roller, wide enough to extend from the arm-pit to the bottom of chest. Pyaemia (streptococcus pyogenes) ; abscess in the lung. Microbe of croupous pneumonia in mem- branous croup. It should be pinned evenly and firmly, beginning at neck, insert- ing a pin every inch, and proceeding down to the bottom, so as to confine the ribs, stop intercostal movement, and cause the pa- tient to breathe by the diaphragm. Outside of all, bladders filled with hot water should, as far as practicable, be placed at BACTERICIDES. 607 the sides, so as to keep heat in poultice. Patient must not be permitted to lie too long in one position, as it gives the blood a tendency to gravitate into the weakened lung structure and con- geal ; a change is very beneficial every two or three hours ; heat to feet, and general treatment for fever ; diet, warm milk, with about five grains of bicarbonate of potassa to the half tum- bler full, instead of lime-water, and warm beef tea, one or other at regular intervals every hour; no other diet of any efficacy ; eggs and oysters strictly prohibited ; drinks are to be warm, and mucilaginous, as flaxseed, etc. There are, now, three drugs that must be unsparingly and persistently given, and these are, veratrum viride, opium and sulphate of quinine. A tablespoonful of tincture of veratrum viride, same amount of sweet spirits of nitre in four ounces or half a tumbler of water, of which one teaspoonful should be administered every half hour till pulse reaches sixty-five, and then at intervals of two or three hours, so as to check the current of circulation, so that when it passes through a weakened tissue effusion cannot take place; a balance maintained, a heart controlled, and by its influence on the connective tissue of lungs, prevents inflamma- tory action spreading into fresh parts. In some cases it is advantageous to combine a teaspoonful of tincture of aconite in the mixture ; to be continued as long as there is any fever. Opium or its alkaloid should be given in every case of pneu- monia. It aids the action of the veratrum, prevents irritation, and so neutralizes the action of that drug that we are enabled to give it in larger doses. Besides, opium acts as a stimulant to the great .sympathetic that so fully covers the lower lobe of the right lung and heart. As soon as the veratrum is commenced, begin with the opium every three hours, and continue at regular inter- vals. The painful oppression of the chest and hacking cough soon disappears ; the noisy and frequent respirations soon become quiet and slower ; the cyanosis of the face and lips gives way to flush; the dry, scorching skin becomes cool and moist; the heart regains its normal force and regularity ; its impulse, its sounds, its murmurs with the lung difficulty subside almost com- pletely. It also counteracts the abnormal quantity of carbonic acid in the blood, and with the attainment of that object, languor and drowsiness disappear. Whether the crude drug or its alka- loid is selected, it must be borne in mind that the condition of the stomach is such that absorption is slow and imperfect ; so to obtain readily the desired effect, it is best to administer it with an alkali ; to facilitate its absorption and soften the effused pro- ducts in the lung, such as opium pulverized, ten grains ; Dover^s 6o8 DISEASE GERMS. powder, thirty grains ; nitrate of potass, one drachm. Mix. Make twenty powders ; one every three hours ; or if the alkaloid is prefefred, take one ounce of lemon juice ; carbonate of potassa, enough to saturate ; add to one ounce of cinnamon-water, to which add one grain and a half of morphia. Dose, one tea- spoonful instead of the opium. The effects of potassa on the lungs is very marked indeed. The next drug is quinine, without which there can be no suc- cessful treatment of pneumonia. Its action on the brain and great sympathetic is good, but in pneumonia the size of the red corpuscles of the blood is diminished. Quinine restores them to their normal shape. Its presence in the blood is most salu- tary, when loaded with carbonic acid, in diminishing tempera- ture. The dose should be such as will give a result, and con- tinued, as it is freely eliminated by the kidneys, in alternation with the opium. To relieve cough, a mixture of equal parts of syrup ipecac, squills, wild cherry and tolu, with muriate of ammonia, in half- teaspoonful doses. If there is tremor of hands, quivering of tongue, or delirium, alcohol in the form of brandy and milk or wine must be given. The important micrographic discovery has been made that a microbe is always present, hence the necessity of a more efficient bactericide treatment, which we hereby submit : Germicidal Remedies which have been demonstrated to cause total dis- appearance OF the Pneumococcus from the blood, sputum, lunc. Internal Remedies. Local Remedies ovei' the Gervi smitten I.ung. Exalgine, sufficient doses and frequency to keep pulse at 65 or 70. Concentrated ozone painted over the area The gluc< side baptisin, triturated with of dulness and beyond, followed with an equal quantity of sulphate of qui- hot linseed meal poultices in which nine added to aromatic sulphur and resorcin and boroglyceride and opium water. are freely incorporated, changed fre- Ozonized tar syrup, or the syrup of quently. If this is not applied, ozon- Tolu with chloride of ammonia, resor- ized turpentine, till an erythema is pro- cin, benzoate of soda, opii et ipecac et duced, followed with hop poultices in camphora et resorcin. The combina- which resorcin and peroxide of hydro- tion administered in small doses fre- gen are incorporated lodol incorpor- quently repeated, so as to maintain a ated in ozone ointment rubbed into the sort of comatose condition, during chest, and also spread on leather ap- which the germ dies. plied. Comp. concentrated tincture of kurchi- A jacket of resorcin jelly is most effica- cine, no fluids permitted, micro-organ cious. isms disappear. Kurchicine con. con- tains 20 atoms of carbon and is more powerfully germicidal. BACTERICIDES. 609 Compound oxygen, administered by the atomizer, is of infinite value, as by this method we bring it into immediate contact with the seat of the disease, thus carrying out the principle of direct medication, and thus sterilizing the micrococcus in the pulmonary tissue. The results obtained by its use are immediate, eminently gratifying and satisfactory to both patient and physician. In the first stage of pneumonia, when the prune-juice sputum is abun- dant, it should be inhaled every half hour or hour, according to the urgency of the case. Do not wait until cyanosis appears. A few inhalations lower heat, quiet the heart, diminish the rapid respirations ; thus enabling the patient to breathe easily, promote free and abundant expectoration. To obtain good results in chronic lung affections, as in asthma, bronchitis, tuberculosis, inhalations for twenty minutes, three times a day, are best. The action of the compound oxygen is that of a germicide, by either the sterilization or annihilation of the microbe, sub- stantial results are obtained ; the germs become passive or dead ; the embarrassment in breathing is overcome ; free and abundant expectoration takes place ; the cough becomes less and less ; the obstructed germ-laden air cells become clear ; the cold is cleared up ; additional breathing areas are opened up, and. respira- tion becomes full and deep. The inhalation of this remedy reddens up the blood, frees it from the presence of all disease germs, even neutralizes the ptomaines of numerous microbes ; thus the nervous system becomes rejuvenated ; appetite is stimulated in a most re- markable degree. Delirium, coma, blueness or lividity of skin due to deficient aeration of blood; tincture of belladonna with a solution of ace- tate of ammonia to maintain fluidity. With the above treatment, during the stage of congestion and the early part of red hepatization, all signs of consolidation of the lung will give way and become absorbed, leaving the walls of the air cells unimpaired and elastic as before. Re- covery is perfect, the breathing being mechanically and physio- logically performed as in health. Neither is the interlobular structure altered, and there is no permanent thickening of the lung or bronchial tubes. The products of inflammation in a congested lung consist chiefly of exudation of fibrine, with liquor sanguinis, white and red corpuscles, and perfect absorption takes place. But some- times cases have progressed too far, and about the end of the second week a change takes place ; temperature goes down ; there are rigors and sweats, and there is thick, viscid or muco- 39 5io . DISEASE CiERMS. purulent matter expectorated, and the physical signs tell us that the lung is still solid but undergoing grave changes; the air does not penetrate ; bronchial breathing still continues, but changes which indicate softening and ulceration begin to appear. Now our treatment must be changed to an alterative and tonic course, including iodide of potassa, tincture of iodine and am- monia ; irritating plaster, so as to keep an open discharging sore over the consolidated part ; diet changed to milk, cream, raw eggs, animal food. If during an acute attack there are the slightest indications of typhoid symptoms, antiseptics at once ; brewers' yeast in milk, tincture of iodine and carbolic acid, as in typhoid fever ^ every hour. The degraded living matter in pneumonia is the pneumococcus, which is to be found all through the case in different stages of growth and development. In a large number of cases patients, Inflammation of the when properly cared for, will recover Substance from acute pneumonia apparently of the Lung. well, but with some portion of lung {^Chronic Pneiunojiia) damaged; that is, weakened, or he may recover with a lobe perfectly consolidated, in which condition it may remain for years; or the products of inflammation may break down and recovery take place ; whereas, in another class of cases, the non-aeration of blood and local irritation tells badly on the nerve-centres, and a degradation of living matter takes place, and we have the tuber- cular germ, or in other words, the ulcerative process of pneu- monia changes into that of consumption of lungs — tubercular. It makes little difference how the inflammation originally started ; its termination, unless managed with the very greatest nicety, is apt to take that course. The treatment of chronic pneumonia is the same as should take place following any and every case of acute until the lung clears. Diet nutritious and generous, flannel clothing, daily bathing, followed by inunction of oil; bowels regulated, appetite stimulated with tonics ; irritating plaster to be kept all the time, if possible, over the seat of consolidation. Encourage free suppu- ration. Iodide of potassa, carbonate of potassa in alteratives. Expectorants in sufficient quantity to keep down cough. In other words, a tonic and alterative course. BACTERICIDES. 6ll The very great prevalence of purulent Inflammation ophthalmia and stomatitis among the of the Mouth. children of the crowded sections of our large cities and our public schools demand mare than a passing notice. Both affections are either directly due to a special degradation of bioplasm, or to contagion and in- fection; in the eye, the normal elements of nutrition are changed or altered into bacteria proper, whereas in the mouth, though the bacteria be abundant, the degraded elements are the oidium albicans. The causes which give rise to a partial death of mucous mem- brane of the mouth are the de- pressing effects of insanitary states, and the crowding of large bodies of children into small areas with meagre or insuffi- cient, bad or deleterious food, bringing about a perversion of nutrition, the degradation, the germ, and then its spread by contagion and infection, espe- cially by the indiscriminate use of drinking vessels. Inflammation of the mouth or stomatitis with its special micro- organism is met with in three forms or stages which are simply degrees of microbe growth. In the primary or first state, the diseased germ aggregates in the follicles of the mucous mem- brane of the lips, cheeks, gums, fauces, and appears in the form of little vesicles or blisters, and is termed follicular ; when those vesicles rupture, the germs are let loose and spread in all directions, hence it is termed ulcera- tive ; if vital force is decidedly lower, insanitary surroundings wretchedly bad, the ulcerative patches may become gangrenous. The symptoms which attend this degradation and germ evolu- tion in the mouth are general prostration and debility, with in- flammation of the mucous membrane of the oral cavity, tender- ness, the formation of vesicles, on lips, cheek, gums, tongue, lauces — the encysted germs in the follicles or vesicles rupture '^'''^^^m^^' The mouth widely opened so as to show the palate; i, i, the upper, 2, the lower lip ; 3, 3, hard palate; 4, 4, soft palate; 5, uvula : 6, 6, the arches of the soft palate ; 7, 7, the tonsils ; 8, the tongue. 6l2 DISEASE GERMS. their sacs and spread (if vital force be low, surroundings bad,) in every direction, giving rise to phagedenic ulceration. There is usually a copious flow of saliva, amounting to salivation ; great fetor of the breath, mal-assimilation, restlessness, fever, loss of appetite, and as the germs descend into the stomach and bowels, most offensive stools. The patches in the mouth are covered at first with a dirty, yellow plough ; subsequently, the patches of infiltrated mucous membrane are purplish, and the ulcers covered with a layer of pulpy grayish matter ; if the disease is permitted to progress, the germs become spongy, teeth loose. As the affection is essentially one of germ evolution, the great- est precautions should be ob- served in isolating the patient, in surrounding him with an at- mosphere of germicides. The essential points in treat- ment are to kill the germ, and by every possible means raise the standard of vital force, so as to prevent its further evolution and growth. The mouth should be washed, throat gargled about every hour with either a teaspoonful of a saturated solution of borogly- or potassa added to half a tum- bler of tepid water or infusion of sage or thyme, and internally every three hours, five or ten grains of resorcin dissolved in water; or a few drops of peroxide of hydrogen. A good blood-elaborating diet, embracing cream, eggs, beef juice and other nourishment. The oidium albicans present' in stomatitis. ceride, or chlorate of carbon Onychia, or inflammation of the root or matrix of the nails, may arise from me- chanical injuries, as contusions, spicula of bodies penetrating the mother of the nail, corns, etc. ; or it may arise from greatly broken-down states of the constitution, as in tuberculosis. Symptoms. — Pain, swelling, and suppuration at the root of nail or nails, and about the surrounding texture. Exudation of sanious, or purulent discharge, on pressure of the nail ; ulcera- Inflammation of the Matrix of Nails. {Onychia}) BACTERICIDES. 613 tion ; nail becomes raised and finally detached, revealing a foul ulcer, with the most intense fetor. The disease-germ, oidium albicans is present, — a true rot. Ulcer becomes glazed, irritable, eating and spreading in all directions, even down to the bone, when the vital forces are at a low ebb. Treatment. — Poultice with linseed and yeast ; wash, by drip- ping hot permanganate of potass lotion on the ulcer, by com- pressing a sponge, morning and night. Remove nail as soon as possible ; continue cleansing sore, morning and night, with permanganate wash. Dress during the day with either the black salve, vaseline, or ozone ointment, iodoform. Place pa- tient upon a general course of alteratives and tonics with nour- ishing food, fresh air, hygiene, etc., when the difficulty can be traced to tuberculae, glycerite of ozone especially ; if to syphilis, ozonized phytolacca, and iodide of potass ; if to mercury, tonics and iodide of potass. The causes of catarrh, or common Inflammation of the cold, may be grouped under two Lining Membrane main divisions — y\z., predisposuig -axvA of the Nose. exciting. Among the former must be mentioned youth ; for it is a well known fact that old persons are practically exempt from this malady. Many individuals appear, moreover, to possess a cer- tain idiosyncrasy as regards the affection. It is not uncommon among the gouty, and in persons whose nervous system is in a condition of unstable equilibrium, and among those with a strumous diathesis, or predisposed to asthma. Hay fever would often appear to be a connecting link between asthma on the one hand, and catarrh on Mie other. Climatic conditions and sudden changes of temperature, not necessarily from heat to cold, but sometimes the reverse, must also be noted. The most common exciting cause is without doubt the action of damp cold, more particularly if the body be heated and per- spiration active. Sometimes simple transition from warm to cold air will be enough to induce an attack ; at others the prolonged action of cold is required, especially on the feet, and in bald per sons on the head. Heat, either as solar heat, or the elevated temperature of a warm room, may produce similar results. In the former case it has been suggested that the catarrhal effects may be due either to direct irritation, or may be of a reflex character, dependent on undue stimulation of the retina. In the latter case the coryza is generally observed in persons in a de- pressed condition of health, and in those who have been the sub- 6 14 DISEASE GERMS. ject of previous attacks. The influence of irritating vapors, and of certain medicinal substances, such as iodide of potassium, and of the pollen of many plants in producing nasal catarrh, has long been known. The earliest symptom of an attack of acute inflammation of the lining membrane of the nose, is a feeling of chilliness and fever, a sense of w^eight and pain in the forehead, dryness of the nasal membrane, itchiness, accompanied with sneezing, nasal fossa becomes blocked, an irritating watery discharge appears, which subsequently becomes muco-purulent. Both taste and smell diminish in catarrhal attacks, and may even disappear. The voice becomes distinctly nasal in its tones. This is due to the fact that when the anterior nares are blocked the nasal cavities can no longer act as reverberating chambers. On the other hand, when the stoppage of the nostrils is chiefl}' posteriorly, articulation becomes defective. The second stage of coryza is marked by an increased secre- tion of alkaline serum, which may cause erosion of the nostrils and upper lip. This discharge may be so copious as to necessi- tate the constant use of the handkerchief, and may even be ac- companied by slight hemorrhage. During sleep the secretion is arrested wholly or in part. The nostril opposed to that of the side on which the patient lies may become dry and free, to be affected in its turn by any change of position. Pathology. — The only actual lesions found in coryza are such as are common to all inflamed mucous membranes, and are superficial and unimportant The initial stage is active conges- tion of the pituitary mucous membrane, followed by serous exu- dation. The exuded fluid contains epithelial cells more or less altered, which increase in number as the catarrh advances, to- gether with blood corpuscles, pus globules, and micrococci. These latter are the real cause of the trouble. It is not quite clear whether the inflammation attacks exclusively the respiratory tract, or both it and the olfactory region. The latter appears the more probable, seeing that the inflammation not uncommonly extends to the cavities accessory to the nose. Treatment. — In the majority of cases a common cold will cure itself with little aid from medicine, but at times, whether from the severity or the frequency of the attacks, treatment becomes ad- visable. This may be either stimulant or derivative. Of all stimulants, opium, either in the form of pulv. ipecac, co., or tinct. opii., is the best. Doses of from five to seven drops of the lat- ter, taken at the commencement of an attack, will often cut it short. But this treatment need not be continued after the second or third day. General principles in all cases. BACTERICIDES. 615 A peculiar inflammation of the pituitary Rhinitis, mucous membrane, due to irritating vapors or (Traumatic.) particles of dust. Etiology. — In addition to the generally irri- tating effects of dust on the nasal mucous membrane as seen in millers, sawyers, brushmakers and other trades, there are certain nasal lesions more especially found in connection with workers in chemical manufactories. This is especially the case among workers in bichromate of potash, yellow chromate, arsenical and mercuric preparations, and generally in those exposed to caustic dusts and vapors. Snuff-takers enjoy almost complete immunity from the affection. The earliest symptoms are much akin to those of coryza, but instead of being merely temporary, persist for a varying length of time, in proportion to the rapidity with which the inflamma- tory process is evolved. To the earlier symptoms of pricking and smarting there is gradually added discharge passing from serous into purulent. This dries and forms crusts, which are cast off with more or less hemorrhage. The next and last stage is ulceration of the bone and cartilage, with perforation of the septum ; without, however, any offensive odor. The sense of smell is rarely affected. Ulceration of the inferior portion of the turbinated bone may take place, and be followed by perforation. Owing, however, to the fact that the anterior portion of the septum is not involved, no deformity follows. The immunity enjoyed by snuff-takers may be explained by the excessive activity of the nasal secretion, and by the fact that the nose is so frequently blown. Hence, no irritating matters can long remain in contact with the mucous membrane, which, moreover, by the chronic thickening it undergoes, is rendered less sensible to external irritants. Prognosis. — The portion chiefly affected is the septum, and little practical inconvenience ensues from its perforation. The treatment should be mainly prophylactic. Frequent spray- ing with alkaline solutions will keep the nostrils clean, while wearing plugs of wadding will effectually prevent the entry of irritating particles. When the disease has been fairly established, local detersive treatment with boroglyceride or resorcin injections are useful. To these should be added tonic and hygienic mea- sures for the general health. Our best tonics in rhinitis are the comp. tincture of matricaria, phosphated tincture of oats, glycerite of kephaline. These remedies should be persevered with for a few months, adminis- tered in alternation. 6i6 DISEASE GERMS. Inflammation of the pericardium, or the Inflammation white fibrous tissue, in which the heart is en- of the cased. This is one of the most highly or- Pericardium. ganized of all the white fibrous tissues of the (Pericarditis^ body, and when weakened by any cause, is the favorite location of the bacillus amylo- bacta, the urate of soda of gout; the pus microbe, uric acid, etc. The most common predisposing causes are tobacco, alcohol, tea, sexual excesses, nervous exhaustion, diseases of brain, struggle for existence, worry. These and like causes weaken the cardiac plexus of nerves, which, if once enfeebled, are very liable to be irritated by morbid states of the blood. The common exciting cause is the presence of the bacillus amylobacta, the urate of soda and other states in which the living germs of disease appear in the blood. Symptoms. — There may be a general attack of rheumatism or there may not. An acute attack of pericarditis is usually ushered in with all the symptomis of fever ; first languor, lassi- tude, debility, with sharp, lancinating pains in the pericardium ; pain in head, back, calves of legs ; rigors, and a fever of high grade ; tongue coats heavily, urine loaded with uric acid ; the sharp, lancinating pain in the heart darts through to the scapula upward to the left collar bone and shoulder, down the arm ; the action of the heart becomes violent, tumultuous ; its action ir- regular ; the difficulty of breathing is often extreme ; inability to lie on affected side ; very much anxiety ; features become con- tracted ; there is great giddiness, noises in ears, bleeding from nose. As the case progresses there is extreme debility, cough, suffocative paroxysms, fainting fits, redema of the face and feet ; often great restlessness, delirium, distortion of the features, spasms or convulsions. In sub-acute and chronic cases the symptoms are so slight as scarcely to be suspected; just a little pain, sharp, darting to shoulder blades, but effusion of lymph, which causes adhesions between the pericardium and heart, and organic disease ; or efifu- sion of serum, which, if copious, may fill up the pericardium and compress the heart, impede its niovements, completely muffling its sounds to the hand or ear. It is easily recognized in any of its three forms by the pain — sharp, lancinating, darting in acute cases through to the shoulder blades up to the clavicles. In the acute and sub-acute form a The microbe of peri carditis. * BACTERICIDES. 617 friction sound can be felt by the hand and heard by the ear; or if not that, an alternate rubbing to and fro sound ; friction sound, attended with valvular murmurs and excitement of heart. In the chronic or declining stage of an acute attack, serous effusion often takes place, when no friction sound can be heard, nor even the sounds of the heart itself, being muffled by the water or fluid, which, if great, may compress the heart, so as to cause weakness or paralysis. The duration of pericarditis depends much upon the treat- ment. With such improved remedies as we now have it should be short. In the acute form, it should be treated in precisely the same manner as a case of acute rheumatism — by rest in bed, between blankets, heat to feet, open bowels with cascara sagrada lozenges; malted sterilized milk and beef essence for diet; local stimulation over the heart with concentrated ozone, subsequently dry heat. Administer at once opium in small but frequently repeated doses until there is a perfect freedom from cardiac pain, such as the fol- lowing : Opium pulverized, 10 grains; Dover's powder, 30 grains; nitrate potass, 60 grains. Mix. Make 20 chart. Give one every hour, till relief is afforded. This is most important. If fever is running high, aconite and veratrum ; or better still would be quinine, administered in small but repeated doses. A selection of some remedy to kill the bacillus amylobacta should at once be made and the patient placed upon it. The special- bactericides to completely annihilate that germ are : The glycerite of wintergreen ; the salicylate soda in liquor ammonia acetatis ; fl. ext. manaca ; salol; and other germicides. Whenever the tongue cleans speedily under any one remedy, that is the one to adhere to and push with vigor. The irritating plaster should be placed over the region of the heart as soon as the more urgent symptoms seemed to be re- lieved and a general course of alteratives and tonics prescribed. On no account is the bactericide to be dropped; that must be persevered with till every vestige of the amylobacta is wiped from the body. In the chronic form, pretty much the same treatment should be carried out, avoiding all causes that would be likely to enfeeble the heart. Here general alteratives and tonics should be administered, until the peculiar diathesis is wiped out. Comp. saxifraga and Phytolacca are our best alteratives; and for tonics, comp. matri- caria is the most efficient. 6l8 DISEASE GERMS. A partial death of the ovary may Inflammation of the arise from a long, tedious, harassing Ovary. labor ; from the use of instruments in {Acute Ovaritis.) producing abortion ; from the inject- ing of fluids into uterine cavity ; from absorption of lochial products, or other debris ; from the use of caustic to the neck of uterus ; from dilatation of the os uteri ; from violence, falls, blows ; also from sudden suppression of the menses from cold, or wet, or shock ; from gonorrhea, excessive sexual intercourse, or sexual intercourse within six weeks after miscarriage; masturbation. Usually left side, unless due to movement of right leg. Symptoms. — There is the shock, with localized pain over the region oi the ovary, aggravated by pressure or movement, with aching or numbness, or pain in the inside of the thighs, with re- peated rigors and a fever. The features are anxious, tongue coated, nausea, vomiting, pulse frequent and wiry ; great restless- ness and loathing of food ; bowels constipated ; urine very scanty, scalding, and high-colored ; patient lies on back with knees drawn up. In some cases the pain in the ovary is intense, caus- ing a bearing-down like labor pains ; in other cases it is of a dull, aching character, with paroxysms of occasional sharp, lancinat- ing attacks. Besides the intense pain in the ovary or gland, there is quite considerable pain in the groin and thigh corre- sponding to affected ovary. Bladder is always irritable. The peritoneal covering always sympathizes and often becomes involved. Passage from bowels gives great distress, the hard- ened faeces passing along in the distended bowel presses hard on the ovary. Besides, the ovary can always be detected exces- sively tender, swollen, or puffed up. If the case is a severe one, or treatment inefficient or shilly-shally, it may terminate in peri- tonitis, or in the breaking down of the effused lymph 'n\ the ovary, and suppuration. If the latter, there will be rigors ; the pulse will become feeble ; there will be great nausea and vomit- ing, tongue will become red and glazed ; there is weight and throbbing in the ovary. In favorable cases abscess will burst into vagina or rectum ; in unfavorable cases, into peritoneal cavity, giving rise to peritonitis and death. When openings or sinuses form, the case becomes very tedious, opening and closing again and again. Treatintnt. — The moment a case is made out, apply turpentine over affected ovary ; as soon as redness is bright, hot poultices of linseed meal ; as soon as it becomes pale, a reapplica- tion of the turpentine, or else croton oil, and follow with hot poultices and opium. At the same time open the bowels with . BACTERICIDES. 6l^ copious enemata of linseed tea and laudanum, and place patient upon opium or morphia and gelsemium, in doses often and re- peated until there is absolute relief from pain. If this does not succeed quickly, introduce pastiles into vagina and suppositories of belladonna and opium into rectum. If skin does not become moist and be considerably better in a few hours, substitute aco- nite for gelsemium, and with it give jaborandi. In addition to the poultices and stimulants over ovary, cushions or small pillows of hops, baked in an oven, hot over pubes, vulva, hips. If in this manner inflammatory symptoms can be held in abeyance for four or five days by establishing a renewal of life in the ovary, then begin with the iodide of potass with bicarbonate very cautiously; by and by iodide of lime, and later on ozonized glycerine. The irritating plaster can be substituted for the more active agents, spreading it fresh every morning and applying. The diet all through the attack should be meagre, and confined to milk and lime-water, and beef tea ; bowels opened daily with warm enemata of linseed tea. If there are elements of venereal poison in the case, tepid in- jections of solutions of borax, or permanganate, should be used thrice daily. As the progress of these cases is essentially slow, great cau- tion is to be observed in resuming exercise, diet, and ordinary mode of life. Even a tonic course, so essential for recovery, is best delayed till all pain has ceased. Usual uterine tonics. One of the most common affections Inflammation of the of modern ladies, during the period Ovary. of sexual vigor. Essentially a very {^Chronic Ovaritis}) chronic disease, consisting in a low grade of irritation of one ovary orboth. Causes. — Suppression of the menses by cold, damp, fright or passion. Masturbation, use of sewing-machine ; violence, exer- cise too great, as dancing; tight lacing; sexual incompatibility; excessive sexual intercourse ; producing abortions with sounds, whalebone, knitting-needles ; retention of puerperal products, as clots and pieces of placenta; the use of sponges, pessaries, rings, uterine supporters ; sexual congress within six weeks after con- finement ; use of caustics ; gonorrhea ; fictitious literature ; rheumatism and gout, etc. Symptoms. — There is general languor and debility, an unde- fined sense of weariness ; a nerve-tire, with a pale, dry, white, doughy skin, torpid bowels and irritable bladder, with scanty urine, and irritation of stomach, nausea, indigestion, flatulence, 620 DISEASE GERMS. with decided hysteria. There is a dull, continuous pain over the affected ovary, aggravated by pressure, movement. In some cases neuralgic shooting pain in addition ; besides this steady pain in ovary, there is also tenderness in the groin, in the sacral region and in the upper part of the thighs. There is trouble of some kind with the menses, usually scanty and painful. Pain in sexual intercourse ; likely to be some puffing or swelling of ovaries; also tumefaction and tenderness of one or both breasts. Nymphomania is a common symptom, and it may even merge into a more decided form of insanity, or peculiar strangeness of conduct. Often in defecation, if stools are hard, pain is great. In all cases the ovary can be detected sensitive or tender, either over ovary, or by vagina or rectum. TreatiJient. — For three weeks during every month the treat- ment can be carried on with vigor, but during menstrual period ii must be entirely suspended, with the exception of local stimu- lation over affected ovary. The points to observe are : ascer- tain the causes, and remove them by daily bathing, hip-baths ; regular evacuation of bowels ; gentle walking exercise ; warm flannel clothing ; excite appetite and give best of food, followed by pepsin ; solid diet of animal food, white-fish, oatmeal por- ridge and cream, eggs, etc. ; avoid slops. Then general course of vegetable alteratives and tonics, such as compound syrup Phytolacca and iodide of potass, Iodide and bromide of potass in the viburnum compound, or in stillingia compound ; iodide of lime ; port wine and Peruvian bark ; sulphate quinine and aro- matic sulphuric acid; glycerite of ozone, ozone-water. Besides these, the following acro-narcotics have a remarkable sedative action on the ovaries : tincture digitalis, tincture belladonna, tincture cimicifuga. Those drugs have an effect to soothe and even prevent the evolution of the ova if long continued. Pastiles and supposi- tories every night at bedtime of belladonna and opium, if neces- sary. The above can be so regulated as the tonic can be given before meals, alteratives after, and the other remedies between. The irritating plaster to be kept continuously applied, keeping an open sore about the size of a hen's &gg. It will be necessary to keep up this alterative and tonic treatment for some months, and while so taking treatment the vagina should be washed out at least twice a day with tepid water and borax, or an infusion of golden seal and borax or sage tea. In chronic irritation of the ovary, the marvellous absorbing power of the mucous membrane of the vagina should be taken advantage of for administering remedies ; pastiles of cocaine, atropia, boroglyceride do good. BACTERICIDES. 521 The parotid suffers from irritation. Inflammation of the inflammation, from the localizing in Parotid Gland. its substance of a pathogenic microbe [Mumps) of mumps. This very fact renders inflamma- tion of this gland a dangerous and a highly contagious form of inflammation. The microbe is freely distributed on the tongue, mucous membrane of the cheek, gums, saliva, breath ; seeks the parotid only when that gland is weakened or devitalized, for if we raise the standard of vitality by applying stimulants, the mi- crobe leaves, seek analogous structures, as the mammae, ovaries, testes, brain. At all periods of the attack the micro-organisms are to be found in the blood. Usually a period of incubation, with the ordinary symptoms of fever, debility, inflammation, with pain in head, back, and Hmbs ; p^in and swelling over one or both parotids, stiffness of jaw, some soreness in swallowing. Fever and inflammation reaches its height in four days and then declines, occupying about a week in all. Treatment consists in rest in bed, warm room, open bowels, heat to feet, aconite and belladonna internally, nourish with warm beef tea, malted milk. To destroy germ in the blood and mitigate its severity, administer syrup of tolu with either resofcin,. creolin, or naphthaline. No local application over parotid. Inflammation of the parotid may arise from cold, or from the presence of the bacillus of tubercle, scarlatina, syphilis^ cancer, etc., and demands a very different form of treatment. If acute, exalgine, followed up with general alteratives, saxi- fraga, phytolacca ; locally, concentrated ozone, followed with dry heat to the parotid. Inflammation of the pleura or serous Inflammation of the covering which invests the lungs and Pleura. inner surface of the thorax ; is met [Acute Plejiritis.) with either in the acute, sub-acute or chronic form ; confined to one side or to both. The cause is usually exposure to wet or damp or cold, or frac- tured ribs. The symptoms in the acute form are languor, debility, pain in head, back and calves of legs, chilliness, rigors and a fever, with hot, dry skin ; temperature not so high, unless pneumonia, to a limited extent, exists — ioi° to 103° F.; cheeks flushed; hard 622 DISEASE GERMS. Acme pleurisy, showing the microbe at work. and quick pulse; increased frequency of respirations; an acute, lancinating pain in the side, called a stitch or catch, commonly below the nipple, over attachment of diaphragm on front of chest. This stitch or pain is aggravated by expansion of the lung in inspiration, coughing, or moving, or lying on affected side, and by pressure. A harsh, dry cough, with frothy expectoration ; anxiety and restlessness; scanty and high-colored urine. Over the seat of stitch or pain can be detected, quite early, a friction sound, caused by the in- flamed, congested and roughened surfaces of the covering of the lung rubbing against the pleura of the ribs. This rubbing resembles the rubbing of two pieces of brown paper or stiff silk against each other ; generally best heard and even felt by the hand forty-eight hours after rigor, often earlier. It ceases when inflammatory action is arrested, or when the two surfaces become moist and smooth by effusion of serum, or when adhesions by bands of lymph take place from the afifected surfaces, or when effusion is in great abundance. The duration of an attack of pleurisy should be but a few days if properly treated ; but if mismanaged, it may be run into some of its terminations or effects, or into a chronic form. Effusion of serum may take place, to the amount of a few ounces or of several pints. It may be pure serum, liquor san- guinis, or serum and blood. When excessive it compresses the yielding lung, suspends its functions, displaces the heart, and somewhat distends the thoracic walls. This effusion is called hydrothorax. When pleurisy terminates in a break- ing down of lymph, or suppuration or pus, which accumulates in the cavity of chest, it is called emphyema. When this occurs constitutional symptoms are more serious — rigors, febrile dis- turbance, often of a hectic character; tongue brown, dry and thickly coated; pus sometimes forms a bulging tumor in intercostal spaces; fluctuation can be detected, or sinuses may form at distant parts, and it may be evacuated ; or ulcera- tion of costal pleura may take place, pus finding its way through muscles and skin, and forming a fistula in the chest; or, more rarely, the covering of the lung may be perforated, and the pus find an entrance into the air cells, and be expectorated. Acute inflammation of the pleura, showing the microbe of pleu- risy in nests. BACTERICIDES. 623 Whatever the nature of the effusion, serum, or serum mixed with blood and Uquor sanguinis, or lymph broken down (pus), it will cause, according to its extent, dulness on the lower part of the chest, extending upwards. The respiratory murmur of the luno- is diminished. The chest may be so filled up that the lung may be compressed, so that little or no air can enter the bronchial tubes, so that no murmur can be heard. The fluid also prevents any intercostal movement. Patient cannot lie down. Treatinent. — Acute pleurisy should be treated with great energy, in order to prevent such grave complications. Wet cups or turpentine to redness over the seat of pain, followed with hot, moist linseed poultices, in which tincture of opium is freely in- corporated ; changed frequently. A flannel roller should encase the chest from the axilla; down to the base of ribs over poultice; the latter can be kept hot by bladders of hot water. Patient put to bed, perfect rest, avoidance of talking or full, deep inspiration ; breathe chiefly by diaphragm, so as to prevent friction between inflamed surfaces. Then one tablespoonful of tincture veratrum viride, tincture of aconite and sweet spirits of nitre in half a tum- bler of water, of which one teaspoonful should be given every hour till pulse reaches 70 ; then at intervals of two or three hours apart. Give half a grain of pulverized opium, five of Dover's powders in an infusion of pleurisy root every three hours, or double the quantity if there is not a speedy relief. Open bowels if confined ; keep heat to feet. If the skin does not perspire well with pleurisy root tea, add compound tincture of serpentaria in half- teaspoonful doses. If symptoms are urgent, inject hypo- dermically one-third of a grain of pilocarpin ; when it acts there is immediate relief and a cure ; so it is unnecessary to lay down rules for diet or drink, which should be gruel, milk, broths, cream of tartar, water or lemonade. With such new and definite remedies, we have the means of geUing rid of all acute and sub-acute cases in twenty-four or forty-eight hours. Tonics, good, nourishing food during conva- lescence ; quinine, in alternation with iodide of potass, is espe- cially valuable. Chronic inflammation may follow an Inflammation of acute attack, or it may come on of itself. the Pleura. There is no fever, rarely friction sound, [Chro?iic Pleuritis^ but more generally efliisions of lymph, with adhesions in the form of threads, bands, or ribbon-like exudations between the two pleuras, which interfere with respiration, especially if deep, or with movements, 624 DISEASE GERMS. as raising hands to face, turning sideways when the characteristic stitch is experienced. As there is in all cases of chronic pleurisy adhesions going on, the best method of treatment is to build up the general health by good substantial food, well-regulated secretions, woolen clothing, rest for a few months. If that is not practicable, an avoidance of positions in which the catch is experienced ; then a general alterative course, with iodide of potassa in alternation with tonics. Over the seat of adhesion, which is readily known by the stitch in certain postures, the irritating plaster should be kept constantly applied, spread fresh every morning, and if sup- puration is not free, occasionally rub over with croton oil. The irritating plaster has a better resolvent action than repeated fly blisters or iodoform ointment. Usually about three or more months are necessary to break down a pretty firm adhesion. The obstacle to free, deep inspiration, and that peculiar retrac- tion of chest will disappear as soon as the adhesion gives way. To Promote the Effusion of Serum in the Cavity of Chest. — The best of diet to raise the standard of blood; tonics to stimu- late appetite. Try first infusion of squills and digitalis, followed with diuretics, diaphoretics and hydragogue cathartics; those failing, alteratives and iodide of potass ; all remedies useless, tap the chest between sixth and seventh ribs, two-thirds the distance from the spinous process of vertebrae to middle of sternum. The old-fashioned trocar and canula is better than the aspiration. In emphyema, aspiration should be performed several times. The thorax to be tapped long before difficulty of breathing, or threat- ened suffocation takes place. A partial death, or inflammation, of the Inflammation serous membrane lining the abdominal cavity of the and investing the viscera ; a white fibrous tissue Peritonaeum, of very low organization. Nothing so likely Acute. to ward off any depressing influence as strong (^Peritojiitis?) vital force, and this is especially true with reference to the peritoneal membrane, for we find in a large per cent, of all cases that it is predisposed to b}' some depression of the sympathetic system, and that the com- mon exciting causes, such as minor injuries, would be insufficient, were it not on account of this nervous depression. In the condition of partial death of this structure there is" also a degradation of its normal living matter into a micro-organism or diseased germ, for we find that if a physician is attending a case of acute peri- tonitis in a male, and by chance becomes the attendant in a case BACTERICIDES. 625 ot parturition, the lady will become affected with peritonitis, severe or mild, according to her vital stamina, so that thus far there seems to be a living poison present. The general causes are injuries, perforation of stomach and bowels, strangulated hernia, damage done to organs in the abdominal cavity, as stomach, uterus, liver, etc. Acute inflammation of the peritonaeum is one of the most grave and serious calamities that can befall a human being. When not due to wounds, it is generally caused by injuries to organs, as the uterus, beginning as a case of metritis, or inflammation of that organ, and spreading over every organ in the visceral cavity. Originating in that manner it is called metro-peritonitis. Symptoms. — Chilliness or violent rigors, accompanied with severe, sharp, lancinating pain, extending over the entire abdo- men, with high fever, small, hard, wiry pulse, abdomen swells, becomes exquisitely tender on pressure, even sensitive to the slightest pressure, as bed-clothes, or movement of abdominal muscles ; patient lies on back, with knees bent, legs drawn up ; abdomen becomes more enlarged, tense and hot, tympanitic or drummy ; motionless in respiration ; features become sharp, ex- pressive of anxiety and suffering ; the tongu^e is sharp-pointed, dry, with a variable coat, according to the location of inflamma- tion ; nausea, vomiting, constipation ; skin very dry and burning ; pulse becomes more rapid ; respiration hurried ; often hiccough. If case drags, the abdomen ceases to be tympanitic, but remains enlarged from effusion of serum. If the injury is irreparable, or treatment ineffective, and the case about to terminate fatally, ab- domen becomes more distended, pulse thready and quick, but intermittent; face becomes of a ghastly expression, cold, clammy sweat, pain suddenly ceases. Unless due to perforation of stomach or bowels, the ordinary duration of peritonitis is about one week; when due to perforation, twenty-four or forty-eight hours. After sudden cessation of pain, Avhen about to terminate fatally, patient may live twenty-four to thirty-six hours. Treatment. — The aim of treatment is to establish a renewal of life in the affected membrane. For effecting this purpose narcot- ism with opium, or its alkaloids, is our only resource. The first difficulty we have to contend with is in selecting the form, whether it be crude or pulverized opium alone, or with Dover's powders, or as paregoric, or the sulphate of morphia in cinnamon wat^r. The best plan is to try the crude pulverized alone or with Dover's powder every half hour in. half-grain doses. If it an- swers the purpose of causing the patient to sleep, then push it; if it stimulates, try other forms until you find the one that answers the purpose. In conjunction or in alternation, a few 40 526 DISEASE GERMS. drops of tincture; of green root gelsemium. If stomach is re- jecting everything introduced, same remedies in suppositories or capsules per rectum, in double doses. At the same time the attending physician or nurse must select one of three remedies and apply over the entire abdomen ; either a fly blister for six hours, or until it causes redness, or turpentine applied until the same effect is produced, or tartar emetic ointment rubbed in over the entire abdomen. There is to be no blistering, as that is injurious, barbarous, draws off the liquor sanguinis of the blood. Whichever is applied, must be followed with large linseed meal poultices made with glycerine and one or more ounces of tincture of opium incorporated in it. Change every two or three hours. If there is any delay in procuring the above articles put on hot poultices of anything that will hold heat and moisture, until proper remedies can be procured. Local stimulants to the entire abdomen are of the greatest value ; they promote vitality, create a renewal of life ; their use is founded on sound principles, for it is a law of physiology that when two parts are nervously in sympathy with each other, if we excite a greater action in the nerves of one, we distract action from the nefves of the other. The blister or turpentine to erythema is a powerful means, it cures by withdrawing nervous action from the nerves of the part, and followed by hot poultices induces contractility of blood vessels and a renewal of life. Turpentine, of all stimulants, is perhaps the best in puerperal peritonitis, and one which, from its action on the skin and kidneys materially helps in the elimination of the materies rnorbi from the system in such cases. Moreover, from the rapidity wath which in many instances the symptoms of peritonitis may subside under treatment by this drug, it would apparently seem to have some direct germicide effect on whatever micro-organisms may be con- nected with the development of puerperal septica^mic fever or metria. In other cases of the same kind muriated tincture of iron, more especially when given in combination with quinine and liquor ergotae, and given in full doses, appears to act in a similar way, and may be tried either with the turpentine, or in its stead, as long as tolerated by the stomach and bowels. It too often happens, however, that vomiting and diarrhea are promi- nent symptoms in these cases ; and, under such circumstances, the remedies just referred to are obviously out of the question, and we must then fall back on the various preparations of opium and its alkaloids, from the administration of which, concurrently with free stimulation and the use of the hot pack — that is, by swathing the patient in mustard or turpentine stupes until reac- tion is established, and gastro-intestinal irritation allayed; re- BACTERICIDES. 627 coveries occur in cases of puerperal peritonitis in which all hope had been previously abandoned. As soon as the skin begins to pour out a copious sweat, and stertorous breath- ing take place, patient must be turned over on right side, carefully watched, and as a rule ten to twelve hours of nar- cotism is sufficient. Then waked up and a little barley-water, or lime-water and milk given. If there are any indications of sink- ing, aromatic spirits of ammonia. The opium, gelsemium and hot poultices should be continued for about a week, the two former in small doses, at intervals of three or four hours apart. Cautiously and carefully begin with a little diet, as milk and water, beef tea, essence of beef Enemata ot warm castile-soap water daily, to remove all fecal accumulation in colon or rectum. A cradle over abdomen to support bed clothes ; most perfect quiet obtained. The best of nursing and care, air of sick room to be kept warm and pure ; carry case over seventh day, then treatment for chronic peritonitis should be adopted. Chronic peritonitis may be the Inflammation of the sequela of an acute attack ; more Peritonaeum. frequently an independent affection. {Chronic Peritonitis.) It may arise from cold, suppression of menses, miscarriage, mechanical vio- lence, such as blows, rheumatism and gout, ovarian irritation. In children, it is associated with deposit of tubercle. Symptoms. — General languor, lassitude, debility, with abdomi- nal pain, sharp and lancinating, tender to pressure, and con- siderable swelling of abdomen ; sometimes slight fever, with obstinate diarrhea, nausea, wasting and prostration. If case progresses, a good deal of abdominal tension ; often effiision of lymph, with adhesions, which give rise to colic. In some cases, effusion of serum or ascites is immense. In chronic tubercular peritonitis in children, there is usually enlargement of mesentery. Treatment. — Patient should go to bed for a few weeks, until every vestige of pain has disappeared ; being treated in the same manner as if the case was acute, with opium, gelsemium and local stimulants. As soon as pain has disappeared, alteratives and tonics, as ozonized saxifraga, iodide of potassa, ozonized glycerine, cinchona and mineral acids, tincture of white bryony. To the abdomen, ozonized clay, if effusion of lymph is suspected, or iodoform ointment, or ozone ointment, iodide of cadmium ointment ; and over all a flannel roller ; great attention to the bowels and diet ; milk and lime-water, raw eggs, raw extract of meat. 628 DISEASE GERMS. Inflammation of the pharynx is a Inflammation of the very rare form of disease. We meet Pharynx. with it occasionally in terribly broken- down conditions, where the vital forces are at a low ebb, mal-nutrition and mal-assimilation ex- treme, as we often find it in the degrading haunts of poverty and vice ; and when it occurs, it is mostly erysipelatous or bacterial, and is attended with great prostration, low fever, and difficulty in swallowing. Death takes place from exhaustion. Our remedies, then, are to get the patient into a better atmos- phere ; abundance of antiseptics or disinfectants around. Ad- minister quinine freely ; give brewers' yeast in tepid milk every three hours. Diet, beef tea with barley, raw eggs. A partial death of this gland may Inflammation of the be induced by violence, blows, kicks, Prostate Gland, falls; by gonorrheal inflammation Acute. proceeding upwards; by the use of strong caustic injections into the ure- thra ; excessive venery, masturbation, disease of rectum ; a metastasis of the poisons of gout or rheumatism in that class of subjects exposed to cold or wet : to the action of such drugs as cantharides, turpentine, balsam copaiba, etc. Symptoms. — Pain in the perinaeum, very excruciating, with sense of heat ; frequent painful micturition, often inability to urinate; great pain and distress in defecation; a feeling of weight and fulness about perin possible. Pain is rarely absent, even when at rest ; it extends from the sacrum along the spinal column to occiput. The diges- tion is deteriorated. Topical treatment, after the mucous catarrh and chronic inflammation of the prostate is quelled, must be laid aside. The best remedy is a life of quiet, absence of exertion of any kind ; a long sea-voyage is one of the best remedies. In rare cases chronic parenchymatous prostatitis excites temporary mania, which has erotic irritation for an early or leading symp- tom. It disappears if the patient recovers from the physical affection. We have found in such cases a most excellent cerebral tonic, prepared from the orange wine of Florida Vinum Co* green coca leaves and the peroxide of hydrogen, alternated with avena sativa. Or, as some term it, chronic enlarge- Inflammation of the ment of the prostate, is very common ; Prostate Gland, not as a result of the dignity of a Chronic. hoary age, but rather of the defects and vices of modern civilization. The character of the gland is such that vnth a slight degree of irrita- tion, its different lobes become rapidly filled up with lymph, and thus become greatly hypertrophied. The enlargement is due to effused lymph, the result of inflammation, which, in old age, undergoes calcareous degeneration. Of the male population of North America, it is estimated that eighty per cent, of all over thirty- five years of age suffer more or less from chronic prostatitis. Causes. — It may be a sequel of an acute attack, or may come on from the same causes, such as mechanical violence, gonorrhea, irritating injections, diseases of rectum ; but by far the most common causes are sexual excesses; masturbation; imperfect copulation, in withdrawing the penis in the act of ejaculation, so as to prevent impregnation ; in having sexual congress with women of large or dilated vaginas, or affected with leucorrhea, in whom the contractility or grasping power of vaginal walls is impaired, and the tonic action of the sexual act on the male is destroyed : the wearing of condums ; the want of compatibility in the sexes. These, and similar conditions, prevent the secre- tion of the prostate, as well as the semen from the testis, from being thrown off; the result is, it remains in the ejaculatory ducts and excites inflammation; in other words, they are im- perfectly emptied of their natural secretion ; sedentary habits ; incessantly in the saddle, as in riding ; strictures ; the debasing or demoralizing effect of our modern sexually exciting literature; 632 DISEASE GERMS. drugs that cause a determination of blood to those parts ; over stimulation in eating and drinking. Those are a few of the most common causes of devitalization of this gland, the cause of premature decay, loss of national vigor or manhood. Although we have stated the disease to be of such prevalency and early occurrence, it is usually at a later period of life that decided symptoms make their appearance, although the enlargement begins earl}\ The increase in size is due to a true hypertrophy of the normal structure of the gland. This hypertrophy may affect the whole gland, or only a lobe, or the two lateral lobes alone, or the middle alone may be affected. Again,* there may be a separate tumor of prostatic tissue em- bedded in the substance of the gland, or pedunculated growths may spring from the surface of the gland and project forward on the bladder or back to rectum, often mistaken by the ignorant for piles. The effects of chronic prostatitis on the spinal cord are bad ; on the brain even worse; and as a mechanical impediment to the bladder, of the gravest kind ; alters the course of the ure- thra, lengthens its vesicle end, increases the curve, and dimin- ishes the calibre of the canal ; besides, the cavity of the bladder may be intruded on by the size of the gland ; its muscular coat thickened by frequent straining to void water, and later on the ureters may, with the kidneys, become affected. Chronic inflam- mation of the bladder may take place, and its capacity be dimin- ished, or it may become sacculated. Although we have stated thirty-five as the period in our country of its appearance, still,.as the symptoms are obscure, patients ma)^ not seek relief for many ' years thereafter. It is a slow, insidious, but progressiv^e disease. The production of prostatic inflammation must be regarded as the result of ignorance and wilful violation of natural laws, and not as the calamity of age. Symptoms. — The symptoms of chronic inflammation of the prostate in the early stage are not of a prominent kind ; indeed, the gland may attain considerable size without giving rise to much trouble. But decided when there is weakness in erectile power, or seminal losses, or obstruction to urinating, or urine escaping with the stools, stream weak, more difficulty in turn- ing it on or off, besides increased frequency in micturition, with more irritability of the gland; if unmarried, nocturnal emis- sions, one after the other, or a morbid desire for sexual inter- course ; often a slight gleety discharge, which keeps the urethra red, tender, or sore. The enlargement causes a mechanical impediment to the function of the rectum, as well as the bladder ; stools are flattened like a ribbon ; constipation ; a feeling as if BACTERICIDES. 633 tlie bowels were not perfectly evacuated. The frequent calls to make water become a serious item, disturbs the patient at night, and interferes with his comfort during the day. Continence or incontinence is Hkely to take place; if the latter, the urine drib- bles away. As the case progresses, there is more irritation of the bladder, urinary misery becomes greater, and fits of reten- tion may take place from the slightest exposiire to cold, or ex- cess. The reflex symptoms are often distressing-^languor, lassitude, debility, nervous prostration, derangement of spinal cord, brain, stomach, liver, and especially in a young patient, a morbid condition of the mind. With all these and other symptoms, there should be an exam- ination per rectum with the forefinger of right hand, and in all cases the gland can be felt, laro-e, hot, tender. The examination should be made with patient on his back, finger-nail filled with soap, and the finger, well oiled, should be introduced very slowly and gently, so as not to excite spasm of the sphincter. Treatment. — As soon as the disease is clearly made out, and the necessary arrangements made, begin with a general vege- table alterative and tonic course, as ozonized phytolacca and iodide potass, ozone-water, glycerite of ozone, gentian, columbo, or some other better tonic. Instruct patient that cure is slow, but positive, unless very old. Inculcate good diet ; attend to skin ; daily bathing and flannel clothing; bowels to be opened daily* a cold water hip-bath, morning and night, for fifteen minutes each time ; forbid tea, coffee, tobacco, and all kinds of alcoholic drinks ; recommend exercise, an avoidance of unhealthy literature, and for a few months at least, a suspension of sexual congress. Patient should sleep on hair mattress, on his right side. While this treatment is being carried out, the special f^^atures of the case should be attended to. Jo Arrest, Clieck, or Control tlie Morbid Sexual Desire, or Emis- sions. — Try first thirty drops of tincture of green root gelsemium at bedtime, and increase dose if necessary. Or tincture digitalis, drops eight. Or tincture belladonna, drops five ; begin in after- noon, and give three doses before bedtime. Or tincture ery- throxylon coca in sufficient doses. Or lupulin and lactucarium. Or black willow extract. Or, best of all, the spermatorrhea pill. The salts of bromine are efficient, and, if used, let it be for a little while. To Promote Absorption of Effused Lymph in Prostate. — The patient is on iodide potass in his alterative ; so, to aid its action, try every night at bedtime a cocaine suppository, with infusion ot hydrangea; or cleavers; or uva ursi. Or muriatic acid in 634 DISEASE GERMS. five-drop doses, thrice daily, in water ; and, in addition to either, a suppository of belladonna and iodide of potassa. To OveTcoine Inflaiiiniaiion of Prostatic Portion oj UrctJira. — Use every other night a gelatinized bougie of iodol. For Retention of Urine. — The ordinary means, warm hip-bath, belladonna suppositories, and gelsemium internally; failing, urine should be drawn off daily with a catheter. This is a good plan if there i§ the least inability to empty the bladder completely, as it is of primary importance that at least once in the twenty-four hours the bladder should be thoroughly emptied. If this is not attended to, it may bring about paralysis of the organ, with the loss of the power of voluntary micturition, and cystitis. For this purpose, a No. 12 silver catheter is better than a smaller instrument ; it goes in easier, is less likely to do damage. Keep the point of the instrument on the upper wall of urethra, and, above all things, use no force. In a short time, even in old cases, the patient will be able to get along. An alterative and tonic course should be persevered in. The sequela of this inflammation, if not cured, is enlargement of the prostate. Rectitis, without the affection termed Inflammation dysentery being present, is a rare form of of the Rectum, disease, but it may be caused by violence, {Rectitis.) or fhe introduction of foreign bodies into the bowel. The Symptoms are the same as dysentery : rigors, fever, great constitutional disturbance, intense heat and soreness about the anus ; severe shooting pain up the back and sacrum ; spasmodic contraction and excessive tenderness of the sphincter ani ; tenes- mus, with passage of muco-purulent matter and blood ; irritable bladder, with a train of reflex symptoms, and the same microbe appears as in dysentery. The treatment should consist in the most absolute rest in bed ; stimulants, such as mustard plaster over the entire abdomen ; followed with hot poultices of linseed meal, changed frequently ; drink, water acidulated with aromatic sulphuric acid ; enemata of starch and tincture of opium every three hours into the bowel ; antipyrine, fifteen grains, every four hours for fever, dis- solved in water ; a selection of some of the following formuLie may be made : Iodol, one drachm ; solid extract of belladonna, five grains ; pulverized opium, twelve grains ; butter of coca, a sufficient quantity to make twelve suppositories. Insert one every four hours. BACTERICIDES. 63s Subnitrate of bismuth, sixty grains ; iodoform and resorcin, of each ten grains ; muriate of hydrastin, five grains ; sweet almond oil, one ounce. Inject at once and repeat. Infusion of slippery-elm, one ounce ; add to it twenty grains of resorcin, with one grain pulverized opium. Green root tincture of gelsemium operates like a charm. Follow with small doses of peroxide of hydrogen and mineral acids ; stone crop, as the case progresses to recovery. Diet very light and bland, as chicken, toast, arrow-root. Inflammation of the delicate net, or web, or Inflammation membrane, called the retina, is rare, al- of the Retina, though it sympathizes with all the inflam- {Retinitis.) matory conditions of the eye. Causes. — Exposure to vivid light ; such as the glare of snow, the white sand in tropical latitudes, large fires in foundries, and molten iron. Symptoms. — Acute, deep-seated pain in the eyeballs, extending to temples and forehead ; great intolerance of light ; dimness of vision ; frequent sensations of flashes of light ; pupil contracted to a pin-point ; iris loses its brilliancy and becomes motionless ; some vascularity of sclerotic and conjunctival coats; constitu- tional disturbance ; high fever, and delirium. If not carefully managed irreparable blindness liable to^take place. Treatment. — Perfect rest in a dark room ; veratrum, aconite, for fever; morphia, or opium, or hyoscyamus for pain, w^hich is to be relieved at all hazards ; bowels to be freely opened ; skin stimulated by frequent bathing and jaborandi ; heat to feet — after mustard. To nape of neck, a four-inch square mustard plaster, followed with croton oil, then poultices, and latterly irritating plaster. To the eye, warm fomentations of opium and tepid water, or infusion of poppies; alteratives and tonics, iodide potass and quinine. As to the great value of stimulating applications to nape of neck, there can be no doubt in all eye affections. The optic nerve originates in the spinal cord and medulla, so that a good stimulant at root induces contractility and normal vigor in the main trunk, and in its finer mechanism or reflexion in the opti- cal instrument, the eye. In all eye diseases, aside from children,^ our motto is active stimulation to its origin. We cannot urge too strongly the use of quinine in glycerite of kephaline as our best tonic in retinitis. It should be adminis- tered in half grain doses thrice daily. 636 DISEASE GERMS. Inflammation of the Stomach. Acute. ( Gastritis.) The stomach being a very vital organ, anything which gives rise to a partial death of that organ is attended with ex- treme danger. Causes. — The ordinary causes are the introduction of irritating agents into the stomach, such as poisons, arsenic, caustics, mercury, acids, emetics, whiskey, and other irritants ; or it may be caused by blood poisons or disease-germs, as in yellow and puerperal fevers ; or by inflammation spreading from other parts, as in in- flammation of the uterus and peritoneal coat; it often spreads to or involves the stomach. Syniptoms. — Nausea and vomiting; burning soreness or raw- ness in the stomach, accompanied with a pricking or lancinating pain, very tender to slightest touch, or even pressure of bed- clothes; intense thirst; great desire for cold drinks, which when swallowed, are almost imme- diately rejected ; tongue at first may be furred or coated white, with red tip and edges, or in streaks, and subsequently it assumes a raw-beef appearance, smooth and glassy; and if the blood is affected, dark at the root. The matter vomited at first is usually serous, or mu- cous, or biliary, then becomes greenish, latterly like coffee grounds, or black, which is simply blood changed by the action of the acids of the stomach. There is a generally tympanitic condition of the abdomen, and patient lies on back with knees drawn up and head and shoulders elevated, so as to keep the abdominal muscles from pressing the stomach. Temperature is very high ; pulse frequent, small and wiry ; respiration frequent and short ; features pinched and sharp-pointed ; constipation ; loathing of food and disgust of warm drinks; urine scanty, high-colored ; its duration, about a week. If not very carefully and energetically managed, death is ver\' liable to take place from exhaustion, or suddenly from o;ang:rene. The best we can obtain is to run it into chronic A vertical section of the walls of the stomach in acute gastritis. Treatment. — The patient must be kept as- quiet as possible in recumbent posture in bed ; weight of bed-clothes kept off by a cradle; heat to feet; sponging body thrice daily; mustard plaster poultices over stomach, followed by hot poultices of gly- BACTERICIDES. 5^^ cerine, flaxseed, and opium ; no drink allowed ; patient can take water or ice in mouth, but must not swallow much, if any — noth- ing to enable the stomach to contract. Small, but oft-repeated doses of tincture of green root gelsemium, in alternation with a solution of morphia. The two remedies administered on and on every half hour till narcotism is induced, which condition should be continued for ten or twelve hours, and patient kept on right side. If successful with narcotism, then continue same two remedies every three or four hours for a few days; give no food, a little mucilaginous drink, as gum-arabic water or marshmallow tea; nutritive enemata every three hours. The point to be aimed at is narcotism, during which inflammatory action ceases. If a complication of other diseases, still this point holds good. The idiosyncrasy that often exists to the action of opium or morphia, is entirely overcome by the gelsemium. If successful, be very cautious about beginning diet ; milk and pepsin, beef tea and pepsin, white of egg and pepsin, juice of raw beef. A low grade of irritation in the vari- Inflammation of the ous coats of the stomach. Stomach It may follow an acute attack, or {^Clivoiiic Gastritis}) may come on from the introduction of irritants into the stomach, as arsenic, mercury, whiskey, etc. ; swallowing immoderately iced drinks ; bolting ice-cream after a hearty meal, thereby suspending diges- tion and devitalizing the stomach. In ladies, belts or other arti- cles of dress irritating stomach ; in men, from dispensing wiih suspenders, wearing belts ; and me^chanical occupations, pressing on stomach ; also, direct violence and other like causes. Symptoms. — The symptoms of chronic inflammation of the stomach involve all that are present in the various forms of dyspepsia, as heartburn, water-brash, eruc- tations of gas or liquids, gastrodynia, slow a vertical section of the stom^ or imperfect digestion, with headache ; be- ^'^^ '" ''^'■°"'^ s^"^^'^'- sides, the tongue is red at the tip and edges, with a w^hite coat in the centre ; there are is pain in the stomach, aggravated by pressure or the clothes ; disordered bowels ; often a craving for food, but only a small portion can be taken without producing oppression and vomiting. Chronic gastritis is essentially stubborn. It may exist many years, even in a mild or aggravated form, but is very apt to terminate in thickening or induration of its coats, narrowing the pylorus, or ulceration, perhaps going on to perforation. 638 DISEASE GERMS. Treatment. — In this affection, rest, daily bathing, bowels opened by enema of some soup ; flannel clothing. A suppurating sore, about four square inches, should be maintained over region of stomach, until a few months, after recovery. The diet should consist of juice of raw beef, milk, with lime-water or bicarbonate of potassa, arrow root, milk toast, boiled fish, chicken, oatmeal mush ; three meals per day, pepsin to follow each in a suitable dose to digest without without making any demand on stomach for digestion ; drinking fluids to be forbidden. After attending to those preliminary points, our next and main object is to increase the vitalizing tonicity of the stomach. For this purpose, compound tincture of cinchona, four ounces ; aro- matic sulphuric acid, one ounce ; one teaspoonful every four hours in water, or if that does not operate well, use infusion of golden seal, from a tablespoonful to three every four hours ; col- linsonia, gentian, columbo, or other remedies laid down under the head oi dyspepsia. If there is much burning, soreness, or rawness, use gelsimium and quinine freely, or gelsemium and chlorate of potassa. Once rid of pain, with tenderness on pressure, and the red tip and edged tongue, then a general course of vegetable alteratives and tonics, with more extended and varied diet. Inflammation of the substance of the spinal Inflammation cord is extremely rare, usually a segment or of the a portion involved, seldom the entire length. Spinal Cord. It may be caused by falls, blows, shocks. Myelitis.) concussion^, or microbial disease of the vertebrae, as the bacillus of tubercle, syphilis, etc. Symptoms will depend almost entirely upon what part of the cord is implicated. If the cranial portion of the cord is affected, there is deep-seated headache ; convulsive movements of head and face ; inarticulate speech ; trismus ; difficult deglutition ; impeded spasmodic breathing ; irregular action of heart ; paralysis. If about to prove fatal in the acute stage, great prostration ; greater difficulty of breathing ; involuntary excretions. When the entire thickness of the cord above the phrenic nerve is affected, death takes place rapidly from cessation of respiratory move- ments. If the cervical portion suffer inflammation, difficulty in swallowing and breathing; impossibility of raising the head, pain in back of neck ; sense of pricking and formication in arms and hands ; paralysis of upper extremities. If the dorsal, pain over the affected part, numbness or pricking sensations in fingers and toes; paralysis of arms and lower extremities, with great difficulty BACTERICIDES. 639 of breathing and palpitation. If the lumbar, marked paralysis of lower extremities, at an early period, abdominal pain, and a sensa- tion as if there were a cord tight around the body, convulsions with retention, followed by incontinence of urine, owing to paralysis This plate represents the under surface or base of the brain, little brain, the pons varolii and me- dulla oblongata, also the anterior surface of the spinal cord, to show the mode of origin of the cranial nerves from the base of the brain and that of the spinal nerves from the spinal cord, a, a. Cerebral hemispheres. b. Right half of cere- bellum. )u. Medulla ob- longata. Above this is a transverse white mass, the pons varolii, c, c. The spinal cord, showing its cervical and lumbar enlargements and its pointed termination, e. the Cauda equina, i to 9, the several cranial nerves arising from the base of the brain and sides of the medulla ob- longata. Below these, on each side are the roots or origins of the spinal nerves — cervical, dorsal, lumbar and sacral. In some of these the double root can be seen and the swelling or ganglion on the posterior root, a, .v, the a.Killarj' or bronchial plexus, formed by the lower four cervical and first dorsal spinal nerves. I. The lumbar plexus, s. The sacral plexus, formed by the last lum- bar nerve and first four sacral nerves, t. Shows a piece of the sheath of the cord cut open and within it a portion of the ligament which supports the cord. Plate -^. A transverse section through the cord to show the form of the gray cornua or horns in the midst of the white substance. B. Shows the same parts and also the membranes of the cord and the anterior and pos- terior roots of a pair of spinal nerves springing from its sides. of bladder, involuntary stools followed by paralysis of sphincter ani. Pain in whatever part is increased by heat, pressure or movement. The loss of power in lov.^er limbs and body below the seat of inflammation, and later, of sensation. 640 DISEASE GERMS. t: :^5S- In the treatment, the cause should be removed, if possible, and the most powerful of all stimulants, the galvanic cautery ap- plied, followed with poultices of belladonna. Exalgine should be administered in fifteen-grain doses morning and night, more frequent if case does not yield ; bowels should be freely opened, and the patient placed upon bromide and iodide of potassa in compound saxifraga. The sole aim of treatment is to cairy l: ' " the patient through an acute attack and run it into a chronic form, which is more easily managed. Chronic inflaniniatwn may be the sequel jt^"^' of an acute attack, but it may arise from Acme.nyeht.sofihe.rray ^he samc causcs whlch produccd an acute ...alter dor.j port.on of attack. Pcrsons in middle life, suftering ""^'"'^ "^ ' from some chronic disease are apt to suffer a form of reflected irritation, which weakens the cord, and gives rise to myelitis. It is easily recognized by the pain on pressure and movement, on the application of a hot sponge, or the pole of a battery, aching in the back and limbs, gradual loss of power of the lower extremities. Symptoms are much ameliorated after a long rest in the recum- bent posture ; the acute form may terminate in effusion of blood ; the chronic, in thickening, with atrophic degeneration. Very likely to be numbness, coldness, loss of sensation and motion in the parts below. If the anterior columns only are affected, motor paralysis prevails ; if the posterior columns, sen- sibility is either impaired or destroyed. If the case has progressed simply to chronic inflammation, an effort should be made to get rid of the inflammation by the ap- plication of external stimulants, like the irritating plaster kept on nearly all the time; by rest in the recumbent posture in bed; by keeping the secretions active ; by the administration of bromide and iodide of potassa in compound syrup of saxifraga; by the administration of such drugs as will diminish the area of the circulation in the cord, as ergot, belladonna, calabar bean, etc., and a diet rich in phosphates, as oatmeal, wheaten grits, cream, eggs. Such a plan of treatment is of no avail if white softening has set in. When white softening of the cord takes place, paralysis of all parts below the lesion is inevitable. All symptoms, however, admit of palliation ; the case should be carefully watched, espe- cially the rectum and bladder. BACTERICIDES. 64: Inflammation of the membranes of Inflammation of the the cord is very rare, as it is well pro- Membranes tected from injuries by the thick, bony of the Spinal Cord. casement. [Spinal Meningitis.) Nevertheless, the rhe':imatic bacillus often excites irritation in its structure. The indiscriminate and careless method of prescribing nux vomica or its alkaloids exercises a most deleterious action upon the membranes of the cord. It is, however, to the pathogenic microbe of cerebro-spinal meningitis that we owe such grave an.d important changes in the cord membranes. It usually manifests itself in acute burning, or often sharp lan- cinating pains along the spine, extending to the limbs, aggravated by pressure and movement. If this irritation is high up, there may be some fever and a tendency to opisthotonos, with some rigidity of the muscles of the neck and back ; feebleness of the limbs ; paralysis and the loss of power increases as the case pro- gresses, sense of suffocation, or constriction in neck, back, abdo- men; lower down still, constipation, retention of urine, priapism, prostration. Acute inflammation of the testes Inflammation of the may be caused by blows, kicks, falls. Testicles. violent exercise; or badly fitting {Acute Testitis.) clothing; by a metastasis or exten- sion or migration of the gonococcus from the urethra, by too quickly sterilizing the urethra by such drugs as balsam of copaiba, turpentine, cubebs, kava kava, or aggravated by strong irritating injections, or alcohol, or venereal excesses. In some cases, only a portion of the testicle is affected, such as its body ; or the epididymis and tunica vaginalis are attacked, or the entire gland suffers. Symptoms. — Pain, and feeling of weight in cord and testicle ; great uneasiness in the loin, groin, and upper part of thigh ; fre- quent micturition ; diminution or suppression of the urethral discharge ; swelling of the epididymis, which embraces and hides the testicle ; scrotum firm and tense ; swelling of the cord ; great tenderness ; pressure aggravates the pain. There is pain in the head, back, calves of legs ; rigors, and a fever ; nausea, vomiting, constipation. The inflammation, if violent, powers of life feeble, or inefficiently managed or treated, may terminate in chronic inflammation, with effusion of lymph, induration and enlargement, or abscess; or, if vital force is greatly de- 41 64: DISEASE GERMS. pressed, and system vitiated with mercury and syphilitic germs, gangrene. Trcatiue)it. — As there is nausea and often vomiting, with a depraved condition of the ahmentary canal, an emetic of lobe- lia, followed by warm or alcoholic vapor-bath ; then open bowels freely with salines ; administer aconite, veratrum and gelsemium, freely and frequently, till pulse reaches seventy, then in small doses at longer intervals ; opium and Dover's powder, to relieve pain ; apply, in the form of packs, several layers of canton flan- nel, embracincr the entire scrotum, saturated with the following : water, one quart; muriate of ammonia, half a pound ; nitrate of potash, quarter of a pound ; common salt, a handful ; tincture of iodine, one ounce. Mix. Cover with oiled silk, and moisten again and again. If skin of scrotum becomes tender or sore, or excoriated, keep it off a few hours, and apply cloths wet with ^ot water and opium. Bowels to be kept freely opened ; patient must be confined to his bed ; diet as for fever. Just as soon as the active stage is controlled, place patient upon iodide of potassa in a vegetable alterative, followed by tonics. If the inflammation of the testis be due to the sudden suppression of a gonorrheal discharge, it is unquestionably a good plan to inject the urethra, once or twice, with a solution of the sesqui-carbonate of potass, so as to cause the gonorrhea to re-appear ; it has the effect of removing the inflammation from the testis at once. In bad cases, powers of life low, and ignorance of medical attendant gross, where the inflammation has been mal-treated, the testicle enormously swollen and very painful, it is found to be a good plan to puncture the body of the testis, so that by a division of the tunica albuginea, the pressure on lobules and convoluted tubes maybe removed. The incision allows a quantity of serum, lymph, and blood to escape, and affords instant relief in such cases. After such, some resort to compression with adhesive strips, but this is very painful, and the best plan is to apply the hot water and opium. After recovery, patient should wear a suspensory bandage for a {^\n months. In this we have a low grade of irri- Inflammation of the tation, with a large quantity of lymph Testicles. effused, which gives rise to very great [Clironic Tcstitis.) enlargement and induration, the testis becoming, in some cases, enormously increased in size. Causes. — It may be a sequel of an acute attack when badly managed, but more generally it is due to a low grade of irrita- BACTERICIDES. 643 tion, as horseback exercise, imperfect coition, strains, condums, stricture, gleet, or the presence of the syphilitic germ in testis. Symptoms. — Testicle hard and swollen ; slightly painful to pressure, but very weighty ; the irritation and effusion of lymph usually begins in the epididymis, and extends to the body of the testicle ; sometimes effusion of serum takes place into the tunica vaginalis. The syphilitic form is usually accompanied with indi- cations of the presence of that germ elsewhere, as on the tongue, throat, skin, bones or iritis. In the treatment of enlarged testicle, the patient should be placed upon comp. saxifraga and phytolacca internally. Remove all causes that can be ascertained, such as a stricture, or mastur- bation, or any impediment to sexual congress. Patient must wear a suspensory, with as much compression as possible. Such local remedies as ointments prepared from iodol ; iodide potassa and belladonna ; iodide of cadmium, and the like. Fail- ing all, an absorption of the effused lymph may be effected by electricity. Inflammation of the tonsils is one of Inflammation the most common affections of the mouth. of the Tonsils. One or both the tonsils may become af- (^Aaite Tonsillitis}) fected. The predisposing causes are weakness of organization, a tubercular diathesis or enervation of the glands by mercury, other poisons, etc. The exciting causes are cold, damp, exposure, cold drinks when body is heated, seasons of the year, as winter, spring, vicissitudes of temperature; common in all periods of life. Symptoms. — Those consist in the usual languor, lassitude, de- bility, rigors, and a fever of a pretty high grade. The tonsils and adjacent parts become sore, tender, painful, red, hot, and swollen. There is also great pain and difficulty in deglutition ; return of liquids through the nostrils in attempting to swallow ; there is pain along the eustachian tube and deafness ; glands exude considerable mucus, so that the throat is filled, and gives rise to some hawking and spitting ; respiration may be affected ; the parotid gland at angle of jaw sympathizes ; tonsils can be seen often, if double, almost meeting at the root of tongue. Its duration is from four to ten days. It may terminate in resolution, but apt to return on exposure ; or it may terminate in effusion of lymph, with thickening and induration,- or in breaking down of lymph, abscess. If indurated or hypertrophied, will alter the voice. Treatment. — Patient to be kept in bed ; warm room ; the ad- 644 DISEASE GERMS. ministration of an emetic of lobelia and capsicum is attended with good results ; to be followed up with large doses of tincture of aconite and belladonna ; mouth and throat washed out eveiy hour with chlorate of potassa and tepid water ; heat to feet, and general treatment for fever ; locally to the angle of the jaws, heat and moisture, poultices with mustard. Patient an adult, hypodermic action of pilocarpin might be tried ; it often breaks up most severe attacks. Its diaphoretic action is excellent, but it has a special action on the tonsils in stimulating them, and causing them to disgorge the inflammatory products with which they are loaded. If young, better to use the acetate of ammonia in alternation with compound tincture of serpentaria. Those two remedies act kindly and speedily. Benzoate of sodium is of great utility. Benzoate of sodium, half an ounce ; glycerine and ehxir of calisaya, of each one ounce. Dose one teaspoonful every hour. Salicylate of sodium is nearly as effectual. Just as soon as fever abates, begin with doses of iodide of potassa, rang- ing from five grains upwards, every three hours. If suppuration seems to be inevitable from the presence of rigors, pain changed to a throbbing one, and by the appearance of a yellow speck on tonsils to the eye, or sense of fluctuation to the touch, then let the patient inhale hot vapors of ammonia, poultice assiduously, and when ready for evacuation of the pus, administer a good, smart emetic of lobelia. In the straining efforts at emesis, the contents of the tonsil is freely discharged, and a rapid recovery takes place under good diet and such reme- dies as compound tincture cinchona and aromatic sulphuric acid. If any soreness or induration remains, chlorate potassa for a gargle, and iodide internally. Once the tonsil has suffered a partial Inflammation death, it is very liable to become irri- of the Tonsils. tated by very slight causes. This re- (Chronic Tonsillitis}) peated, spring and fall, soon tells disas- trously on the medulla oblongata, and the patient, after suffering a few attacks, becomes tubercular ; so that in chronic inflammation we usually find tubercular de- posits in the tonsils. In the chronic form there is little soreness or heat or pain, but a vast deal of effused lymph or tubercle thrown out, and as the gland is very vascular, they often become enormously hypertrophied , the enlargement being so great that they meet on tongue, causing thickness of speech and obstruction to swallowing and even to inspiration. In such cases, don't resort to excision, as there is danger ia BACTERICIDES. 64; such a proceeding. Place the patient upon saxifraga and Phyto- lacca. The one remedy one week, the other the following. An effort should be made to hasten and stimulate absorption by painting the tonsils with equal parts of tincture of iodine and iodide potass, or jequirity in the form of distillation or powder ; never irritate ; apply about once a week. The jequirity causes a shell- ing or peeling to take place every time it is applied. Soothing mouth washes or gargles of slippery-elm ; benzoate of soda ; chlorinated soda, naphthaline. A tonic course, change of scene, best of food. Perfectly developed cocci found in the mouth and throat in aphthori tonsillitis. Magnified 400 diameters. Inflammation of the Tongue. [Glossitis.) The tongue is greatly exposed to the in- roads and colonization of disease germs. Either acute or chronic inflammation of the substance of the tongue is comparative rare affection, usually dependent upon some or some caustic or irritant poison applied to constitutional cause the organ. In either case there is fever, great nervous depression, and debility. The local symptoms are those of pain, heat, redness, sweUing. The tongue becomes of a very deep red color, and so swollen that it fills and protrudes out of the mouth. It usually comes on quickly, and is often attended with urgent symptoms, and requires prompt treatment, as active purgatives, followed by hypodermic injections of one-third of a grain of pilocarpin, heat to feet, poultices of slippery-elm to tongue, and suppositories of veratrum viride and gelsemium per rectum. If mercury is the cause, iodide of potassa, chlorate of potassa gargles, and sulphu- retted potassa baths, or both. Acute inflammation of the uterus is comparatively rare in unimpreg- 'nated states, but very common asso- ciated with impregnated states. Causes. — The causes of this condi- tion of partial death are, exposure to cold, damp, and excitement when menses are on ; shocks of all kinds, falls, blows ; irritation from sponges, rings, and pessaries; abortions ; violence from the Inflammation of the Uterus. {Acute Metritis) 646 DISEASE GERMS. instrument, of a whalebone, knitting-needle, in performing the act, and in the subsequent non-expulsion of all the membranes and clots; lingering labor, tedious, and painful violence from instruments in delivery ; the use of emmenagogue drugs, as savin, tansy, aloes, ergot ; the use of injections. It is doubtful whether or not, in very highly civilized women, it may be brought on by grief, worry, passion. Poisons, as the imperfectly-washed hand of an uneducated physician in removing the placenta, or pieces of the placenta ; or in administering ergot erroneously, causing the uterus to contract ; or a clot, or coagulum, which excites the inflammation ; gonorrhea, the forcible entry of large hands. Pathology. — i. Incases of puerperal endometritis, the uterine The uterus and its appendages viewed on their anterior aspect. 1, the body of the uterus ; 2, its fundus ; 3, its cervix ; 4, the os uteri ; 5, the vagina laid open ; 6, the broad ligaments of the uterus on the left side ; 7, a convexity of the broad ligament caused by the ovary ; 8, 8, the round ligaments; 9, 9, the Fallopian tubes; 10, 10, their fimbriated extremities; 11, the right ovary; 12, the utero-ovarian ligament; 13, the Fallopio-ovarian ligament in the peritonaeum of the anterior surface. and vaginal discharges contain a streptococcus which is present in pure, or almost pure, cultivation. 2. In cases of puerperal pelvic inflammations associated with exudation, the discharges contain either the streptococcus with a staphylococcus, or the staphylococcus alone. 3. In such cases where the womb or vagina contain some decomposing dead tissues (retained placenta, vesicular mola, etc.), the extremely fetid uterine and vaginal discharges prove to teem with peculiar rod-shaped microbes, which occur either alone or are accompanied by scanty non-pathogenic bacteria of various species. 4. The puerperal streptococciKs is quite identical with the streptococcus of erysipelas. There is no difference whatever in their morphological properties and biological behavior. Besides, the inoculation of the former coccus to rabbits and man gives rise to a distinct erysipelatoid attack. BACTERICIDES. 647 The puerperal baci fairly [I are rainy thick and ^short (almost ovoid). They are, as a rule, arranged in pairs, which form irregular small-sized heaps. They grow well both on jelly and agar, but somewhat less so (especially in the absence of air) in broth. On gelatine they form large circular colonies of a yellow- ish-orange color, without liquefying the medium. When culti- vated in test-tubes, the microbes develop in from four to six days a characteristic offensive putrescent odor, closely resembling that of the puerperal discharges from which they have been obtained. When inoculated to animals they do not produce any local changes, but give rise to fever, the febrile elevation oscillating between a few tenths and 2° C, and lasting from, four to eight days, ac- cording to the quantity injected. 6. Hence, mild puer- peral affections may be subdivided into two large groups, one of which em- braces specific cases caused by the penetration into the patient's genital tracts of certain pathogenic mi- crobes (streptococcus or staphylococcus). The other group consists of non-specific affections determined by the absorption into the patient's circulation of certain ptomaines that are elaborated by the putrefaction bacilli described above, in the presence of putrescent substances (dead particles of animal tissues). Symptoms, — Should the shock come on the uterus during the menstrual period, or during the lochial discharge, the flow is suddenly arrested, and this will' also happen in hemorrhagic congestion. Simultaneously there is sharp, lancinating pain in the uterus, followed by rigors, and a fever of a high grade. Patient lies on back, knees drawn up ; features sharpen and be- come anxious; eyes look sunken ; tongue coated, pulse rising; Uterus, showin the thickening of its gestion. great tenderness o\'er uterus, a sense of fulness and weight. There is throbbing above pubes, in groin, and perinseum ; great pain in sacrum, irritable bladder and rectum. Either constipa- tion or diarrhea ; if the latter, tenesmus, which is troublesome. Usually nausea and vomiting, which is great or persistent if the outside covering or peritoneal coat of uterus is involved. The OS uteri, to the finger, is hot, congested, patulous, sensitive ; to the eye, it looks of a scarlet redness. The secretions of uterus 648 DISEASE GERMS. acid and acrid ; usually after twenty-four hours there is a watery discharge, then bloody, or sanguineous, mucous, and serous ; pains become acute and bearing-down, intermittent, cutting, but at all times the uterus is the seat of pain, which is aggravated by pressure of the hand, or bed-clothes. This pain extends to perinseum and front part of thighs. If case does not ameliorate, symptoms assume a typhoid form. Acute symptoms rarely last over seven days. Recovery may take place when the damage is not great, and the patient's affections not blasted. In unfavorable cases abscesses form in the structure of the uterus, or other tissues, as the pelvic, areolar tissue, peritoneal membrane; substance of liver and stomach becomes involved, and gangrene sets in ; or, in another class of cases, it may leave chronic inflammation, or enlargement, or induration of uterus, labia, and a muco-purulent diarrhea. It may come on at any time if violence is inflicted. After parturition, a lady is not quite safe from an attack until after five or six weeks. It is exceedingly common and very fatal, and with very ordinary care it might be rare. Treatment. — Formidable as metritis generally is, still, if seen early, much can be done to aid recovery. Suffering is much relieved by the recumbent posture and complete repose. Com- mence at once with opium and tincture of green root of gelse- mium — half a grain of opium every half hour, with a few drops of the gelsemium (same as in peritonitis, pushed to narcotism). If we delay, or don't come right up to the mark of energetic treatment, the patient will die ; don't hesitate ; aconite does well, combined with gelsemium; excite an action on the skin with an infusion of asclepias, or boneset, or jaborandi ; mustard over pubes for an hour, then followed with hot poultices of linseed and opium ; keep patient on back, hips elevated ; enemata of linseed tea, with tincture of opium, irrespective of diarrhea or constipation, twice a day; injection per vagina, of the same, or else an infusion of camomile and boroglyceride, thrice daily ; dry heat to vulva; hop bags. If there is the debris of a placenta in the uterus, then that organ should be washed out with camo- mile and resorcin or creolin injection once a day. The great aim in the treatment of the case is narcotism ; the opium relaxes neck of uterus sufficiently to permit the escape of clots or other bodies. If there is much distressing tenesmus, and pain in the sacrum, suppositories of belladonna and opium should be used. Indeed, whatever the cause, from shocks, fright, lingering- labor, or violence, or whatever the symptoms may be, they can often be very successfully combated with the opium and gel- semium ; under those drugs the inflammation soon subsides, BACTERICIDES. 649 becomes tractable and manageable. Great care should be exer- cised less abscess takes place, and it is well, as the active indica- tions subside, to begin with small doses of quinine and antiseptic drugs. The period of treatment is so short, that if the patient can be tided over the seventh day, the condition of death, at least, may be obviated. Nourishment must be meagre, and increased as recovery progresses ; otherwise, if patient do well, the treat- ment of chronic metritis must be followed out. She must be careful not to get about too soon, as indiscretion may lead to a relapse. Chronic inflammation of the uterus con- Inflammation of sists in a low grade of irritation, either of the Uterus. the neck or entire body of the uterus, with \ Chronic Metritis^) effusion of lymph, which produces en- largement and induration. Causes. — It may follow an acute attack, or be brought about by masturbation, tight-lacing, which causes local plethora, or engorge- ment, or frequent miscarriages, or abortions ; wearing sponges, pessaries ; whalebone, knitting-needles, recklessly used ; gonor- rhea, excessive coition, cold, fright and a sudden arrest of menses, or suppression; use of irritating injections; emmena- gogue drugs. Symptoms. — There is a languor, lassitude, debility, pain in the head and. back, accompanied by a sense of weight at bottom of abdomen ; a bearing-down ; aching in thighs and hips, with severe griping pains in uterus, which is very sensitive to external pressure ; there are heats and colds, or slight febrile attacks ; loss of appetite, constipation, difficulty of breathing; and the head- ache is often intolerable. To the finger, neck of uterus is very tender, and has more heat than the surrounding parts ; to the eye, it is a little redder, but considerably thickened, and there is leucorrhoea. The plethora or congestion of the uterus, with aug- mentation of bulk, causes it to descend, and produces some ab- dominal swelling. This increase in size and weight is due to re- laxation of its tissues, and they being filled up with serum, lymph, blood, now grave changes take place, owing to the lost contractility and engorgement ; its functional activity is entirely abolished ; there is inertia, and the organ is predisposed to organic changes. The changes are not uniform, they depend often on condi- tions, as the transition to puberty, confinement, or forced, celibacy in virgins, or mental states; engorgements, indurations, ulcerations, are frequent results. These conditions are much aggravated if the chronic inflammation occur late in life, for then if the germs 650 DISEASE GERMS. of tubercle, or cancer, or any dyscrasia lurk in the system, it will be likely to manifest itself In chronic metritis there is apt to be bladder trouble, rarely pain in sacrum, but possibly some pain if stools are hard. The entire train of symptoms of hysteria, in addition to the above, may be present. It may last a long num- ber of years. The menstrual flow is usually excessive or may come on several times during the month. Chronic inflammation of the uterus is one of the most common diseases among modern females, and renders their whole life a complete misery ; and even if in mild cases they should marry and pregnancy take place, miscarriage at four and a. half months will inevitably take place, owing to the stretching of the indurated fibres at neck, as the body expands, the irritation being carried to the fundus, and thus contractions are induced. Treatmoit. — Patients suffering from this very chronic disease are usually able to be about, and are often engaged in their ac- customed duties, although suffering greatly. If they are unable to rest a month or two, it renders the process of cure very diffi- cult, because rest in the recumbent posture, in bed, with elevation of pelvis, is one of our main stand-bys. The recumbent posture is always to be preferred to sitting, and gentle walking to stand- ing still. When menstruation is absent, daily bathing, shower bath, if possible, with hip-bath thrice daily ; the vagina should be syringed out three times a day with demulcents or emollients, as linseed tea, infusion of marsh-mallow, slippery-elm, or camo- mile flowers ; and as the case improves, alkaline injections, as soapsuds, borax-water, chlorate and permanganate of potass ; the temperature that is best is slightly tepid ; both bathing and in- jections to cease during the catamenial state, and when that is over to be resumed. Flannel clothing; bowels to be kept open once a day with cascara ; the appetite to be stimulated with tonics ; the very best of diet ; beef, mutton, game, poultry, boiled white-fish, eggs, milk, coffee. If digestion is faulty follow with pepsin. Then place patient upon alteratives and tonics, general course, with a class of remedies bearing more especially upon the uterus. The alteratives should be administered two hours after meals and should consist of one of the following for a week; then another, selecting the two that does the most good, using them alternate weeks : Iodide of potass in compound syrup of Phytolacca, compound viburnum, compound stillingia, iodide and bromide of potass, macrotys in compound yellow dock. Tonics before meals, selecting from the following : Glycerite of ozone, glycerite of kephaline, ozone-water, compound tincture of cinchona and nitro-muriatic, aromatic sulphuric acid and quinine, port wine and Peruvian bark. BACTERICIDES. 651 Inflammation of the different coats of a Inflammation vein with a coagulation of its contents, is of Veins. most Hkely to occur from the introduction {Phlebitis) into the true skin or cellular tissue of some pathogenic microbe, as the micrococci of metria, in the lochial discharge ; the virus of chancres ; the dressings of wounds, etc. Physicians, nurses, and especially washerwomen, are liable to have phlebitis, provided they have scratches or abrasions upon the hands, through which the germs might find an ingress. The germs of puerperal fever, erysipelas, the micro-organisms of all forms of pus, venereal germ, are most active and verv viru- lent. Symptoms, — The moment these micrographic molecules enter in the course of the radiating (^'^ the living tissue, there is pam, veins ; these vessels become thick, cordy, swollen, and a streak of redness appears along the entire course of the affected vessel, first extending to the elbow, then up the arm ; very prone, if not energetically treated, to terminate in suppu- ration ; if so, there are rigors and flying pains in different parts of the body, with great constitutional disturbance and fever of a nervous or irritative type. When suppuration and abscess take place the coats of the vein ulcerate, and the con- tained clot is discharged by means of an abscess. The bacteria or germ-poison or microbe does not produce coagulation ; it mixes with the blood, rendering that fluid a river of disease- germs, affecting the entire body, and giving rise to bacterial de- posits in weakened parts, with embolism and abscess in vital organs, as the heart, lungs, spleen, liver, kidneys, joints and areolar tissue. In some cases a clot is carriea from the \^ein to the heart, and causes sudden death. Treatment. — The general management of such a case is of great importance ; the suction and cauterization of the wound, the application of a solution of muriate of ammonia, and poultices with yeast and creolin. If the vein has become engorged, thick, cordy, the application of a row of leeches along it to empty it of its bacterial contents, and hot fomentation of ammonia or per- Section of a lymphatic gland in phlebitis, mag- nifying power, 700. In and around large number of minute bacilli are found at the seat of inoculation ; the spleen is large ; in the oedematous tissue and iii the blood-vessel-;, large and small, numbers of minute bacilli are found, chiefly contained in the white blood corpuscles, but also free. They are very minute, about o 008 to o.coi mm. long, to o.oooi to o'ooo2 mm. thick, isolated or in couples, or in chains. 652 DISEASE GERMS. manganate of potassa; or if the clot in vein is so firm that the diseased !blood cannot be drawn off, then to paint along the course of the entire vein with creosote, and then poultice with alkaline antiseptics, as tincture iodine in lime-water, etc. The creosote permeates the walls of the vein, kills the bacteria, and the blood regains its fluidity. It penetrates better than carbolic acid, and is just as effectual in annihilating the micro-organisms. Internally, acro-narcotics, as opium and belladonna in alterna- tion ; the former to relieve pain, the latter to maintain the fluidity of blood. Otherwise the case should be treated with a free use of antiseptics, those possessing alkaline properties, as ammonia, chlorate or permanganate of potass ; sulphide pf lime should have a preference. Suitable doses of quinine should also be given. The patient should be well nourished with essence of beef, eggs, cream, lime-water and milk, and a total alleviation from suffering. Influenza. Infusorial Catarrh. A specific, epidemic, and endemic disease, due to the annexed microbe, which is pathogenic of it, and cultiires from which it can reproduce itself again and again. Like all microbial diseases, it has a definite period of incuba- tion — sprouting and full growth. In some respects it is a marvellous germ, aerobic, can multiply in the air and reproduce itself Race and sex are equally attacked by the microbe. Symptoms . — The symptoms con- sist chiefly of a general and definite febrile disturbance, and of a special affection of the nose and air-passages. The disease commences with shiver- ing or a feeling of coldness down the spine, with a hot, dry skin, quick pulse, thirst, and severe headache. Sometimes these symptoms come on suddenly, sometimes they de- velop slowly in two or three days. If they come on suddenly, intense frontal headache with aching pain over the eyes is generally the first symptom. This feverish state usually lasts four or five days, and then gradually disappears, and its disappearance may be accompanied *iii^^ The microbe present in influenza or infusorial catarrh. BACTERICIDES. 655 by profuse perspiration or a troublesome diarrhea; in some cases the fever may last several days longer, but then some complica- tion has probably arisen and given rise to inflammation of the lungs or some other organ. The peculiar catarrhal affection usually follows the early symptoms of the fever ; it begins with swelling and dryness of the lining membrane of the nose, and the tissues or* cavities of the forehead, causing great frontal head- ache and frequent sneezing; the mucous membrane of the eyes or the conjunctiva are generally affected in a less degree, and a thin acrid discharge takes place; now and then bleeding occurs from the nose ; this condition then occurs all the way down the air-passages, even down to the smallest branches of the bronchial tubes. This affection may occur in the whole tract of the mem- brane at once, or, beginning in the nose, it may spread down- wards into the lungs. The inside of the mouth and the tongue and pharynx may also become implicated, but in a less degree. The discharge from this inflamed surface is at first thin and acrid, and at times bloody ; it then becomes thicker, tenacious, and purulent. The patient sneezes, has a troublesome and violent cough and pains in the side. There is great distress in breath- ing, and the pallor of the face and lividity of the lips show how great is the obstruction to the circulation in the lungs, for the blood becomes in such cases imperfectly aerated, and, owing to the accumulation of carbonic acid, flows through the vessels with difficulty. - In most cases the catarrh is at its height by the third or fourth day, and generally declines from the fifth to the seventh, but in severe cases it may last longer. Coincident with the fever and catarrh, and perhaps in proportion to the severity of the former, is a peculiar state of the nervous system. There is great depression and loss of spirits, with aching pains in the muscles and neuralgic pains in various parts of the body or extremities. The mind is often affected, and the patient may become stupid or delirious. The temperature of the body appears to be raised in most cases, but no exact observations on this point have yet been made. Sweating of the skin often occurs during the defer- vesence of the fever, or at the time when a descent of the temper- ature takes place, but rarely in the early stages. Crops of minute transparent vesicles, or little blisters containing fluid, are often seen on the skin. Meningitis, or inflammation of the membranes of the brain, and otitis, or inflammation of the ear, may come on now and then. Great delirium, as well as intense headache, is a dangerous symptom. Neuralgic pains are met with in many parts of the body, and there is also a remarkable prostration of the muscular strength. The cough comes on in paroxysms, and may be so severe as to bring on a rupture, or 654 DISEASE GERMS. even abortion in pregnant women. There is but slight expec- toration at first, and then the phlegm which is expectorated is stringy^ and often bloody, then it becomes more consistent, opaque, and purulent. Bronchitis, or inflammation of the bron- chial tubes, pneumonia, or inflammation of the lungs, and pleurisy, or inflammation of the serous covering of the lungs, are present in some cases, and add to the danger ; however, the frequency of their occurrence varies much in different epidemics ; their presence may be detected by a careful physical examination of the chest, and by the increase in the distress of breathing. Vomiting and nausea often come on at the commencement of an attack ; diarrhea, as a rule, occurs later on in the disease, when the fever begins to abate. In some cases the skin assumes a yellow tint, and bilious vomiting comes on. As in most febrile affections, the urine is at first high-colored and scanty, and after- wards it often deposits a pink or reddish sand, made up of lithates. Occasionally there is complete or partial suppression of the urine. Now and then swelling of the glands under the chin or in the neck has been observed. Convalescence is often retarded by rheumatic-like pains in various parts of the body^ and by prolonged debility or unusual nervous depression. Treatmejit. — Consists in general principles, warm bath, rest in bed in a warm room ; administer exalgine to reduce temperature, and comp. serpentaria to excite diaphoresis. Select an efficient bactericide, such as sulphide of lime, or glucozone, or carbolic acid and tincture of iodine, as in typhoid ifever ; hot steam atomizers charged with iodine, or liquor chlorinated soda should be kept going on at bedside, and disin- fectants exposed in the room in which patient is confined. Naphthaline is excellent for this purpose, as it retards the devel- opment of the spores. Naphthaline finely powdered and well spread, or in solution and continually shaken, has its disinfecting power increased. In a temperature of 98° the effect of naphthaline is much more powerful, which makes it highly probable that it is chiefly in its gaseous state that it destroys the germs. Gaseous naphthaline in solution has more effect on aerobic than on anaerobic bacilli, and more on germs cultivated in a solid medium than on those cultivated in liquid. The conditions for the full effect of naph- thaline are much more favorable in the intestines than in the test- glass. Naphthaline added to feeces decreases their germs by about a half, but, administered internally, it first decreases them to one-third or even a quarter; after this, however, their number rises again almost to its original figure. Against the bacilli of infusorial catarrh, naphthaline is considered still more effective, BACTERICIDES. 655 and decreases the number of the germs even to one-tenth. The administration of naphthaUne should be commenced at the very beginning of influenza, and continued all through the case. Subsequently tonics and nourishing food. Epizootic affections in the horse are identical with influenza in the human being — in causes, symptoms and treatment, the amoeba in animals being of a large or giant micro-organism.. But suppose this form peculiar to the horse is communicated to man, we not only have an aggravated form of influenza or catarrh, but the giant amoeba brings about chronic inflammation of liver, spleen, kidneys, giving us ha^maturia, Bright's disease, leucocythaemia, dropsy and death ; so that in cases of \\ is kind our best modes of nutrition, our most powerful antiseptics and tonics, fail either to destroy the germ or maintain vital force. /^z';//^ ^^ is simply a modified form of the epizooty or giant amoeba, only affecting the mucous membrane of the eye instead of the nose. There is a scarlet redness of the eyes, quite con- siderable swelling, intolerance of light. General health is usually bad from over-work, over-crowding, sameness of diet, or else poor food, bad ventilation. In all such cases an alterative and tonic treatment should be maintained for some months, and the very best of diet that the circumstances of the patient can afford. These consist in the bruising, laceration, and Injuries, division of various tissues, with or without w-ound of the skin and other parts. In all injuries from a simple contusion or bruise up to the most aggravated lacerated wound; from a simple strain up to a perforation of the skin, all are changed, altered into a bacterial mass. Even an ecchymosis, superficial or deep, all is bacteria. When superficial, the ecchymosis of the skin appears speedily as a swelling of a reddish color, which speedily becomes black ; on third day, violet, with diffused margin or edges; on fifth or sixth day, green; on seventh or eighth day, yellow ; and then gradually disappears about tenth or twelfth day, sooner or later, according to the vital force of the patient, and intensity and depth of contusion. If the contusion is deeper-seated, it may not appear for twenty-four hours, or several days. Ecchymosis may, besides being due to injuries, be a symptom of purpura, scurvy, fevers, or of gangrene in inflammation. The object of all sound treatment is to overcome the condi- tion ot partial death, by checking extravasation of blood, by preventing inflammation, by sterilizing and annihilating all mi- 656 DISEASE GERMS. crobes. For this purpose, the injured part should be placed in an elevated position, and a bactericide applied. To an ecchy- mosis, a lotion of peroxide of hydrogen should be applied ; to an incised wound, a solution of boroglyceride ; to a laceration, a wash of chlorate of carbon. being a word of negation, is not easy to define. Insanity, Doubtless we may speak of it correctly enough as any condition which is not that of sound mind, but as this soundness of mind cannot be judged absolutely but only relatively, in giving such a definition, we are simply tossing the ball from one hand to the other. Each case, in point of fact, must be considered by itself and as a whole. Nay more, one law which after all defines insanity, lays down different tests to be applied in different classes of cases. Broadly it may be said that the tests of lunacy, which are com- monly used in exactly the same sense as insanity, are in each case incapacity to manage property or danger to the public, in criminal law ; however, it is broadly laid down that the test of sanity is the knowledge of right from wrong — a test, as has been well said, which, applied to our lunatic asylums, would set at liberty three-fourths of their inmates. It would be useless here to enter into metaphysical speculations as to the connection between mind and brain, or the alterations in brain substance which are most commonly associated with the insane condition ; suffice it to say that the current belief is, that in the great majority of cases of insanity there is a change in the brain substance just as there are changes in the lung in diseases of that organ,, or of the heart when that part of the body is affected. For just as the function of the lung is respiration, and that of the heart circulation, so is the function of the brain the manifestation of mind. As we find in other parts of the body, however, when the self-balancing power is lost or in abeyance, there may be disorder of its func- tions without any marked, or, at all events, protracted signs of local change, so we may have in the case of the brain temporary insanity without any permanent disease of its structure such as give rise to the more permanent form of the malady. The causes of insanity are generally assumed to be of two kinds, as is usual in medicine ; predisposing and exciting, but the so-called predis- posing causes mean merely a state in which the individual is more likely to become insane than if the same set of circum- stances were operating on him in any other state. Accordingly, the term predisposing cause may be looked on as synonymous BACTERICIDES. 657 with tendency, and the origin of these tendencies has here to be discussed. By far the most potent of these tendencies is derived from here- ditary transmission, or, as would sometimes seem, transmission from collateral branches of the family. It is of the greatest pos- sible importance to fairly understand and to face the tendency of insanity to become hereditary, for an individual with such an inheritance, if duly guarded, may pass through life fairly able to fulfil its duties, whereas if the fact of this inheri- tance be ignored and the individual left to face the world like men of stronger mental equilibrium, it is more than likely that at some crisis the equilibrium will be upset more or less permanently. The most difficult question arises, however, when marriage comes into play. Too often these things are kept - profoundly secret, or even intentionally hidden away, especially where property is concerned ; the result in rnany cases is un- fortunate, the more so that the consequences of the deception frequently fall on the guiltless. We may, however, lay it down as a rule that if one has once been insane — be the individual male or female, though the rule is more binding on the latter than the former — marriage should determinedly be put out of the question. Much more difficult is it to decide in the case of those who belong to an insane family, but who have not themselves shown any signs whatever of the malady. There is always a certain risk, and this must be fairly faced, but the risk is less the further removed the insanity is from the individual concerned. Thus, an insane uncle or aunt would be a matter of much less moment than an insane father or mother, and an insane father or mother portends less risk than does an insane brother or sister. This here- dity, however, tends to obliterate itself in course of time in two ways. Intermarriage with a healthy stock gradually diminishes the tendency to insanity in the survivors, and there is besides not only a natural but an artificial tendency to put an end to the heredity from the increasing num- bers thereof. Thus, a certain number of those tainted will probably be incapable of propagating the race, and a certain number more being locked up will have no opportunity, and so between the two the insane members of the family tend to die out, whilst the stronger, having intermarried with a more healthy stock, in course of time become like other people. Age has something to do with the liability to insanity. It is greatest between twenty-five and forty, least in the first ten years of life. Then, too, the nature of the insanity varies M'ith the age at which the individual is attacked. In the earlier years 42 658 DISEASE GERMS. of life there is much more violence connected with insanity than there is with the later ; if this rule is reversed, the likelihood of recovery is very greatly lessened. Sex, as already hinted, has a good deal to do with the liability to insanity, though not in the way one might have conceived. When men have grown up they are exposed much more to conditions likely to disturb the mental equilibrium than are females ; but, on the other hand, if there is a tendency to insanity in m.arried females, it is, especially in the time of childbearing, etc., likely to have full effect. Next come the causes called exciting, which are special to the individual and not to any class or group, though practically it is found that the same causes do operate in a very considerable number of in- stances. Chief among these are the moral causes of insanity, which may operate suddenly in the way of mental shock, or they may act over a number of years. Doubtless the former are the more potent in destroying mental equilibrium, especially ia a mind which is badly balanced by heredity or by means of the individual's own habits and training. These last, however, belong rather to the group of physical exciting causes. The most important, according to all accounts, is the inordinate use of alcohol. This is especially to be avoided in those of originally weak mind. The symptoms of insanity differ greatly from the signs of any other disease. They consist in great measure of the sayings and doings of the insane individual, either acquired by the observer from direct inspection or by hearsay. There are certain words used in connection with the mistaken beliefs of the insane, which, though in ordinary parlance used synonymously, yet, strictly speaking, have got totally different significations. These are de- liision, lUnsion and hallucination. A delusion is a false belief relating to something which has a real existence, but to which the insane individual supplies attri- butes totally false. Thus he entertains a belief that some one, probably the least likely to do so, desires to swindle him ; that he himself is a prince possessed of boundless wealth, etc. An illusion is a false interpretation of the senses. There is something to be and something, to have, but the patient gives them a totally false significance. A ii pyromania. Undoubtedly a good many patients have an inclination to set things on fire, but such a tendency is hardly to be elevated to the rank of a special form of insanity. In many insane people the impulse to destroy everything they can lay their hands on is very great, and a very convenient way of so getting rid of things is to set them on fire. But in all of these patients there are other signs of insanity than a tendency to set a light to everything they can. Roughly, and in such a way as will well suit our purpose, we may divide most cases of insanity into two divisions ; those in which there is apparent exaltation, and those in which there is depression, and these two we shall describe as mania and melancholia ; but both of these tend in the long run to end in a condition characterized by absolutely no mind — what we term dementia^ though there is a condition not inappropriately termed acute dementia. Most forms of insanity are preceded by a period during which the patient is. not quite himself; he is odd in his ways; there is confusion of intellect ; bad sleep at night, and the patient is easily excited. The advance of the malady depends a good deal on the amount of sleep taken. His delusions, at first mere mo- mentary fancies, become fixed and insuperable, and drive the patient to acts of insanity. Then most likely the medical prac- titioner is called in, and the patient is probably moved to some place of refuge. At this time the patient will probably complain of headache, very likely with slow pulse and confined bowels ; if a woman, the menstrual function is generally impaired, or there may be pregnancy, recent parturition, or nursing. All these may be removed, and yet the patient does not get well ; we can- not restore the mental balance. As a rule, the first thing is to remove the patient from home, and surround him with new at- tendants who will take him duly in charge in every way, when he will be removed from the causes of aggravation, be they what they may. With this change of scene and pursuit there should be a change of diet to a nutritive one, if it has not been so before, and then everything must be done to secure good digestion and a due nutrition. The bowels must be properly looked after, and sleep must be got. Opium is not good ; in such patients it often excites rather than soothes, and increases the headache. Chloral is better, and had better be given in good full doses, thirty grains or so. It does not confine the bowels. If there is a tendency to epileptic fits, bromide of potassium had better be given them too, in full doses of twenty or thirty grains, three times a day. 662 DISEASE GERMS. Tonics, especially strychnine, in careful doses, given so that the patient can never command enough to do himself harm, should be administered. All these things require very careful superintendence, and as it is quite possible that the patient may get worse instead of bet- ter, when constant action may require to be taken, it is always better to select a place for change of air and scene where there is a good practitioner on whom you can rely, not only for medicine but also for what in such cases is more valuable — namely, advice how to act. Most probably, if the case assumes a confused character, it will also assume the phase either of melancholia or of mania. If melancholia, then the utmost depression overpowers the unfortunate individual. Everything that happens round him seems to be connected with his evil fortune. Very likely he thinks he has committed sins too black for him to hope for for- giveness. No argument will get him out of these notions ; it is useless at this stage to attempt it. The appearance of many such patients is very striking. Woe-begone in the extreme he may stand for hours in one spot, never moving, or he may be restless and trying to wander away, so to speak, from his evil fate. Usually such patients suffer a good deal in health ; they be- come thinner from want of food and sleep. The pulse is slow and weak, and the general condition of the patient indicates im- perfect nourishment and bodily change. Suicide is greatly to be apprehended in a good many cases, perhaps the majority; and this tendency may be so suddenly developed as to defy anything save the greatest caution from the commencement. For this reason, skilled attendance is of the first necessity, but it does not greatly matter whether that be carried out at home or in an asylum. Food and sleep are the two great remedies for this state, with absolute mental quiet. For sleep, chloral is best ; but if this does not suit, morphia may be given under the skin. The diet should be carefully selected, so that nourishment in abundance may be given. Sometimes these patients refuse their food, and when that is so, they must be made to take it, either bylthe stomach pump or through the nose. The bowels must be moved and kept open. First had better be administered a turpentine enema, after which a dose from time to time of castor oil, or a small quantity of aqueous extract of aloes, daily at din- ner time, will suffice to keep them open. The moral treatment of such patients needs to be begun as early as possible. The great thing is to draw their attention from themselves, and that must be done carefully and judiciously. Once they are brought to take an interest in anything outside themselves, they will generally do well; this is the first step towards recovery. At BACTERICIDES. 663 this Stage, any sudden event which necessitates, or ought to ne- cessitate exertion, will frequently suffice to complete a cure ; but if there has been no improvement, it may do harm. Certain of the peculiarities above alluded to as characteristic of melan- cholia are much better marked in the form of the malady known as dcute melancholia. The patient becomes actually frenzied from fright. Such patients have very high suicidal tendencies,, and require the most careful watching. These, too, are the patients who most commonly refuse food, and who require to be fed forcibly. They also refuse to lie in bed at night, and espe- cially to be covered by bedclothes. This too must be forcibly combated. Patients, the subjects of this form of disease, gener- ally end badly. They are sure to be badly nourished, and a very little superaddition to their troubles in the way of acute disease, finishes them. The lungs are especially liable to be fatally affected by low forms of inflammation. Mania, accompanied by delirium, is perhaps that form of the malady which is taken as the type of madness by uneducated people. The patient may be suddenly seized wath this form of the malady, and may as suddenly become free from it. It is most frequently caused by violent passions, disappointed love, violent grief and the like, especially if the patient be weak-minded or hysterical. The importance of such an attack must depend very greatly on the soil in which the bud is cast ; if there be much of an hereditary taint, the attack rray be a final and complete one, whereas under more favorable circumstances it may speedily pass away. As a rule, too, the more marked the symptoms of onset, and the longer they have shown themselves before the actual malady bursts forth, the more severe it is likely to be. It is not always desirable to hurry these patients to an asylum, for, as said, they may recover perfectly in a day or two ; but fre- quently it becomes absolutely necessary to do so. Acutely delirious patients generally behave much in the same way. They sing and shout, and will not rest a minute. Com- monly they are utterly incoherent, jumbling their words together, or they repeat one word or phrase like a parrot ad infiiiituin. They show less delusions than do many other insane patients — their condition is indicated more by gesture artd behavior than word. Sometimes they are full of glee, laughing and shouting ; at other times they are angry and outrageous, but not nearly so dangerous as some who are quieter in their demeanor. As in most similar conditions, the great object here is to get sleep and rest, for which chloral is the best medicament. Opium generally does harm. Some prefer digitalis to all other remedies, or give its active principle, digitalin, under the skin. The wet pack is a 664 DISEASE GERMS. means of treatment greatly commended by some. (See Packing^ It is chiefly with regard to these cases, or to the occasional out- bursts of chronig lunatics, that the question of restraint or non- restraint arises. To some it may seem superfluous to speak of there being nowadays a question between the two. Nevertheless, no asylum can be carried on without some system of restraint. It is itself a system of restraint, and the only question is how best to restrain the patient ; if that can best be done by living force, let it be applied in the form of the male or female attend- ant's hand. If such is likely to do more harm than good, or even if it cannot be used with such advantage as can some other form of restraint, let the other, even if it be the strait waistcoat, be applied. During the. very acute attack there will be some- times an entire absence of sleep for days and nights. Women •can stand this much better than men ; but both men and women require to be well sustained by food during the sleepless period. Rest, food, and sleep are the great remedies, and the means of procuring the last have once more to be examined. Once more chloral stands at the head of the list ; once more opium has only to be mentioned to be forbidden. Indeed, before chloral came in, treatment by baths was relied upon, so general was the dis- trust against opium. No doubt the baths did good by soothing^ but they also weakened the patient. The bath, to do any good, must be hot, and a stream of cold water or an ice bag should at the same time be applied to the head. The best temperature for the bath is about 92° or 93° F., and the patient must be kept in it for a considerable time — half an hour or so. Shower baths are not to be given. If the bowels be confined a good dose of calomel may be given ; but this had better not be repeated. There is still another form of niaiiia, which may be acute, and yet there is no delirium. This insanity may consist of delusions, but more frequently manifests itself in actions usually of a vio- lent and dirty description. Frequently the patients have their wits about them in an almost surprising fashion, quite baffling the medical man who endeavors to examine them, so as to sign a certificate for their admission to an asylum. Yet, as soon as the practitioner is gone, they are dirty and abusive as ever, shameless in their conduct, tear up clothes and sheets, break windows, chairs, and the like — in short, act like the veriest demons. Their incoherence might sometimes be mistaken for delirium; but it is totally different. The health of these patients is fairly good ; they eat well and sleep well apparently when they like. At all events they will have good rest one night, and the next they will disturb the whole ward throughout the whole night. Sometimes they may go on like this for long periods BACTERICIDES. 665 together, and, as they are exceedingly troublesome, care must be taken to get them quieted. This was the class, and they consti- tute a goodly proportion of our asylum folks, who used to be dealt with by bodily punishments. The plan did not succeed. The plan now adopted, which as a rule, but not invariably, answers, is to give to those who are quiet and well-behaved, and who do any work, some trifling reward — extra beer for dinner, tobacco or snuff, which are always greatly relished ; the privilege of excursions and the like. Work in the field or garden is the best means of keeping such maniacs out of mischief Very often these patients are allowed to run on without care or attention until too late, provided they are not especially troublesome, for the malady tends to a chronic course if not speedily cured, and the only hope of cure rests in seclusion. There is a variety of insanity to which the name monomania has been given, and of it kleptomania, entomania, pyromania are commonly adduced as exam.ples. But it is rare, if indeed such a thing ever happens, to find a man mad on one point and not on others also. At all events this almost invariably happens — one permanent feature of their maladies may for a time be most marked, but by-and-by, as time passes, the madness is seen in other features of the patient's character, and he probably ends by becoming a chronic maniac of the class just described, or a melancholia, but without the characters of either division being very strongly marked. Such are the main divisions of insanity ; but there is one other so peculiar that we are fain to give a brief sketch of its history. The malady is commonly called general paralysis of the insane. It is commonly described as constituting three stages, of which the first is such as may give rise to little anxiety on the score of insanity, though the individual is often greatly altered from his former self The second period is one of acute mania, with ex- alted delusions, and the third one of complete dementia, with complete prostration of mind and body. In the first stage, a general paralytis is usually a prey to exalted notions of his own importance and power. If he has money he scatters it broad- cast, fancying his supply of it is unlimited. He asserts himself as some great dignitary, not unfrequently God Himself; but if this position is denied, he will not take the trouble to argue the question — he will let the objector go in what seems to him his besotted ignorance. As a rule, too, sexual ideas take hold of him, he exposes himself in any situation, or assaults women in the most unlikely neighborhoods. He is restless, and, above all, forgetful. He takes an interest in nothing, or if he do it is laid aside in a moment, all about it being forgotten. At this period, 666 DISEASE GERMS. too, in some cases, though not in others, there may be observed a tremulousness about the upper hp, and a slowness of speech, which are very characteristic. Both these signs, are, however, much more marked in the second stage, when the patient becomes fairly the subject of delusion. These delusions, as already pointed out, are all of an exalted character. He can do wonders in every way. All his surroundings, though of the most trumpery kind, are interpreted as being of the grandest character ; his power is immense, and his bodily strength, though like that of a child, he thinks incomparable. As to physical signs, as already pointed out, they commonly begin with slowness of speech or rather a kind of interval between each syllable, with a kind of stutter or drawl something like the utterance of an intoxicated man. There is, too, that tremulous motion of the upper lip which is so peculiar; but in some there is a kind of stiffness and swelling instead of the tremulous condition. The tongue, too, trembles when thrust out, and it is thrust out with a jerk, as if the patient had not full command of it. As the malady advances the delusions of these unfortunately get worse. At the same time they are liable to break out in fits of violence of a most dangerous character. They are altogether unreasoning, and as they are generally men in the prime of life, they are not easy to manage when they break out in fits of vio- lence. By-and-by they become subject to fits of a peculiar kind, not seldom resembling the slighter attacks of epilepsy called/^/// ynaL The walk alters, it becomes vacillating about the hips, and the legs are not moved as usual, but are rather thrown forward with a kind of jerk. The hand-writing, too, becomes imperfect both as to mechanism and material. Words or letters are omitted or inserted wrongly, the same word is repeated over and again. The whole is nonsense. ■ The food is eaten voraciously, sometimes bolted, but in other cases, especially as the malady advances, there is difficulty in swallowing from paralysis of the fauces. Such- patients are very destructive and very dirty, but they tear up their bedding without knowing what they are doing, and they dirty themselves very frequently for ornament. By-and-by the patient gets worse ; he can hardly walk or shuffle round the room ; he loses power over the bladder and rec- tum if not constantly attended to. His face has lost all expres- sion, and yet it seems fat and puffy. He can hardly hold any- thing in his hand, and if he is confined to his bed, sores form which are hard to heal. Grinding of the teeth is very often a marked symptom. His appetite is still good, but he has lost the power of swallowing comfortably, so he crams his mouth and throat, and there is a risk of suffocation if this is not seen to^ BACTERICIDES. 66/ At this time all such patients require to be fed. In point of fact everything must be done for them. But even in this state they may survive a good long time if care be taken of them, and if they are protected from cold, to which they are very sensitive^ The averag-e duration of the disease, from the onset to the end,, does not exceed as a rule two years, whilst it may be much less. The causes of the malady are hard to determine. It generally occurs in the prime of life, and most frequently in males. In a certain number of cases it can be traced to overwork of the brain, but as the malady is more common among the laborers than the rich, this will not account for nearly all. Another cause assigned is sexual excess. This, of course, is no easy to make out, but irrregular lives have been noted in a considerable number. As ta treatment, that is useless ; we must just do our best to keep the patient quiet, clean and orderly. We must try to feed him well, and as soon as any difficulty in swallowing appears no food must be given in the solid state — the pulpy condition is best. If they are confined to bed for a day or two their backs must be care- fully watched, and, if necessary, washed with some weak spirit with a little corrosive sublimate in it. Stimulants are usually necessary, especially in the latter stages — in the maniacal stage, they must be given with caution. In these cases during a maniacal paroxysm digitalis or digitalin often does good, but only for subduing the paroxysm ; nothing does good permanently. Meanwhile, as far as we know, the malady invariably ends in death. Feigned insanity has already been alluded to, but briefly. Often as insanity is assumed the fiction rarely succeeds. The would-be lunatic, as a rule, overdoes his part ; most likely he has never seen a lunatic, and his only conception of one is a raving maniac. The means of*detecting feigned insanity are not too nu- merous, each case must be dealt with on its own merits; and there are some men known to be sane who have for years succeeded in keeping up an ostensible insanity. Associated with, and dependent on a shal- Kleptomania. low state of the typical fissures of the brain, among the ordinary phenomena of minds not regarded as insane, there is an inordinate tendency to acquire, or collect, or hoard. So long as such an impulse does not inter- fere with the rights of others, or involve a breach of the law, it is readily admitted as an indication of disease, or an absurdity or eccentricity which may consign the individual to an asylum, or to contempt. But when the amount of the object appropriated. 568 DISEASE GERMS. or the circumsiances under which it is purloined, bring the mat- ter into a court ofjustice, the act is treated as a theft and pun- ished. In very many cases this is the result of cerebral disease, in which the typical fissures of the brain are partially wiped out. The inclination to steal is a premonitory indication of many forms of mental disease, often a characteristic symptom, where violence, delusion, eccentricity, incoherency leave no doubt as to the source from which it springs. But there are many other cases in which the morbid origin cannot be so clearly demon- strated ; where the mind is clear and cogent, the morals pure, and where the theft is the only proof of insanity. The propensity to steal may be so irresistible that the will is impotent, that the appropriation is involuntary and the perpe- trator irresponsible. The gratification of the impulse is found associated with phy- sical changes and conditions which may be regarded as incom- patible with the healthy discharge of the nervous system, but the connection is not invariable, and the best mode of establishing the reality of such a disease, is to consider marked cases, in rela- tion to the character, interests, and previous development of the individual, to the nature of the articles taken, to the motive which determined the action. The incongruities of some point to the existence of deep-seated cerebral changes. Each case must be tested on its own merits and all its salient points and features well considered. The objects stolen, often ostentatiously, without any adequate precaution to conceal the attempt, or perhaps the article taken may be of no value, even useless to the taker, or the taker quite wealthy. The act is soli- tary, without motive, and promptly and spontaneously avowed and restored. This disease is observed in extreme, youth, near puberty in both sexes. It often follows falls, blows on the head or spine, and looms up as a symptom of perverted sexual abuse, and of pregnancy. But it is when the uterus undergoes those critical and crucial changes at the turn of life, that this affection is most prevalent. The interstitial changes in the womb and ovaries is reflected to the brain proper, and produces grave changes in the cerebrum — changes which the modern jurist and philanthropist should note. The incarceration of such cases is a blot on the civilization of the age. The therapeutics of insanity are of late years becoming more extensive. Chloral hydrate and bromide of potassa in syrup of orange peel, must be given cautiously lest cardiac syncope be induced. BACTERICIDES. 669 Chloral, bromide potass, conium and hyoscyamus best adapted to procure sleep. The hydro-bromate of hyoscyamus very valuable in melancholia. Amyl nitrate is very useful alternated with morphia. Ergot, combined with hypophosphite of soda, excellent when paralysis is threatened. When insanity is complicated with epilepsy, belladonna, gel- semium and cannabis indica afford most salutary results. Turpentine of utility when symptoms of an hysterical nature manifest themselves. Strychnine, avena sativa, electricity, calabar bean, used with variable success. For procuring sleep, amylene nitrate, sulphonal, paraldelyde, hydrochlorate hyoscyamus. Insomnia is often an early and premonitory Insomnia. symptom of a partial death of the brain. (Sleeplessness) It may be caused by passion, mental anx- iety ; dyspepsia ; imperfect action of the liver ; constipation ; disease of the heart, pregnancy. It is often an aggravated and persistent symptom of chronic inflammation of the brain, insanity, mania, chronic alcoholism. Besides, it is often present in neurasthenia, poverty of nerve force, cerebral softening, paralysis and other states, which are the sequel of exhausted nerve force, whether by mental work or sexual excess ; it brings about the state of an organ tissue- starved. Following this, granular deposits on the arachnoid, adhesion of the membranes to the surface of the convolutions, crystalline granulations in the lining membranes of the ventricles, with an unusual amount of fluid in the sac of the arachnoid and in the lateral ventricles are found in the brain of those who de- vitalize that organ. A tissue-starved brain gives rise to inflam- mation of the cortical part of the brain, ending in its degenera- tion of the nerve cells of the hemispheres, structural change in the convolutions, the cells of which lose their integrity and look like an irregular heap of particles ready to fall asunder. The brain of man owes its healthy existence to the quantity of phosphorus it contains ; if this is enconomized, independent of its scantiness in modern food, it might sustain him probably as long^ as life lasts and health holds out; but let the brain starve, health fails, nature can supply no more ; then, unless the patient can obtain phosphated food, or ozonized tincture of oats, or the animal phosphorus of kephaline, degenerative changes will take place in the gray substance of the cerebrum ; the cells of that 6/0 DISEASE GERMS. part will become granular and deposits of granules scattered through its substance, and these changes take place in all parts of the brain and spinal cord, when the phosphorus in the brain is exhausted. Brain workers, merchants, professional men, know this ; they feel it in their languor, tired brain ; those are the victims of excessive brain exhaustion. How far this granu- lar change in the nerve cell is compatible with healthy mental action, we cannot yet say. In the treatment^ the removal of the cause, whether it be men- tal or physical ; the regulation of the secretions ; daily baths, with massage ; good digestible food ; moderate exercise ; abundance of fresh air ; an avoidance of all stimulants, as tea, coffee, tobacco, are all important. One essential element in the management of all cases of insom- nia is to crowd in more elements containing more phosphorus. In order to accomplish this, without disturbing the organism too much, it is always best to administer a tonic, either wine of cinchona or ozonized coca wine ; the latter being essentially the most active, it stimulates the absorption of vitalized phosphatic compounds. The tincture of oats and the glycerite of kephaline are the two best remedies for brain nutrition ; and we can pro- cure their absorption by means of the coca. These remedies when thus administered, penetrate the brain, nourish and invigo- rate it. These are our two best brain foods, a nerve-vital essence ; they entirely supersede comp. hypophosphorus as a recon- structor of shattered nerve force ; invaluable in all forms of loss of brain power, as loss of memory, paralysis, white softening ; very refreshing to the nerves when tired by worry, when in neu- ralgia they cry for richer food, purer blood. These are the only true remedies, they cause sleep by promot- ing cerebral nutrition. In order that this point be correctly gained, sulphonal can be administered in doses sufficient to procure sleep, until the remedy has time to act. Sulphonal is the best of all drugs for that purpose, as it does not interfere with the secretions. It is a capital remedy in cases of sleeplessness in brain-starved subjects. Other drugs of value are boldo ; glucine ; methylal ; hydrate of amylene ; somniferin ; antipyrine ; hyoscyamus, etc. All remedies failing, then the case should be placed upon precisely the same treatment as that employed for neurasthenia, namely, vitalized massage, electricity, seclusion, rest, and gener- ous brain diet. This is never-failing, although expensive. BACTERICIDES. 671 Invagination or intussusception is the most Invagination frequent of all kinds of interstitial obstruc- of tion. In the case of children, it is the charac- The Bowels, teristic form of obstruction, and any other kind is a rarity. In adults, the affection is far less -common, and differs in its locality and in its clinical course. The disease is far more frequent in children than in adults, and in infants at the breast than in older children; it is more common in boys than in girls; in adults, the distribution be- tween the two sexes is more nearly equal, or even. The invagination may take place at any portion of the bowel, but most common at or near the ileo-caecal. In the so-called enteric form, the lesion is in the small intestines ; next the colic variety, in which the large intestines is affected, and the valvular or iieo-colic variety, in which the ileum passes through the valve. Intussusception of the rectum is so rare that it is a pathological curiosity, and still more exceptional is it for the duodenum to be involved. judging from statistics, the common types are more common, and the rarer forms more rare than is generally supposed. The course of this affection is essentially acute, from a few hours to a few days from the first symptom to the termination in recovery or in death. Synnptovis are remarkably constant and even; pain always per- sistently present, severe, and sudden in its accession ; then remit- ting, returning again and again. It is of a colicky character. Vomiting is usually an early and very constant symptom. It is a reflex effect. In chronic cases it subsides, or may even be absent at first, and appears in the later stage, when mechanical obstruction has become complete. Tenesmus, which is often mentioned as a characteristic symp- tom of invagination, only appears when the intussuception has reached the rectum. It would seem to be always absent when the small intestine is the seat of the disorder, and is naturally more obvious in adults and older children than in the case of infants. The bowels are, in some of the most acute cases, confined from the first, in others diarrhea appears for a time, and in the more chronic there is often a period of irregular looseness of the bowels, ending in complete obstruction. A more characteristic symptom is the passage of blood, or of blood and mucus, unmixed with fecal matter, containing no pus, and varying from frequent and abundant hemorrhage to the presence of a little blood-stained mucus on the examining finger. We never see the black, tarry stools ■ of mela^na, for the blood has ^,7 DISEASE GERMS. r.ot undergone acid digestion in the stomach. Hemorrhage from the bowel is almost invariably present. The characteristic sign of a tumor felt through the abdominal wall was present in sixteen cases out of twenty-four. The only other movable tumors likely to be present in a case of obstruction are a scybalous mass in the colon, a gallstone im- pacted in the small intestine, or a cancerous nodule in the omen- tum. The two latter possibilities would be excluded in the great majority of cases of invagination by the age of the patient. No other tumor moves gradually from the right iliac fossa across the abdomen, and no other contracts under the hand as an invagina- tion sometimes does. If the reflex centre is in any way weak- ened, tetanic symptoms slight or aggravated according to the weakness existing. Abdominal distension is occasionally an early symptom, but more often only appears in the latter stage of chronic cases. It was most marked in a case which lasted three months, and was associated with visible peristalsis, an appearance commonly in- dicative of chronic obstruction in the larger intestine; but in this case the invagination affected the ilium. Infants very early show signs of collapse, with cold extremi- ties, feeble pulse, and sighing respiration. The temperature is often subnormal, but in one case of mine, in a child six months old, it rose to above 103° F., although the autopsy showed neither peritonitis nor any other morbid condition, but a reduced ileo- caecal invagination. Diagnosis. — When there is no tumor to be felt either in the rectum or through the abdominal walls, the diagnosis of the case depends on the combination of symptoms of acute abdominal disturbance, pain, vomiting, and early or late obstruction, with the passage of blood and mucus. When these occur in a child almost the only condition likely to be confounded with invagina- tion is ulcerative colitis, so-called infantile dysentery. In adults the diagnosis is more difficult. Cancer of the upper part of the rectum may closely simulate the effects of invagination, particu- larly when it leaves diarrhea, instead of, or in addition to. constipation. Prognosis and Treatment. — Invagination is always a grave con- dition. There is little doubt that the bowel occasionally extri- cates itself by a reversed movement, as may be seen in the case of animals dying from asphyxia. This natural reduction hap- pened in three out of twenty-four cases, in one of them under the influence of chloroform. Far more frequently cases left to themselves go from bad to worse ; the invagination extends farther and farther, and the BACTERICIDES. 673 patient dies quickly of abdominal shock, or more slowly from exhaustion or from peritonitis. If the invaginated gut slough? off speedy death often follows by perforation or by hemorrhage. Probably this event was more frequent formerly than now, when our power of diagnosis and of treatment is better. It has rarely been recorded in the case of children, and is an accident of chronic rather than of acute cases. The part involved is more often the small than the large intestine. The best treatment seems to be to administer chloroform at once, and then to inject air. When the abdominal walls are re- laxed, a tumor before undetected may be readily felt, and the condition is more favorable for inflation. If for any reason, how- ever, it is undesirable to administer chloloroform, or if inflation has to be repeated, there is no need for an anesthetic, since the operation is painless. The hand should be kept upon the ab- dominal tumor while air is being forced into the bowel ; the inflation of the colon is then felt, and the tumor disappears from the touch with a characteristic sensation. Moreover, one can thus better appreciate and regulate the force used, which must be gradually and cautiously increased. If with justifiable pres- sure reduction is not effected, the best plan is to desist for two or three hours, put the patient under opium, and try again either by inflation or by an enema. Not infrequently the invagination returns after reduction, but it may be again reduced by a second or even a third inflation. When the invaginated gut has reached the anus, or protrudes therefrom, it must first be replaced by a large, well-oiled bougie, until there is sufficient space in the rec- tum for the nozzle of the inflation-pipe to enter two or three inches. An ordinary pair of bellows is as convenient and efficient as any other means of inflation, and has the great advantage over specially devised apparatus of being always at hand. Some good authors prefer the administration of forcible and copious enematato inflation as a means of reduction. The water should be warm, plain or medicated with lobelia ; and the requi- site power obtained by raising the receptacle from which it flows. Advantage is moreover gained by raising the patient's pelvis, or by more complete inversion of the body, so as to open out the sigmoid flexure and increase the space between the *' plug '^ and the anus. On the whole, the injection of air appears to be the safest and most efficient treatment. Neither method, however, is uniformly successful. Indeed, when the invagination has long existed, adhesions have taken place, so that no safely exerted pressure can reduce it ; and if this were effected it is likely that a rupture of the softened Oj. sloughing gut would take place. In one case that lasted only ^ 43 6/4 DISEASE GERMS. single day it was found impossible, even after death, to effect re- duction by injection of water into the rectum. In these cases we must, after two or three careful and patient attempts, either keep the patient under opium and hope for a natural cure by the plug sloughing off safely, or else open the abdomen and deal manually with the invagination. In this case we have the great advantage of a diagnosis, so that the surgeon knows what he has to deal with. The seat as well as the nature of the obstruction can usually be ascertained, and there is scarcely ever already existing peritonitis. These are all favorable circumstances, but on the other hand we have the early age of most of the patients, and the fact that they are already exhausted by want of food for hours or days, as well as by pain and vomiting. In the more chronic cases the patient is usually older and stronger, and more nourishment has been taken ; but it is likely that adhesions and other local changes may have rendered reduction impossible or dangerous. The results of treatment are not, therefore, very favorable. Of a very large number of cases treated, a very large percentage died. The most recoveries take place under the administration of large doses of opium, hyoscyamus and belladonna, internally ; with copious warm lobelia injections into the rectum. In nearly all cases of abdominal section, death follows, not from the operation and peritonitis, but from the damaged state of the invaginated intestine, or from the shock and collapse. This is the name given to a disease of the skin in Keloid, which there is hardening or thickening of that tissue, so that the part very much resembles that seen after a burn. It occurs on the back and upper extremities chiefly, and seems to be an incurable disorder. The word ** keloid " or **kelis" is derived from a Greek word signifying a crab's claw. There seems to be two kinds or varieties of this disease. The one appears as hard, shining tubercles or small nodules of a dusky or deep-red color, and generally attended wtth itching, pricking, shooting, or dragging pain in the part. These tuber- cular elevations gradually increase in size until they are as large as a horse-bean or even an almond, and about one-tenth or one- sixth of an inch above the general level of the skin. They are hard, firm, and elastic, but after a while they become broader and more irregular. Some delicate whitish, glistening lines appear on the surface, and from each there is a claw-like process from a quarter of an inch to an inch in length, which appear to cause a puckering of the skin. Growth may go on for months and even BACTERICIDES. 675 years, but they only cause local inconvenience and do not impair the general health. The other form of keloid does not begin with tubercular elevations, but as white, roundish patches of skin, very slightly raised and surrounded by a zone of redness. At first there is no pain nor uneasiness ; afterwards there is itch- ing and pain with a feeling of tightness in the part ; at length the part becomes hide-bound, and the skin is hard and rigid, so that the movement of the part is impaired. The fingers are very liable to be affected in this way. After a time the skin shrinks, becomes red or yellowish, and may go on to ulceration. If the affected part be extirpated it often returns, and no treatment seems to be of any avail, but a prolonged use of the Chian turpen- tine mistura. Skin diseases in our country have neither the Leprosy, virulence nor malignity of other parts of the world. This is due to our highly oxygenized atmosphere, to the extreme abundance of healthy food, and cleanliness of our people. We look with holy horror at the emigration to our north- western States of nearly all the lepers of Scandinavian Europe and Asia. It is well known to our profession in those States that certain localities are literally packed with individuals having this malignant disease. The time is opportune and no false notions of philanthropy or religion should deter us from insist- ing upon the segregation and isolation of all lepers, and upon forbidding all such entering our country in the general tide of immigration. Lepra is an infectious parasite disease of an exceedingly chronic character, the microbe or parasite in its embryonic state breeding in the blood, when more matured invading every organ and tissue of the body ; chiefly characterized by cutaneous pig- ment changes, disordered or abolished sensation — making its chief ravages upon the skin, in either tubercles, bulbae, cicatrices, atrophies, or destruction. The germ creates a cachexia which terminates fatally. There are several varieties as lepra tuberose, maculae, anaesthe- sia, etc. Leprosy is a contagious and infectious parasite disease, produced by the bacillus lepra. Common to both sexes, all ages. After the microbe is once hatched, breeding freely, it produces organic or degenerative changes in the nerves, which explains the anaesthesia, or hyperaesthesia, and possibly th-e pigment altera- tions, so characteristic of the malady. The peculiar inaptitude of the nervous tissue to undergo retro- 676 DISEASE GERMS gressive metamorphosis ; the slow growth of the germ, its ten- dency to invade the skin with no involvement of the internal viscera, explain the slow growth of the disease. The bacillus lepra is discernible in no other disease affecting man, although in leprosy, in tuberculus, in syphilis the aggrega- tion of germs often tend to cutaneous and subcutaneous growths or nodes ; nodules in the cornea, cartilage, testicle, spleen, liver, bone. In a drop of blood placed under the microscope the germ is visible in lymph spaces, or in any new formation. The microbe consists of fine, slender delicate rods with tapering extremities, some rather long and pointed, some clearly mobile and others not. In the secretions they are recognized sprinkled through the mass, have a beaded appearance. The germ bears artificial culture in blood, serum, and alkaline The microbe of leprosy in its embryonic state, magnified 1000 diameters. .•^^ The full-fledged bacillus of leprosy, mag- nified 1500 diameters. meat extracts. Inoculation on animals nearly allied to man pro- duces the disease. The germ is most prolific in the tubercular form of leprosy ; here their growth is prodigious, and as a result they are found in enormous numbers in the mouth, palate, larynx, liver, spleen, kidneys, testes, lymph glands, and in the interstitial tissue of the nerves in anaesthesia form. The recognition of leprosy is very easy ; the eruption, its ap- pearance, odor, chronicity, its large, brownish-yellow, glazed bulbous lesions; its leathery, mica-tinted cicatrices are rare in any other contagious disease. As regards treatment we have a most remarkable and exceed- ingly tenacious microbe to deal with. No remedies known to science have thus far had any direct curative effect ; that is, we have not yet found the potent germicide. Even the Chian tur- BACTERICIDES. 677 pentine with the ethereal peroxide of hydrogen, with resorcin and thallin, which so effectually annihilates the cancer germ, fails in half the number of cases in which it has been used to destroy the lepra bacillus. Other remedies, as the comp. saxifraga; half-drop doses of creosote ; oil cf cashew nut, gurgun balsam, ichthyol, chaulmoogra oil, alvelos milk, siegesbeckie, internally and locally have all been employed with varying success ; they mitigate greatly, but fail to exercise a controlling influence over the disease ; that is, they do not kill the germ. The most recent and extensively used remedies to kill the mi- crobe in the connective tissue between the nerves, are chaul- moogra oil and gynocardic acid with glycerine. Both oils are administered internally in increasing doses to one drachm a day. Chaulmoogra oil in emulsion. ■The adoption of a highly nutritious diet, the exhibition of our best tonics, as iron, cinchona, avena, kephaline, wine and malt liquors are always of good service. Baths are of great advantage in all cases. Those of the high- est potency in germicidal properties, as ozone, sulphur and iodine, should have the preference. Such remedies would be of utility in syphilis and cancer. Every secreting ulcer and open surface in a leper should be attended to by the application of resorcin and ozone ointment, so as to destroy the bacilli that are contained in it. The prominent indications in each case should be met. If the patient happen to reside in a district where the disease prevails, an immediate change of residence and climate is necessary. An essential symptom of all diseases of Leucorrhcea. vagina, uterus, ovaries. It is therefore present in debility of the va- ginal walls ; in acute and chronic inflammation of the uterus ; uterine catarrh, and ulceration ; in all forms of displacement; in all forms of ovarian irritation, etc. If the original morbid condition can be got rid of, there is little trouble in getting rid of leucorrhcea. General internal treatment consists in the use of tonics and alteratives; pulsatilla and caulophyllum, in alternation with the aleteris cordial and compound tincture cinchona. As the discharge in all cases is loaded with disease-germs the remedies used must be bactericides ; as extract hydrastis, dioxide of hydrogen in tepid water ; hemlock bark, dioxide of hydrogen in tepid water; acetic acid, solutions of boroglycerides ; packing the vagina with boroglyceride ; lime-water and tincture of iodine. 6/8 DISEASE GERMS. Infantile leucorrhcEa, as seen in children of three or four years of age, differs altogether from the leucorrhoea of adolescence or maturity. Its location is the vulva ; discharge, sero- or muco- purulent. The subjects of this disease are tubercular, and the victims of hereditary syphilis. Exceptional cases are due to the germs of the eruptive fevers and ascarides. There should be an improvement of the general health by all possible means, fresh air, abundance of nutritious food, cleanliness and the affected parts bathed three times daily with a warm solution of borogly- ceride. Internally, compound tincture of matricaria in five- drop doses, in water, is most effectual in overcoming the patho- logical condition of germ evolution which is dependent on debility. A disease in which the number of white Leucocythaeniia. corpuscles in the blood is greatly in- creased, with a simultaneous diminution of the red. This state is brought about by chronic, exhausting diseases, exposure to cold, wet, privation, and insanitary condi- tions, and often a sequelae of malaria, typhus, typhoid, puerperal fevers and pneu- monia; affections of the lymphatic glands or of the spleen, and is attended with a decided train of symptoms. Great weakness and de- bility, anaemic pallor, with all the other symptoms of anaemia ; disordered re- spiration, loss of appetite, mental depression, abdomi- nal swelling, with enlarge- ment and induration of the spleen ; sometimes diar- rhea, at others, constipa- tion, nausea, jaundice ; often hemorrhage from nose, lungs, stomach ; jaundice, anasarca, ascites, prostration, ending in death. Very chronic, lasting usually quite a number of years. The morbid condition is characterized by an excess of white corpuscles in the blood, with great enlargement, induration of the spleen, often as large as a child's head, its proper structure Destruction of the red corpuscles of the blood in the spleen by the microbe of malaria, which gives rise to the white-cell disease of the blood. BACTERICIDES. 679 obliterated, filled with coagulated blood, soft and friable, and a mass of bacteria. Oftentimes we have a peculiar inflammation of the retina. All methods of treatment and our best remedies fail us in this disease. An eruption consisting of small pimples or papules, Lichen, arranged together separately, or in clusters, and oc- curring anywhere on the surface of the body. The term is restricted to inflammatory papules, which undergo no metamorphosis. In the treatment there are three indications, the improvement of the general health, especially as regards the nervous exhaus- tion ; the relief of the itching by local means, which will go far towards the removal of the eruption. The patient should not scratch the heads off the pimples, as he may produce an irritable sore which may become eczematous. The papules arenot large, but are hard, dry and red in color. They tingle or itch and disappear by scaling off. Numerous varieties are described, according to the cause which gives rise to it ; none of them dangerous, but as a rule troublesome or intractable. The employment of general alteratives and tonics, among the latter, avena, mineral acids, nux vomica. Local remedies of most utility are thymol, naphthaline, respr- cin, creolin, rubbed up in lard or vaseline ; in the form of lotions, try oil of cade cut with alcohol ; or chrysarobin five to ten per cent, solution ; baths of sulphuret potassium. The case must be pushed; nerve tonics, it is essentially chronic, and if untreated may last for years, spreading and leading to grave complications. Various lesions may be occasioned by the local application of many substances ; chiefly irritants ; but eruptions also some- times follow the internal administration of certain drugs. Amongst the more common thus caused are the following : A scarlatiniform eruption (from belladonna), erythematous patches (from quinine or chloral), a rubeoloid eruption (from copaiba), a vesicular rash (from arsenic), pigmentation (from the prolonged administration of arsenic or silver-salts), an acneiform eruption (from iodides or bromides), and a purpuric rash (from iodide of potassium). By leaving off the drug, those various eruptions will each and all disappear in forty-eight or seventy-two hours, without any treatment whatever. 68o DISEASE GERMS. A hybrid micro-organism produced by the pre- Lupus. sence of the microbe of syphilis and the bacillus tuberculosis. It usually attacks the face and mani- fests itself in a variety of forms. L. erythematosus. — The least severe form. Most common in the female sex and usually attacks face. It is mostly symmetri- cal and makes its appearance as an erythematous patch on either cheek. These generally become joined across the nose, the ar- rangement then somewhat resembling a butterfly with its wings spread out. Sooner or later scabs form which adhere closely to the skin. When removed by the nail, they are seen to extend into the orifices of the sebaceous glands by numerous fine pro- cesses from their under surface. The scabs, in fact, consist of dried sebaceous matter. The disease has, therefore, been con- sidered by some as an affection of the sebaceous glands. Its affinities, however, are more marked with the other affections de- scribed as lupus, and like them it leaves permanent cicatrices. It is a chronic affection and may last for years. L. vulgaris. — The more severe form often causing great de- struction of tissue. Begins mostly in early life — usually before puberty, often in quite young children. May go on for years even if vigorously treated. More common in the female sex. Sometimes hereditary. Said to be frequently associated with struma, but many cases of scrofuloderma were doubtless formerly erroneously regarded as instances of lupus. Any part of the body may be attacked but, as with the erythematous form, the face is the favorite locality. It also attacks the mucous membranes. The characteristic appearance of lupus is that of rninute yellowish- brown translucent (" apple jelly") nodules in the substance of the skin. They average a line or two in diameter, are not raised above the surface, and are covered with epidermis. The tuber- cles may occur singly or in groups. The former arrangement is rare and has been termed acne lupus from its superficial resem- blance to the follicular prominences seen in acne. More generally the nodules occur in groups which gradully tend to get larger owing to fresh portions of the skin getting attacked. The older nodules get paler in color. Microscopic examination shows the growth to begin by an aggregation of small round cells in the corium mainly in the coats of the vessels. The growth extends along the vessels until it involves the whole thickness of the corium. It occupies the interspaces of a fine fibrous network in which a few capillaries may be seen. Later, there is marked over- growth of the epidermis, and the cells of the rete malpighii are infiltrated with leucocytes. The two principal varieties of L. vulgaris are L. exedens (or BACTERICIDES. 68 1 exulcerans) and L, non-exedens, so named according as ulceration does or does not occur. L. tuberculatus is a form in which the new growth forms prominent tubercles, and pustular lupus is a variety having a superficial resemblance to impetigo. In L. non-exede7is the new growth does not extend deeply but is limited to the skin itself, a considerable tract of which may become ultimately involved by irregular gradual extension of the disease. As the growth advances in a fresh direction cica- trization takes place in the parts first attacked and grayish-white glistening scars are left. The hair-follicles are destroyed in the process and the hair is therefore not reproduced on the areas attacked. Compared to the next form this is a comparatively benign affection, though deformities may result from the con- traction of the cicatrices. L. exedensls that form in which the process goes on to ulceration. Most common on the face, especially on the nose and cheeks. As a rule the ulceration has more tendency to advance superfi- cially than deeply. When the process has lasted a certain time a fresh patch is attacked, and on the older patches a scab forms, beneath which gradual destruction of the tissues may still go on. More or less cicatrization may ultimately result and disfigure- ment or deformity may ensue. On the face the lower eyelids may be drawn down and everted, the mouth drawn out of place, and incurable nasal deformity be caused. On the limbs the con- traction may limit the movements of the joints. In those rarer cases in which ulceration tends to extend deeply extensive destruction may be caused. Almost the whole of the face may thus be destroyed and even the bones may be attacked. Pustular lupus is an eruption consisting of isolated tubercles {occasionally confluent) which may reach two lines in diameter. They become pustular at their summits, and soon small dark scabs form and adhere firmly. If removed fresh ones form. The tubercles finally disappear, leaving temporary discolora- tions and permanent scars. In lupus we have a hybrid germ ; a microcosm, which ex- ercises a fierce, unrelenting struggle for existence. The hybrid microbe lupus in nests interspersed T„ ;j.^ f^^t^^t-l^^^ i^ra. "U'^rro. o with sweat ducts and sebaceous follicles. -■■" iLS lOrmailOn WC naVC a disappearance of both the bacilli of tubercle and that of syphiUs ; no doubt these two bacilli, when together, generate a diastase which kills themselves. 682 DISEASE GERMS. The hybrid microbe, the factor of lupoid infiltration and ulcera- tion in all its varied forms, is the direct offspring of the micro- organism of syphilis and tubercle in the blood. The presence of both germs in the lupus nest in the skin, actively proliferating, places the origin of the disease beyond all doubt, as well as the fact that both disease germs can be isolated and cultivated. Simultaneous with the evolution and growth of both mother- germs, the hybrid lupus follows. Both the internal, as well as the external, treatment, must ne- cessarily be, in the highest degree, germicidal. The internal treatment should be constructive and alterative, the best of diet, bathing, clothing and a mode of life calculated to build up vital force, embracing the very same remedies which are of utility in syphilis and tuberculosis, as the iodide of starch, saxifraga, glycerite of ozone, sulphur water, hydrogen, peroxide, Phytolacca, have a marked effect in sterilizing the organisms, dwarfing their micrococci and their multinucleated masses of protoplasm. Constitutional remedies do great good ; they sterilize the blood and the lupus-nests fail in their organization. The favorable results obtained by some of the following local remedies have again and again been verified. The favorite are either iodized oil, thymol, ich- thymol, naphthol, chrysarobin, iodol, sozoiodol, creosote, per- oxide of hydrogen, salicylate soda, chromic acid, sulphurous, pyrogallol in ointment form. Equal parts by weight of ozone ointment and resorcin most efficacious ; lactic acid. Erosion, scraping by the der- mal curette or spoon*, followed by the application of iodoform, has met with fair results. Be- fore any remedy, either in ointment, lotion or in gutta- percha and chloroform be ap- plied, the crusts should be softened by boroglyceride oil and slippery-elm. If a caustic be deemed indispensable, electrolysis, or nitric acid in which the chloride of gold et soda is dissolved, should have the preference. A mixture of thallin and papoid. made into a paste, of immense value ; sprays of C. P. peroxide of hydrogen, very effectual. Lupus microbes removed with ozone ointment and resorcin. BACTERICIDES. 683 Several most interesting cases of facial lupus have been speedily and permanently cured byjthe local use of one ounce of ozone Lupus ceedens before treatment. Lupus exedens after treatment with ozone ointment and resorcin. ointment and one ounce of resorcin. Mix thoroughly and ap- ply over night, during the day sprinkling the part with iodol. This is a term applied to a most pernicious Masturbation, and disastrous habit — the stimulating the or penis with the hand, in order to excite the Self-Abuse. pleasurable sensation of coition and a dis- charge of semen; an act revolting to humanity, destructive to vigorous manhood, and one which depreciates vital stamina, entails degeneration, disease, insanity and death upon all who practice the vice. The causes which give rise to this habit are the defects and vices of modern civilization ; a poverty of nerve force ; isolation, monotony, solitary confinement which wipe out and obliterate the typical fissures of the brain ; isolation of the sexes ; the developing the nervous system at the expense of the physical ; the moral tone of society is blunted. The symptoms incidental to this habit are insidious languor, lassitude and debility ; a want of energy and ambition ; a depres- sion of spirits ; a disinclination to society ; a pallor of the face ; weakness of the back and knees ; hands and feet are cold and 684 DISEASE GERMS. clammy ; noises in the ears ; specks and spots before the eyes ; the circles around the eyes are depressed and darkened ; a gen- eral want of nutrition, emaciation ; he cannot bear the cold, as he is morbidly sensitive ; morbid thoughts annoy him ; his old pur- suits and amusements have no attraction for him, neither do new ones have any charm for him ; his memory becomes imper- fect, so does vision and hearing; the freshness and vigor of health disappear ; a general destructive metamorphosis sets in ; the skin becomes rough, often of a leaden hue ; the eyes lose their brilliancy, and by languor express that of the whole body ; the lips lose their vermilion tint ; the teeth their whiteness ; the hair becomes dry and falls out, and sometimes even the whole body is bent and distorted ; his face is shrunken, haggard, pale, unmeaning, soulless, inexpressive ; eyes become dull and lack lustre, in other words, the masturbator is a physical, moral and mental wreck. This vice is not confined to the male sex, it is equally com- mon among women. Young and apparently modest ladies are dying by thousands from tuberculosis, uterine complaints, spinal and nervous disease, general debility, prostration caused by this habit. The symptoms and effect? are similar to the male. The practice causes a glary, white discharge to pass away, which is very weakening ; besides, it gives rise to leucorrhoea, ovarian and uterine irritation, mental aberration, suppression of the menses, and general disorganization and bankruptcy. The effects of masturbation are invariably disastrous, it always gives rise to irritation of the prostate gland and ejaculatory ducts ; damages the testes, the veins of which with those of the spermatic cord, become weak, varicose ; atrophy or wasting set in, or if the practice has begun in early life, they do not attain their full size, lose their power of secreting semen, and the entire body is dwarfed and suffers vital deterioration. As a rule the generative organs suffer first, the penis and tes- ticles resemble those of a boy, they take on interstitial absorp- tion, lose their elasticity and firmness — their proper structure is anaemic — the spermatic cord atrophies, its nerves degenerate and the cremaster muscle disappears. The thin, watery semen that is formed under such a state is entirely destitute of spermatic granules and spermatozoa ; its fertilizing power is gone ; impo- tency supervenes. When the testicles waste away, as the result of masturbation, the wasting is equal, dwindling to nothingness ; whereas if they waste as the result of the localizing of the syphilitic germ, they alter in shape, become uneven, or irregular, or elongated as well as small. BACTERICIDES. 685 In some cases, enlargement of the testes takes place, puff up, insidiously increase in bulk, but diminish in firmness, consistency and elasticity ; in others, they become spongy. Whether it be enlargement or atrophy, it is the precursor of degeneration. The reflex effect of the act upon the spinal cord and brain is most disastrous in setting up an irritation, in draining off the nervo- vital fluid, in changing the whole aspect of the cerebral areas. The time when most males and females become addicted to this vice, is usually about puberty, the most critical period of life. The generative propensity, called forth perhaps prematurely and viciously gratified, steps in amidst the natural efforts of growth, with its unnatural train of nervous shocks, and physical pollu- tions, causing our boys and girls to have the appearance of old age, being feeble, pale, effeminate, with perverted tastes, drained out brains, mere wrecks of humanity, victims of nervous disease. It is thus the delicate, the impressible nervous system of the young of both sexes, that most vividly experiences the depress- ing effects, the soul-wrecking ravages of self-abuse. Such a habit strikes at the root of society ; the origin of species ; dwarfs humanity in its very bud, deforms its features, stunts its growth. Its direct reflex effect on the nerve centres creates an intense tubercular diathesis, and this peculiar nervous defect aids in the creation of this abnormal desire. Fathers, but especially mothers, must not shut their eyes to the fact that their children often, at an early period of life, resort to tickling their sexual organs. Later on, just at the time when all the energies of the system are needed for growth and develop- ment, the practice is most devitalizing, but when puberty sets in with its rapid grov/th of the organs, the increased power and frequency of erection, the dawn of a new life, the practice is most demoralizing, and its effects more permanent. Man, with his instinctive and moral nature, is often a slave of habit, and if the act of masturbation be but a few times indulged in, this habit is created. The blighting effects of masturbation are not confined or lim- ited to the sexual organs, to wasting or atrophy of the spermatic cord, testicles, spinal cord, but re-acts upon the brain, impover-. ishing the nerve centres ; so that the semen secreted becomes thin and watery, of a sickly odor, with no living spermatozoa in it, consequently not fertilizing. The effects produced by masturbation may be embraced un- der three heads : I. A condition of genital debility, in which the seminal ducts will not retain the semen, but it oozes away by day or night or ^^^ DISEASE GERMS. both, with or without seminal incontinence ; or a chronic prosta- titis may be the result, with emissions often and persistent. 2. Chronic irritation of the lumbar portion of the spinal cord. 3. Exhaustion and irritation of the brain. The leading or characteristic symptoms of these three stages are as follows : A general feeling of languor, lassitude, debility ; there is vertigo or swimming in the head ; specks or spots be- fore the eyes ; noises in the ears ; skin becomes white ; pupils are dilated ; breath fetid ; digestion is feeble ; bowels constipated ; the faeces harden in the rectum, and produce irritation of the seminal ducts in their vicinity ; the circulation is languid ; the extremities cold and clammy ; the muscles soft and flabby ; by- and-by, the forehead may be dotted over with pimples ; the corners of the mouth are lengthened ; the nose and features be- come sharp ; eyes sunken and deprived of their brilliancy ; there are bluish circles around them ; no look of gaiety or animation ; he cannot look you in the face ; becomes morbidly sensitive ; loses all his vivacity or grit. The case progresses onwards ; there is weakness about loins and knees ; a crack- hng in the joints; memory fails; percep- tions become dim ; desires blunted ; dis- traction or absence of mind, which ren- ders him unfit for business ; imagination gives birth to the wildest fancies and most ":S?rLrmTn'°X^Tver groundlcss fcars ; an allusion to the habit, turbation"^ ^^^ ^""^ °^ "'^" ^^ ^^^ prcscnce, causing a twitching, a flush of shame, or even despair. The affected one shuns the face of man, and dreads the observation of women ; then, after a while, there are fainting fits, wandering pains, chorea or convulsions, trembling, epilepsy, and partial paralysis. The debility of masturbation is both local and general, never partial. Persons so affected, in attempting sexual intercourse, may be unable to get an erection ; or, if the act is accomplished, an emission takes place too quickly, and is followed by exhaus- tion ; besides, there are daily as well as nocturnal losses ; the ^ semen regurgitates, and finds its way into the bladder, and is passed in the urine ; or it may be passed during an evacuation of the bowels ; the patient becomes keenly alive to his weakness ; is timid, fearful, careless of everything; his mind becomes ab- sorbed in the consideration of his malady, until the presence, re- currence and persistence of the same train of thought, with the ever-leaking seminal ducts, creates a monomania or premature BACTERICIDES. 687 old age. There is not a gland or function or movement of the body natural, nor a faculty or organ, nor sense or perception of the brain clear or healthy ; all is out of gear ; nothing but dis- integration and disease ; incessantly, by night and day, the seminal fluid or brain juice oozing, dribbling away without sensation, erections, or any show of natural ejaculation. This persistent drain of the most vital fluid in the body varies in quantity, according to the state of weakness. Onanism wipes out the deity of manhood. The victim of the solitary vice is repulsive to his fellowman ; his very skin emits an odor resembling the smell of the ailanthus blossom in a decaying state, or that of a dog-kennel ; his brain softens, insanity super- venes. First Stage. — The main, if not the only trouble, is in involun- tary emissions. The patient, after having practiced masturba- tion, has generally discovered its pernicious nature and aban- doned it, hoping by temperance and frugality to outgrow its evil effects. But the injury once having been done to the delicate sexual apparatus, he is sooner or later surprised and alarmed by the occurrence of involuntary discharges of semen. These, in the first stage, occur at night, sometimes at considerable inter- vals, at others several times a week, usually accompanied by a dream of an obscene nature. These seminal losses are a terrible drain upon the system ; they impoverish the blood, and rob the body of the precious elements of manhood. For some time no other serious effect is observed, the general health being good, and the sexual powers vigorous. When these symptoms are present, treatment should be resorted to at once, for if the evil is not remedied it soon passes into the second stage. Second Stage. — The emissions now occur not only at night with dreams, but sometimes without them, the patient knowing nothing of it until he observes the stains on his linen the next day. He also soon learns to know, by a wretched feeling of malaise and depression the next day, that he has suffered a loss of the vital principle. In this stage the weakness of the organs increase so that emissions take place in the daytime, the semen escaping with the urine, or while straining at stool. The sufferer now begins to experience a gradual failure of his usual strength and powers of endurance ; in some cases there is loss of flesh, and various abnormal symptoms, headache, dyspepsia, low spirits and melancholy, weak back, gloomy forebodings, etc. And, although from not being married he may not observe it, there is perceptible weakening of the sexual powers. The power of erec- tion may remain comparatively perfect, but the sexual powers are easily exhausted. In such cases, on attempting intercourse, 588 DISEASE GERMS. the emission takes place too soon, thus defeating the end of marriage, and bringing disappointment instead of mutual happi- ness. In an advanced degree of this stage urethral complica- tions set in. The urethra becomes relaxed and weakened, the semen is not ejected with force, and is sometimes thin and watery, producing feeble, unhealthy children. There is a low degree of chronic irritation, which produces uneasy sensations in the passage at times, a burning sensation on passing water,, and a driobling of urine afterwards Sometimes there is a kind of oozing of a clear, whitish fluid, like the white of an Gggy which may be either mucus, prostatic fluid, or these discharges mixed with semen. These are always bad symptoms, as they denote an advanced stage of the disease, and debilitate the genera- tive organs and impair the health. This is followed by nervous irritation, restlessness, lack of energy and ambition, loss of memory and want of self-confidence. If, from neglect or im- proper treatment the disease has been allowed to reach this stage, appropriate treatment should be adopted at once ; as, if not remedied, it gradually passes into the third stage, making a con- siderably longer course of the remedy necessary. Third Stage or impotence and sterility, '' Loss of Manhood," as it is termed, the sexual powers continue to gradually fail ; the emissions are now less frequent, because but little semen is secreted. The nervous energies, however, suffer the same. Inclination for the opposite sex is irregular and feeble, the secre- tions are slow, weak and imperfect, and no longer under the con- trol of the will, intercourse is often wholly impracticable, owing to absence of erection, or premature discharge ; when the semen escapes it is often accompanied by a burning sensation, owing to the unhealthy state of the urethra. In time all sexual power is wholly lost ; occasional erections of mornings may be observed, but they are due to a distended bladder rather than the presence of semen. If married, the patient discovers himself incapable of consummating it, and many under such circumstances have com- mitted suicide in despair. The general health is often still more impaired, although on the gradual extinction of the sexual func- tions, a person will sometimes become fleshier, and to outward appearance look well, the same as eunuchs and castrated animals. No one knows better than himself, however, what a fraud he is to womankind. He is impotent; or if capable of occasional inter- course, his semen is imperfect, containing no spermatozoa, and he is sterile and incapable of transmitting life to posterity. Towards the latter part of the second stage, and during any part of the third stage, the mind is liable to become diseased as well as the body; then comes mania, insanity — a grave consultation BACTERICIDES. 689 of friends and physicians — a hurried removal to the confinement of an asylum — and he is entombed alive — a few months, or at most years, of mad delusion follow — and all is over ! This is the sad end of many a once ambitious and promising life, recklessly sacrificed by vice and ignorance. This is a function performed by women Menstruation, between the age of puberty and middle life; this forms the child-bearing period, and usually lasts about thirty years. Various names have been given to this function ; it is spoken of as the menses, the period, the catamenia, etc. When not performed at all the patient is said to have amenorrhoea, when the function is performed with difficulty or pain it is called dysmenorrhoea, and when the dis- charge is very profuse the individual is suffering from menor- rhagia. The appearance of menstruation is generally accom- panied by more or less pain in the back, headache, and lassitude ; often, also, the patient loses color, and has a dark ring round the eyes. From thirteen to fifteen years of age is the average time when menstruation commences, but it may come on a year or two earlier in some cases, or it may be much delayed in others. The periods are frequently irregular at first, and some months may elapse before the function is carried on with regularity. When well established, an interval of about four weeks elapses between each period, but sometimes only three weeks intervene. The blood that flows differs from ordinary blood in being acid instead of alkaline, and in not clotting unless poured out in large quantities. This function is always suspended during pregnancy, and is, in fact, the chief symptom from which a woman dates the expected time of her confinement. Many things will tend to cause irregularity in the performance of this function during the child-bearing period of life — exposure to cold or wet, mental emotion or worry, acute diseases, consumption, cancer, and many other diseases may either cause menstruation to stop altogether, or be diminished in quantity, or to occur at irregular intervals. The period of life when menstruation ends is known as the climacteric period, and the cessation of the function is often accompanied by more or less distress ; the patient becomes nervous and is easily worried, suffers from lowness of spirits, pain in the back and between the shoulders, pain also frequently in the left side, and headache ; the temper may be irritable and the appetite capricious. These symptoms arise in a great measure from a disturbance in the nervous system, giving rise to various neuralgic pains ; such symptoms, however, though often 44 690 DISEASE GERMS. troublesome, are not attended by danger, and subside when the function of menstruation has quite ceased. The flow generally ceases gradually, and becomes more and more scanty ; sometimes it is for a short time much increased in quantity. Menstritation has a nerve origin ; not a sliedding of imicoiis membrane. Recent authority points out that this monthly phe- nomenon is the result of changes in the condition of the nerve supply, manifested by symptoms of a general character. With the approach and appearance of the monthly flow the whole frame, as one would naturally expect, participates more or less in the change, and the amount of disturbance experienced as well as manifested is commensurate with the power the organism possesses of adaptation. The true nature of the catamenial dis- charge is still conjectural and theoretical, yet its elimination from the body renders it highly probable that having already served some special end, its detention in the blood may exert some deleterious influence upon the animal economy. Ovula- tion and menstruation are coincident. It is alleged as an estab- lished theorem that from the period of puberty to the climacteric age there is, besides a gradual death of the mucous membrane lining the whole uterine cavity — which must ever recur, to be compatible with life — a more or less regularly-recurring and complete death of this coat. In the whole animal kingdom we search in vain for a physiological change truly analogous with this. To maintain the integrity and activity of the menstrual function almost indefinitely, we have two most remarkable rem- edies, namely: avena sativa and ozonized distillation of apiol ; the former acts on the origin of the sexual appetite in the brain ; the latter upon the uterus. The mesentery is a double fold ot Mesenterica, peritonaeum which retains the small in- Tabes Mesenterica. testines in their place in the abdominal {Marasmns) cavity; it is fan-shaped in form, and attached to the front of the spine at its narrow end. Around its longer margin the bowels are arranged, so that perfect freedom of movement upon each other is allowed, while yet each portion keeps in its proper place. Between these two folds run some vessels which take blood to and from the in- testines ; these are called the mesenteric vessels, and consist of arteries and veins ; they are also accompanied by various nerves. There are besides a great many glands in the mesentery, called the mesenteric glands, and these are often liable to disease. Through these glands passes an alkaline, opalescent fluid called the chyle ; BACTERICIDES. 691 this chyle is collected in the intestinal walls by a vast number of small v^essels called lactcals, which are very analogous to the lymphatic vessels in other parts of the body : these lacteals join toi^ether and form larger branches, until, having- passed through the mesenteric glands, they convey the chyle, altered by that process, to the receptacuiinn cliyli — a dilated tube lying in front of the spine and servmg as a kind of reservoir fjr that fluid, which afterwards passing up the thoracic duct, enters the blood at the lefc side of the root of the neck. The lymphatics of the mesentery belong to the same class of glands as the suprarenal capsules, spleen, pink marrow of bones, lymphatics, active blood raisers. Any irritation in the bowels, as diarrhea, cholera infantum, worms, irritates and weakens the mesentery and renders it a congenial place for the localization of germs, so that the bacillus of typhoid, tubercle and other germs, lodges in its meshes or network; grows with great rapidity, fills up its tissue, destroys the function of the gland ; their growth obstructs the passage of chyle through the convo- luted lacteals which traverse the mes- entery in all directions ; besides there is a complete failure on the part of the gland in elevating the white discs of the blood, consequently all the tissues of the body starve and waste. The symptoms of tabes mesenterica are very plain, usually some intestinal disturbance, as diarrhea or cholera infantum ; when the abdomen becomes hot, tender, swells with less or more pain in the bowels ; in some cases pain severe, griping, causing the legs to be drawn up towards abdomen ; deep red color of lips ; angles of the mouth covered with small ulcers, in which the oidium albicans abound ; the passages from the bowels resemble chopped spinach, and sour smelling ; are very irritating ; abdo- men continues to swell or bloat; becomes tense and greatly en- larged ; at the same time the emaciation is fearful ; the patient gets down to skin and bone ; even the marrow in bones wastes ; skin white and wrinkled ; intense debility, \\\\h rapid, increasing weakness. The abdomen, although intensely swollen, soon be- comes irregular to the feel, lumpy in masses like large eggs at first ; when tubercle is active and growing, soft ; then a cheesy feel, and latterly calcareous ; there may be a tubercular condition [nflammation of the omentum; the tubercular bacilli filling up its interstitial structure. 69: DISEASE GERMS. of lungs, bronchi, or membranes of brain. Its duration is un- certain, depending on the condition of vital force and season of the year. If it appear early in June, the little sufferer, unless taken to the seashore or country, stands a poor chance of recovery before September ; whereas, if it appear in August, there is usually little difficulty in tiding the patient into the cool weather. It may occur at any season, but much more common when the vital forces of the child are depressed by solar heat and city life — season when cholera infantum is prevalent. True, the mesentery may be the abode of numerous germs, but none seem to have the power of holding their position, breeding and going through its different stages of growth, like the tuber- cular bacilli. The treatment of tabes mesenterica requires the nicest tact and good judgment. Bathing twice daily, with massage; diet chiefly essence of beef The whole aim of treatment is to keep up vital force and kill the microbe ; a good plan to begin on is to keep the intestinal tract aseptic. Several remedies have lately been proposed as intestinal disin- fectants. Naphthaline, which has been recommended by Ross- bach, is very sparingly soluble, so much so that it passes to a great extent unchanged through the whole of the intestinal canal. It certainly destroys the disagreeable odor of the motions in infan- tile diarrhea, but it does not appear satisfactorily to check the disease. Salol is the phenyl ether of salicylic acid. It passes through the stomach unchanged, but in the duodenum it is split up by the pancreatic juice into salicylic and carbolic acid. Although the carbolic acid is set free at the point where its action is wished, yet there is still the disadvantage of its being poisonous, and so betol has been recommended. The constitution of this substance is similar to that of salol, but it splits up into salicylic acid and beta-naphthol, which is more sparingly soluble, and which is less poisonous than carbolic acid, while it is much more powerfully antiseptic. Resorcin, thymol and benzoate of soda are among the antiseptic remedies which sometimes are used here with success. A disease of the skin, characterized by MoUuscum. round elevations of the skin, varying in size from a hemp-seed to a hazel-nut, and marked on the summit by a dark point and a depression in the centre. The color of the skin over them is sometimes translucent, or of a pinkish color. Some of the growths have no black mark and no depression. These little tumors may increase slowly in size BACTERICIDES. 693 without undergoing any change, or they may ulcerate and dis- charge their contents. There seem to be two kinds : (i) Mol- luscum fibrosum, which consists in an increased formation of the fibrous tissues round the hair follicles ; and (2) Molluscum con- tagiosum, which is due to an increase in the sebaceous follicles, so that the contents of each tumor have a cheesy appearance. The usual seats of molluscum are the back or front of the trunk, the neck, face, and scrotum. Its presence is not attended with Microbe of molluscum. Section of molluscum (microscopic). any constitutional disturbance ; it may exist at any age, but is most frequent in children. There are generally several of these small tumors present at the same time. The treatment is purely local ; the tumor should be laid open, the contents squeezed out, and the inside touched with caustic ; if attached by a thin stem to the skin, the growth may be snipped off with a pair of scis- sors, and the cut end touched with caustic. Some cases are benefited by a course of general alteratives and tonics, as saxifraga, phytolacca, in alternation with glycerite of kephaline, tincture of oats ; with a local treatment of either resorcin, ichthyol, or creolin in a solution of gutta-percha. The nails may be absent or imperfectly developed Nails. {onycliatropJiid). Either of these conditions is usually congenital and associated with absence or imperfect development of hair. Hypertrophy of the nail {onychauxis) may occur and be either lateral, causing ingrowing toe-nails, or be limited to the extremity of the nail. A special form of hyper- trophy, limited to the centre portion of the nail, is termed ony- cliogry pilosis. Either of these forms of hypertrophy may be treated by scraping away the nail with knife or scissors. In- growing toe-nail may be treated by scraping the nail with a piece of glass until it is very thin, or softening it with liquor of potassae. 694 DISEASE GERMS, Inflammation of the nail (onychia) may occur in a Hmited form from ingrowing toe-nail, or more extensively as the result of injury. Pus forms under the nail and the latter becomes loose. Certain diseases of the skin involve also ^the nails in some cases. The most important in this connection are eczema, psori- asis, lichen ruber, ringworm and favus. These may not be easy to distinguish one from the other by having regard only to the condition of the nails, but the accompanying eruption will gen- erally guide to a correct diagnosis. Ringworm or favus may, however, attack only the nails, usually by direct contagion in persons who have to attend on patients suffering from these dis- eases. They may be diagnosed by scraping the nails and exam- ining the scrapings under. a microscope after soaking them in liquor potassae. The nails become brittle and split when in- volved in eczema, lichen ruber, or psoriasis. The former affec- tion of the nails begins with pitting, the pits gradually extending until the nail splits longitudinally. After febrile diseases shedding of the nails may accompany the desquamation of the skin which goes on; the nails may also be shed in acute eczema and pityriasis rubra. During a severe illness transverse lines form on the nails ; one at the root of each nail. As the nail grows they are carried for- ward until they reach the free edge and are cut away. It is hence possible, on seeing a patient several weeks after a severe illness, to calculate the date of his illness by observing the situa- tion of the lines and taking into consideration the known rate of growth of the nails. Violent paroxysmal pain either in the trunk or Neuralgia, branch of a nerve, due either to a want of nutri- tion in the nerve or to the presence of disease germs or their ptomaines, toxically acting on the same. The causes, then, of neuralgia, are disease, germ-laden blood, anaemia, debility, overwork, struggle, worry, defective nutrition. It divides itself in numerous varieties, according to the special nerve affected, and the cause producing it. The primary indication in all cases is to afford immediate relief of the pain, and subsequently remove the cause. The various antithermic drugs, exalgine, phenacetine, solol, are used with success in all neuralgic affection, whatever their loca- tion may be ; the best results are obtained from small doses, fre- quently repeated. Croton Chloral Hydrate. — This contains two more atoms of hydrogen than the chloral, and is, properly speaking, butyl chloral, which has the property of diminishing sensibility before BACTERICIDES. 695 producing narcosis. It gives instant relief in facial neuralgia in doses of fifteen grains, repeated, if necessary, after meals or largely diluted with water. The syrup of croton chloral is an elegant and efficacious preparation. It gives immediate relief. To combine the croton chloral with quinine we have still a more effective remedy. Citrate of caffeine is a valuable drug in facial neuralgia, the dose to be such as will give relief of pain. It operates better than guarana — not so rapid and effectual as the croton chloral. Bromo-hydric acid, with or without quinine, of which it is a solvent, operates very beneficially, if the neuralgia is due to reflex causes, in doses of half a drachm upward. Tincture of green root gels eniiiim, being non-poisonous, only in very large doses, is best adapted to malarial cases, in doses of a half drachm upward. Salicylate of quinine, in rheumatic and gouty cases, is so speedy in its action that it is unnecessary to precede it with any of the above remedies, for in six-grain doses it is usually efficacious within a {^\n minutes. While pursuing this course of treatment in relieving pain, the cause must, if possible, be ascertained and removed. In looking over the list of causes, we must scan them carefully as to anaemia, mercury, malaria, gout, rheumatism, syphilis ; and to reflex causes, as teething, worms, liver, kidney, or other forms of chronic disease. The treatment should in all cases be adapted to each, and if no cause can be ascertained, the patient should be put upon an alterative and tonic course ; all through relieving the in- tolerable pains. In these cases the condition of the stomach, bowels, skin, kidneys, should be seen to. Local remedies for the relief of pain are of little utility, but if used should, in all cases, be combined with chloroform, to carry the remedy down to deep-seated parts. Aconite and belladonna are especially valuable in neuralgia of facial nerves ; cinchona, iodine and gelsemium, if of a malarial type ; coffee, if due to nervous anaemia; phosphate of quinine, if due to gout; and general treatment as to cause. Improvement of the general health in all cases. Diet very nourishing, raw eggs, animal food, milk. Clothing warm, flannel next the skin. Warm tepid or cold salt-water baths. Friction to skin ; change. Indeed, every- thing to improve the nervous system, and give the patient richer and purer blood, pure air night and day, great cleanliness, and avoidance of all causes. The true aim of treatment is to fertilize the brain by the persistent administration of avena sativa and glycerite of kephaline— thorough reconstruction. 696 DISEASE GERMS. The free anastomosing of the uterine Neuralgia of the nerves with those of the mammae, their Breast. blending or junction with the sympathetic {Mastodynia}) in the breast of all highly civilized ladies, renders the nerves of the mammae ex- tremely susceptible of irritation and weakness. j^They are very liable to suffer from the presence of microbes in the blood, from reflex irritation from the uterus or ovaries ; from certain other causes, as occupations ; corsets ; sitting at benches. Neuralgia exists without any structural lesion. Symptoms. — Pain in the breast of a sharp, lancinating charac- ter, or it may be an aching, .wearying kind, but usually like neu- ralgia elsewhere, acute and liable to exacerbations. There may or may not exist a slight pufifiness, or swelling, or even an in- crease of temperature of the affected gland ; and even the lobules may feel rather firmer than natural. But it is more generally the case that the gland feels healthy to the touch. When due to uterine or ovarian trouble anaemia is generally prominent. In some women the breasts enlarge and become irritable ; suffer from neuralgic pains at and during menstruation. In all cases there is some impairment of general health ; nervous dyscrasia ; loss of appetite; constipation; leucorrhcea; restless nights; anxiety. In the treatment, immediate relief must be afforded from the distressing pain. For this purpose a combination of the sulphate of morphia and atropia is most effectual ; or cocaine subcutaneously ; iodide and bromide of potassa ; belladonna plaster over the entire breast followed with dry heat. As soon as pain is relieved, the cure of the disorder upon which the pain depends ; search carefully for malaria, mercury, syphilis, gout, rheumatism, anaemia, chlorosis ; but above all for ovarian and uterine irritation, and the greatest attention to diet of the best; proper outdoor exercise; daily bathing; flannel clothing, and regulated bowels. Alteratives and tonics, embracing ozonized phytolacca, or saxi- fraga, iodide potass, iodide of lime, glycerite of ozone, and keph- aline, sulphate of quinia, cinchona. No application to breasts equal to the belladonna; if the plaster does not produce the necessary anesthesia, put on the chloroform, aconite, and belladonna liniment; the chloroform will carry the belladonna down to the deepest nerve. There should be proper support, but no pressure. The uterine trouble should be seen to, and removed, according to its cause. BACTERICIDES. 697 Young infants, boys, and girls about puberty, are liable to slight neuralgia of the breasts. In some cases there are enlarge- ment, tenderness, and secretion of milk. There must be no irri- tating applications applied, no friction, nor any stimulating ap-. plication, the belladonna plaster being usually sufficient. Neuralgia of the auditory nerve is Neuralgia of simply the cry of a nerve for better the Auditory Nerve, and purer blood. It may be brought {Otalgia^ about by cold, damp, rheumatism, gout, tubercle, syphilis. When an attendant upon some acute disease there may be fever, but more generally it is unaccompanied by any febrile dis- turbance. The intimate connection of the auditory nerve with the various nerves of the face, especially those supplying the upper and lower jaws, the stomach, liver, uterus, render ear-neu- ralgia common where those organs are out of gear. Ear-ache is thus common, as its causes are numerous and varied. It is easily recognized by the sharp, lancinating pain in the ear, very severe ; frequently also shooting through the nervous fila- ments distributed over the side of the head and face, causing much suffering and great restlessness. Treatment. — If it is traced to imperfect performance of stom- ach or liver, an emetic of lobelia, and saline purge ; a carious tooth, extraction ; or to any special diseased germ, treat for its destruction ; drop one or two drops of mullein oil in the ear. In all cases, and at once, relieve pain by resting the head on very hot pillows of hops, or camomile flowers, or bran, or salt ; or the roasted bulbs of onions ; or, better still, garlic. In addition, if very severe, the aconite, belladonna and chloroform liniment should be applied to the side of the face ; cotton-wool, saturated with glycerine, tincture of opium and belladonna in ear. Dur- ing the day, aconite and belladonna, in alternation with quinine, are true stimulants to this nerve, and it is well to give pretty large doses; at night either chloral or morphia, to procure a good night's rest. In the mean time, treat the case according to the cause, with alteratives and tonics ; and bear in mind that in this painful nerve-cry, that brain-food, or nerve-forming diet, is an essential and important element in the cure. Animal food, eggs, milk, boiled white-fish, oatmeal porridge, cream, and those admirable drugs, glycerite of ozone and kephaline. Nutrition is an important indication in the treatment, so as to prevent a re- . currence, especially among the little ones. 698 DISEASE GERMS. Pain, tenderness about coccyx; often Neuralgia of the sharp, tearing, lancinating ; is a most un- Coccyx. pleasant form of neuralgia. Most com- {Coccyody?ua.) mon in women, on account of their great development of coccyx, and above all, in women of high civilization, who have as an index of that condi- tion a sacrum at an angle well verging on to 45°, and a coccyx most perfect. In women of low civilization the sacrum is nearly straight, and the coccyx almost as rudimentary as it is in man. Causes. — Hurried labor, or insufficient support to the peri- naeum, whereby the nerves of the coccyx receive a shock; blows, falls, fractures, and horseback exercise, etc. Symptoms. — Pain in sitting down or in rising, or in v/alking, or in defecating. Pain is even more than neuralgic, more than sharp and lancinating ; there is a general soreness. In many cases patient can only sit on one hip. Any movement or pres- sure on the surrounding parts give rise to pain. It is aggra- vated by menstruation, or sexual intercourse. It may be reflex, as in chronic inflammation of uterus or ovaries. It is very chronic in its nature. Treatment. — Remove all sources of irritation about uterus, ovaries, rectum. Place patient upon a general alterative and tonic course of treatment, with the best of food. Keep bowels open with cascara ; suppositories of cocaine, belladonna and opium at bedtime, or hypodermic injections. To raise the standard of vitality in the nerves of the coccyx, warm hip baths, quinine, iron, pulsatilla, glycerite of kephaline, and other nervines, such as musk, valerian. Painful Sitting. — In coccyodynia, as a result of fracture of the hinge-joint, after ossification, in having a child after thirty-five years of age, there is apt to be a laceration of the nerves, and neuralgia established, which gives rise to painful sitting. This is also present in deep-seated inflammation of the genital organs, especially in the uterus and ovaries, so very slight, how- ever, that the patient does not experience uneasiness, only in the sitting posture. Relaxation of the great joints of the pelvis towards the end of pregnancy is very natural ; they become loose and juicy, and a considerable increase of motion is observed in them. If the labor is long, the presentation not a good one, or the head of the child large, or instrumental delivery, made with force or violence, there may be a low grade of irritation set up in them. So that there is a morbid loosening, which not only gives rise to pain in sitting, but hopeless lameness. Rest, general alterative and tonic treatment will, in time, effect a cure. BACTERICIDES. 699 Facial neuralgia or irritation of the nerves Neuralgia of the face may be due to any of the mi- of the Nerves crobes which infest the human body ; to of the Face. cold, damp, exposure ; to the irritation of the microbe of dental caries. In the treatment of all forms the cause must be removed, and the microbe annihilated ; if due to the rheumatic germ, manaca ; salicylate soda in acetate of ammonia ; colchicum and quinine ; if due to the microbe of syphilis, chloride of gold et soda, saxi- fraga ; if due to cancer genu, Chian turpentine; if due to the malarial germ, com. tincture of kurchicine, etc. To procure anesthesia of facial nerves, aconite, belladonna, ammonia, phosphate of quinine, as a local remedy in all cases, concentrated ozone with chloroform. Often due to gravel, or disease-germs, Neuralgia of the like malaria ; to drugs ; to suppression of Kidneys. an eruption ; in the left kidney to poisons (Nepliralgia}) of rheumatism ; gout, cold, wet. It is attended with most excruciating suffering ; sharp lancinating pains, coming on suddenly, violent in intensity, relieved by pressure, never ap-gravated by it. If due to gravel, it may be continuous, beginning at the time it com- menced to pass into the ureters, and continuing till it reached the bladder. The pain is paroxysmal in its character, not only experienced in the loins, but extends to the groin, thigh, or abdomen, causing retraction of the testicle in the male, and irri- tation of ovary in the female. If the paroxysms are severe, they may be accompanied with nausea and vomiting; a small, wiry^ feeble pulse ; profuse perspiration ; prostration, with a desire to pass urine, and an inability to do so. When concretion, if due to that, reaches the bladder, pain suddenly ceases ; if due to other causes, it may continue till the cause is removed. Its location (relieved by pressure), character of pain being paroxysmal, with other symptoms of kidney irritation, are always important land- marks. In the treatment, alcoholic vapor-bath ; external warmth over kidneys; if stomach is so irritable as to cause everything to be rejected, apply mustard over it, and 'give a large dose of tincture of green root of gelsemium ; if vomiting still persists, hypo- dermic injection of morphia, preceded by the inhalation of a few drops of chloroform. Then apply belladonna plaster over kidneys, and depend on quinine and gelsemium internally. In some cases aconite and belladonna answer well, with dry cups yQQ DISEASE GERMS. and lobelia fomentations. If due to the retrocession of an erup- tion, compound tincture serpentaria or jaborandi ; if due to rheu- matism, alkalies, as nitrate of potassa and cream of tartar, fol- lowed with nitro-glycerine ; and acetate of ammonia and salicy- late soda. Each case manag^ed as to its cause. Neuralgia of the nerves of the pleura Neuralgia of and of the intercostal are generally Intercostal Nerves, due to the bacillus amylobacta, more {Pleurodynia) rarely caused by the microbe of syphilis. Associated with the presence of one or both microbes, we find all that class of patients suffering from great impairment of the general health, with mental and physical prostration — phosphates and chlorides in the urine. The recognition of the pain being non-inflammatory coming on, leaving suddenly but intensely sharp and lancinating, fatigue is often an exciting cause. In the treatment, apply either dry cup, or irritating plaster at once — dry heat ; then follow with either salol or manaca, or salicylic soda in acetate of ammonia ; these three remedies are most efficacious. Follow up with comp. saxifraga and phytolacca, tincture of oats, glycerite of kephaline. Stiffness, soreness, cramp, or pain in the vol- Neuralgia of untary muscles of the body, may be due to Muscles. various causes : for example, in young persons (^Myalgia) of rapid growth, persons in whom the bones grow faster than the muscles, the muscles and tendons become stretched, and the individual suffers from what is termed groiviiig pains. These are often quite severe, and in- volve both the fleshy part of the muscles as well as its tendons, either the centre, or where it is inserted into the bone, or both. It is often due to a strain, lift, over-exertion, and involves the muscles of back, chest, abdomen, arms, or legs. It is also a symptom of a shock from cold, great nervous prostration, and is thus prominent in certain diseases, as fevers, inflammation, partu- rition, rheumatism, scurvy, tuberculosis, cancer, chlorosis, leuco- cytha^mia, dysentery, diarrhea, prolonged lactation, exhausting maladies generally, and spermatorrhoea. Symptoms. — Pain is the chief s)'mptom ; and this in its degree and intensity bears a direct ratio to the amount of debility that BACTERICIDES. ;oi is present. Where it depends on too rapid growth of bone in young persons, they seldom complain of it in the morning after a good night's rest, but comes on after exertion, and gradually increases till night. In the case of the masturbator, or those suffering from seminal losses, pains in the morning, and rather wear off during the day ; whereas in case of disease, mostly an aching all the time. The pain in all cases, however, is aggra- vated by movement. General health in all cases is poor; skin cool, pulse natural or depressed ; appetite good, clean tongue. In bad cases there may be night-sweats, loss of appetite, im- paired digestion, constipation, no vigor or energy, inability for work, severe mental depression. Treatment, — The principles of treatment will be modified by the cause, but all cases require good nourishing diet, as animal food, boiled fish, oatmeal porridge, cream, raw eggs, fruit, vegeta- bles in abundance ; tonics, as cinchona and mineral acids ; sul- phate quinine and aromatic sulphuric acid , quinine, iron, hy- drastin, nux pill. Rest for the affected muscles, by splints or otherwise. Massag;e to be performed twice daily; begin with half-an-hour treatment, and increase length to two hours, if pa- tient has means to carry out treatment. In the massage treat- ment, bathe a limb with soap and water ; dry ; use dry hand until there is a glow of warmth ; then shampoo, rub, knead, and otherwise manipulate with warm olive oil ; then another limb in same manner until the entire body is massaged. Electricity can follow if case is bad, or in a hurry to get well. An intense form of neuralgia, character- Neuralgia ized by acute pain following the course of the of the great sciatic nerve extending from the sciatic Sciatic Nerve, notch down the posterior surface of the {Sciatica^ thigh to the popliteal space, and often along the nerves of the leg to the foot. The causes are a depression of the sheath of the nerve, by cold, damp, sprains, etc., and blood charged with the bacillus amylobacta circulating through the weakened tissue, giving rise to thickening and compression of the nerve. Sciatica, properly speaking, is not an affection of the nerve, but its sheath, which, under the irritation, becomes thickened and contracted, compressing the nerve, and thus causing the excru- ciating pain in movement, or numbness in the leg by compression. Sciatica, then, is not, at least at first, neuralgia of the nerve, but inflammation and thickening of its sheath, and this thickening produces a mechanical condition which presses the nerve, and thus gives rise to the neuralgia. yQ2 DISEASE GERMS. In the treatment we must pursue a course of treatment very similar to rheumatism. SaHcylate soda and acetate of ammonia, salol, manaca, cascara sagrada lozenges, etc. One of those remedies should be admin- istered ; if it fail to give relief, then try a mixture composed of equal parts of tinctures of aconite root, colchicum seed, bella- donna and actia racemosa. Mix. Six drops every few hours till relief is felt, or use a hypodermic injection of morphia and atropia. Locally, along the course of the nerve, paint on and confine concentrated ozone — its action is prompt, much superior to men- thol, acupuncturater, or dry cups. Exalgine has been very highly recommended. If case resists ordinary treatment remedies then it should be placed upon iodide potass in the compound saxifraga. 'A temporary irritation of a special Neuralgia of nerve or nerves often gives rise to a Special Nerves, spasmodic and involuntary contraction (^Q'amps) of one or more muscles, attended with rigidity and great pain ; most common in the muscles of the lower extremities, as the large, muscle of the calf of the leg ; but it is very apt to affect the muscular fibres of internal organs, as the stomach, intestines, bladder, uterus, pharynx. The true cause is a weakness in the nerves that supply special muscles, and those weakened nerves crying for pure or better blood ; so that disease-germs in blood, poverty of blood, gout, rheumatism, metals in blood, the bacteria of dyspepsia, the cholera germ, etc., besides pressure on nerves not infrequently causes it, as the head in labor, etc. Swimmers often attacked, and common cause of drowning. Symptoms. — The nerves of a muscle, weakened, irritated, cause the contraction, which gathers the muscle into a knot, apprecia- ble to the touch and often to vision, when external. Pain is not only severe, but agonizing. The cramp, or contraction, or spasm, may last a few seconds, minutes, hours, and leave the part tender and patient prostrated. The same nerves of a muscle may be affected over and over again, if its vital integrity is not restored ; or if due to*a poison, it may affect different muscles, as in cholera, where all the muscles of the body are in a cramp. Treatment. — To relieve the cramp immediately, administer either chloroform or the antispasmodic tincture, in twenty or thirty-drop doses, in warm boneset tea, every few minutes till re- BACTERICIDES. 703 lieved. Then search for causes, as debility, anaemia, indigestion, constipation, lead, tin, zinc, gout, rheumatism and other blood diseases, and remove them with alteratives and tonics. Best of food ; pure air. To raise the tone of nerves, quinine, glycerite of kephaline, aconite, belladonna, friction, shampoo, massage, stimulatincr liniments, baths. When the nerves of the testes are irri- Neuralgia of the tated by the microbes of syphilis, rheu- Testes. matism, etc.; or weakened, exhausted, or drained out by venereal excesses; or when the ejaculatory ducts become clogged, or stopped up, affording no outlet for for semen secreted, and the testes suffer compres- sion ; or there may be a shock from mechanical irritation — in which condition the nerves suffer a partial death, neuralgia supervenes. If due to rheumatism, acetate of ammonia and salicylic acid; manaca; colchicum and quinine; tincture black cohosh, etc.; locally, dry heat with camomile flowers or bran. If due to syphilis, iodide and bromide of potassa ; saxifraga, phytolacca ; chloride of gold et soda. A poverty of nerve force. May be general, Neurasthenia, involving the whole body, or it may be local, affecting an organ. The present work aims to increase our knowledge of the origin and phenomena of disease-germs ; how normal living matter, concerned in the nutrition of the body, can be changed, altered, or degraded by conditions adverse to life, into diseased or malig- nant living matter, of a special kind, genera and species, each capable, in a proper medium or fertilizing fluid, of reproduction and independent existence, the powers of growth being prodi- gious ; Jiow such diseased living matter is contagious and infec- tious ; that living, breeding, organized germs are no phantom but a living enemy ; hozv such conditions can be averted by maintain- ing a high standard of health, of vital force and rigid enforcement of the laws of sanitary science ; and how all can be obliterated by an antiseptic treatment. In nettrasthenia or nervousness, there is a degradation of the primary molecules of nutrition of brain and nerve tissue into the disease germ; in all deviations from health, or mental vigor; in all states of ph^enal incapacity ; in all nerv'ous affections, even in nervous headache ; in trance, natural or artificial ; in all grades ^Q, DISEASE GERMS. or degrees of insanity, mental aberration ; in epilepsy, inebriety, cholera, etc. ; evolution and dissolution, or a change of living elements, preside over all the phenomena of nature. For all practical purposes, the definition of neurasthenia may be thus given : It is a condition of nervous debility or nervous- ness ; a chronic morbid condition of the nervous system ; a prac- tical death of that tissue, the basis of which is an impoverish- ment of nerve force; a starved phrenal state, in consequence of which there is a liability to quick exhaustion and an impera- tive necessity for frequent supplies of force ; there is beside in this state a lack of inhibitory or controlling power, both physical and mental ; a feebleness, an instability :i-4:0}.'''VPi f'^'^' of nerve action, with excessive . .-• • I r^^ \ S\^ rc^^i ^ sensitiveness and general and local r^^r -'■^^ physical and mental con- stitution of man gives us the high- est type of evolution, of organic life, of phrenal development; and 3)/3'- no acquaintance with the laws of physics and natural science is re- quired to rightly understand, that if the human brain is placed in an Microbe orneurasthenia. abnormal condition by worry or strain or overwork ; or by over- stimulation by climate, alcohol, tobacco, opium, chloral — a con- dition analogous to a hot-house, that its evolving cells will be weakened, degraded, or take on excessive development; hence, debility, weakness, exhaustion, etc. A partial death of the nervous system, or as it is termed nerve exhaustion ; a most common condition, one incidental to all nerve- ous diseases ; one that is dove-tailed into them, blended and enumerated under different heads ; in an infinite variety of forms, in all affections that are common to men and women who have exhausted their vital force ; affections that are generally looked upon by the profession as modified forms of idiosyncrasies, crankiness, hysteria, morbid thoughts, increased sensibility, de- praved appetite, perversion of special nerves or senses, or parts of the nervous organism ; giving rise to neurosis of mucous membrane, glands, skin, organs; special modifications impress the nerves that supply the organs of circulation, giving rise to nerv- ous headache, nervous palpitation of the heart ; abdominal pul- sation, due solely to nervous influences, which has too often been mistaken for abdominal aneurism ; besides we have nervous cough, asthma, a .spasmodic contraction of the bronchial tubes ; BACTERICIDES. ^05 aphonia, weakness of the laryngeal nerves ; musca volitantes, tinnitus aurium, and many other marvellous nerve disorders. In this condition of nervousness, there is very apt to exist restlessness, mobility, with or without undue excitability of nerves. The brain presides over nutrition, secretion, excretion, diges- tion and assimilation. If the integrity of that organ is impaired the whole body is out of gear and a degradation of the primary elements concerned in its nutrition takes place. Causes. — The causes that give rise tP general nervous debility in individuals and nations are very numerous, as the increased necessities and activities of civilization — a condition very wear- ing to the brain, unless muscular work be in excess. The con- dition of early precocity in children, fostered and nursed by a perniciously too early education ; by children's magazines, rushing the immature brain of childhood into excessive develop- ment by over-culture. To this hot-bed of civilization, we add care, worry, overwork, struggle, intense tension, the brain being overtaxed at the expense of the physical. There are causes in our country, in our highly oxygenized and ozonized atmosphere. There is no climate, no portion of the earth, so productive of neurasthenia as North America. There is every essential in it to produce increased brain activity, active cell development, and no one living under its influence can escape becoming neurasthenic ; its exhausting faculty added to great mental efforts, together with the almost universal use of tobacco, alcohol, excesses, effect the result. The mighty momentum of all that is great in science, in arts, in practical utility, sways the ever active brain of the American who, if left to himself, will soon become the prototype of the noble Roman. While glancing at these and other causes, we must ever bear in mind that the human body is but a reservoir of nerve force, which is constantly escaping, while at the same time it is con- stantly renewed from the centre of all force. A healthy man be- tween twenty-five and fifty-five years of age has a large amount of nerve force in reserve, and is not much if any way exhausted by the ordinary tear, and wear of the body. He has, so to speak, always a margin left behind and beyond that required for his ordi- nary avocation, on which in powerful emergencies he can draw with no other efft^ct but shght fatigue, which disappears under rest, sleep and food ; whereas an individual suffering from neurasthenia have a very meagre amount of nerve force in reserve ; the slight- est exertion, mental or physical, will drain it off. Symptoms. — In appreciating the condition of nervous debility 45 7o6 DISEASE GERMS. we must look closely at the nerve centres. True the entire ner- vous system is a unit, a whole, but for the sake of description or a perfect elucidation of symptoms, we map it out into three great centres, the brain proper, spinal cord, and great sympathetic, — they form a trinity, a three in one — one emanation of Deity. This microcosm, in a highly civilized and sensitive man is a per- fect centre of reflex action, and it is this that in some measure ac- counts for the variety and intensity of the symptoms. An individual or race suffering from general nervous debility usually manifests itself in a strong nervous temperament, with a white skin, sharp cut features. They suffer from languor, lassi- tude, debility, being easily exhausted on the slightest exertion ; they have no reserve of vital force, no margin upon which they can draw, the fountain-head is empty or drained off. They may do more work, exert more nerve force in a short time than a strong man, but they are more easily exhausted than the vital ; may eat and digest with little expenditure of vital force, but they cannot bear labor nor fatigue, nor privation, nor loss of sleep. It may not shorten life, nor destroy its usefulness, but the indi- vidual or race has not the tone, or vigor, or vivacity of the vital ; they have lost the stamina for essential work. Neurasthenia may exist in an individual or race for many years, and the affected party be unconscious of its existence. The leaves, blossoms, twigs, branches may begin to fade, while the tree remains sound and strong ; and the true condition is not realized until the disease, in its progress downwards, attacks some of the main branches or trunk, or until some vital organ is smit- ten ; until pneumonia, cardiac and kidney disease, nervous dys- pepsia insomnia, physical and mental prostration, attract the individual's attention. The fatigue, pain, worry, want of rest, the wreck produced by mental toil is marvellous. The symptoms of neurasthenia are very varied, being often central in the brain proper, but the largest number are reflex, taking place through the motor and sensory nerves ; the sympa- thetic and vaso-motor, the irritation being transmitted to weak- ened parts in the cord and bulb. When the mental wreckage is great, fear is a predominant symptom, fear of society, fear of soli- tude, of place, of disease, of morbid impulses ; suicide, mental depression, wakefulness, headache, impaired memory, deficient mental control, palpitation, aneurosis, neuralgic pains, dysentery, spinal irritation, cardiac insufficiency, etc. — neurosis somewhere. Effects. — The grand predominating effect of neurasthenia is general vital deterioration. The intellectual torpor of a semi- civilized state is more favorable for brain vitality, national growth and vigor, than one highly civilized. We have an excellent illus- BACTERICIDES. 707 tration of this in an Irish woman, she keeps all her vital force in reserve, she will do any amount of hard work, even drudgery, unblessed, uncared for by exhausting sentimentalism, without being able to read or write, or calculate past, present or future. In her daily toil, she seldom brings out all her available vital force; whereas, the sensitive, highly civilized American woman, with a small amount of inherited vital force, living an in-door life; her mind highly active, subsisting upon pernicious litera- ture ; real or imaginary stories, the effeminating journals of the day, attending theatres, receptions, balls, subject to worry, care ; she has no reserve of vital force, it is exhausted as generated ; whereas the Irish woman has a large amount of vital force, a full reservoir, an excess — a battery of potential vitality, with great power of resistance ; while the neurasthetic is endowed with the most meagre supply. All highly evolved nervous organizations have a smaller amount of vital force, have very little resistance to disease, or to the entrance of disease germs into their bodies, or to molecular change, much less than those whose organizations are low. The highly evolved nervous organizations are more complete, they are stronger reflex agents ; the mechanism of their nervous sys- tems is more elaborate, has a finer grain, contains more cineri- tious matter, it has deeper fissures of thought, but it is less re- sisting, less vital than the lowly organized. Individuals free from neurasthenia are vital, all organs are strong and normal, and resist disease. Among nations, the modern American is the most nervous ; they are ever in a state of tension, or strain ; they are incessant at work, from the cradle to the grave, and do an immense amount of work, though not of the highest. All forms of nervous exhaustion prepare the way for disease ; they prepare and fecundate habits of inebriety, in tobacco, opium, and alcohol. This inherent state of deteriorated nerve power comes from weakness and degeneration ; all the victims have oxaluria, lithae- mia, phosphuria ; all have degradation of blood elements, and suffer from disease germs in every structure of the body ; all have the stamp of effaced vitality. Children affected with n^eu- rasthenia exhibit well marked symptoms. The child is restless, fidgety, suffers from insomnia, headache, indigestion, manifest weakness and irritability in the cerebral nerve mechanism. The higher grade of brain life, phrenal activity, is illustrated in rapid development, or evolution, early precocity, weakness of organi- zation with attendant symptoms. Pathology. — Neurasthenia, poverty of nerve force, cerebral ^708 DISEASE GERMS. softening, paralysis and other states, are the sequel of exhausted nerve force, whether by mental work or sexual excess; it brings about the state of an organ tissue-starved. Following this, granular deposits on the arachnoid, adhesion of the membranes to the surface of the convolutions, crystalHne granulations in the lining membranes of the ventricles, with an unusual amount of fluid in the sac of the arachnoid and in the lateral ventricles are found in the brain of those who devitalize that organ. A tissue- starved brain gives rise to inflammation of the cortical part of the brain, ending in its degeneration of the nerve cells of the hemi- spheres, structural change in the convolutions, the cells of which lose their integrity and look like an irregular heap of particles ready to fall asunder. The brain of man owes its healthy existence to the quantity ot phosphorus it contains, if this is economized, independent of its scantiness in modern food, it might sustain him probably as long as life lasts and health holds out ; but let the brain starve, health fails, nature can supply no more ; then, unless the patient can ob- tain phosphated food, as ozonized tincture of oats, or the animal phosphorus of kephaline, degenerative changes will take place in the gray substance of the cerebrum ; the cells of that part will become granular and deposits of granules scattered through its substance ; these changes take place in all parts of the brain and spinal cord, when the phosphorus in the brain is exhausted. Brain workers, merchants, professional men, know this ; they feel it in their languor, tired brain ; those are the victims of ex- cessive brain exhaustion. How far this granular change in the nerve cell is compatible with healthy mental action, we cannot yet say. But we do say, and nothing can invalidate it, that unless our brain-workers obtain more phosphorus, white softening, paralysis and insanity will become more common. General Remarks. — Man, the embodiment of the Great I Am, in whom he lives and moves and has his being, his body, with his instinctive, moral and intellectual nature — embraced in the sympathetic with its numerous ganglia or little brains, the gen- erators of nerve force, constitutes a bundle of nerves, reflex in their character, that rebound upon each other, reflecting irrita- tion, to the medulla oblongata, which force thence is reflected to weakened parts, so that any irritation set up in one part is liable to produce an irritation in another. There are certain organs, which, on account of their importance, complexity of their nerves, and from the fact that they are indispensable to the func- tions of life, are pre-eminently the seat or centre of reflex action ; the cord, the heart and blood vessels, through their abun- dant, complex and sensitive nerve supply, keenly feel any irrita- BACTERICIDES. ^09 tion from any source. The circulation is kept unbalanced, waves of irritation, under a myriad of causes, explain the fugitive char- acter of the symptoms. There is a power within the human body, partly physical, partly mental, of working off or tolerating disease. A vigorous man physically and intellectually, with a certain mental organization, will bear pain, suffer shocks well — states which would make a weak man a chronic sufferer, a life- long invalid, rendering his existence a cipher. Strong, vital con- stitutions will bear suffering, ward off disease, and by the inherent element within them will prevent degradation under which others would succumb. Neurasthenia is as jealous as a woman, it allows no rival. Let there be malaria, syphilis, gout, any form of blood poisoning, the nerve debility intrenched in the constitution of the individual will hold its own and ever be on the top, in spite of all diseases, but being paramount, it modifies every affection known to the human race. Varieties of NeurastJienia. — Nervous debility is a devitalized state, a disease, which has its cause, its symptoms, its effects, its antidote, and when thoroughly intrenched in any individual will hold its own position, often in spite of every effort. It is true it may be aggravated, complicated, modified by every known dis- ease, and its presence in the individual makes other diseases more difficult to eradicate or overcome. The action of the mind upon the body in health and disease, is a problem that has caused much perplexity to all medical men, and still more the enormous capacity of those affected with neu- rasthenia for mental exercise and work. Neurasthenia, like insanity and other mental states, is divisible into a vast number of varieties, such as hypochondriasis, or crankiness, a demonstrable form of cerebral disease ; certain idiosyncrasies, which are purely mental wrecks ; the infinite num- ber of forms of neurosis of every organ, gland and structure of the body. The most marked or noted of all forms of neurosis is the sexual — pruritus is very common ; painful connection is most distressing ; continence or incontinence of urine annoying. Nymphomania, a species of madness, in which the excitation is so great, that spasms are excited by the sight of a man ; or the irresistible desire to masturbate or hold abnormal rfiethods of in- tercourse of the sexes, is often accompanied with peculiarities of voice (squeaky) or by obscene language or conduct, fits or at- tempts at suicide, states in which the mind is peculiarly affected — termed Erotomania, a mental state, exclusiv^ely occupied by illusions, hallucinations, etc. Nymphomania is physical ; erotomania, mental, ps)xhical ; 710 DISEASE GERMS. satyriasis is peculiar to the male sex, and is to man what nym- phomania is to women. Its symptoms are hallucinations, fits of sexual furor at the sight of women, repeated ejaculations, obscene conduct and words, a tendency to suicide. Strange, undefinable sensations amounting to numbness or even pain ; inharmonious states, incompatibility, loathing, dis- gust, complete perversion of the sexual appetite, which gives rise to callousness, imaginary impotency ; or farther, where the neurasthenia has progressed to a wiping out of the typical fissures of the brain. A poverty of vital force, a want Neurasthenia of Brain, of nutrition is often applied to tis- Spinal Cord and sues or organs when tjfieir vitality Great Sympathetic. is impaired, irrespective of any disease of the blood, such as anaemia of a nerve in neuralgia, a starved heart in rheumatism and gout ; atrophy of a muscle, owing to an insufficient blood supply ; anaemia of the uterus, etc. In cerebral anaemia the quantity of blood in the brain is reduced below the natural standard, or the quality of the circulating fluid is impoverished. In either case the nutrition of the organ is interfered with. In the one case there may be a loss of blood, or the blood cannot permeate the nerve-centres, or there may be a lack of blood formation. Insufficient nutrition is the cause of anaemia of the brain, spinal cord and sympathetic, and this may be brought about by worry or struggle for existence, or it may be due to insomnia, to sameness, monotony, isolation, or to irritation reflected, to diseases within the body, or to disorders of diges- tion or assimilation interfering with nutrition. It is well known that under a condition of worry, sorrow, grief or other depressing passion, the blood becomes poor in quantity and quality from deficient nerve supply, and is unfit to nourish the brain, and the great centres suffer from the shock incidental thereto as well as from poor blood, and with it the whole body suffers. In cerebral anaemia from impoverished nutrition, there is not only a decrease in the red corpuscles of the blood, but the power of the heart and blood-vessels is lowered; there is a deficiency of the functional energy of all organs, due to a want of blood and innervation; strength of will, vigor of intellect and the vital capacity of execution and determination are impaired, and the individual is capable of no effort. The mental inertia or depres- sion is generally accompanied with lassitude and a feeling of utter incapacity for muscular and mental exertion of any kind. The causes of anaemia of the nerve-centres are very varied, BACTERICIDES. 7ir and embrace to a certain extent a long list of diseases, such as concussions, the action of the sun, chronic inflammation, soften- ing ; the action of whiskey, opium, chloral, tobacco ; mania, monomania, dementia, melancholia, nervous dyspepsia, hysteria, epilepsy, catalepsy, ecstasy, somnambulism, paralysis, convul- sions, -headaches, etc., in addition to worry, tire, exhaustion, study, mental strain incessant; masturbation, sexual excesses, deteriorating influences of civilization, over-stimulating the nerve power ; defective assimilation of brain elements, improper reading, deleterious trades ; solitariness or sameness, which wipe out the typical fissures of the brain and thus lower its quality ; too early an education, which causes a defective power of assimi- lation in the brain, protracted inhalation of air deficient in oxygen, whereby the centres are not vitalized. Nerve tire ; to which may be added civilization, refinement, culture, which create new and abnormal responsibilities, new anxieties, every one of which brings on additional mental strain. The mind of highly civilized man is ever on the alert. The brain has no rest ; nutrition of other tissues is diverted to repair the waste of nerve-tissue, and sooner or later inevitably comes the anaemia or exhaustion. It is undeniable that anaemia of nerve-centres increases with civilization, and that diseases of the brain, spinal cord and ganglionic nerves are alarmingly on the increase. Among the most prominent of these causes is worry, struggle, real or imaginary ; this gives rise to a grave loss of nervous energy and anaemia of nerve-centres. By it the united brain, in tone, strength, capacity is seriously impaired ; by its wearying, gnawing, exhausting influence, the organ is devitalized and irre- trievably suffers ; by it the whole machinery is thrown out of gear, and exercise, recreation and amusement become painful and destructive. The victim of worry is on a precipice ; if he escapes, it is something providential. Worry is disorder, and nature abhors it. The energy employed in any pursuit under a state of worry gives a small result and speedily becomes exhausted. Under it the faculty of recuperation is arrested ; the failure of the appetite soon takes place and the effort to work is laborious ; the task of fixing the attention grows increasingly more difficult; thoughts wander ; memory fails ; reason becomes feeble ; preju- dice takes the place of judgment; brain disturbance very apt to supervene and a crash is likely to follow, with mental disquietude and distraction. Next to worry we have mental strain, incessant attention for hours in bank officers, railroad employes, merchants, etc. No one who has any practical acquaintance with the human brain can fail to recognize the fatuity of a policy which entrusts the 71 DISEASE GERMS. safety of their lives and fortunes to the integrity and precision of the mental function performed by one brain, continuously engaged for several hours in succession ; the keeping o( the brain on the stretch for long intervals; the sustained attention of onerous duties weakens its integrity and it becomes anaemuc. In the na- ture of things, physical memory fails ; mind wanders ; and if it were not for habit, the task probably could not be performed. The higher cerebral centres are relieved by the strain put upon them by delegating their power to the lower automatic centres ; but if with this relief the tension is excessive, and the Avay in which the ease is purchased by habit, is in itself a source of peril. Acts that do not call the reasoning power into operation and form a judgment ; acts that are merely routine or habitual, are dangerous. It is critical for man's brain to work automatically or by habit ; it leads to anaemia. In anaemia of the nerve-centres, produced by over-study, there is usually irritability and excitability of manner and an utter im- possibility of concentration. When intellectual exertion, if monotonous, is carried on beyond a certain point, the brain be- comes fatigued and anaemic, and the nutrition in the ganglionic cells of the cortex become impaired, diseased, altered from health; then headache becomes not an inR-equent concomitant of the case, and indicates a still more advanced condition of an irritable and exhausted brain. Headache is indicative of cerebral debility, whichever of its two great factors be present, anaemia or conges- tion. A great deal of the present amount of anaemia of the nerve-centres is due to brain starvation, as well as overwork, worry and strain. It is simply preposterous for a nation of brain- workers to live on vegetables and starch. Our present diet is poor in phosphates. A brain-worker should eat freely of corn- bread, oatmeal in some form, and boiled white-fish, which are true brain and nerve food. If no deleterious compound is intro- duced into them they give or afford pabulum for lost nervous energy ; they relieve lassitude, refresh the nerves when tired by any drain, strengthen the failing memory and give renewed vigor in nerve-tire. Cerebral starvation is also brought about by adulteration of food, as the use of baking powders, which destroy the phosphates in flour, corn, buckwheat, and the introduction of diabolical, dis- ease-generating food, as pork, oleomargarine, glucose, which shouid certainly be prohibited by rigid laws. This insufficiency of brain elements in food tells dreadfully upon the offspring in the production of infantile brain anaemia, and it is doubtful whether it is not of more importance in whittling down the nervous system to the very lowest ebb than over-stimulating BACTERICIDES. 713 diet, tobacco, literature and other assigned causes. Under the absurd name of hysteria we find a large percentage of anaemia of nerve-centres in ladies. This is due to a variety of causes, such as their extreme susceptibility to impressions, to their in- door life, monotony or sameness, sedentary habits, which neces- sarily gives rise to a deficient aeration of blood, a deviation from a natural type, and causes a marked characteristic, which condi- tion is aggravated by literature and surroundings. All morbid states of the body directly or indirectly tend to produce brain anaemia. This is explained by reflex action. .Masturbation is a dual cause, a direct drain and irritation superadded. Symptoms. — To lay down a train of symptoms is impossible ; there might be forgetfulness, loss of memory, nervous debility, indifference to the world, white face, dilated pupil, nerve-tire or irrepressible languor, sleeplessness, irritability, heats and colds, burning in the hands and feet, vertigo, noises in the ears, specks and spots before the eyes, phosphates and chlorides in the urine, abnormal sensation in the skin, seminal weakness and loss of power of the generative organs, or, in other words, no definite symptoms can be laid down, depending a great deal on the so- called disease present, or that develops itself. Hypochondriacs, cranks, nervous dyspeptics, confirmed invalids of all sorts, widely scattered over the entire countn.', paralytics, monomaniacs, hys- terical subjects, bed-ridden, sleepless, helpless victims, the result of abuse and erroneous treatment, worn and wasted, a burden to themselves and their families ; subjects who may or may not suffer from some local disorder, if none, the exhaustion, prostra- tion, difficulty of progression, and general nervous disturbance incident to the anaemia will be paramount. As a general rule, whatever the phase in which it presents itself, there is wasting of the fatty and muscular tissues combined with the anaemia ; the patient having lost all healthy appetite and power of digestion and assimilation, there being scarcely enough eaten to keep vi- tality alive. Patients suffering from cerebral anaemia, whether it be the monomaniac, hypochondriac, hysteric or dyspeptic type, have their sympathetic system highly excited and are highly emotional, constantly craving pity, sympathy, which they usually obtain to a degree prejudicial to their welfare, and monopolize it until the entire household and neighbors become victims to their morbid selfishness. One doctor is tried and another, one cure, water-cure or spring, and even different sections of the country are utilized with no good. Treatment. — In cerebral anaemia our usual medical treatment is almost useless, and this very fact necessitates a complete change of procedure, a change that involves not only great ex- 714 DISEASE GERMS. pense but considerable inconvenience, as it involves the removal of the patients from the unwholesome moral atmosphere in which they have been living, away from sympathizing friends and neigh- bors ; by a renewal of the patient's vitality by baths, brain food, and other nutrition, and causing its assimilation by positive mus- cular exercise ; by resorting to peripheral stimulation, thus stimulating the reflex centres, causing an increased cutaneous circulation, and thus improving nutrition. The treatment is physiological, and up to the latest discoveries in medicine, and involves the following heads : I. Seclusion and Rest. — This is absolutely indispensable to carry out the entire treatment in its most minute detail ; the en- tire seclusion of the patients under a competent nurse, and their removal from old scenes, associates, and the morbid atmosphere of invalid habits which encircles them. Unless the patient is en- tirely removed from the injudicious sympathy and constant wait- ing on of friends, it is impossible to obtain the necessary control over them which is requisite for a cure. This point is to be made absolute ; sever the connection between th^m even if it seems harsh and strange ; no compromise on this point can be made, and if it is impossible to secure the removal, the isolation and perfect seclusion of the patient, better to have nothing to do with the case and its peculiar treatment, for even if they are iso- lated in a separate room in the same house under a competent nurse and visited by no one but the medical attendant, the case does not do so well as when apart. There should then be a perfect separation from all moral and physical surroundings ; the change is beneficial, and aids im- mensely in the cure. Following this is rest in bed, absolute re- pose, no reading, talking, looking at pictures, no sewing or knit- ting, not even allowed to feed themselves for at least six or eight weeks. Under this condition of rest the whole system becomes regenerated, and new tissues begin to form ; it acts like a brain or nerve food ; it restores lost energy, refreshes the nerves tired by worry, excitement or strain, and gives renewed vigor to the whole body. After this condition of absolute repose has existed for six or eight weeks, it may be broke or lessened, and then the patient be permitted to sit up several hours daily, and gradually this is to be extended. The old diseased habits are to be dis- carded and a new life to be inaugurated while the above is being faithfully carried out ; the essential part of the treatment is also being fulfilled in the form of — Massage. — Simultaneously with the condition of seclusion and rest being commenced, this, the really indispensable part of the treatment, should also be inaugurated : the entire surface of BACTERICIDES. 715 the body of the patient morning and evening to be thoroughly sponged off with castile soap and water, and well dried by the nurse, and thus made ready for the massage. This is to be per- formed by a young, healthy, vigorous person, full of vital force,, intelligent, and well posted in his or her work. Massage should be commenced the first day, half an hour in the morning, and same length of time in the afternoon, the duration of time in- creased daily, until two and a half hours are thus occupied morning and evening, making five hours altogether daily, and after its performance each time, one-half or three-quarters of an hour of electrical manipulation to follow. This massage is to consist in taking a leg and thigh, beginning at the toes, foot, leg up to groin, first rubbing from the extremity up ; then grasping the parts between both hands, from foot up, moving each joint as you go along ; then a careful, pains-taking kneading from the sole of the foot up, manipulating the joints well ; this is to be followed by beating or patting with the fingers of both hands coming down on the part at the same time, and the whole to be followed by a rubbing with the points of the fingers, always moving the joints. Aftef one limb has been well done, then the other ; then one arm, then the other ; the back, and laterally the abdomen, spending upon each a little over half an hour. If there is great sensitiveness, it is often best not to spend the en- tire time on one member at once, but to go from one to the other, going over each several times. The intensity of massage will depend altogether on the sensibility of the patient. In no case is there any violence or roughness to be used ; neither is the skin to be irritated nor much redness induced. During this manipulation, the patient is to remain perfectly passive — not to make a single effort ; all to be done by the operator. This sys- tematic shampooing, grasping, kneading, patting, beating and exercise of all the muscles and nerves of the body, extremities and trunk, has a magical effect. Its advantages are, the peri- pheral nerve stimulation carried to brain, cord and other centres, raising the standard of central vitality, the vital force or stamina of the operator is planted into the nervous system of the patient by reflex emanation ; all his reserve vitality accumulated are thus given to the devitalized. Nerve action in all cases is vibra- tile ; in anaemia of brain an abnormal series of nerve vibrations are set up. This is at once changed by massage, which restores the healthy, mechanical vibrations to the nerve ; carrying the same state of vitality to the centres, it thus relieves wandering, erratic pains and neuralgia, strengthens the nerve centres, and gives renewed vigor in all diseases of nervous exhaustion or debility ; it stimulates the cutaneous circulation, the muscles are 7i6 DISEASE GERMS. exercised without the expenditure ot nerve force; the reflex stimulus carried to the medulla oblongata gives greatly improved vitality, and the psychological condition of the manipulator, as well as his vitality, is implanted in' the patient. To do it effect- ually, requires a well-educated person, of fine mind, strong will, solid determination, sound vigor, and of high vitality. The party who does the massage should have nothing else to do but walk around, eat well, and acquire all the vitality possible, so as to communicate it to the patient. The regular nurse, tired and wearied with his peculiar avocation, should never be permitted to perform the massage. There is to be no oleaginous body used by the operator, as that destroys or breaks the vivifying current. After the first application the patient v/ill feel sore and stiff, but this will soon wear off in a few days. Although we incul- cate gentleness, still it must be efficient ; this feeling of soreness will soon pass off, when the patient will enjoy the manipulation amazingly, and after it is performed will have a pleasant sense of exhaustion followed by refreshing sleep. Electricity. — This should follow the fnassage, and is to be used simply as a means of exercising the muscles. The interrupted current should be employed twice daily, from half an hour to three-quarters of an hour. The poles armed with wet sponges squeezed out of salt water, so as to to carry the electricity away down into deep parts, are to be placed on the muscles to be operated on in turn, beginning at the leg and going up, taking each muscle in turn. The sponges with the poles should be placed four inches apart and moved slowly up and down the muscle until it contracts fully and freely. This is somewhat pain- ful and annoying, but is of unquestioned utility in long-standing cases of cerebral anaemia, espec'ally where there is wasting or muscular paralysis. It is not to be used about the neck or head, and it should never be rubbed about indiscriminately, but simply applied to the muscles. Regimen and Diet. — These form an important and essential part of the cure. All this class of patients are but living skele- tons, skin and bone ; white, anaemic, wasted, emaciated, neither able to sleep nor walk ; suffering a living death, mocked at by ignorant physicians who are too superficial to understand their case. And it is perfectly astonishing to see how the treatment tends to recuperate and rejuvenate them. Once the patient is secluded, it is well to cleanse out the bowels and begin with a milk diet exclusively for a few days. This should be given every two hours in sufficient quantities, which they are able to consume and perfectly assimilate, usually from three to four ounces. After BACTERICIDES. 717 two days of the massage, the amount can be increased to eight or ten ounces, so that within the twenty-four hours from two to three quarts of milk will be consumed. There is no difficulty in getting rid of that quantity even if there are dyspeptic symptoms, for they disappear like magic, and flesh, strength and increased weight are visible to the eye from day to day. As soon as the manipulator reaches five hours of massage and an hour and a half electricity daily, one-half in the morning and the other half in the afternoon, then the diet is to be increased by the following additions, which are greedily taken, thoroughly digested and as- similated into brain, muscle and other tissues. The following schedule will give an imperfect idea of the diet list or something near it : Every evening during the treatment there should be made beef tea, say a pound and a halt of fine lean meat, chopped fine, and water sufficient to obtain ten ounces ; this should stand over night, so as to be ready for use at five a. m., when, after the patient is sponged off, a portion of it should be taken with a soda- cracker. This meat extract should be seasoned to suit the taste, and parsley, if in season, added to it. At five a. m., beef extract with cracker, to be followed with two and a half hours massage and half an hour electricity ; to be followed with a bowl of oatmeal porridge and cream. A nine o'clock a. m., breakfast, consisting of toast and butter, soft-boiled eggs, corn bread, boiled beefsteak and coffee. At eleven a. m., milk. At one p. m., dinner, consisting of boiled white-fish, chicken, mutton chop, broiled beefsteak, vegetables, fruit and cream. At three p. m., milk, to be followed with massage and elec- tricity for three hours ; to be followed with beef extract, fish, biscuit or milk. In other words, a system of feeding consisting of brain ele- ments, and that to excess. In this treatment, which is so successful, the massage is the dominant agent, and the question is — How does it work? The vital stimulus of the rubbing, patting, kneading, shampooing, is imparted to the superficial nerves. This passes along the nerve tubes by means of the pulp to the gray matter of the spinal cord, where, by the influence of the ganglion through which it runs, the supply of blood to the nerve cell is regulated. In the cell of the gray matter of the cord a vital electrical condition is estab- lished which travels along the spinal cord to the brain, which is toned up and receives more blood. Every rub, every vibratory thrill gives a myriad of tonic phenomena, and causes the anaemic capillaries to become filled with blood rich with brain 7i8 DISEASE GERMS. elements, and a renewal of life in the weakened tissue promoted. This treatment, simple as it looks, needs the supervision of a medical attendant of great skill. The time necessary to accom- plish a cure is usually about twelve weeks, unless in old cases of paralysis, which may require a longer period. Is this treatment reliable ? Assuredly it is. Not only reliable, but endorsed by the highest medical authorities, and thousands of hopeless cases of disease have been cured by it. It is no ex- periment. The nervous system is the controlling agency by which development is perfected, and the animal magnetism of the operator is the mysterious force that rouses it into action. No drug, no remedy whatever can quicken the benumbed and paralyzed limb or faculty like the invigorating stimulus of intel- lectual animal magnetism. There is an affinity in all cases of debility to absorb or draw from the strpnger around, to imbibe their nerve vigor and thus rouse their own dormant activities. The system of cure as laid down above comes right in among a class of diseases in which all remedies fail. For there is no drug or mechanical contrivance that can induce a healthy vibratory action of the nerves with living, thinking matter, and bring a new power to the deadened nerve forces but this. • The disorders of the sympathetic or of the great sympathetic ganglionic system, which in the white man is so profusely re- flected to the face, lungs, heart, spleen, liver, and genito-urinary organs of both sexes, in which the moral nature of man, emo- tions, desires, affections and passions reside, or what some term his visceral brain or soul, have not as yet been elucidated, and therefore not classified. The immense amount of rich gray matter in the sympathetic ganglia and its connection with the organs of animal life, with the united process of nutrition, blood formation and reproduction, exercise an immense influence on the circulation through the medium of the sympathetic, by which the neuric manipulations are produced, and any deviation from health in any of the organs of chest and abdomen leads to anaemia of cord and brain, especially so i( the complex^ genera- tive system is affected. It may be called reflex irritation, or irri- tation carried along the sentient gray matter to the cells of the cord, which in time wears them out and the influence of repeated or abnormal vibrations exhausts completely the central cells and the non-vital condition is established, with the weakening and disturbance of the electrical condition of the cord and brain. The superiority of the gray cell of the sympathetic, its intrinsic sentient matter is apparent, its growth and development in man being coeval with his moral responsibility ; and when any organ it freely covers is affected, as the uterus, the penis, the left kid- BACTERICIDES. yig ney, spleen, mesentery, heart and lungs, then rapid changes do occur on the supervention of the irritation. In such cases we see the rosy hue of the cheeks becoming pale ; the graceful gambols of the child giving way to the distortions of chorea ; we hear the sad gurgling of the epileptic, or the fierce ravings of mania, or the meanings of melancholia. Once the affections of the sympathetic are classified, we will be better able to treat the diseased manifestations of those organs under ganglionic control. * It is not our purpose to speak of evolu- Neurasthenia. tion, or of the opposite state, dissolution. {Sexual.) Suffice it to say here, that the order in which the principle organs of the body are evolved, are as follows : Heart, brain, eye, ear, mouth, nose, digestive organs, organs of special sense, moral qualities, reason and higher faculties, and lastly the reproductive organs, and the fac- ulty of abstract thought. It is a principle of evolution that functions, when not disturbed by disease, decline, wither, decay, atrophy, and disappear in the reverse order in which they are developed. The functions of the hum.an body, that are last in the order of development, are the reproductive, or procreative, the power to reproduce the species, and the power of abstract thought. Puberty in the Caucasian is not reached till fifteen years of age, but even then the male is not mature till he is twenty-five, and the female till she is twenty-one, and few persons attain the power of reasoning earlier. Before that period the human pro- geny are simply imitators. It is a fundamental rule in physiology, that it is the sexual organs that make the man — that it is upon them manhood is built up. The nervous system of man is intrinsically the most valuable substance in nature, and when thoroughly matured in either sex, between twenty-five and forty-five, it is the most difficult to de- vitalize, but when impaired it is the most tardy in recuperation ; *The most brilliant results have been obtained in the treatment and cure of chronic and hitherto deemed incurable, nervous disease, by the use of vitalized massage, elec- tricity, seclusion, rest, over-feeding, glycerite of kephaline, avena sativa. Sanitariums are best adapted for carrying out the treatment in all its details, and affording a com- plete rejuvenation of the patient. In the United States we have a few which excel, in magnificence in the profound ability of its attending physicians, and in their thera- peutic appliances, anything in the world. In the East, The Flower Medical Hotel, 41 7 Columbus xA.venue, Boston, Mass. ; in New York State,the Sanitarium of Dr. Gleason, of Elmira ; and Dr. Dewey, CUfton Springs ; in the West, Prof, Skelton's Sanitarium, at Bloomfield, Iowa, and Prof. W. T. Burks, M. D., Napa City, California. ^20 DISEASE GERMS. the great nervous ganglia with the reproductive organs are late in maturing ; and when there is any wreckage or disease, the genital organs and intellect suffer first. This law holds good, subject to some variations of tempera- ments, idiosyncrasies, hereditary conditions, or perversion of the intellectual faculties. The genital organs are the first to suffer in all cases of nervous debility ; they arc the first to feel the slightest disturbance of the nervous system ; the first to feel the shock ; and this sexual im- pairment is soon followed by heats and colds, by feebleness of memory, more or less general depression. Nerve shock, nerve tire — worry, struggle for existence, operate actively, keenly upon the reproductive organs, giving rise to such conditions, as sper- matorrhoea, the flowing away of semen in the urine or otherwise ; different grades of impotence, even to a want of power of intro- missions ; irritable prostate, with dribbling of urine, or frequent micturitions ; oxaluria, phosphuria, lithsemia, often existing months or years without the knowledge of the individual ; but sooner or later, other functions will suffer, as digestion, power of mental concentration, irritability of the spinal cord, torpidity of liver, Bright's disease. Disease of the brain, cord, great sympathetic, makes the indi- vidual sick all over. No one can have any form of nervous dis- ease and be well, and absolute impotence may exist and the individual be to all intents and purposes well. The explanation is, that the function of generation being the last to be developed, is the first to give way, or decay — it has nothing depending on it — it is simply a twig, a branch, not a main trunk like the brain ; it is a periodic function, capable of long intervals of inactivity, not of short intervals like the diges- tive organs, or constantly active like the heart or lungs. A man may enjoy excellent health, and his sexual apparatus dormant, without being capable of reproducing ; without exer- cising the function of abstract thought; without general activity. These functions are of late development. There is a border line of local sexual debility that cannot be passed without bringing suffering to the entire body ; so sexual neurasthenia leads to nervous dyspepsia, constipation, liver, kid- ney and heart disease, and numerous other morbid conditions. True, in the sensitive, in those of high mental culture, in the highly developed, this border line is speedily reached as they have little power of resistance ; little, much less reserve of vital force than those of a more rugged constitution. The muscular man is stronger, more vital, offers more resist- ance, has greater vital tenacity, is in other words impregnable to ingress of disease, to depressing influences. BACTERICIDES. ^^21 If the neurasthenia is induced by masturbation, the individual so devitalized loses his manhood, and all the attributes of virility long before old age; his beard and hair fall off; his genital organs atrophy ; his sexual appetite and desires disappear ; his voice becomes feeble and altered ; his body loses its force, vigor, energy — he becomes effeminate, he acquires the habits and attri- butes of a woman. But there is in modern society other elements aside from mas- turbation existing, operating, devitalizing, which might be termed sexual perversion, which exhibits itself, in unnatural forms of coitus, even worse than self-abuse. These we need not enumerate, suffice it to say that the wearing of condums and the common practice of both single and married men resorting to premature withdrawal in the act, is the worst, the most blighting; the prac- tice gives rise to irreparable damage to the prostate, perverts the sexual appetite, causes early impotency and nervous disease. Certain trades, occupations, as photograpers, riding on horse- back, reading dime novels, give rise to seminal losses or leakages, general genital excitation, prostatic disease ; under which the generative organs atrophy, grow smaller, feeble ; the desire, power of intromission by and by ceases ; courage and man- hood disappear. Sexual neurasthenia, in all cases, leads to feeble-mindedness, or imbecility, epilepsy, inebriety, insanity. The practice of mas- turbation or perverted sexual appetite, however gratified, gives rise to ph renal incapacity, which leads to insanity, preceded by melancholy, a state which leads its votaries to lunatic asylums. Genital losses depreciate, destroy, the intellectual and moral nature, they demoralize, wreck, throw out of gear the entire in- tellectual fabric. An unmarried man in apparent good health may occasionally have emissions ; they are evidence of weakness, debility ; they are exhausting, have a debilitating effect on the body and always bring on nervous disease, and if they are combined with any form of sexual perversion induce anaemia of the brain and cord. Masturbation and all forms of sexual perversion are ruinous, the involuntary oozing or loss of the seminal fluid is disastrous in the extreme. True spermatorrhoea, or the flowing away of semen, either nocturnal or diurnal, or its loss at stool or in the urine, indicates debility of the parts, and of the sexual appetite or sense at the base of the brain, and is a frequent and persistent symptom of neurasthenia. Such states are very common among the highly civilized American. The urhie^ aside from the general feeling of languor, is a barometer test of the true state of the system, and 46 ^22 DISEASE GERMS. the amount of urates, oxalates, phosphates, etc., present, indi- cates the degree and intensity of neurasthenia. Our habits, our literature, our highly oxygenized atmosphere, mould us into sexual neurasthenia, and when induced, there is genital debility, less or more impotence, spermatorrhoea prostra- tion, irritable prostate, structural nervous disease. Numerous complications or deviations arise in all cases, no two being alike; in some there is the loss with stinging pain; in others the testes atrophy, penis is cold, erections slight ; in others erectile power is increased abnormally, prostatic secretion or seminal fluid scanty, priapism and aspermatism may exist, owing to excitation of the cord. The desire for sexual intercourse is the most powerful passion of human nature, indispensable for the perpetuation of the species, yet how few understand the importance of that function. Normal sexual intercourse is a sedative tonic, promotes sleep, removes the cobwebs on brain, calms, strengthens the nervous system ; if in excess it exhausts, wrecks the whole body, but if the sexual act is perverted by unnatural methods, whatever they may be, whether they be prolonged, or a dalliance, or a with- drawal in the act of ejaculation, or in the use of condums, or other methods, too diabolical and soul-perverting to enumerate, it shatters the vital elements of being, of existence. In order to have a healthy race of children, a man should never have mastur- bated, nor resorted to unnatural methods to gratify his sexual appetite ; all are bad, but I cannot too emphatically condemn the practice of married men, withdrawing in the act of ejaculation, also the very common practice of dalliance or prolonged coitus, which is much more injurious than when frequently repeated ; all such and too many other obnoxious methods are fearfully hurtful to the offspring. The diagnosis of neurasthenia is not difficult, the presence of general nervous debility at all periods, year in and year out, with no special disease, if any. The brain is chiefly affected, usually phrenal disturbances manifested in a thousand ways ; if the sym- pathetic ganglia are implicated there will be emotional disturb- ance, religious hallucinations, hysterical conditions ; if the cord is affected loss of power will be predominant. But it may penetrate further and deeper, special neurosis of nutrition central, with a collateral loss of power in the lymph canals, and pink marrow where the degradation of living matter takes place with the disease germ tubercle ; further and deeper, this nervous debility may be so great that the primary elementary molecules may be degraded into the diseased germ vibrios in which typhoid fever appears ; besides, there is always likely to occur a spinal neurosis of weakened parts or organs. BAClEklClbfc:^. j2't In the diagnosis of sexual neurasthenia, every appHance known to science should be brought to bear upon the case, the ordinary physical signs as to spermatorrhoea or leakages must never be neglected; the examination of the urine, that great barometer, should never be overlooked. Determine the sensitiveness of the prostate by introducing the index finger of the right hand into the rectum, press firmly against the prostate, if it is healthy the pressure causes very little pain, but if the individual suffers from sexual neurasthenia there is pain, tenderness of an acute char- acter, often excruciating pain ; sensitiveness may exist without enlargement, irritable bladder or rectum, frequent micturition, aching testicle, pains in the lumber region, etc. The more highly developed the nervous system the more serious the effects. A very high grade of neurasthenia may exist without tuber- culosis — there is a border line to be reached before a degrada- tion of bioplasm takes place into the disease germ tubercle. In making the diagnosis we must bear in mind that life begins in a homogeneous fluid ; from this is developed the varied forms of living beings. There is a life force inherited from a pre- existing life which builds up matter into living tissues and holds it together for a time, and the tenacity with which this force holds organized matter together does not depend on size or strength or muscular development, but on an even balance of the several parts, on an entirety of vital force. Neurasthenia is not incompatible with intellectual greatness, for the greatest men in science, art,^ literature have been so afflicted. Our aim should be to leave the body better than we found it, and to transmit improved vital force to posterity, which true evolution will do, making death the beginning of life. Treatment. — General principles must guide us, the predomi- nating idea being to improve vital force. True a general altera- tive and tonic treatment is always of utility, and frequent changes of treatment are indispensable. Besides a well-grounded faith in the action of drugs that they will aid vital force, we shall briefly enumerated the essential points of treatment by which neuras- thenia can be wiped out in individuals and nations. Clothing for those affected with general nervous debility from the cradle to the grave should consist of flannel next the skin. It should be fine, not to irritate, and sufficiently thick to be com- fortable, free from all drugs, which simply render it most delete- rious and toxical. The use ot such an agent over the entire sur- face is to stimulate vitality, its reflex action is superb ; it generates vital electricity which is reflected to the nerve centres ; it, directly over the abdomen, keeps up continuous ganglionic ^24 DISEASE GERMS. action from the million of little brains located there ; a barom- eter of force, besides it protects the keenly sensitive neurasthenia from the vicissitudes of change of temperature. We not only insist upon flannel over the entire body during all seasons of the year, but durmg night in bed asleep, when the nerve centres are drawing or draining living vital force from the centre of all force. The affected individual should sleep between blankets, which are highly vitalizing ; if the climate does not permit of such, silk is most excellent. Diet. — Obviously man was made to eat a mixed diet, including both animal and vegetable food. The grade of civilization, country, climate, development, peculiarity of individuals, eccen- tricities, determine the kind, quality, supply and demand. The theory of evolution aids us in providing our drugs and also our food, because food is medicine, it supplies material which the vital forces can organize into living matter, to aid and nour- ish nature in the cure of disease. The earth itself feeds on grasses ; fruits and cereals feed on the the earth ; the lower animals feed on fruits, cereals and other animals ; man, according to this gradation should feed on the lower animals, with a small proportion of fruits and cereals. In proportion as man becomes civilized or diseased, he, through those conditions becomes sensitive or nervous, he should diminish the quantity of fruits and cereals, which are far below him in the scale of evolution, and increase the quantity of animal food which is nearly related to him in the scale of being, as these are more easily assimilated. The best food for all suffering from nervous debility is beef, mutton, lamb, game, poultry, milk, eggs, boiled white-fish, oysters, butter, etc. Lean, tender meat is in all cases to be perferred to fat, because fat is a non-vital element and is of very low organization, — all fats except butter. Beef animals are nearer to him in the scale of evolution, and an ex- cess of it, mixed with other articles, contains more brain ele- ments, is the best food for brain and muscle workers, and is in most perfect harmony with the theory of evolution. Just as civilization advances, as the human constitution in- creases in development, the diet should be still closer, nearer to man in the scale of development. Flesh meat of some kind should be the main staple or factor of diet, and on this alone is it possible to maintain the highest working capacity for brain and muscle. As a rule the nervous debilitated are unable through sheer lack of force to digest food, at least enough to maintain the wear and tear of the body, hence it is of the utmost utility to either administer some reliable preparation of malt or pepsine after every meal. BACTERICIDES. 725 Thorough mastication, an active liver and a normal evacuation of the bowels once every twenty-four hours are indispensable. The rule is food of the best, even over- feeding is justifiable. Poor food or poverty of food is productive of debility. It is true, the human constitution possesses great elasticity and will toler- ate poor or bad for a long time, but lessened vitality inevitably follows ill nourishment, and the heart is an organ that suffers vastly with irregular action under poor food. One thing is posi- tively certain, that modern diet is insufficient to maintain the activity of brain work, and we need a thorough reform ; our dietetics should be prepared for nutrition of the brain, for that organ becomes more complex, its cells gain greater power, as civilization progresses. The first essential of life is good food. The majority of people are underfed and a large proportion are improperly fed. Lessened vitality inevitably follows impoverished blood and ill-nourished tissue. Massage is of the greatest efficacy. It should be performed for at least one to two hours daily. It is valuable in stimulating the nutrition of the entire body, but especially by its reflex action in promoting activity of the brain. Under massage the brain cells become more active, they grow and gain greater power, a higher evolution or development of the nervous system takes place, the assimilative process becom_es more active, patient gains flesh and strength. In all cases of under nutrition of the brain, the cerebral areas are much enlarged by massage. It should, in all cases, be per- formed systematically and regularly, and by highly vitalized manipulators, and is always beneficial in correcting irritability of the nervous system, in overcoming defective nutrition. Massage, when properly performed, is a never-failing remedy in causing an improvement of tissue, by w^hich all is strengthened and degra- dation of tissue prevented. It is a means in itself, if the directions are closely followed as laid down in the domestic practice, that will cure many forms of nerve disease and effectually overcome nerv^ousness and prolong life to an indefinite period. Electricity is a powerful constitutional tonic, a local stimu- lant of no mean value, an excitor of nerve force, valuable in ex- haustion of the brain, spinal and great sympathetic ; and in cases of genital debility. It is a remedy that should be applied with great care. The faradization of the superficial muscles ot the entire body is attended with the most happy results. It enables the vital forces of the body to draw renewed life from the centre of all force. 726 DISEASE GERMS. It should follow the massage. While using this excitor of nerve force the bed or table on which the patient is placed should be thoroughly insulated by glass castors, the head placed to the north, in order to conform with the magnetic law of the earth, and thus prevent the escape of the vital electricity of the body. It should be used under the auspices of an experienced physician. Bathing the entire body, at least once daily, is always at- tended with the most happy results. It is efficacious under all possible conditions, cold or tepid baths, and, if near the shore, salt-water bathing. After the bath the individual should be well dried, and either well rubbed with the dry hand or massage performed ; the latter being the best. If the patient is a child, bathing twice a day will be beneficial. Location has much to do in the production or cure of neuras- thenia. Inhabitants of cities all manifest a typical type of de- generation, whereas denizens of the country are highly vigorous. The sea, or in close proximity jto it; as well as mountain tops, imparts great life, strength to its people, chiefly from the atmos- phere of ozone which surrounds them. Next in value to mountain air is well-directed sea bathing during the summer months, associated with abundant exposure to the sun and the open air of the seaside. Sea bathing is best with repeated plunges ; or the dashing of the surf over the body is the best natural douche. No condition or location that favors isolation, monotony, sameness, should be selected, as those states directly induce vital deterioration by wiping out the typical fissures of thought in the brain. Exercise, moderate in kind and never exhausting, should be inculcated. Walking, riding, rowing, fishing ; there should be incorporated an aim, an idea, and in no case persevered with till fatigue ensues. * * Although we would insist upon moderate exercise, never to the slightest fatigue, still it must ever be remembered that sedentary occupations and habits are most per- nicious. There are certain kinds of exercise highly injurious to the nervous. One of those is bicycle riding, the perineal pressure, the jarring, the succession of shocks, the movements are conveyed to the spinal cord, having a disastrous effect on the prostate. It is more prejudicial to growing boys, because it interferes with the nutrition of that gland, first causes hypen\.'mia, then atrophy or wasting, and a general withering of the genital organs, leading to an increase of masturbation in the timid, or early sexual indulgence and impotency. Even horse riding is bad to the neurastheniacs, causing prostatic disease, atrophy or enlargement, with impotency in the strong, robust or BACTERICIDES. 727 Rest at different periods of the day, should be taken in the re- cumbent posture, but especially after exercise, or bathing or massage. Sleep should be prolonged to eight or nine hours out of the twenty-four. If bathing, massage and exercise is not sufficient to procure refreshing sleep, then every artifice should be resorted to to procure sleep — prolonged, refreshing sleep. All worry, care, struggle, tension and nerve tire must be wiped out. Amusements, of a most healthy kind, are most beneficial to the mind. If the theatre, never tolerate anything but the healthy drama. Variety shows are demoralizing. History is in all cases to be preferred to trashy romances ; religion and morality invigo- rate the brain, whereas infidelity and vice Ipwer, deteriorate, wipe out the fissures of thought, of deity. Change in all things is vitalizing, — change of occupation, of society, of location, of habits, of diet. Change creates a higher grade of mental and physical being ; whereas, monotony, same- ness and isolation are deteriorating, produce a cerebral wreck ; every gland, organ, tissue succumbs to the devitalizing effects of sameness. Travel. — Change of scene is good, provided it is not carried to fatigue. Work^ labor, and the prospect of work, an aim in life, is a remedial force — with rest, recreation and vacations. The usual avocation, if healthy, is the best ; it is rooted in the system by years of toil, devotion and costs, as a rule, compara- tively slight cerebral force, because it runs in well-worn grooves, with very slight friction, and therefore is less exhausting, but, while we recommend holding on to their trade or profession, we would inculcate abundance of relaxation and pleasure, gentle ex- ercise and no strain. Marriage with its duties must be restricted within proper bounds ; and an interval of weeks should take place between the sexual act. Most cases are benefited by it, while others are positively injured. Coitus to some brings prostration, while to others it rouses up daring — reducing or wiping out the masculine characteristics. It will even change the tone or pitch of the voice, cause the beard or hair to drop off. All bicycle riders are sexual neurastheniacs ; they are effeminate, soft, debilitated, ambitionless, etc., such is the outcome of this form of exercise. Another modern craze is roller-skating, which, if indulged in for a few years, and to the same extent as at present, will cause hypertrophy of the clitoris in all young ladies who indulge in it, ?o that nymphomania and masturbation will reign paramount. The modern ballet girls all suffer from enlarged clitoris as a result of their occu; aiion, although the exercise of moderate dancing is free from this objection. 728 DISEASE GERMS. the vital energies, and elasticity reverberates through the entire body. The medical treatment of nervous debility involves a general tonic and alterative course ; the use of remedies all the time, remedies under which a degree of vigor and vivacity is experi- enced. Faith in the action of drugs must be inculcated, and they should be changed at least once a week ; the system should never become habituated to any one drug. Cinchona and its alkaloids are always worthy of special atten- tion. It should be invariably administered with some mineral acids. The ozonized glycerite of kephaline must be given in all cases of neurasthenia. It is a brain and nerve food composed of C. P. glycerine and the life-giving principles of the ox brain, the vegetable phosphates of wheat, the most highly evolved of all animal and vegetable substances. It is, without a doubt, the best remedy in all forms of nervousness, or nervous exhaustion, impaired vitality or weakness of any kind in children or grown persons. It is a true nerve food — a true nerve vital essence, indicated in all cases of weakened energy ; it gives vigor and promotes nerve supply, a true physiological restorative in all cases of nervous debility. Being such, it is admirably adapted to imperfect development of the nervous system and active brain expenditure. Ozonized tincture of oats, prepared from the best Scotch oats, has been found by experience to be extremely serviceable in dyspepsia, indigestion, mental and physical exhaustion, insomnia, nervousness. It acts as a nutriment to the cerebral and nervous systems, restoring to their normal condition secretory organs that have been damaged, giving vigor where there has been debility, and renewed strength where there has been exhaustion. It causes the tiny cells of the nervous system to increase in size, become more elaborate, imparts intellectual vigor, brilliancy and vivacity of thought, a redundancy and freshness of ideas ; in- creases the typical fissures of thought, and creates a higher and nobler type of manhood. It is a remedy that is indicated at all periods of life ; in chronic debility in infants and children, in difficult or retarded dentition, where we are desirous of increas- ing organization and growth of brain and bone. This phosphated tincture of oats (avena sativa) is thoroughly ozonized and highly germicide, and is one of our best remedies in conditions of debility. Coca et celerina has been in use for many centuries, for nervous prostration, mental derangement, spermatorrhoea, impotency and all debilitated conditions of the generative organs, with the most BACTERICIDES. 729 gratifying results. It is a most valuable remedy, restoring health to millions, who, had it not been for this remedy, would have died prematurely. The range of action of this preparation is large ; being a nerve stimulant it recruits the languid, debili- tated, aids the brain to pick up its pabulum from the blood, it rejuvenates the nervous system when exhausted. The wine prepared from the coca leaves is never failing in all forms of neurasthenia, its daily use is attended with the best results ; it strengthens the system, restores lost vigor and ex- hausted vital power, debility of the brain, feebleness of digestion, conditions inseparable from high civilization. The action of coca upon the ganglia of the sympathetic is admirable, it introduces strength, while it nourishes, sustains, refreshes, being an antidote to exhaustion. It is thus prepared : Sherry wine, one pint ; fluid extract coca, two ounces. Mix. Dose. From one tablespoonful to a wineglassful every three hours. A powerful nerve stimulant. The cocaine sttppository is of great utility in all cases of nervous debility, or lack of nerve force, especially if there is sleeplessness or mental distress dependent on an enfeebled condition of vital power, attended by some of the following symptoms : Tenderness of the scalp and spine ; severe itching all over the skin, especially on the legs and arms ; dryness of the skin ; mova- ble pains; restlessness and sleeplessness; great disturbance and palpitation of the heart ; great prostration after slight exertion ; extreme sensitiveness to changes in the weather; profound melan- choly and exhaustion; local anaesthesia or hyperaesthesia of the skin ; continued pain in the back, shoulder or side ; spermator- rhoea ; complete impotence, etc. We cannot too strongly urge upon those afflicted with sexual neurasthenia the use of these suppositories. We recommend them in all the worries and vicissitude of life, in over-indulgence in eating and drinking, in the abuse of alcohol and sexual excess, in the high pressure of civilization. It is an open fact, that the pathological condition of all forms of nerve exhaustion is impotency. The desire for sexual intercourse may be great, but in those cases there is an inability to perform, owing to an insufficient nerve stimulus to produce an erection. The man is nervous, his heart flutters, his desire may be good, but to his utter amazement and mortification the organ fails to perform its legitimate function, and despondent and humiliated he seeks relief Medical science has been appealed to in vain, till the in- troduction of this cocaine suppository. The use of this in those cases is attended with the most happy results. The loss of semen, the most highly vitalized fluid in nature. 730 DISEASE GERMS. enervates, emasculates and degenerates, produces the most alarm- ing e:^haustion. This cocaine suppository arrests this leakage, and invigorates the whole man. The combination of coca-calisaya is a superb and agreeable tonic, a safe excitant, gives great vigor to the muscular system, sustains the brain under extreme tension, produces rapid recu- peration ; as a remedy in neurasthenia, loss of nerve power, it is one of the best combinations, being invigorating and exhilarating in over exercise of the brain or intense study. It aids essentially the evolution of the nervous system ; enables the vital force to attain further development. The true damiana is a most efficacious remedy in all forms of neurasthenia, but especially the sexual. It is the most powerful invigorant ever introduced. Perma- nently restores those weakened by early indiscretions, imparts youthful vigor, restores vitality, strengthens and invigorates the brain and nerve. A positive cure for impotency and nervous debility, prompt, safe and sure. Damiana is beyond a doubt the most reliable, useful and perma- nent tonic to the genital organs of both sexes known ; acting, as it does, directly upon the nervous system, it restores, as it were, the debilitated functions of the principal organs of the human frame, and is unsurpassed as a nervine. Its merits are well estab- lished as a powerful, permanent and positive aphrodisiac, as well as an alterative aperient of remarkable fine quality. It has acquired the distinction of being, not only a simple, pleasant and convenient vegetable remedy, but one that is en- dorsed by all medical men, and relied on as an invaluable re- medy for nervous dyspepsia, debility and all weakness which would disqualify the human race from the arduous duties of civil- ized life. It is highly recommended in mental over-work, sexual debility, impotency, and decidedly beneficial in cases of nocturnal emis- sions, the result of excesses, mental apathy, or indifference, and in an enfeebled condition of the general system, with weakness or dull pain in the lumbo-sacral region. In disease of the reproduc- tive organs of the female, and especially of the uterus, it is one of our most valuable agents, acting as a uterine tonic, and gra- dually removing abnormal conditions, while at the same time it imparts tone and vigor ; hence, it is of value in leucorrhoea, amenorrhoea, dysmenorrhoea and in removing the tendency to re- peated miscarriages. It is a safe, certain and speedy cure for nearly all the varieties of seminal and physical debility of the generative organs of both sexes, whether coxistitutional or acquired. The indiscretions of BACTERICIDES. 731 youth, which produce such injurious effects upon both mind and body, can be rectified, and the nervous system health- fully invigorated, where the qualifications of manhood have been impaired. Although we give a decided preference to kephaline and avena sativa in nervousness, mental and physical exhaustion, there are cases in which the compound hypophosphites of soda, lime and iron are beneficial, they act as food to the nerves. Every mental and physical act, every motion, every thought, is attended with waste, literally renders effete portions of the brain. In nervous- ness there is an excess of waste of the phosphate, and especially is this augmented where the intellectual duties are arduous. So that in some few cases this remedy may be used with ad- vantage. The sole aim of all treatment is the elevation of the standard of vital power; the improvement of the race; every means to aid an evolution of a higher and nobler type of mankind ; all reme- dies, all means, an aggregation of all science and art, in atmos- sphere and earth ; every thing to give us a pristine vital force, a larger area of phrenal life. Besides the condition of general nervo-us debility involving the whole body, we have neurasthenia of special parts or organs, so that while we are treating a general state by alteratives, tonics and special agents to build up the brain, the specially weakened part requires attention. Neurasthenia in special organs is termed a neurosis, as of the brain, heart, stomach, bowels, bladder, uterus, prostate, eye and lungs. To a few of those we solicit attention in the order of their frequency. A common disorder of adults of both Neurosis of the sexes, and may co-exist with pruritus of Anus. the genital organs. In the large majority of cases this affection consists in the pres- ence of itching, without any characteristic morbid appearance, which causes intolerable annoyance, especially when heated ; in a small number of cases, the anus becomes infundibuliform from indurations ; its mucous surface excoriated ; its cutaneous borders seamed, puckered, eroded, fissured, often complicated with eczema. Piles, ascarides, chronic prostatitis, rectal impaction, unnatural vices, diabetes ; insanitary states, morbid secretions,, bowel ulcer may all be responsible for their occurrence. Although no appreciable morbid appearance can be seen or even detected in the large percentage of cases, still there are ele- J ^2 DISEASE GERMS. ments in the blood and nervous system which give rise to this local nervous jarring or neurosis ; there is something out of gear, a deviation from the normal state ; it may be obscure, latent, still there is a source from whence it springs. In all forms of neurosis, we must recognize a failure of the general health, the presence of a diseased germ, aggravated by the nocturnal exacerbation, perverted nutrition incident to the continuous teasing of the nervous system, or from germ>laden blood, or a morbid mind. The degree of success in treatment is in proportion to the skill with which it is managed. The gastro-intestinal tract, the liver, kidneys, bladder, uterus, prostate gland, rectum, should be seen to by placing the patient upon an alterative and tonic course, with every possible means to improve the general health. The substances which have been topically applied are most numerous, as hot baths, lotions of hot water, or alternately hot and cold, medicated by the addition of sodic bicarbonate, or biborate — the carbonate and sulphuret of potassa, the anti- bacterial microbe powder. Some of the following formulae are excellent : Hyposulphite of soda, half an ounce; carbolic acid, forty drops ; distilled water, four ounces ; glycerine, two drachms. Mix by shaking. First bathe the affected parts with castile soap and hot water ; dry well off. Then either paint on or apply the above. That failing, then try : Resorcin, half an ounce ; boroglyceride, three ounces ; water distilled, half a pint. Mix. Spirits camphor, one ounce ; boracic acid, one ounce ; water, half a pint. Mix. Sulphuret potass, half an ounce ; spirits camphor, half an ounce ; glycerine, two ounces; water, half a pint. Mix. Solution resorcin, concentrated ozone, of each one ounce ; water, half a pint. Mix. All for external use as a lotion, or to be applied on lint ; one grain of morphia or hydrochlorate of cocaine added to each. Various other valuable formulae may be made by adding boroglyceride, or sulphur water, alum, chloral hydrate, hydro- cyanic acid to a sufficient quantity of water; lime water and tincture of iodine ; a lotion of peroxide of hydrogen is most effectual ; menthol and thymol act well in some cases. As a rule, ointments or oils do not operate well. If desirous of trying one, take one ounce of ozone ointment, one drachm of gum camphor and the same 'quantity of chloral hydrate. Mix ; or hydrochlorate of cocaine, dissolve it in glycerine of the strength of one-tenth of a grain to the drachm ; painted on the part is most effectual in some cases. BACTERICIDES. 733 Neurosis of the Aorta. {Descending}^ Aorta is the name given to the large vessel which arises from the left ventricle of the heart, and thence conveys the ar- terial blood by numerous branches to the various parts of the body. It is an elastic tube about three inches in circumference at first, but afterwards becomes considerably narrower. In the first part of its course it is nearly vertical ; it then forms an arch and, curving from right to left, and from before backwards, it descends through the diaphragm into the abdominal cavity, and then divides into two terminal branches called the iliac arteries. From the upper portion of the arch arise three great trunks the innominate, left carotid, and left sub- clavian, which supply the head and neck and upper extremities with blood. From each side of the descending aorta are sent off numerous branches which supply the lungs, and the thoracic and abdominal walls, while from the anterior aspect in the lower part of its course, vessels are given off which convey the blood to the stomach, liver, kidneys, pancreas, spleen and intes- tines. As people advance in age, or when their blood becomes impoverished by dis- ease, the walls of this artery are liable to decay through receiving insufficient nour- ishment, and degeneration of the coats takes place in consequence. As a result of this the vessel becomes more rigid, and there is difficulty in the conveyance of the blood to the various organs ; some- times a uniform dilatation of the aorta occurs, at others a bulging of the wall takes place at one spot, and gives rise to an aneurism, a state attended with great danger. Aneurisms more frequently occur in the ascending part of the aorta than in the rest of its course, as here the strain upon its walls from the impetus of the blood current is the greatest. People who are subject to gout, or who indulge in drink, or those who have kidney disease, are liable to have degeneration of the coats of the vessel. Great exertion tends to cause dilatation of this vessel. Malformation of this vessel sometimes occurs in foetal life ; it is in rare cases given off from The aorta; a, arch of the as- cending aorta ; a a, coronarj' arteries; ^.innominata artery; ^, right subclavian; c, right carotid ; d, left carotid ; e, left subclavian ; f, thoracic aorta; g g, diaphragm; h h, phrenic arteries ; /, coe- liac axis; k, coronary or ga-stric ; /, splenic ; m hepatic; «, superior mesen teric; o o, renal arteries /, inferior mesenteric ; p spermatic ; q , common iliac r, middle sacral. y^. DISEASE GERMS. the right ventricle instead of the left; for such cases no treatment can be of any avail, and death generally takes place in early life. In neurasthenia, or spinal irritation, or exhaustion of the lum- bar portion of the cord, the state of debility, with other causes of neurosis, gives rise to a relaxation, pulsation in the descending aorta, which is often mistaken for aneurism. The fact that it occurs in hysterical women, or effeminately created young men, should at least put a physician on his guard as to its origin. The treatment for neurasthenia is appropriate. Involves either constipation or diarrhea, Neurosis of the with some pain. Bowels. General treatment consists in the ad- ministration of virg. stone crop, in alterna- tion with ozonized liquor cerri. In addition to the general treatment as already laid down, tonics and alteratives and special remedies to stimulate a renewal of life in the reflex centres. We find it a good plan in all neuroses to resort to repeated applications of blisters to the nape of the neck an inch square, one on each side of the spinal column for six hours at one time, twice weekly. They are of great utility in all cases of neurasthenia. It is difficult to explain their action on such a limited area, but they cure and control morbid conditions located in the periphery in distant organs, vby rousing up the fibrillary connection into activity between the cord or nerves conducting motor or sensory power to organs. The ailments that yield to this kind of stimulation of the cord are all forms of diseased germs in the human blood, all nervous affections, neuralgias, paralysis, hysteria, nervous dysmenorrhoea, reflex states, vomiting pruritus, all forms of nervous irritation occurring in paroxysm, and sexual hybrid states, as chorea, •epilepsy ; asthma and bronchitis yield readily. Neurosis of the brain often takes place, Neurosis of the there are certain well defined symptoms Brain. which exist peculiar to this condition. The general health is poor, the function of the body and vigor impaired ; digestion weak, circulation feeble. The entire nervous system is in an unstable condition, and the patient irritable, restless, excitable and depressed or despondent. BACTERICIDES. 735 General nervousness, with headache, pains and tremors, with a failure of mental power, feeble and defective memory, with intel- lectual aberrations. The physical suffers, nutriment is imperfect, skin pale, muscles flabby, motor power enfeebled, culminating in paralysis and some endless type of mental deviation. Constant and distressing desire for sex- Neurosis of the ual intercourse, with an erectile condition Clitoris. of the clitoris ; may arise from disease of [Nympho?nania) the brain, spinal cord, inflammation of clitoris, from masturbation, or excessive venery, sedentary habits or occupations, and, above all, by the vascular excitement that is produced by our abominable sensu- ally exciting literature. Treatment. — Removal of cause, plenty of exercise, or hard work ; daily shower bath, well regulated bowels, sleep on straw or hair mattress, light covering ; cold water hip-baths, and vagi- nal injections of cold water, except during menstruation ; large doses of green root tincture of gelsemium and bromide of potass at bedtime, or camphor, belladonna, and conium, to cut off sex- ual desire ; alteratives and tonics administered persistently. The best of all remedies is the fluid extract of black willow, to har- monize the nervous energies of the organ ; should be adminis- tered persistently for six months. A strict avoidance of all light literature; a pure, moral atmosphere; same treatment as for masturbation in male. The amputation, or partial destruction of the organ with caustic potassa, is of doubtfifi benefit. In cases of inflammation, rest, open bowels freely, hot poultices, and general treatment for fever. is an exceedingly severe and distressing Neurosis of the form, as the affected parts are very apt to Genital Organs be rubbed or scratched, in order to obtain relief from the itching sensation ; orgastic effects and pollutions are often produced in early life and extreme age, whose moral effects are degrading. All parts of the geni- tal organs of both sexes may be the seat of the neuroses. Independent of the malarial, syphilitic tubercular, cancerous germ, search should be made for ascarides of the rectum or vagina ; saccharine urine ; uterine or ovarian disturbance ; urethral and prostatic damage, or a perverted sexual appetite may lie at the origin of the trouble. There may be associated with it thickening, erosions, a squamous condition, etc. 736 DISEASE GERMS. is manifested in a variety of complications, Neurosis of the as an aching heart, an irritable, sensitive, Heart unsteady organ, characterized by inter- missions, irregular action and intermittent pulse. This is brought about by anaemia of the sympathetic that so profusely covers the heart. Emotions, desires, affections and passions must be controlled, great self-denial exercised, else the heart will become permanently out of gear. All excitement, mental or muscular, with the use of tea and malt liquor must be avoided, coffee is not objectionable ; good, rich, wholesome food should be taken in moderate quantities and frequently. Fasting is prejudicial, giving rise to indescribable exhaustion. The nervous power of the heart is sensitive to over-work, to the least failure of power, and requires a renewed stimulant, as cinchona, cactus and avena sativa. No indigestible article of food per- mitted ; forbid nuts, pies, salt meats, pork and cabbage. Protect the body with silk or flannel from cold, damp and wet. Har- mony and equality of every vital function or process, so that the nervously exhausted heart may neither long for new support nor be over-taxed with work. Struggle, anxiety and pecuniary care abolish. Try matricaria, cerebrin, avena sativa, cinchona. The larynx is the organ of voice ; Neurosis of the the organ by which sounds or pri- Larynx. mary elements of speech is produced; [Laryngitis Clericorum) it takes part in the respiratory pro- cess, as all air passing to and from the lungs, must pass through it. Its construction is most perfect ; its various parts of the highest possible organization ; so perfect that the slighest alteration of its mucous surface, of its chords, nerves or muscles is invariably accompanied by a change of voice, either in its intensity, tone or modulatipn. No' mucous membrane in the body, so richly organized, so finely studded with nerves as the larynx — none to which the microbe of syphilis, tubercle, diphtheria have such a strong affinity. „ The larynx, like all other parts of the body, is liable to suffer a condition of partial death ; hence we meet with acute laryngitis in males of a high nervous organization, and chronic forms of laryngitis in both sexes. Chronic laryngitis exists in many forms, which have certain symptoms in common, such as loss of voice (aphonia) ; cough and expectoration, and in the sputum the disease germs, single or hybrid, which is pathogenic of that in the blood. BACTERICIDES. j^j II the laryngeal irritation be due to cold, damp, exposure, the amoeba, the degraded bioplasm of nutrition of the air passage, is present in breath and sputum ; if due to syphilis that microbe is present ; if to tubercle, that bacillus is there ; if to the blighting effects of masturbation, the aphonia, the squeaky voice, in the breath, the degraded bioplasm of nerve nutrition, the vibrio is present; in all cases of preachers, with aphonia, due to a want of harmony in volition, the same germ is present. The larynx, like all other parts of the body, can be improved and developed, up to a point in which there is an inadequate nerve-supply, hence development ceases and atrophic changes begin. How the larynx can be developed will be seen frgm the follow- ing : By massage, exercise, faradization, a system of over-feeding the muscular system can be developed in whole or a part; the arm of the blacksmith often is greatly developed. The penis from a mere withered stump can be made to grow to a well- deiveloped organ ; the testes, the mammae under the influence of the saw palmetto will often attain an enormous size. As there is a perfect anastomosing of the nerves of the reproductive organs and the larynx, if the former is healthy, the latter can be indefinitely developed. Experience tells us that the larynx can be developed by the use of the laryngotome to the finest, on& of exquisite modula- tion. The laryngotome is an instrument for breathing through by spells, say half an hour at a time, taking prolonged inspira- tions of the nascent .chloride of ammonia — a germicide' of great power. ^ Whenever the will is not brought into a unison of action,- or exercise of any muscles without the will harmonizing, there is apt to be a neurosis, or degeneration of structure. The vocal chords are made up of a series of fine muscles* abun- dantly supplied with nerves from brain, spinal cord and great sympathetic, to enable man to express his thoughts. The brain gives the stimulant, the nervous energy, and thus gives the motive power ; but this motive power must be in perfect co-ope- ration with their exercise — a will, an intellectual effort with voli- tion in the delivery of a discourse, if it is duly carried out, and all ranting avoided, the vocal chords will improve in their vital integrity. The disease is common among a class of clergymen who are wrought hard and poorly paid, who find it often difficult to put an intellectual effort into their words. .The symptoms in the early stage are simply hoarseness and loss of voice, with no apparent change in the mucous m.embrane ; 47 738 DISEASE GERMS. but after a while a follicular degeneration can be detected, with congestion and ulceration of the mucous follicles. In some cases it is ushered in with a complete loss of voice ; in others it originates in a sort of uneasy sensation in the upper part of the throat, with an inclination as if there was something to swallow ; cough, and the larynx painful on pressure ; expecto- ration of a thin, viscid mucus, occasionally pus, with gradual loss of voice or diminution of its power ; hoarseness towards evening, which gradually merges into complete aphonia with ulceration, or unhealthy granulations, or even vegetations. As the disease advances, it gradually merges into tuberculae, and terminates, if not in recovery, in lung consumption, caries of cartilages. Symptoms' are nearly identical with chronic laryngitis, — aphonia, cough, and expectoration. The diagnosis is important ; the history of the case is always of great service, one who exercises the vocal chords without the will effort, the presence of the microbe of neurasthenia in all cases. In the treatment of this neurosis, we have of late years intro- duced some most valuable remedies. The first and most essential remedy is rest of voice, with a most liberal diet; and attention to every means which will im- prove the general health. Follow with a general alterative and tonic course, for altera- tives, the comp. saxifraga and phytolacca are most efficient ; for tonics, no remedies can excel the avena sativa, glycerite of kephaline, matricaria, Warburg's tincture, con. tincture kurchi- cine, wine of erythoxylon coca. A class of special remedies, as terebene, distillation of the pine, creosote, naphthaline, dioxide of hydrogen, comp. oxygen. Either administered internally, or by atomizer, or otherwise, are most efficient laryngeal stimulants and bactericides. The irritating plaster to the nape of neck, or else electricity every other day, is of rare value in all cases. It has long been demonstrated that the Neuroses of the nerves of the nose, subjected to irritation. Nose. give rise to certain symptoms of difficulty of breathing. Subsequently a large number of other general symptoms have been traced to some abnormal condition of the nasal fossae or their lining membrane. Thus it has come to be recognized that affections of the nose, though apparently slight in themselves, may exercise an important influence on the general health. BACTERICIDES. j-^^ Certain diatheses, such as the gouty and rheumatic, appear more hable to these attacks. Besides polypi, such conditions as hypertrophied mucous membrane, foreign bodies, and chronic catarrh may induce attacks of asthma, neuralgia, cough, migraine, hay fever, brow-ague, and certain vaso-motor phenomena, such as temporary redness of the cheeks and nose, giddiness, rhinorrhcea, and even epilepsy. We consider that the posterior portion of the middle and inferior turbinated bodies, with the correspond- ing part of the septum, are the seat of these disturbances ; whereas others consider they can only take place after the an- terior part of the lower turbinated body has become turbid. The duration and frequency of neurosal attacks are very vari- able. Sometimes patients may remain free for months : but, on the other hand, the attacks may recur frequently, and continue intermittingly till removed by suitable treatment. As a rule, the prognosis is favorable. The treatment will consist in removal by operation or medical treatment of the exciting cause. Cocaine in powder or solution, mild electric currents, inhalations, sprays, with internally, quinine, iron, arsenic, or bromide of potassium have in my own practice proved at times very beneficial. Douches of boroglyceride solution, alternated with resorcin, ot great utility. Characterized by a constant and dis- Neuroses of the tressing erection of the penis. Penis. It may be due to some injury of the (Priapism}) spinal cord, as fracture, concussion, occur- ring at the lower portion of the dorsal or upper lumbar vertebrae, or at the origin of the nerves in the brain; subacute inflammation of the corpus cavernosa, or effu- sion of lymph or blood into that structure. Both conditions may be caused by venereal excesses, or masturbation ; that is, effusion may take place into the corpus cavernosa from the irri- tation of the hand, and the irritation is transmitted to the spinal cord and brain, the reflex centre. Treatment. — If due to fracture of the spinal column at the point mentioned, or disease of the brain, all that can be done is to afford relief until the cause is removed, if it is possible ; when due to masturbation, if the practice can be discontinued, a cure is usually effected. Our chief dependence is to be placed upon large doses of tincture of the green root of gelsemium, with bro- mide of potass. The dose here must be large and carefully regu- lated. The gelsemium, in doses of from thirty to sixty drops every three hours in divided doses, so as to watch it. The bromide, in from thirty to sixty grains during the same period, y.Q DISEASE GERMS. with a few grains of bicarbonate ; it may be given at one dose. At the same time, suppositories of belladonna and camphor, this could be followed up by a long and persistent course of adminis- tration of the fl. ext. black willow. If due to effusion in the corpus cavernosa, arniqa lotions and iodoform suppositories are of utility. ^V Diet regulated. Cold is sometimes of utility to pehis, or ice to lumbar portion of spine. There is little good in camphor, coca, Indian hemp, lupulin, etc. A course of vegetable altera- tives and tonics should always be resorted to. is most pievalent, and may exist from a Neurosis slight irritation, to a grave interstitial in- of the flammation, with atrophy and impotency. Prostate Gland, a deficient prostatic secretion, as well as an absence of spermatozoa — a state insep- arable from sexual neurasthenia — one that requires (in addition to the genera' treatment) the long continued use of the saw pal- metto, a nutrient tonic, a promoter of glandular growth, rnost efficacious in wasting or atrophy of the testes and prostate. This remedy persevered with, in connection with general treat- ment, will restore those glands to their original integrity and size, even after they have shrunk into nothingness. The restora- tion of those important glands to their pristine condition rejuve- nates the whole man ; the pitch of the voice is strengthened, the masculine elements are built up ; vitality recuperates itself, and the man is as it w^ere born anew. Saw palmetto and kephaline are the necessities of our age and our clime, we must not forget it, nor permit our condition to ignore it. The object of medical science is to Neuroses ameliorate suffering, and prolong human of the life, as such it is necessary to examine the Sexual Appetite, causes at work that give rise to chronic inflammation, with enlargement of the prostate gland in 85 per cent, of all Americans over fifty years of age, and in numerous instances much earlier, even at thirty. The causes at work are bicycle riding, horse-back exercise, sedentary avocations, vicissitudes of temperature, cold, wet, gouty diathesis, gonorrhea, gleet, strictures, introduction of bougies, strong injections, masturbations ; unnatural methods of coition, as dalliance, withdrawal, use of condums, prolonged intercourse, falls, blows, running, jumping, prolonged retention of urine and BACTERICIDES. 741 excesses of all kinds, the tear and wear of life, the struggle, the tension due to a highly civilized state, worry, etc., damages the sympathetic, which is so freely distributed over the anterior sur- face of the genital organs, and in itself gives rise to aching at the neck of the bladder, and loss of the vital fluid at stool, and en- largement. Chronic inflammation of the prostate, enlargement, and other morbid states are inseparable from impotency. Impotency, partial or complete, resolves itself under the fol- lowing divisions : Failing power, with slight deficiency of desire and capacity. Deficiency of capacity, with increase of desire, blended with spinal anaemia, seminal emissions or oozings. Profound deficiency of both desire and capacity, power of erection weak or wanting, penis usually cold, benumbed, testicles shrunken or wasted, prostate hypertrophied. An abnormal increase of erectile power, with or without wast- ing of the enumerated tissues, and no discharge of seminal fluid. No two cases are alike, nor can they be treated in the same manner. Each individual case requires a special treatment of tonics and alteratives, and besides these a special course, involv- ing electricity, nux vomica, ergot, damiana, iron and kephaline or brain food. This latter is essential to brain life and activity. The majority of our people have thin brains, under-fed; as a re- sult, brain vitality is feeble, the organ suffers from impoverish- ment, hence impotency, national effeminacy. All cases of lost sexual power are benefited by coca, in some one of its varied forms ; coca strengthens, exhilarates, sustains, refreshes, aids digestion imparts new energy to the worn-out or exhausted genital organs, excites to healthy action ; besides it is a specific for all nervous complaint^, as headache, neuralgia, wakefulness, loss of memory, tremors, loss of appetite, depres- sion of spirits. To every impotent man there are elements of strength, of vitalization in coca, as it increases brain nutrition. No matter what the cause of impotency may be, kephaline and coca possess the necessary qualities for curative treatment, by causing a full and continuous supply of nervous or vital force. This brain essence increases the nutrition and growth of the marasmic, atrophied, or wasted genital organs, restores them to their pristine vigor, their full natural size. Saw palmetto is indicated whenever wasting of glands has taken place. Administered internally and applied locally either in the form of an ointment or suppository. Electricity, applied for half an hour each application ; thrice weekly. 7^2 DISEASE GERMS. This is a condition characterized by ex- Neurosis of the aggerated sensibility, unattended with Skin. structural changes. It may be either idiopathic or symptomatic, general or par- tial, unilateral or bilateral, variable in degree or intensity. . In very mild cases, there is merely an unusual sensitiveness of the cutaneous surface to the contact of foreign bodies, a waft of wind, the passage of a feather, even some kinds of clothes may give rise to intolerable uneasiness, or be a' reflex manifestation or warning of some nervous disease or explosion of nerve force, as chorea, epilepsy, hysteria, tetanus, paralysis. Its chief manifes- tations are itching and pain. Active symptoms of cutaneous congestion give rise to heat, formication, tickling, dripping or pouring of liquids. Pruritus is essentially a neurosis, a functional disorder of the nerves of the skin ; a state in which the sensient nerves are teased, altered, irritated or otherwise damaged, characterized by itching. The causes which give rise to pruritus are disease germs in the blood, as the presence of the microbe of syphilis ; the bacilli of tubercle ; the germs of carcinoma, malaria, variola, etc., or the fungus of diabetes ; most common reflex causes are disturbance of the alimentary canal due to intestinal worms; hemorrhoids; genito-urinary disorders of both sexes ; dietitic and medicinal agents, depressing passions, mental distress, etc. All forms of neurosis of the skin should be treated by sooth- ing applications. A peculiar nervous disease that attacks Neurosis of the both sexes, but especially females between Spinal Cord. puberty and cessation of the menses. It {Hysteria.) consists in peculiar, nervous hyperaemia, which occurs in paroxysms, and simulates other diseases. Causes. — It is, or has been, caused by some irritation of the genito-urinary organs, as exciting the sexual organs to irritation by works of fiction, lascivious thoughts, luxurious living, seden- tary habits, causing congestion; heated rgoms, ti^jht lacing; undue excitement of sexual organs, masturbation. The sympa- thetic nerve covering the front of the uterus is often involved, so that depressing passions may be regarded a: a cause ; besides, it is a general symptom in all uterine diseases, and is thus caused. The patient commonly is of a nervo-sanguine temperament, with a weakened reflex centre, involving both cord and bulb; and there is, or has been, an irritation in or about the uterus, which BACTERICIDES. 743 is, or has been transmitted to the seat of reflex action. It is a genuine nervous malady, of grave importance. It is not neces- sary for a cause that there should exist present irritation ; it may have been twenty years ago, but it has left an indelible impres- sion on the centres that is easily roused into action by the slightest nervous ruffle, or tire. Symptoms. — The common characteristic symptoms are convul- sive movements of the trunk and limbs ; beating of the breasts with clenched hands ; or tearing the hair or clothes ; shrieks, screams,, violent agitation ; a feeUiig of suffocation, as if a ball was in the throat (globus hystericus); the attack probably ending in an out- burst of crying, sobbing, or laughter, or hiccough. The patient may fall to the ground insensible and exhausted ; soon recover- ing, tired and crying. The urine is of a low specific gravity,, loio, or even less, and may be passed involuntarily during the excitement. The portion of the cord down to where the sympa- thetic emanates is chiefly weakened, consequently we find organs supplied with spinal nerves from that part exhibiting or simulating disease, as loss of voice, cough, pleurisy, consumption, paralysis, suppression of urine and affection of the lower parts. Passive paralysis may take place ; even increased sensibility of the parts supplied with special spinal nerves, as tenderness of uterus, ovaries, and even loss of sensibility may take place. The appe- tite is generally diminished ; still it may be increased, or even depraved, the most extraordinary substances being craved and eaten. In some cases the expression of the countenance is peculiar : fulness of the upper lips ; drooping of the upper eyelids. Abrupt in manner. The menstrual flow usually irregular, and there is generally leucorrhoea, or some uterine trouble. Symptoms are not always feigned ; they may be exaggerated, but there is a real morbid condition at the base, and that may be a nerve prostra- tion, or nerve tire, from some old disease. A not uncommon form of hysteria is where they take to the bed. They are lan- guid, cheerful, have good digestion, hut lie in bed, and greatly appreciate the attention of kind, sympathizing friends. They are fully convinced that their disease is of the most serious charac- ter, and involves the spinal cord or womb. Menstruation may be normal, or there may be endometritis, with leucorrha^a, or some form of displacement, or perhaps coccygodynia. Any defect must be rectified, and the case managed on the general treatment. Many of the confirmed invalids scattered far and wide over the the country, who have been to one doctor and then another, and subjected to all kinds of uterine medication, mechanical and 7'H DISEASE GERMS, Otherwise, with no lasting improvement, and have become chronic sufferers, a burden to themselves and families, have had originally- uterine mischief; for we cannot minimize the local irritation on the general health, but the cases have drifted from their original condition. The pain, the backache, the leucorrhoea, the uterine partial death, the difficulty in locomotion, the disordered men- struation, which are the usual attendants, have ended in a general disturbance of all the bodily functions. The nervous system is profoundly affected, the blood impoverished and the general nu- trition at the lowest ebb. After the disease has become confirmed, or chronic, there are a few prominent symptoms that are well marked. One of the most common is wasting of the fatty tissues of the bod}^, com- bined with anaemia, loss of appetite. Associated with this we often find chloral, morphia or stimulants resorted to; exercise is abandoned, and the patient becomes confined to the house or bed. Her vitality is at a low point ; her emotional or hysterical condition craves sympathy, and the whole household becomes victims of her morbid selfishness. Same treatment as for neurasthenia. An altered condition of the nerves that •Neurosis of the supply the mucous membrane and sphinc- Vagina. ter muscle of the vagina. An irritable, ( Vaginismus.) spasmodic condition of the sphincter muscle of the vagina, with such excessive sensitiveness of the parts and of the surrounding tissues as to form a complete barrier to coition. It may exist in various forms or degrees. In some cases, it is a mere tenderness, or increased sensibility ; in other cases, the sensitiveness is great, amounting to a distress, or severe agony, the slightest touch giving intense pain. This super-sensitiveness is due to a pure neurosis from altered nutrition, and we can find nothing tangible to account for it ; or the cause may be clear, as some irritation, which causes inflammation of the mucous fol- licles above the vulva, and spasm of the muscular fibres ; a true closure, or tonic spasm of an involuntary muscle. What the irritation may be that gives rise to this is somewhat varied. There are various examples of spasm, or contraction, to be found in the uterine appendages ; for example, irritation of the clitoris causes contraction of the uterine horns; irritation of the urethral orifice causes contraction of the fundus of the bladdeh In the largest number of cases of painful or difficult connection, the trouble is not discovered until sexual intercourse is attempted, BACTERICIDES. ^ac and then the mere touching of the parts throws the woman into a paroxysm of intense agony. In the more simple forms, nothing cin be detected in the lady to lead us to suspect its existence. It may even come and go, • and its coming and going has nothing whatever to do with the sexual appetite, because it is not necessary for conception that a woman should have sexual desire. Women affected with pain- ful connection may conceive and have a child, and the birth of the infant may not cure the disease; but it generally happens that the great distension and laceration of the vagina causes it to become less. In a large proportion of cases the true condition is found, in newly married women, in a redness, or fissure, at the anterior margin of the perina^um, or in the fossa navicularis around the hym.en. In some cases a true ulcer or an imperfectly ruptured hymen with ulcer which may heal and break out again and again and form little hypertrophies at seat of hymen, which are intensely tender and irritable. These ulcers are of a lupoid or eczematous character generally. It is only when pain and sensi- tiveness exists, and are extreme without textural difference that • the condition may be said to exist In all cases the patient should be placed upon a general alter- ative and tonic course of remedies, as comp. saxifraga ; aleteris cordial ; glycerite of kephaline ; avena sativa. Vaginal injec- tions of either boroglyceride, creolin, resorcin, naphthaline,, are of great benefit, much superior to lime-water and tincture of iodine, or bicarbonate of soda and gelsemlum. Cones prepared from boroglyceride and cocaine, rarely fail to effect a radical cure. Pastiles of boric acid and cocaine are also excellent. There may be a neurosis of every or- Neuroses ot gan of the body. Various Organs. Neurosis of the bronchi, very common in our latitude, and the affected regard the weather as a natural foe, their bodies are a subtle meteorological machine, they keep in a warm room for long periods, become additionally enervated. No exercise, thus the liver is deprived of its proper stimulus. The bronchitis is a bronchorrhoea. There becomes engrafted in the brain a decided hypochondriasis. Neurosis of the stomach, manifests itself under a general condi- tion, technically termed dyspepsia, which arises from deficient brain elements, so that the microscopical cells or bladders which profusely cover the lining membrane of the stomach are scantily 746 DISEASE GERMS. or deficiently filled with gastric juice, and other acids essential; a brain failure reduces this active living principle so indispensable for chylification to a minimum. In such cases the avena sativa, from oats, and kephaline, with some bitter tonic, will supply the stimulus until the neurosis subside. Neuroses of the teeth, due to the want of phosphates in the food, which early give rise to tooth-starvation, caries of the teeth, overcrowding of the teeth ; abnormal state of the gums preventing their egress ; the presence of disease germs in the mouth. This is. a peculiar condition of the nerve Nightmare. centres, consisting in a true anaemia of the {Iiiaibj^s) brain and sympathetic system. It is impos- sible to locate it precisely, although the co- ordinating chemical centre at the base of the brain is chiefly affected. The exciting causes are indigestion, debility, late and heavy suppers, great fatigue, worry, over-study, breathing impure air, sewer gas, badly ventilated room, intoxication, sleeping on back, food indigestible, anything that would be likely to load the blood with any impurity. Syj}tptoins.—ThQ patient in sleep feels an oppression, a weight about the stomach and breast ; he groans, is in great distress, dreads suffocation ; he fancies himself in imminent danger, and tries to escape, but cannot move ; he imagines himself about to fall over a precipice, to be drawn into a river, or eaten by wild beasts, or consumed in a burning house, etc. Treatment. — The affected person should eat a very light sup- per or none at all ; keep the mind free from care and anxiety ; no study ; have a well-ventilated room to sleep in, free from gases, growing flowers ; must sleep on right side ; have a daily bath and massage; bowels to be well regulated and abundance of exercise in the open air. It is to be looked upon as a true condition of cerebral debility, so the diet is to be essentially of a brain-nourishing kind ; oat- meal porridge, boiled white-fish, animal food, steaks, chops, poultry, eggs, corn bread, fruit and vegetables. He must eat no pies, pastry, cabbage, nuts, salted meat or fish, nor any red fish, like salmon, for that abounds in oil, and, although very stimu- lating and nutritious, is heavy and does not agree well with a weak stomach. As remedies, glycerite of ozone, kephaline, aromatic sulphuric acid and quinine, and other tonics. BACTERICIDES. 747 The accumulation of fat a non-vital element, Obesity, under the skin, around the viscera on the posterior abdominal walls, constitutes what is termed obesity. It must in no instance be confounded with what is termed fatty degeneration. There are certain conditions, aside from heredi- tary, which give rise to it, as indolence, prolonged sleep, over- eating ; the consumption of large quantities of fluid ; the exces- sive use of fatty, farinaceous, saccharine foods, malt liquors, an avoidance of care, worry, anxiety. Obesity is not by any means conducive to longevity, as the increase in weight and bulk impedes the working of vital organs Hke the heart and lungs, as the presence of fat diminishes both mental and physical activity, disturbs respiration, circulation and digestion ; greatly affects the elaboration of the blood, causing it to become deficient in vital elements. Usually the victims of obesity suffer from gout and neuralgia. Partial obesity, as fatty tumors, fat around the heart, fatty omentum, is common. In the removal of fat from the body, the first thing which should be attended to is the regulation of the diet, which should consist of meat, white-fish, green vegetables, biscuit, dry toast, tea without sugar, at the same time forbid as much as possible all articles which contain starch — potatoes, puddings, beets, beans, peas, bread, milk, butter, broths ; moderate exercise, and if patient can afford it, horseback exercise. Bathing should be resorted to daily, it should be alkaline and followed by the most thorough massage for over half an hour. Sleep must be restricted to six hours out of the twenty-four. Bowels stimulated by salines to two evacuations per day. The medical treatment to get rid of fat are few but reliable. The best is unquestionably the fluid extract of the fucus vesicu- losis, a bactericide of some power, from the fact that it is highly charged with dioxide of hydrogen, iodine and bromine. From one to two teaspoonfuls administered thrice daily in water, regulating the dose by the loss sustained by the patient, one pound per week being about the proper amount. Other remedies, as liquor potassa, iodide potass, are very apt to give rise to irritation of the stomach. Of 1000 cases, one-half men, the other Old Age. women, between seventy and ninety years of {Its Maladies) age, the immunities from disease and failure of particular organs are in favor of the women. Affections of the urinary organs preponderate in men, being more than twice as frequent as among women. Brain affections are more common in men. 748 DISEASE GERMS. Bronchitis is the dominating malady, and superadded to it, debility. It is the most frequent malady at all times of life. In the aged it is persistent, increases gradually with enfeebled circu- lation and general weakness. The demands on the activity of the respiratory functions are diminished in the aged in propor- tion to the diminished activity of the nutritive and other pro- cesses. Heart, some irregularity and intermission of pulse, attributable to atheroma and calcareous degeneration. Brain affections are the most remarkable, passing attacks of unconsciousness, a suspension of cerebral activity, with no per- manent diminution of mental power. Motor power impaired. We are often astonished to find grave attacks in the aged, not infrequently recovered from. While considering this point we do not forget that in the aged person the brain is gradually and progressively shrinking, and the interspace between it and the skull caused by this shrinkage is being filled by fluid effusion in the sub-arachnoid or pia mater tissue ; and there may be temporary irregularities and imperfec- tions in this compensating adjustment of pressure of fluid on the surface and of the blood circulating in the interior, which would to some extent account for these cerebral attacks, and also for the recoveries from them. The senile alterations in the arterial coats must also be an important item ; but our knowledge of the physiology of the cerebral circulation is at present scarcely suffi- cient to enable us to make clear deductions respecting its path- ology. In only 1 1 out of the 340 returns of men between 80 and 90, and in only i of the 92 returns between 90 and 100, is prostatic disease said to have existed \ in one of these it had existed sev- eral years, and in others two, three, and four years respectively. In one the affection is said to have given less trouble than for- merly. The condition of retention relieved by frequent use of the catheter may be extended with care over many years ; but the enlargement of the prostate, with its associated bladder-symp- toms, is, I fear, a malady from which recovery; even in old age, is scarcely to be expected. It is something to find that our re- ports confirm the view that it is a malady from which age gives, after 70, a gradually-increasing exemption. Fifty-two were troubled with rheitmatism in some of its many forms, which include pains in the limbs, aching in the bones, etc., for which, I suppose, a remedy is not very easily to b: found. Indeed, it is difficult to define precisely, or clearly account for, the various pains, rheumatic and other, which old people often complain of, and which disturb their comfort without materially BACTERICIDES. y^g affecting their health. The women suffer from these even more than the men, probably in consequence of the nervous system in them being more on the alert; 5 of the men and 6 of the women had gout, all these being between 80 and 90. Two cases of se?ii/e gangrene were noted. They were in men above 90. The severe forms of malignant disease are rare. One man, above 80, had rapidly advancing sarcoma of the shoulder ; 5 women, between 80 and 90, had cancer of the breast ; 5 men and I woman had epithelioma ; and i man and i woman had rodent ulcer. None of these maladies are mentioned in the men or w^omen above 90. Still, although the very aged appear to be less liable to some of the more severe diseases, such as cancers and diseases of the urinary organs, they are, on the whole, rather more liable to the ordinary maladies, the proportion of those above 90 who were altogether exempt from malady being 34 per cent., while the proportion oi those between 80 and 90 was 43 per cent. With regard to the eyes, 8 per cent, are stated to suffer from cataract, 80 per cent, are said to have good sight, although 83 per cent, use glasses. Some have used glasses for many years, which is confirmatory of what has been stated regarding cen- tenarians, that "the occurrence of presbyopia does not seem to be associated with, or to be a prelude to, inconvenience or im- pairment of sight beyond that which may be corrected by glasses."- The more frequent failure of the organ of hearings which is noted in more than one-half (56 per cent.) of the returns, is probably due in great measure to the liability to impairment of the delicate mechanism of the middle ear — the tympanum with its membrana tympani, its ossicles with their joints, its muscles, its eustachian tube, and its lining membrane — in consequence of colds, shocks, and a variety of causes. But in comparing the organ of hearing with that of sight, in this respect, we must not forget that the lessening of elasticity and muscular activity — which we must assume to induce defects in hearing in old persons corresponding with the visual defects classed under the term presbyopia — does not, like the latter, admit of alleviation by an early applied physical apparatus. At least, nothing correspond- ing to the portable and convenient lenses for presbyopia has yet been adapted to meet the auditory defects which may be attrib uted to a presbyotic condition. In 4 per cent, only is the digestion said to have been bad. In 71 per cent, it is reported as good, and in the remainder moderate. Very few were troubled with constipation. In 62 per cent, the j^O DISEASE GERMS. appetite is reported to be good ; and by far the greater number are stated to be good sleepers. I am continually seeing and hearing of instances confirmatory of the inference as to the reparative powers of the aged after fractures, wounds, and ulcers, which were based upon the returns furnished in reply to collective investigation inquiries. These inferences are so contrary to preconceived notions, indeed, to probabilities, that it takes some time and effort and frequent repetition to obtain for them a fair measure of acceptance ; but I think the reparative powers of age are becoming more accredited, and that we shall ere long cease to have age adduced as a reason against the hopeful, and therefore careful treatment of fractures, wounds, and sores in the. octogenarian, the nonagenarian, and even in the centenarian. What is even more remarkable than the healing powers of the aged after local lesions are the reparative powers evinced by them after illnesses, as shown by numerous examples of those between 80 and 100, and also by some of the centenarians. Indeed, the recoveries from severe attacks of bronchitis, pneu- monia, apoplexy, and paralysis indicate the reparative powers after illness as well as after accident to be among the most inter- esting of the senile features. It is certainly strange that, when the other nutritive forces are failing — wearing out, as it were — those which are concerned in the work of repair, which m.ay be regarded as, next to development, the highest effort of nutrition, should hold their ground so well. Instanced some other condi- tions in which the same contrast is observed, notably that of the healing of the stump after separation of a part following gangrene senilis, where the structures next to those which .were unable to maintain their vitality at all often evince so much granulating and cicatrizing energy. High breeding in most animals conduces to a marked diminu- tion in the bodily recuperative capacity ; also that the higher bodily recuperative capacity shown to be possessed by all men living in a rude state, whether in the form of savages or in the gypsy or tramp wanderer among ourselves, arises from the fact that the refining influences of civilization materially diminish the animal recuperative capacity. We are familiar also with the great reparative powers exhibited in some of the lower animal forms as compared with those in the higher animals. It would seem that the greater sensitiveness — that is, irritability or suscep- tibility of the nervous system and of the tissues generally — which is associated with higher organization, where we may suppose the balances of nutrition to be most delicately swung, are, in a measure, unfavorable to reparative work. We can quite BACTERICIDES. 751 conceive that the calm, quiet processes upon which it depends are less likely to proceed in an orderly and uninterrupted manner under conditions of high excitability, where stimulus easily engenders disorder, than under lower vitality and less suscep- tible circumstances. Herein, possibly — namely, in the lower and slower excitability of their tissues — may be found an expla- nation of those recuperative powers of the aged to which I have referred, and of which it is practically important that we should take due account. The first cranial nerve is not of such vital im- Olfaction. portance as the auditory, or optic. In the Cau- casian, it may be said, to exist in a refined but very rudimentary condition ; whereas in the colored races it is peculiarly large and well developed, probably two-thirds greater than in the white. In animals, and some fishes, as the shark ; it is immense in the latter, being reflected over twelve square feet of mucous membrane. The peculiar structure of the cavity of the nose shows that there is one nerve for sensation and another for olfaction — that the lower portion of the nose possesses epithelial cells ; the upper portion pigmentation, the latter lying in grooves. In ordinary quick breathing little air enters these olfactory chan- nels, for most of it passes through the posterior nares into the pharynx. If we desire to smell keenly, we instinctively resort to the use of the dilator muscles of the nose, whereby the olfactory channels or grooves are opened or enlarged. This nerve gives us protection against poisonous gases, but does not in all cases prevent their absorption, although not near so active as the salivary glands of the mouth. The specific stimulation of the olfactory nerves are, odorous gases, scents and odors of flowers, which come in contact with the flattened-out ends of the olfactory, causing a peculiar vibra- tion in the molecules of the nerve, which is transmitted to the brain, where it is appreciated. The sense of smell is often lost in catarrh, polypus in the olfactory channel, also, in injury to the head or nose ; disease of brain may exalt or destroy smell. In- flammation of nerve is rare. The nerve may be absent or but very rudimentary, or it may be covered over with lymph, or de- stroyed with ulceration ; and owing to these states, there may be an entire absence of smell, anosmia; or from a high state of nervous development the sense may be very keen, excessively sensitive hyperosmia. Functional disturbance of the fifth nerve is very rare, but when it occurs, it gives rise to anaesthesia of the mucous membrane. y^2 DISEASE GERMS. The most pungent odors are not perceived, nor do they give rise to sneezing. The treatment of most use are alteratives and tonics, with mild electrical currents. Hypersesthesia is more common, chiefly due to reflex irrita- tion, nasal irritation, itchiness, caused by tape-worms, ascarides. Anosmia, or loss of smell, may be complete or only partial ; in one nostril or in both ; and congenital or acquired. A variety of causes may produce either total or partial anosmia, such as ab- sence of the olfactory bulbs, injuries from blows, or compression or concussion of the brain, cerebral tumors, and insufficient nu- trition of the mucous membrane, or excessive dryness of the same from paralysis of the fifth nerve. P'.ralysis of the seventh may also affect smell by paralyzing the dilator and contractor muscles of the nose and the orbicularis of the eye. Any cause which prevents ocjors entering the olfactory portion of the nose will also have the same effect, e. g., polypoid tumors, hypertrophy of the mucous membrane, perforation of the septum, or presence of foreign bodies. To these may be added dryness of the Schneiderian membrane, careless or excessive use of the nasal douche, inhalation of excessively strong vapors, snuft^-taking in excess, over stimulation of the olfactory nerves, and some authors add, absence of pigment. The prognosis is not very favorable unless the cause, such as polypi, foreign bodies, or unhealthy mucous membrane can be removed. The treatment should be alterative and tonic, chiefly cerebral and spinal tonics. As far as our present knowledge goes, there are only two reme- dies which have a decided and antagonistic influence on olfac- tion. Strychnine will exalt, while morphia will impair and deaden it. Strychnine rubbed up in some inert body and used as a snuff, or taken internally in suitable doses, wonderfully increases the keenness of the sense; the snuff is the most effective. It acts so well that it causes a sensitiveness to pungent odors, almost amounting to pain ; whereas, morphia confuses the appreciation of odors to such an extent as to produce a kind of chaos. The olfactory nerve is narcotized, and odors appear at an enormous distance. Other remedies possessing analogous properties have a lesser influence; belladonna causes dryness, and pilocarpin the opposite state; both conditions unfavorable for good smell. The prolonged use of the* ozonized wine of erythroxylon coca leaves exercises the same salutary action on the olfactory nerve as it does upon the nerve of taste and vocal chords, being a true vitalizer of all the senses. BACTERICIDES. 753 Othsematoma, {Sanguineous Tumor of the Auricle}) Othaematoma, or sanguineous tumor of the external ear, is, with very rare- exceptions, solely met with amongst those affected with cerebro-mental dis^ and has hence been termed "the ease^ insane ear. Nature and Appearajice. — Othaematoma consists of an effusion of blood from the perichondrium investing the cartilage of the auricle, appearing as a tense and shining tumor of a reddish-blue or livid color, varying in size, and occupying some portion of the concavity of the organ, rarely forming on the posterior convex surface. One such case has, however, come under my observation ; here, however, the tumor was not confined to this region. When Othaematoma in the acute or primary stage. Tu- mor of moderate size filling up the cavity of the concha ; full and rounded above where it is bounded by the ridge of the antihelix, being lost below iu the lobule. Result: Disappearance with but little subse- quent deformity. Othsematoma in the acute or pri- viary stage. Tumor of moder- ate size occupying the entire cavity of the auricle, and oblit- erating its ridges and hollows. Surface uneven, and in parts of a plum color. Result : Slow absorption, with extreme con- traction, and finally the almost complete distortion of the au- ricle, and obliteration of its several component parts. it commences in the concha, the tumor is generally localized above, and externally by the ridge of the antihelix, and extends inward toward the meatus externus, which it may occlude, causing deafness according to the degree of occlusion. In this situation the tumor presents itself as a smooth, and usually even swelling, about as large as a pigeon's egg ; when the fossa of the helix is the site of the effusion, it is confined below by the ridge of the antihelix, and the sweUing then assumes a somewhat kidney- shaped outline. In exceptional cases the tumor becomes extended over the en- 48 yq4 DISEASE GERMS. tire surface of the auricle, and when this is the case, the various iridges and cavities become wholly obliterated, the hollow of the ^ar being filled by an egg-shaped swelling, fuller above, and losing itself inferiorly in the lobule, which is never implicated. As to the etiology of the affection various theories have been advanced. One of the best : " Under the influence of this profound disturbance of the •economy, there occurs a ramollissemeJit which plays a considera- ble part as a predisposing cause in the production of sanguineous tumors." M. Bonnet is of opinion that the sanguineous .tumors of the ears are veritable congestive apoplexies due to degenera- ■ tion of the sympathetic, which results in turgescence of the ves- sels of the ear, and, as a result, the apoplexy is produced. " The formation of sanguineous tumors of the auricle is most often preceded and accompanied by a general disturbance of the cephalic circulation." Pathological Appearances. — The morbid appearances presented by the shrivelled ear differ according to the age of the formation. When a few months old a fine section under the microscope showed it to consist of somewhat loose fibrous tissue with de- posits of fine hyalin cartilage, and a little within a centre a trian- gular-shaped mass of bone containing wide channels with lacunae and canaliculi. The condition of the ears here, as I have men- tioned, was of very long standing, and between this and the or- ganized clot of the earlier stages I noticed fibrous tissue and V cartilage in varying degrees of development. Forms of Mental Disorder in which Othcematorna Occurs. — ^IDthaematoma is not confined to any one form of insanity ; it has feeen found in mania, melan^cholia and dementia, but it occurs most frequently in general paresis, and insanity associated with .epilepsy. In the treatment of such cases, there is considerable difficulty. In some few cases indeed, where, on other grounds, a hope of final recovery from the mental disorder exists, and when it may be important to prevent the possibility of the after deformity which will in all probability result if the swelling be allowed to run its course undisturbed, the aspiration of the sanguineous effusion may perhaps be attempted, and an endeavor be then made to induce rapid and equal adhesion between the cyst walls. \ Painting the surface of the tumor with vesicating fluid has been also s suggested, and I believe tried successfully in several cases, though as far as I am aware it has not come into extended use. BACTERICIDES. 755 Otomycosis. {Aural Fungus, Aspergillus Nigrans.) Vegetable microscopic organisms are found in the outer ear. In the etiology of otomycosis the favorable character of the external meatus for the growth of fungi and schizomycetes has to be remembered. The partial occlusion of the canal in ordinary healthful states of it by hairs and cerumen, its shape, the temperature of its walls, the presence of moisture, at once strike us as affording in it a favorable situation for the generation and development of micro-organisms and the occur- rence of fermentative changes. In the limited supply of air, in the heat and moisture, we have the most important elements of fermentation. The further tendency to otomycosis and the de- velopment of parasitical fungi is increased by the nature of the substances introduced into the meatus. It is chiefly with the object C^ Aspergillus nigrum ; mag- nified 400 ; the first ap- pearance of the fungi in the ear. Aspergillus nigrum ; magnified 400 ; second staee ; fruit stalks or frurtifer: us hyphens; the mycelial filaments ; the sten- igmata on the free ends are the spores. Aspergillus nigrum ; full-grown spores; unripe fruit stalks: the ripe aerial fruit; fully- grown spores literally drop oflF in myriads. of preventing the possibility of the dissemination and engrafting this very painful and obstinate cjisease upon the community at large, that we call attention to it. In a great number of cases the affection is provoked by the introduction of an oily substance into the external ear, such as olive oil, oil of almonds, etc., at times lard, balsam, or pomade. In employing these oily sub- stances, it is not sufficiently remembered that they all undergo rapid decomposition once they remain exposed to the atmo- sphere, even at an ordinary temperature; how much more so at the more elevated one of the auditory meatus. Oils contain in solution azotic substances which, under the influence of the oxygen of the air, provoke special fermentation, becoming ran- cid. This raises the temperature rapidly ; the neutral fatty mat- ters contained in the oil are changed into glycerine and fatty acids. Thus the spores of the musty fungi, which are abundant, are provided with all that is necessary for their germination', 756 DISEASE GERMS. viz., oxygen, watery vapor (in the air), sufficient heat, organic decomposition, and the acidity which favors their development. The filaments of the mycelium grow rapidly. The acid pro- ducts of the decomposition on the one hand, and the vegetable foreign body on the other, irritate the ear and set up this inflam- matory process, causing the watery secretion, and exciting the formation of the organic azotic substances that are so easily as- similated by these cryptogames. Various astringent lotions in common use induce this fungus. The presence of cloudy collections of mycelia and spores, which form in those solutions after being kept a few days ; bottles not carefully corked are often teeming with these fungus spores. The fungus when once generated in the ear, encysts itself in a flat oblong bag, completely closed on all sides. When the fungus has reached its maturity, completed its growth, it becomes encased in an oblong flat bag, closed on all sides ; it measured from 1 1/3 to i ;^ centimetres in its longest diameter (corresponding to the long axis of the meatus), and about one centimetre in one of the transverse diam- eters, and half a centimetre in the other. These measurements varied slightly in different cases. One of the flat faces was obliquely truncated at the end, and showed an exact cast of the membrana tympani. The color was yellowish-white in one case, light brown in the second, and whitish-gray, turning to a dirty brown, in the third. These bags were composed of mycelium, sporangia, free spores, and epidermic cellules. On examining such cases the otoscopic aspect is very puzzling, the growth entirely filling the fundus of the meatus, and hiding the membrana tympani. After removal of the bag, which is followed by great relief, the drumhead is found injected, and marked with white specks on a red ground. In nearly all cases we have small boils or fur- Otdrrhea. unculi in the ear. These are the result of a mi- crobe affliction, proceeding from the internal media, the invasion taking place by the cutaneous follicles. The successive appearance of furunculi is due to the migration of cocci. The micro-organisms most frequently is the staphylococcus, albus, aureus or citreus, all generally found in the boils. The correct treatment in all cases is anti-bacteric, which may abort the affection and prevent its occurrence. This is best effected by the ozonized oil of mullein dropped into the ear thrice daily. Before this is done the ear should be carefully syringed out BACTERICIDES. 757 with tepid one-per-cent. solution of the dioxide of hydrogen and subsequently the mullein oil dropped in ; by this plan of treatment the micro-organisms are destroyed. A chronic inflammation of the mucous Ozaena. membrane of the nose, characterized by (^Atrophic RJdnitis.) enlargement of the nasal fossae, and ac- cumulation in the enlarged cavities of crusts, having a peculiarly repulsive odor. The affection is so common and so serious that clear notions of its etiology, diagnosis and treatment are absolutely indispens- able. Not essentially dangerous to life, its existence is most dis- tressing, as the overpowering foetor of the breath renders their society a burden to friends and strangers, who both alike turn away from them. Such persons gradually become isolated. They dread meeting others, and often lead aimless and disap- pointed lives. Until a comparatively recent date all affections of the nasal fossae characterized by foetor were grouped under the generic term " ozaena." Improved methods of examination of the nasal fossae and diagnosis have, however, eliminated these errors, and have placed ozaena as a distinct symptom due to or associated with atrophic rhinitis. There need, therefore, be no difficulty in separating it from syphilitic, tubercular or trau- matic ulcerations of the nasal bones, which' are also attended with foetor. Etiology. — Among the causes which conduce to ozaena, con- stitutional dyscrasi^, such as tubercular or syphilis, undoubtedly hold a chief place. Most authors mention the influence of here- ditary syphilis, but this, though probable, cannot be considered as absolutely demonstrated. A debilitated or broken down state of the general health is also an important factor in the causation of ozsena. Among the large number of cases which I have seen in hospital and private practice, I cannot recall one in which there were not some traces of either anaemJa, chlorosis, scrofula, or inherited specific disease. According to some authors ozaena, and, therefore, atrophic catarrh, is a direct sequence, a more ad- vanced stage of hypertrophic rhinitis, or of ordinary chronic catarrh. This view is undoubtedly correct, as there is an evolu- tionary link between all three states. As regards the age of pa- tients, adolescence is the period when the disease is most com- mon. It is seldom seen in elderly persons, though I have known cases as late as forty-five years of age. The female sex is more liable to it than the male, in the proportion of nearly two to one. Amongst imrtiediately exciting causes of ozaena is the entrance 758 DISEASE GERMS. of irritating vapors or dust, especially if from any cause such as undue patency of the nostrils, absence of vibrissae, or a faulty direction of the nostrils, this entrance should be facilitated. Mal- formations of the bony framework of the nose, deviations of the septum, narrowing of the nasal passages, with obstruction to the removal of secretion, the relative smallness of the turbinated bones, or the disproportionate size of the nasal fossae, are all factors in the development oi ozaena. The symptoms are both subjective and local. Among the former, patients frequently complain of headache, pressure over the brows, impaired power of hearing, with noises in the head. Along with these there is often associated naso-pharyngeal catarrh, characterized by difficulty in swallowing, dryness of the throat, with a constant desire to clear it. There is, moreover, especially in children, a very characteristic type of countenance, exhibiting many of the signs of scrofula. The normal bones of the nose, instead of forming the bridge, are sunk below the level of the frontal bone, so that the nostrils are directed forwards instead of downwards. The general appearance is that of being intensely tubercular. Smell is either generally diminished or destroyed, so that pa- tients are not aware of their unpleasant odor. The secretion of the nasal mucous membrane is scanty, dries in the form of crusts or concretions in the nose, and are expelled by violent efforts. They are all colors, owing to the germ present, and aerial germs present. The crusts emit a pungent, nauseating odor of putre- faction, bacilliLS saprogcmis, pathogenic of the same odor which patients diffuse around them. The cause of this foetor has been by no means satisfactorily explained. According to some authorities it is due to the abnormally large size of the nasal fossae, whereby the force of the current of expired air — the air draught — is notably diminished. Another author, while partially adopting this explanation, con- siders that the secretions from the sphenoid and ethmoid sinuses are also at fault. In individuals with rudimentary inferior tur- binated bones the ethmoid is imperfectly developed, a fact which is in favor of this theory. Others consider atrophy of the mucous membrane and degeneration of the mucous corpuscles with pro- duction of fatty acids, as the cause of the fcetor. Other authors, on the other hand, believe it to be due to the presence of a specific coccus, formed by the union of the amoeba, bacillus sapro- genus pyogenes, tubercular and syphilitica, and others to a special ferment; while all see "in the physical and chemical changes of the secretion the condition necessary for the occurrence of foetor." BACTERICIDES. 759' The diagnosis is at once established by the pecuHar and charac- teristic odor which will be readily recognized, and cannot be mis- taken for the stench arising from a foreign body, diseased bone^ or syphilitic ulceration. Any strong disinfecting lotion will remove the odor of the ozaena, but not of caries or ulceration. Moreover, the atrophy of the tissues, coupled with the absence of ulceration of the mucous membrane, cartilage or bones, becomes distinctive and characteristic features. The prognosis is not hopeless, neither is it difficult to effect^ under bactericides and the cavities of the nose, to become normal once more. As far as the characteristic odor is concerned, it can be kept completely in check by suitable treatment, and using daily a douche of boroglyceride, resorcin or creolin. In the treatment of ozaena two distinct objects must be kept in view : destroy the various microbes and build up the general health of the patient. The former is best effected by the occasional use of the ozone et chlorine wash or douche, which will dislodge the crusts; as this is severe once a month will be sufficient for its use. Excel- lent bactericide lotions are made of boroglyceride, resorcin, creolin, thymol, benzoate of soda, distillation of jequirity, morn- ing and night. Sprays are very useful of glucozone, sulphur water, iodide of ethyl, oil peppermint. The improvement of the general health must be carried out on general principles, and such remedies as glycerite of kephaline, avena satina, matricaria, chloride of gold and hydrastis cana- densis. Kephaline combined with iron and strychnine most effec- tive. Change of air, seaside. Moreover the above treatment, as a whole, must be scrupulously carried out night and morning by the patient, for months, perhaps, in succession. With young girls the appearance of the catamenia often exercises an unfavorable influence on ozaena, aggravating both the discharge and the foetor. It is also a matter of observa- tion that in adult females, the odor is always most intense and obstinate just before or after the menstrual period. In all cutaneous diseases there is either a mi- Papulse. crobe, fungus vegetable growth, or parasite pres- (Lichcn}) ent ; with our limited knowledge of the habits of disease germs, we are unable to say why some micrococci cause a general erythema, why they swarm in patches, or seek the follicles, and form a papula. Lichen is a papular affection of the skin, with minute hard, red elevations, either distinct or scattered in clusters, with a 760 DISEASE GERMS. tingling irritation and slight desquamation. The contents of the follicle are usually microbes, either of mal-nutrition, or syphilis, or tubercular, etc. The following embraces the principal forms : 1. Lichen Scrofulous, or tooth rash, or red gum rash; pecu- liar to infants and young children, may appear on any part of the body. It is caused by derangement of stomach and bowels, and is characterized by an eruption of minute, hard, red, clus- tered or scattered pimples. 2. Lichen Simple. — Cause, mal-assimilation and bacteria; eruption red, inflamed papulae on face, arms, legs and body. There is itching, tingUng and fever ; in spring and fall will probably return. 3. Lichen Pilaris, or hair lichen, appears at the roots of the Siair in young persons, about puberty ; involves the hair sac ■and root sheath. The general cause is want of cleanliness, mal- nutrition, use of alcoholic drinks. 4. Lichen Circumscriptus , or clustered lichen ; patches ot papulae with well-defined margins, and irregular circular form. The eruption consists of rings and small groups of papulae, which tend to spread at their circumference into rings, the pap- ules forming a bright, well-defined margin, while the skin in -centre is yellow, owing to spores of a fungus. 5. Lichen Agrius, or wild lichen. Usually a severe form; rigors, nausea, fever, slight erythema, with the papulae upon the inflamed base. In a short time inflammation subsides ; skin peels off; papulae exhibit intense itching, tinghng ; their points become scratched or rubbed off, and cracks or fissures form, which are painful, and discharge a sero-purulent fluid. 6. Lichen Lividus. — When the eruption has a purple, or livid iiue, and is not accompanied with fever. 7. LicJien Solaris, or prickly heat ; due to exposure to heat, 'l)efore system has become acclimatized. 8. Lichen Urticatus, or nettle lichen. Skin presents the ap- pearance of wheals, like those produced by bugs, gnats, mos- •quitoes, etc. The wheals subside, and leave papulae, with itch- ing, pricking, tingling. In the treatment of all papular eruptions of whatever form, the condition of the stomach, bowels, diet, bathing, merit close at- tention. Comp. tincture cinchona and matricaria for the stomach ; bowels opened with the cascara sagrada lozenge ; alcoholic vapor bath twice a week, otherwise alkaline baths. If there be fever, aconite and serpentaria. Plain nourishing food, forbidding shell- fish and drinkingr water from a calcareous base. One of BACTERICIDES. 76 1 our best remedies here is the lycopodium tincture ozonized, in ten to twenty-drop doses every four hours, keeping the bowels well regulated. A partial or complete loss of sensibility, or of Paralysis, motion, or of both, in any part of the body. It is said to be perfect or complete when both sen- sibility and motion are lost ; imperfect when one or other is either lost or diminished. The term local is used when a small part of the body is affected, as a limb or hand. It is termed re- flex, when it commences in the periphery of a nerve, and is re- flected to its origin in the spinal cord, and from thence reflected back to the muscles. There are, in addition, some peculiar forms, due to the presence of special poisons, disease-germs, in which special symptoms predominate, as wasting, tremor, etc. There are certain general features, which prevail and predis- pose in all cases of paralysis, either a condition of hypercemia, or congestion, or one of ancemia of either the brain, spinal cord, or some nerve ; both being essentially devitalized conditions, and either of these two states are usually associated with an exciting cause, as apoplexy, embolism, or thrombosis ; abscess, softening, induration, the microbe of tubercle, syphilis, cancer, poisons of mercury, lead, diseases of the urinary organs, intestines, uterus, prostate, masturbation, epilepsy, chorea, disease of the spinal cord, as inflammation and its results ; lesions or compressions by which its working power or conducting medium is impaired. A very large percentage of all cases of paralysis is due to disease germs localizing on weakened nerve tissue, and to the direct action of such poisons as lead, mercury, nitrate of silver, bis- muth. The condition of general paralysis cannot exist without death, although occasionally cases do occur in which general loss of sensibility and motion are much impaired, not wholly destroyed, but nearly so. The general division of all cases into one of congestion or anaemia is a good one, on which to base a scientific treatment. Paralysis of one-half of the body, extending Hemiplegia, from the crown of the head, clean down through the median line, involving one side, arm and leg, half of the face, tongue. It is* the most common form, and usually spoken of as a paralytic stroke or attack. The left side is more frequently affected than the right side, and the arm somewhat more than the leg. Occasionally we meet with cases 762 DISEASE GERMS. of transverse or crossed paralysis, due to accidental conditions — the causes either due to congestion or anaemia. Under the former, we must look carefully for apoplexy, clot, tumor, nodule of tubercle, cancer, etc. ; under the latter for chronic inflamma- tion, white softening, epilepsy, chorea, blood poisons, etc. A dis- tinction or true line of demarcation is important as leading to correct treatment. Cases due to congestion are accompanied with headache and other symptoms of plethora, and are sudden in their seizure, whereas those due to anaemia exhibit such symptoms in the white face, nervous temperament, etc., and come on slowly and insidiously. Symptoms. ^\xi both are the same ; muscles of the side of the face and brow affected ; paralyzed cheek drops loosely ; mouth is drawn to one side by non-contraction of paralyzed muscles ; tongue usually implicated ; when protruded, point turned to the paralyzed side, owing to the vigorous action of the healthy mus- cles ; articulation is imperfect. Third nerve not involved in the common form of hemiplegia, but temporary lateral deviation of both eyes, and persistent turning of the head to the sound side in severe cases. As the hemiplegia is either due to the effects of congestion or anaemia, the pathological result usually takes place at the base of the brain of the right side, or on the side opposite from the one paralyzed, so the condition of the eye, as to contraction or dilatation of pupil, closed or staring open, will depend on the location of the difficulty. The arm is always more paralyzed than the leg, and recovers more slowly. Para- lyzed limbs are soft, flabby ; in rare cases, rigid. The muscles of the chest and abdomen may not be affected chiefly in sensa- tion, if at all. The mental faculties afe less or more damaged — reason, judgment, memory, a tendency to shed tears. In effusion of blood from congestion, muscles often rigid or contracted; in anaemia, with white softening, the softening or degeneration de- scends the cord from want of nutrition, and the muscles waste or shrink away. Where muscles waste, case is hopeless. When the leg regains power first, the case is very hopeful ; whereas, if the arm before the leg, always unfavorable. Some cases of hemiplegia occurring in persons advanced in life occur without cerebral lesion in individual suffering from subacute and chronic nephritis. Treatment. — In all cases, whether due to congestion or anaemia, the following is to be recommended : Secretions from liver, kid- neys, bowels to be promoted ; skin to be daily bathed with alka- line washes ; feet to be kept warm by capsicum ; head cool ; sleep to be prolonged to nine or ten hou*-s by extract of hyoscyamus ; the efficacy of repeated blisters, say for six hours at a time, three BACTERICIDES. 763 times per week, or the irritating plaster constantly exciting free suppuration of both sides of the spine below nape of neck can never be doubted. The most satisfactory results are to be obtained from this proceeding. We need not ignore the fact that at least two-thirds of all cases are due either directly or indirectly to the syphilitic germ in the blood irritating a weakened patch of brain, and thus causing the paralysis. If satisfied that it is due to con- gestion, cerebral hemorrhage, effusion, active cupping to neck and shoulders, free action of bowels, and a persistent persever- ance in alteratives and tonics, with iodide of potassa ; the idea being, if possible, to procure absorption. If due to ansemia, or softening, then no cups nor free purgation, but a treatment highly constructive, rich diet, excess of phosphates ; and to rectify the defective nutrition or anaemia, the glycerite of kephaline in alter- nation with the tincture of avena sativ^a. An alterative and tonic course is often beneficial, such as the comp. saxifraga and phytolacca, and such tonics as columbo, cinchona administered. A very large percentage of this form of paralysis is due to phrenal syphilis, the microbe burrowing in the brain. This fact is often overlooked by the physician either through delicacy or otherwise. The copper-colored appearance of the roof of the mouth, the nocturnal languor, insomnia, point to syphilis, it is unnecessary to call for a history of the case, but invariably to push a course of treatment which will kill the syphilitic germ, with massage, elec- tricity, etc. Paralysis of the lower half of the body. Paraplegia. There are two forms, one due to congestion, the other to ansemia or want of nutrition ; the former may be caused by falls, mechanical violence, causing spinal meningitis, myelitis, with effusion of blood or lymph on the membranes or substance of cord, causing a thickening, tumor, tubercular, cancerous, or syphilitic deposit; the latter, defective nutrition, caused by masturbation, sexual excesses, disease of kidneys, uterus, and other parts, a condition in which, in its first stage, the reflex impressibility of the cord is increased — due to an insufficient amount of blood in the cord. There is a form of reflex spastic paraplegia due to uterine dis- placement, very common during the child-bearing period of life. This is easily seen when we look at the nervous relation of the parts. We have, therefore, to return to the sympathetic or reflex caus- ation, and in considering this the nervous supply of the uterus 764 DISEASE GERMS. and its ligaments must be noted. This is, to a large extent, through the sympathetic system, which is also intimately con- nected with the spinal cord. Thus the uterus derives its nerves from the hypogastric plexus, which is in connection with the twelfth dorsal, and first, second, third, and fourth lumbar nerves, and also from the pelvic plexus, which is in connection with the second, third, and fourth sacral nerves through the fifth lumbar and upper three sacral sympathetic ganglia. The round liga- ments derive their nerve supply from the genital branch of the genito-crural nerve. Thus there is a wide area of the spinal cord in intimate relation, through the sympathetic ganglia, with the uterus and its ligaments ; and the phenomena which are present can all be traced to the same region of the cord. Further, there is the fact that when the uterus is replaced in position the symp- toms vanish at once, which would not be the case if any severe pathological lesion had been at the root of such cases.* Symptoms. — If not due to mechanical violence, it comes on slowly and insidiously, with great weakness, numbness and tingling of the feet and legs. These symptoms increase until there is a total loss of sensibility and motion in lower extremi- ties, paralysis of bladder and sphincter ani follow, decomposition of urine in bladder, involuntary movements of the legs, often very distressing, marked deterioration of general health. Note special symptoms — if the congestion or pressure or nod- ule be on the membranes of cord, there is severe pain in limbs or back, especially on movement or coughing, resembling rheu- matism, reflex movements sometimes exaggerated, paralysis of sphincters later. In myelitis, dull pain, sensation as if there were a cord around the body ; paraplegia more decided ; reflex action in parts below segment attacked ; often exaggerated ; sphincters early affected. In the anaemic forms symptoms are less definite ; worse on being in recumbent posture. When not due to mechanical irritation or reflex action, as in spinal irritation, often syphilis is the cause, which will be recognized by its concomitant symp- toms. Treatment. — The first point in the consideration of treatment is — Is it one of congestion or anaemia ? The land-marks must be carefully drawn as to that point. If there is congestion or inflammation, with increased deter- mination of blood in the cord, there will be symptoms of irrita- tion of motor nerve fibres, as convulsions, cramps, twitching, priapism, with indication of sensitive nerve fibres, as itching, crawling, pricking sensations, heat and cold feeling alternately, and symptoms of irritation of vaso-motor or nutritive nerve BACTERICIDES. 765 fibres, as wasting of muscles, bed sores, alkaline urine. There is also pain corresponding to the upper limit of congestion, tenderness on pressure, or a burning or sore feeling on the ap- plication of a hot sponge or pole of battery. In treating these cases, the quantity of blood sent to the cord must be diminished, and the normal integrity of the cord re- stored ; apply cups, blisters, irritating plaster ; better than all the galvanic cautery on both sides of spine above and below the difficulty, followed with hot poultices or continuous application of irritating plasters on both sides of spine, two inches wide on each side, subsequently belladonna plasty, or some stimulating liniment. Internally, iodide and bromide of potass, with calabar bean ; to be alternated with belladonna, ergot, salol, camphor, henbane, conium, Indian hemp, to relieve distress and procure sleep ; as case progresses, glycerite of kephaline and oats, ery- throxylon coca. Skin, liver, bowels, kidneys to be well stimu- lated, and diet to be generous to a fault, containing as much phosphates as possible. The nutrition of limbs must be main- tained by olive oil inunction, friction, shampooing, at least twice or thrice daily, for twenty or thirty minutes. In the paraplegia due to anceinia or white softening, the object in view is to cause an increased determination of blood to the cord and its membranes and restore its vital integrity if possible. The diet should be such as will liberate brain elements, ani- mal food, boiled fish, oatmeal, corn-bread, extract of meat. Local stimulants should be applied to the spine, concentrated ozone with chloroform ; irritating plaster, very efficacious in causing a determination of blood. Our best internal remedies are the glycerite of kephaline, avena sativa, quinine, nux vomica, matricaria, concentrated tincture of kurchicine. If the paraplegia be due to rheumatism, salol, manaca, should have a fair trial. If it can be traced to syphilis, saxifraga and phytolacca, with bactericides over the spine, as menthol or thymol dissolved in chloroform and alcohol and applied ; ammonia can be added, which will increase its power. The paralysis of ataxia is due Paralysis, to an excessive formation of {Due to Excessive Formation connective tissue, with wasting of Connective Tissue}) and disintegration of nerve- fibres of the posterior columns of the dorsal and lumbar portion of the spinal cord, which gives rise to a peculiar form of imperfect paraplegia. 766 DISEASE GERMS. It is supposed to be caused by sexual excesses, the germs of syphilis tubercle ; by the poison of gout, rheumatism, exposure to cold, damp ; falls or blows being simply exciting causes. It is almost invariably met with in males about the middle period of life. In well-marked cases there is atrophy and disin- tegration of nerve-fibres of posterior roots of spinal cord, with formation of amyloid corpuscles, and great hypertrophy of the connective tissue of the cord. The lesion is not, in all cases, con- fined to the posterior columns of the cord. There is often a gray defeneration of cerebral nerves, of spinal nerves, and various lesions of gray structure. Sclerosis of lateral toliumis of cord, or excessive formation of connective tissue, with wasting and degeneration of nerve-fibre of lateral columns ; invading also the anterior cornua of gray matter. The symptoms are gradual paralysis of muscles and contrac- tion of limbs ; no loss of sensation ; the sphincters often unaf- fected. Treat same as ataxia. Disseminated Sclerosis . — Patches of sclerosis in different parts of brain and cord. In this there is a general loss of power, with tremor and agi- tation of the muscles whenever they are called into exercise. Lips and tongue tremulous in speaking ; chin kept on breast to avoid the effort of supporting the head, which brings on tremor. Limbs quiet till moved, then agitated. The inhalation or absorption of mercury pro- Paralysis, duces a characteristic form of palsy, chiefly affect- [Mercurio) ing the nerves that supply the voluntary muscles, causing a convulsive agitation, which is very much increased when volition is brought to bear upon them. It is much more common than is generally supposed. The finer soluble preparations used by physicians acts very deleteri- ously on their patients. The amalgam used by dentists is made up of pure mercury, and the coloring matter of much of their vulcanites is of the same metal. Besides, the workmen are ex- posed to its fumes in various mechanical and scientific pursuits, as looking-glass makers, button-gilders, glass and metal-platers, barometer- makers, etc. Chemists are much exposed, and should observe the greatest precautions to avoid the inhalation or absorp- tion of this deadly poison. The symptoms of mercurial poison of nerve -tissue are variable, but embrace impairment of articulation and mastication, and often the power of locomotion. Delirium and acute mania are often BACTERICIDES. 7^7 present; the use of the hands are almost entirely lost; often epilepsy ; great weakness and restlessness ; skin acquires a dirty brown hue ; soreness of gums ; teeth turn black and decay ; other bones become affected with inflammation, caries or necrosis, or nodes form on them ; anaemia. All symptoms aggravated by a change in the weather. Treatment. — Removal of cause. Very liberal and nutritious diet, attention to bladder and bowels ; baths, sulphur or else sul- phuret of potassium with electricity ; chlorate of potassa as a mouth-wash, of which some may be swallowed ; due attention to other symptoms. From the moment of its recognition till weeks after recovery, iodide of potassa in doses of from five to fifteen crrains thrice daily in sweetened water. .The iodide unites with the mercury in the body, forms an insoluble compound, which is readily eliminated by the kidneys and to some extent by bowels and skin. In some cases it is advantageous to combine it with bicarbonate of potassa or carbonate of ammonia. No drug is of any real value but the iodide. Lead exerts a very deleterious influence on the Paralysis, nervous system and blood. Its poisonous effects {Lead) seem to manifest themselves on the finer nerves that supply the muscles of the forearm and duo- denum. It usually finds access to the body by inhalation, in water, food and through the skin. Lead poisoning is more com- mon than is generally supposed. The inner surface of the lead water-pipes of cities, oxidizes and finds its way into the water and is drunk. Lead enters into the composition of culinary ar- ticles, as glazed earthenware. Acetate of lead is freely introduced in claret wine, and sailors who drink water from casks that once contained claret are often affected with lead poisoning. Opera- tives in lead mines, workers in lead, either as metal, medicinal or chemical agent, paint, all suffer to a great or less degree. Those engaged in preparing the finer preparations, as carbonate, acetate, oxide, etc., are more common victims than plumbers, painters, oil-cloth workmen, paint-grinders. Symptoms, — General indications of debility, with paralysis of the nerves that supply the muscles of the forearm and hand ; ex- tensor muscles of hand and fingers get paralyzed and hang down by their own weight when arm is stretched out — called wrist- drop. Frequent attacks of lead colic. Taste and breath have a lead odor. Formation of a blue line on the edge of* the gums just where they join the teeth is nearly always present and is typical of lead poisoning. It rarely affects lower extremities. If 768 DISEASE GERMS. the patient's vital forces are impaired by drink and excesses, or frequent attacks of gout or rheumatism, it may cause death. Treatment. — Same as for mej'ciiry. Iodide has the same action on lead as on mercury. All operatives in lead should be strictly temperate ; use no alcoholic drinks, endeavor to maintain a high standard of health, promote the function of skin by daily alkaline bathing, and should drink sulphuric acid lemonade daily. Shaking palsy, characterized by an in- Paralysis Agitans. voluntary tremulous agitation of mus- cles, which is independent of exertion and goes on while the muscle is at rest. Usually makes its ap- pearance from fifty-five to sixty-five years of age; generally met with in men. Its cause and pathology are unknown. It commences in the hands, chin or knees, and gradually extends over the entire body. Fingers and thumb generally in contact, as if taking a pinch of snuff. Associated with great nervous debility, restlessness and sense of heat ; muscular power greatly diminished ; intellect and senses damaged. Disease progresses slowly, usually taking about seven years before general paralysis and white softening set in. When well advanced, agitation or tremor may be so bad as to prevent sleep ; deglutition and mastication performed with difficulty ; a propensity to bend the head forward and to pass from a walking to a running gait ; inclination of the body for- wards, with bending of chin on sternum : slobbering, involun- tary escape of urine and faeces ; delirium, fatal coma. Treatment. — Cases are so utterly hopeless that few remedies are of much avail. Nevertheless, a general alterative and tonic course should be inculcated, with baths, friction, shampooing, local stimulation to spine. Diet to be very generous, containing an excess of vegetable phosphates. The essential paralysis of children, Paralysis Infantile, from its being thought to be peculiar to early life ; not infrequently do we find it in adults. It is, properly speaking, a systematic myelitis, a circumscribed, well-defined lesion of the cord, not involving neip-hboring parts. It is usually confined to the anterior horns of the gray matter of the cord ; hence the term anterior polio- myelitis has been applied to the disease, whether occurring in infants or adults. As it occurs in infancy, or to children under two years of age, who have received a fall, blow, or suffered BACTERICIDES. '6g from teething, worms, there is following a febrile excitement, one or more or all of the limbs become paralyzed; the muscles of the trunk being also sometimes involved, and very exception- ally those supplied by the medulla oblongata. There may have been convulsions, coma or a transient loss of cutaneous sensi- bility, or temporary trouble with bladder or rectum ; but to a great extent the brunt of the disease falls upon the motor power of a limb or limbs. After the attack, the limbs does not gen- erally become more paralyzed; on the contrary, after a few weeks or months there is a gradual clearing off of the difficulty, as regards some of the limbs, one or more remaining unim- proved. Many of the affected muscles begin at once to waste, and lose all power of contractility (degeneration sets in) ; others again resume their tone and function. The paralyzed muscles are soft and flaccid. After a variable period, there may be a gradual return of power, and some recover, while others rarely do so. In the end, in the affected muscles, atrophic changes are well marked, which may be so wasted as to leave the limb in a skeleton-like condition, or fatty substitution may mask the real loss of muscular substance, and give a false air of plumpness to the limb. The development of bone is also arrested, so that in. several years after it may be shorter and thinner than its fellow. There is diminution of the calibre of blood-vessels, leading to comparative coldness and blueness of the limb, which often shows a strong liability to chilblains. The tonicity of unaffected muscles would seem to increase and overpower those whose function is destroyed, giving rise to deformities which no efforts can reduce. In treating cases of this kind, the cause, if possible, should be removed, the mouth examined, and gums lanced, if necessary ; confine the patient to bed for many months. Bromide of potass and ergot should be given early ; muscles tested electrically for the first few weeks ; any electrical treatment better to be avoided ; discourage all attempts of voluntary movements of the damaged muscles or limbs, as it tends to excite action in their antagonistic muscles, and thereby increase the deformity ; baths, oil inunc- tions, shampooing twice daily ; stimulating liniments to spine ; secretions attended to, and the general health built up ; a general alterative and tonic treatment persevered in ; diet rich in fibrine and phosphates. The best agents of this class are the glycerite of kephaline, alternated with the ozonized wine of coca erythoxylon ; the tincture of oats, alternated with some preparation of cinchona. A persister.t use of those remedies, with massage, effects excel lent results. 49 770 DISEASE GERMS. The microbe, amylobacta of rheumatism, Paralysis, may be a cause of paralysis, by exciting an Rheumatic, hyperaemia, excitation, or exaltation of the sensory and motor nerves, either the nerves themselves or their origin in the spinal cord. The same treatment as laid down under the head of rheu- matism. The ptomaines of the microbes of diphtheria Paralysis, and typhoid fever are highly toxical alkaloids, Diphtheric, which have a special affinity to poison and paralyze nerves, more especially those of a fine or delicate character, as the facial, laryngeal, pharyngeal, cardiac, etc. In some instances they cause irreparable damage ; more gen- erally, with rest, country air, good diet, they make a good recovery. Paralysis from the ptomaines of diphtheria should be treated by the administration of glycerite of kephaline, nux vomica and quinine, or by the tincture of oats. Wasting Paralysis. [Progressive Muscular Atrophy) Wasting paralysis involves, as its name implies, a gradual wasting of the involuntary muscles. It is well known that in cases of lead-poisoning, wrist- drop is apt to occur from atrophy of some of the muscles of the fore-arm. In this affection, however, the atrophy or wasting is much more general. As a rule it be- gins in the arms, and is often most noticeable in the upper arm and shoulder, so that the patient is pre- vented from raising his hand to his head. It affects both sides, and extends pretty equally on both sides. Causes. — These, at present, are not understood ; it may occur in children as well as in adults ; it has been known to be heredi- tary in families, so that several children of the same parents have been carried off in turn. It is though a very rare disease, nor is it yet determined whether it depend on an alteration of the ner- vous system or of the muscular system, although most authors are in favor of the former view. It is a disease which is very chronic ; it goes on gradually from worse to worse, until finally Microscopical appearance of the nerves, exhibiting a sclerosis of the neurilemma in wasting paralysis, with muscular atrophy. BACTERICIDES. y^I the muscles of respiration become iiivohed, and death may ensue from suffocation. Symptoms. — The first symptom generally noticed is a wasting- of the muscles of the arm or leg, but more commonly the former ; the fingers are used awkwardly in picking up anything ; there is a numbness and tingling in the extremities, and occasional twitchings of the muscles of the part. In time the wasting is more marked, and the loss of power is proportionate to the amount of wasting. The patient cannot raise his arm nor flex it properly; if bent, he cannot resist any one trying to unbend it; he cannot make his hand reach his head without assistance. On examining the parts chiefly affected, great wasting will be noticed, and the bones can be felt through the emaciated tissues ; when the muscles of the shoulders waste, the head drops for- ward slightly, and the patient has a high-shouldered appearance. In a similar way the legs waste, so that walking is performed with difficulty, and finally the sufferer has to keep his bed. Yet all the while the general health is not much impaired ; he can eat, drink, and sleep well ; the mental faculties are not affected, and his chief distress is the ~^^ progressive weakness. But in time other parts get affected ; as long as only the extremities are atrophied, loss of power alone ensues, and locomotion is rendered difficult ; after a while, the muscles of the chest will begin to waste, and the patient becc5mes short of breath. As this goes on, the expansion of the chest is in- ^^^ -*//^'".^r,^ terfered with, and the sufferer is liable to bron- ' "^^ ^°-'' ''^•" chitis and congestion of the lungs ; he has not '^^^"^0^ Ihe^pYrSi strength to spit up the accumulated phlegm cord jn a wasting par- in his air-passages ; exposure to cold or damp air makes him have a distressing cough and aggravate his symp- toms. Hence it is always a bad thing for them to have catarrh or bronchitis, as it generally carries them off suddenly ; in very severe cases hardly any expansion of the chest-walls occurs, and death really occurs by suffocation. Treatment. — For this disease, when once developed, but little good can be obtained by any drug. Iron, quinine, strychnine, kephaline, avena, und various tonics have been tried, but none of them seem to have any influence in checking the onward pro- gress of the disease. Shampooing, electricity and massage should be tried, and for a time benefit seems to result. The general health should be kept up by a nourishing diet ; the body should be kept warm, and flannel must be worn next the chest. All exposure to cold and wet should be avoided, and although 7^2 DISEASE GERMS. out-door exercise should be taken when fine and dry, yet such people should not go out after sunset nor risk an exposure to the night air, as they might in that way catch cold or obtain some lung complication. In the later stages the patients have to be propped up in bed, as they are too weak to support them- selves ; in such cases all that can be done is to adopt any means that may please or give comfort to the patient, and so render more easy the inevitable end. There are many varieties of local paraly- Local Paralysis, sis, extending from the head to the foot, (^Various Forms) and dependent on very varied causes — such as facial ; paralysis of the muscles of the eye, supplied by the third nerve ; ptosis ; immobility of eye- ball ; outward squint, double vision, dilated pupil. Of external rectus, supplied with sixth nerve, inward squint, etc. Paralysis of fingers and thumb in needle-women, of the supinators and extensors of the fore-arm and hand in dish-washers ; hemiplegia of penis often present in the sensualist. It is unnecessary to go overall ; the point is to ascertain their cause and remove it : If due to congestion, an active counter- irritant and antiphlogistic course ; if to anaemia, rest, stimu- lants, etc. Nearly all forms of local paralysis about the face are due to syphilitic disease at base of brain ; some due to other blood- poisons ; others to sameness, overwork, excess. General altera- tives and tonics seldom fail to benefit. Paralysis of the bladder may be due to Paralysis of the irritation of the spinal cord ; to the pres- Bladder. ence of the bacillus of rheumatism, tuber- cle, syphilis ; to the urate of soda of gout ; to over distension of the bladder, and excessive stretching of the muscular coat, brought about by retention of urine; to debility, old age, enlarged prostate ; and in ladies by the long-continued pressure of the head during labor. Symptoms. — When the bladder is paralyzed its contents are retained ; but when the distension becomes very great the mus- cular fibres of the contracted sphincter are stretched apart, and the urine begins to dribble away by the urethra; hence the in- experienced are apt to be led astray, taking it for a. case of incon- tinence. But if the hand be placed above the symphysis pubis the bladder can be felt, as an immense enlargement. Urine is BACTERICIDES. 773 highly ammoniacal, loaded with mucus, pus and phosphates. Pain at the neck of the bladder and glans penis is not to be de- pended on as a symptom, because the bladder loses its sensi- bility, and the desire to void urine is not experienced. The constitutional disturbance is usually severe ; the pulse becomes quick, wiry, feeble ; the tongue coats ; appetite fails ; great restlessness and depression ; vital power grows feeble, and the patient, if not relieved, sinks into a state of stupor, and dies of exhaustion. In such cases the bladder should be immediatel}^ emptied by the catheter, and then washed out by injecting it with a tepid solution of boroglyceride. The cause, if possible, should be removed, and the case treated with such remedies as avena, kephaline, nux, matricaria, comp. coca, erythroxylon, iron, quinine. With general alteratives and tonics. Constriction of the foreskin behind the Paraphimosis, glans penis, due to an irritation of the nerves that supply the circular muscular fibres of the foreskin ; there is a preternatural contraction, but the tight prepuce is behind the glans penis, that is drawn back over it, whereby the head of the penis becomes con- stricted, swollen, and in some cases so engorged with blood that the prepuce cannot be replaced. The causes are the same as phimosis. Symptoms. — Great swelling before and behind the constriction at the neck. The mucous membrane forms a thick, brawny girdle, like a tightened rope. Great congestion of glans penis. Pain, inflammation, ulceration, gangrene of head, if neglected. Violent constitutional disturbance. Treatment. — Hot bath ; then warm hip-bath, with tobacco ; enemata of lobelia ; then sit patient down in a chair, the physi- cian or operator sitting opposite with a yard of silk ribbon in his hands, the width of the glans penis. Place the centre of the rib- bon on the dorsal or upper aspect of the glans penis, drawing each end downwards, forming a loop ; then place one end of the ribbon round the second finger of the right hand, to form a loop; the other on the same finger of the left. That will leave the index finger and thumb on each hand free for manipulation; then tighten, compress glans gently but firmly ; keep com- pressing steadily, and as soon as you perceive a decrease in size taking place, persevere still, and while thus compressing, catch the constricted prepuce with index finger and thumb of each liand, still compressing ; pull the prepuce over the glans penis. yy^ DISEASE GERMS. If you are unable to accomplish that, a notch, although we are partial to incision of the prepuce at several points, if only one, let it be a free one, at the tight, preputial collar. . If several incisions are made, say five or six, it is equal to circumcision, for in the process of healing, the foreskin entirely disappears. Unless there is some legislative enactment made to prevent the spread of syphilitic disease, it would be well to reinstate one of the best and wisest methods of protection or prophylaxis, the Mosaic sacrament of Circumcision. There can be no doubt but that the circumcised are a highly-favored and chosen people, having a great immunity from this terrible disease-germ. The term parasite is applied to living crea- Parasites. tures which take up their abode on or in another living substance and feed on it. The animal or plant which supplies food and lodging to a parasite, is termed its host. Parasites are common in both the animal and vegetable king- dom, when there is a state of vital deterioration present, when vitality is low, the soil poor. Parasite existence is very complex, presenting every extreme, every variety of gradation between one case and another, every form of dependence between the parasite and its host, the benefit or injury one receives from the other. Usually the benefit is one-sided, the parasite deriving its entire means of subsistence from the metabolism of its living host, or from its tissue, while the host receives nothing but injury in return — the parasite drawing off its nutritious means of growth and reproduction from it — and also giving rise to me- chanical, chemical and reflex changes, which are productive of disease. The maladies caused by the presence of parasites are most numerous, from simple states of innervation to violent convulsive attacks. Some parasites, by means of their spores, ova, germs, may be transferred from their host to others and produce disease, and these maladies may be transferred from host to host and others in which it will produce disease. Parasites may be said to make a selection of the host which they will occupy; it will attack one host, thrive well in him, re- fuse altogether or grow less vigorously in another ; the choice of a host by a parasite, is marked by a one-sidedness; a narrow cycle of affinity ; the physiological causes of these preferences are an inherent predisposition to weakness, debility. BACTERICIDES 77S Parasite affections of the skin possess many features in com- mon, all induced by a parasite of either vegetable or animal origin, and as a consequence characterized by special features. They involve the skin or its appendages. They are all contagious, induced by local and tangible causes.. The fact that there is often associated with entozoa, more espe- cially trichin?e and tape-worm, epilepsy, chorea, convulsions and other nervous affections, has induced some observers to imagine that these parasites, like disease-germs, emit ptomaines, alkaloid bodies, such as are isolated from pathogenic bacteria. This idea has not been confirmed. The predisposing causes as to why parasites take up their abode in or on the body, is some depressed, weakened or devi- talized condition, for in a condition of perfect health, no disease- germ, parasite or fungus can germinate or breed in the human body. There is no such thing as spontaneous evolution of a parasite, in all such cases, the larvae, spores or eggs must find their way into the body by the skin, breath, drink or food. Spores, ova, find their way into the alimentary Parasites. canal, hatch, and produce a parasite of its own [IntcstiJtalis) kind or species, giving rise to some of the fol- lowing symptoms: These are variable when worms exist; still, the following are nearly always met with: capricious appetite, acid eructations, pains in the stomach, grinding or grating of teeth during sleep ; fetid breath, coated tongue, picking at the nose, white or pasty appearance of the counte- nance, dark ring about eyes and mouth, hardness of abdomen, griping pains about umbilicus, itching at rectum and fundament, irregularity of bowels ; an indescribable feeling of debility, often heats and colds ; short, dry, hacking cough ; general emaciation ; often febrile paroxysms; irregular pulse. Reflex symptoms; epilepsy, convulsions, chorea, twitching. In girls, even very young, leuchorrhcea ; in boys or men, irritation of the ejacula- tory ducts, spermatorrhoea, or masturbation. The only conclu- sive sign of worms is their passage, or a joint of them in the stools. In the trcatvioit of all varieties of intestinal parasites general principles must guide us, ever bearing in mind that the reason they have lodged and hatched there has been owing to the poor health of the individual, so that the greatest possible attention should be paid to the improvement of the general health. Remedies calculated to give tone and strength to the bowels ; to improve assimilation. 776 DISEASE GERMS. Special remedies, in each individual case, should be adminis- tered for either the expulsion or destruction of the parasite. Germicides or bactericides are not as a rule efficacious, except in some rare instances, we need here parasiticides. We employ germicides, parasiticides outside of the body, without regard to anything but their power to destroy microbes, yet when we use them for intestinal parasiticides, we must con- sider the effect they will produce on the organism. When the contents of the stomach are undergoing decomposi- tion, either from the yeast plant, sarcinae or bacteria, we may then get good results from the use of creosote, carbolic acid, salol, naphthaline, resorcin ; because these agents in small doses will disinfect the bowels, and render the intestines uninhabitable for parasites. In very many cases, when one of those drugs are ad- ministered regularly in intestinal parasites, and the bowels thoroughly disinfected, the parasites leave. The usual treatment is parasitical. A very common variety ; white, thread like ; Ascarides. very slender, and only from one-fourth of an inch (S^ai- Wojins) to an inch in length. They possess great celerity in their movements, and, when touched, contract to about half their length. Their seat is the large intestines, and are most abundant near the termination of the rectum, although they are occasionally met with higher up. Signs of Ascarides. — Irritation, and intolerable itching and pricking sensation, and often some swelling at the extremity of the rectum; occasionally congestion, e^en inflammation, and discharges of blood, with tenesmus; often heavy muco-purulent leucorrhoea. Treatment for Ascarides. — In addition to the general manage- ment of the case, enemas are of the greatest utility. It is im- possible to effect a cure without them, such as injections of salt and water, lime-water, camphor-water, aloes, gentian, golden seal, etc., in infusion. Any of the above will kill and remove them from rectum. Resembles the common garden or earth Parasite. worms, in appearance round and white, like (Lunibricoides.) a goose quill ; varying in length from six to twelve inches. Their principal seat is the small intestines, but they are occasionally found in the colon and rectum. Signs of the Lumhricoides. — Pricking and rending pain about the umbilicus ; colic, with rumbling noise in the abdomen, occa- BACTERICIDES. 777' sioned by the worm nibbling or irritating the mucous membrane with the sharp, cutting point of its head. In the treatment our best drug is santonine, which acts upon the worm with powerful certainty. In the administration of santonine, always see if it is of a snow-white color ; if it is, it is good ; if yellow, or even slightly so, it is worthless — perfectly inert. It is a peculiar drug; acts on the brain, the coats of stomach and bowels, as a bracing tonic ; improves assimilation, and thus aids nutrition. On account of its irritant action upon the brain in larger doses, especially upon the children of highly- civilized parents, it should seldom, under five years of age, be given in larger doses than a grain every other night ; from five to ten vears of ag^e, in two-P"rain doses. Dissolve in a little hot water ; cool, and give before retiring. Early next morning a dose of compound licorice powder, or neutralizing mixture, or oil, sufficient to move the bowels ; continue this treatment for two or three weeks. Santonine may chemically destroy the worm, or it may mechanically tear it up in shreds, which will float on top of water, if poured into the chamber. or commonly known as tape-worm. Of Parasite. this species of worm, some 250 are said to {TcFiiia Solinni), exist, and out of that number some eight or nine have been found to exist in the alimen- tary canal of man ; still, none of these, except the taenia solium, have been able to maintain an independent existence, and if it were not for his hooks and suckers he, too, would not long be a denizen of the human bowels. The tape-worm is a true parasite, restricted to vertebrated ani- mals, which derive it from the hog generally, but also from other sources. The cysticercus cellulose, or pork measles, is the larva or scolex of the taenia solium, consequently it is very common among pork eaters. A heat of 212° F. effectually destroys it. The imperfect cooking of pork, its conversion in a partially raw state into sausages which are eaten, is a fertile source of the para- site. Early vegetables, as lettuce, spinach, onions, cabbage, are often sources through which the ova or eggs reach the intestines, as they are frequently manured from cesspools teeming with the ova of this parasite. All drinking water into which sewage enters is literally loaded with millions of the eggs of this worm, and acts disastrously upon the inhabitantsnvho are compelled to drink it, and is a prolific source of this parasite in man and animals. Every tape-worm passes through several distinct phases during 778 DISEASE GERMS. its life history. There is no doubt but insanitary states, bad food, eating of rats, and drinking water are common sources from which pigs swallow the eggs, and the moment they are transferred to its stomach they hatch out from their egg shells, bore their way through the living tissue of the animal and lodge themselves in the fatty portion of the flesh to await further trans- formation. The animal becomes measled, its flesh constitutes measly pork. In this state the parasite is partially developed, drops its hooks and awaits developments. It is called the cysti- cercus cellulose as in the annexed cut. Whether from the hog or from water impregnated with sewage or from vegetables, the ova find their way into the human body by the mouth, but the eggs do not hatch until they reach the duodenum ; in that delicate, 'velvety, eider-down bed it germi- nates and makes an attachment. There may be a large number of eggs swallowed, as they are very minute even when the shell is broken and the cestoid worm set free; with its microscopical hooks it may hold on, but it possesses the power of migration, and even at that embryonic period can perforate the stomach, get lodged in the capillaries, from which it may extricate itself by perforation, wander around until it finds a suit- able place in some of the tissue, serous cavities, flesh or some organ like the brain, liver, spleen,, kidneys, and 6nce domiciled it rapidly increases in size, and, if in a vital organ like the brain, causes death. The common tape-worm derives its name (taenia solium) from the idea that there is only one, which is not always the case, as three or four have been found in one patient, varying in length from ten to thirty-five feet. The natural history of this worm is of the utmost importance to mankind and domestic animals, as when it is present there is always danger. The cestoid worms in a perfect state are really compound ani- mals, like many zoophytes and ascidians. They have no mouth, but are nourished by endosmosis from the surrounding medium. The head of a cestoid worm is furnished with organs by which it affixes itself to the inner surface of the intestines of a verte- brated animal. At first there is the egg, its hatching, its getting into proper position, and as soon as fixation takes place it begins to develop joints which appear as transverse striae and gradually increase in size, form segments or joints, each of which is a perfect ovary The cysticercus cellu- lose as seen in the fat of the hog. BACTERICIDES. 779 loaded with eggs. Each joint of a cestoid worm is androgynous. As the posterior joints are thrown off new joints are continually forming in the part nearest the head. When segmentation takes place from the parent the various joints thrown off are a living mass, possess some independent motion, can creep on grass, plants, or humid ground, but they soon burst, and the eggs or em- bryos begin their career by getting into some solid or liquid which is eaten or drank, and then develop. In the ordinary colonial or tape- worm state it is termed the stro- bila ; the separate joints of which the strobilia is composed are termed proglottides or zooids. The anterior segment forms the head and remains barren ; those of the neck and front part of the body being sexually immature during the process of strobile formation. The mature proglottides, at the caudal end, are capable of realizing an independent existence, and the eggs which they contain develop the six-hooked embryos in their interior. These bodies become metamorphosed with scolices or nurses, representing ceral state, which, in its sterile or aborted condition common hydatid. The true tape-worm, tceiiia soliitni, may be distinguished from all others of the group, by the possession of a small distinct head, furnished with four round or oval suctorial discs (suckers) and with a more or less rostellum (proboscis), placed at the sum- mit of the median line. This prominence when largely developed is retractile, and when not in use is lodged with a flush-shaped cavity, lined by a sheath, and supplied with special muscles ; it is also armed with a single or double crown of horny chitinous hooks, often five or six circular rows of these. The head is usually about the size of a pin's head, with black pigment en- graved on it. The joints or segments represent the body, and each seg^ment contains both male and female organs of genera- tion. The entire series of joints is traversed by a set of vascular canals, constituting the aquiferous system which consist of two main channels, one passing down either side of the worm, both connected with narrow vessels which coalesce at every joint. Head, neck and upper joints of taenia solium magnified; a, the circle of hooks; b and c, two of the sucking discs; ^. the neck. 2. One of the lower or sexually mature joints of the same, showing the water-vascular canals and the branched uterine organ oistended with ova. the cysti- forms the 78o DISEASE GERMS. It is only in the alimentary canal of man that a tape-worm can live along for years and reach the highest pitch of maturity. No doubt millions of eggs are daily finding ingress into the stomachs of large masses of our people and, simply because they are vital, there is no hatching out, 7io attachment. It is only on weakened tissue, reduced by disease, medicine or errors of diet of a highly civilized state, where the worm can flourish, and how fortunate it is that fecundation never takes place before being discharged. The mature segments are usually passed off or expelled at the rate of six or eight daily. Their greatest danger consists in their liberation in the rectum, and finding their way iilto other and more vital parts. Signs or Symptoms of Tcenia. — General languor, lassitude, debility ; a dark circle around the eyes and mouth ; fetid breath ; transverse fissures on the tongue ; livid complexion or else pale and doughy; di- lated pupils ; vertigo, nausea, often vomit- ing ; a feeling as if there was something alive in the bowels with a sense of weight ; a biting sensation at pit of stomach ; ab- domen swells and subsides at intervals ; appetite may be capricious, usually vora- cious ; the presence of the parasite may by reflex irritation give rise to convulsive tremors, spasms ; epilepsy, if it occurs, ;mall portions of the worm pass with the faeces like gourd seeds. Treatment. — The armed tapeworm is found exclusively in the human subject, and it is often difficult to effect its expulsion, as it is completely armed so as to hold on tenaciously to the mucous membrane ; besides, it must ever be borne in mind that the parasite propagates from segments of the neck, that it is of vital importance in its removal to effect its entire expulsion, espe- cially the head. As every physician has his or her own remedy or formula for causing its expulsion or death, a brief enumera- tion of the remedies will sufifice. Pomegranate root-bark, pump- kin seeds, kousso, male fern, kamula, turpentine, naphthaline. The properties of those remedies is due to an active principle termed valdivine, or to an alkaloid pelleturin. These active parasiticide elements are more abundant in the pomegranate root-bark, kamula, and male fern. Valdivine and pelleturin are the most reliable and eleg^ant preparations ever introduced, The double crown of hooks highly magnified. usually very severe very positive and all. in action, seldom failing to bring the worm, head BACTERICIDES. 781 The bark of the wild or sour pomegranate is much richer in taenicide properties than the cultivated. The bark is sometimes administered in powder or decoction, the latter is preferred. It is made by macerating two ounces of the pulverized bark in two pints of water for twenty-four hours and then boiling down to one pint. Before drinking the above the patient should fast twenty- four hours, and drink the pint inside of an hour ; follow with a brisk purge. The decoction will nauseate, cause emesis, and often purges. The following is a good formula for the expulsion of the worm : Pumpkin seeds, crushed, one ounce ; ergot pulverized, two drachms; pomegranate root, pulverized, one ounce; water, one pint. Macerate twenty-four hours, then boil down to four ounces and strain ; then add : croton, two drops ; gum arable, two drachms ; male fern, two drachms. Mix. After fasting twenty- four hours, give little by little so it is all taken in. For the valdivine, as its properties are very volatile, it is best to be given in soft capsules, the entire quantity inside of half an hour, followed by a large dose of castor oil. The experience of six thousand physicians confirm all we have urged in favor of this remedy, the best criterion of all is the remedy bringing away the head in nearly all cases. Trichiniasis is the name of a diseased Parasite. condition induced in man and animals, {TricJiinia Spiralis) by the ingestion of food or water con- taining the trichinia spiralis, a minute worm, measuring one-sixteenth of an inch in length and one one- hundredth of an inch in breadth, a minute cyst, scarcely visible to the naked eye. These cysts are more or less cov- ered externally with calcareous matter accord- ing to the time in which they are encysted and the degree of degeneration their walls have un- dergone. Cysts are often absent. These larval worms exhibit a well marked digestive apparatus, and afford evidence of the presence of reproductive organs, which are often sufficiently developed The worm lying coiled as to enable the observer with a small mag- up m muse e. nifying glass to determine the sex of the parasite. The number of the larval trichinia that may exist at one time and in one case is enormous, being estimated at twenty millions. 7^2 DISEASE GERMS. Sexually mature female trichinia spiralis magnified. A single trichiiious pig, if its flesh is eaten without being sub- jeoted to a heat of 212° F. for some time so as to destroy the vitaUty of the larval trichinia, may establish a local epidemic of the disease. Suppose an animal was fed with flesh containing the larval worm and is killed a few days afterwards, there will be found in the intes- tines a large number of minute worms ; on closer examination, the larger ones are the female, and the smaller the male. On the second day after being swallowed, the trichinia attain full sexual maturity, and in six days the females contain innumerable perfectly developed and free embryos. The female is a slender worm in length from one-eighth to one twelfth of an inch. The anterior end presents a beaded ap- pearance, from which the intestinal canal proceeds ; the posterior portion three-quarters is mainly occupied by the reproductive organs, which are filled with eggs and free embryos in various stages of development. When the embryos attain maturity they pass out of the genital aperture and begin life on their own account. The ac- companying diagram shows the em- bryo in various stages of develop- ment. The males are less numerous, and shorter lived than the females. How pigs acquire the trichinia is unknown ; beet-root, earth worms, moles, rats, have been suggested as their infectors, but nothing is really known hov/ widely this parasite is diffused through the animal kingdom. By ingestion of food of rare pork, underdone sausages, and flesh in which the larvae of this worm are present, the following symptoms would be likely to put in an appearance in a few hours after being swallowed — loss of appetite, nausea, vomiting, with great languor, lassitude, debility — general undefined prostration. The embryo of the trichinia. Sexually mature male trichinia spiralis magnified. BACTERICIDES. 783 These symptoms last about a week, when pain, stiffness in all the joints and muscles supervene ; then oedema of the face, re- peated rigors, fever, with high temperature, and frequent pulse ; great thirst, nausea and vomiting continue. Constipation with a most offensive diarrhea, copious fetid perspiration. The tongue exhibits great gastro-intestinal irritation. Synchronous with the trichinous brood migrating from the stomach and bowels into the muscles, the second stage com- mences when the patient lies on his back like one paralyzed ; pressure or any attempt to move the swollen muscles is attended with most excruciating pain ; sleep is impossible, even respira- tion is difficult and prolonged ; the oedema of the face disappears, which is replaced by a swelling of the feet, which proceeds up- wards to the body. The tongue still presents the appearance of one with gastric fever, and diarrhea often prevails ; urine scanty, loaded with lithates. In about the fourth week of the disease, the trichinia may be regarded as having permanently settled and of having completed their destructive action on the muscles. Now begins what is termed the third stage, which is character- ized by extreme exhaustion, the gastric symptoms abate, appetite returns ; in favorable cases, the muscular pains and swellings gradually diminish and disappear ; while in some cases this third stage is the most critical, the diarrhea is often severe, and accom- panied with tenesmus ; involuntary discharges of faeces and urine; pallor of the skin, which becomes enormously distended with fluid. Various complications very apt to set in as aphonia, pleurisy, pneumonia, peritonitis, etc. The fourth and last stage, that of convalescence, takes place about the fifth week, sooner or later, and may last a few weeks or even months. No definite line can be drawn. Death may occur at any time. The diagnosis of the disease rests chiefly on the history of the case, the gastro-intestinal irritation when the parasite burrows through the mucous coat of the stomach and bowels, then it bears a strong resemblance to cholera, or typhoid fever; the muscular pains resemble rheumatism ; the oedema or swelling, Bright's disease. No reliable treatment can be laid down, as poor success has attended the use of our best remedies. More recently an effort has been made to destroy or sterilize the parasite by the use of germicidal remedies. Such bactericides as glucozone, naphthahne, salol, would be of some utility if the parasite were located in the bowels ; but when encysted in the muscles, they fail to reach it. 7H DISEASE GERMS. The human body may be infested with Parasite. three different kinds of lice ; the head-louse, [Pediculosis, Lice?) body-louse and crab- louse. Uncleanliness, insanitary states, perverted nutrition of skin, bad food, filth, etc., give rise to a depraved con- dition of skin, which render it a chosen pasture-field, or seat, for the hatching and breeding of the larvae of those parasites. The three species are oviparous, the eggs being known as nits ; sexes distinct ; young are hatched in five days, and in eighteen days are capable of reproduction. The numbers of eggs laid are im- mense. Each of the three has its favorite location or abode. On the head they are very easily got rid of by daily washing and using vaseHne or ozone ointment as a hair-dressing ; on the body, it should be thoroughly bathed and lightly sponged with tincture of lobelia. The crab-louse, on pubes, axillae, eyebrows, may be got rid of at once, by washing thoroughly, drying off and damping the affected parts with a lotion of two grains of corrosive sublimate to an ounce of water. The stavesacre, or cocculus ointment, is excellent. Peroxide of hydrogen makes an exceedingly efficacious remedy for all varieties. To destroy the larvae on head, body, pubes, warm vinegar is very efficacious, applied morning and night. Bedclothing, and also body-linen, should be boiled and subjected to a strong heat with hot iron, and all due precautions taken for thorough de- struction. Itch or psora, a contagious vesicular dis- Parasite, ease of the skin, attended with great itch- {Acarus Scabiei.) ing, which is increased by warmth and use of stimulants. All parts of the body, ex- cept the head are liable to be affected, but the most common seats of the disease are the wrists and hands and finer portions of the skin between the finger. Commences as a papular, vesicu- lar, or pustular eruption, with an itching sensation, which, upon minute examination is found to proceed from a minute conical vesicle, while the adjacent portions of epidermis present a more scaly appearance than natural. The cause of this condition of the skin is due to the presence of the acariis scabiei, a microscopical animal parasite, which bur- rows within the epidermis and excites the cutaneous vesicular, irritation, and as it is utterly impossible to refrain from scratch- ing, the vesicles get more or less broken, causing patches of ex- coriation. The itch is always communicated by contact, shaking hands, BACTERICIDES. 7^3 drinking vessels articles of clothing, sheets, blankets, towels, used by a person suffering from the disorder. The female is much larger than the male, and after impregna- tion burrows herself beneath the skin, and forms a furrow or ditch, in which she lays her eggs. The males have itinerant habits and wander about the skin. The diagnosis of the presence of the itch insect is most im- portant. Rupture a vesicle, place the exudation under a micro- scope, and the figures in the annexed cut will be /, j seen. Eczema, prurigo, '^ '^ ^ ^ and lichen are affections most likely to be con- founded with it ; but eczema, though a vesi- cular disease, presents round, and not conical vesicles, and at most only a pricking sensation, and nothing like the irritation of the itch ; while pru- rigo and lichen are papu- lar disorders, and are not accompanied by the presence of vesicles, moreover none of those disorders are contagious. Different names are applied to it in various sections of the country, as the prairie or lumberman's itch. Treatment. — As it would be somewhat of an expensive cure to resort to vaseline, ozone ointment, glycerine and oil of berga- mot, or the like, which are destructive to the parasite, the cheapest plan is to take two or three pounds of common lard, deprive it of its salt, and stir into it as much sulphur as it will hold, still retaining its properties as an ointment. The patient being bathed all over with an alkaline wash, into which a handful of lobelia has been introduced, well dried, and the sulphur and lard well rubbed into every part of the body except the head. He must be put in a clean bed, and his contaminated clothes either fumi- gated with sulphur, or else washed with sulphurous acid water. This process is to be repeated every night for three or more nights in succession, on each occasion the body to be thoroughly washed before the application of sulphur and lard. The immer- sion of the body-linen, bedclothes, or ordinary clothing in water, acidulated with sulphurous acid, is sufficient in all cases to de- stroy the larvae and the parasite; so is a heat of 212° Fahr, Itch-mite, i, abdominal view of female itch-mite, magnf- fied 65 diameters; 2, one of its manibles, magnified 65 diameters ; 3, manible of male sugar-mite, magnified 390 diameters. either in boiling or by hot irons. 50 There need be no detention 786 DISEASE GERMS. from business ; the first application could be made on a Friday night, and the two succeeding ones on a Saturday or Sunday evening. The following is highly esteemed : Lard, one hundred parts green soap, fifty parts ; naphthaline, fifteen parts ; white chalk, ten parts. Mix. The same may be used in acne with success. One of the following formulae may be substituted for the ordinary sulphur ointment : Sulphur flor., twelve drachms; potass, subcarb., six drachms; adipis, nine ounces. Styracis, liq., one fluid drachm ; petrolei, ol. olivcX, of each, half fluid ounce; balsam. Peruv., two and a half fluid drachms ; spts. sapon. virid., five fluid drachms. Potass, sulphuret., five drachms ; sapon. alb., twenty drachms ; ol. oliv., four fluid drachms; ol. thym., fifteen drops. Sulphur, sublim., balsam. Peruv., of each, half a fluid drachm ; adipis, one ounce. For use especially in the scabies of children : Styracis liquid., one ounce ; adipis, two ounces. Melt and strain. Styracis liquid., one fluid ounce ; spts. rectificat, two fluid drachms ; ol. olivae, one fluid drachm. Ft. liniment. An affection due to the presence of the Parasite vegetable parasite tricophyton tonsurans. Trichophyton. Most common on hairy parts — especially the (Ringworm.) scalp — but non-hairy parts may be affected ; the nails may also suffer. Most common in children, and spreads readily by contagion. Hence common in schools, where it may be conveyed from one to another by means of combs and brushes, hats, towels, etc. ; the spores of the psrasite have also been found floating loose in the air of schoolrooms. May last for years if untreated, being especially obstinate when attacking the hairy parts. Ringworm of scalp {T. tonsurans) begins in circumscribed patches, with redness of skin, which becomes covered with slight scales. Tendency to assume crescentic or ringed form. Slight itching, flairs brittle and break off, leaving bald patches, over which numerous stum.ps of hair are seen. Ringworm of the" beard {T. barbce, T, sycosis) is similar in appearance; often confounded with ordinary sycosis. In many cases of ringworm of scalp diagnosis often obvious at once. The bald patches covered with broken stumps of hair present a marked contrast BACTERICIDES. 787 to the smooth, perfectly bare " bilUard ball " patches of alopecia areata. Absence of discharge or crusts will differentiate from eczema, though either may occur from irritation in long-standing cases. Diagnosis only rendered certain by identification of pa- rasite under microscope. On scalp or beard, extract broken stump with forceps, place on glass slide with a few drops of liquor po- tassae, and examine with quarter- inch — preferably after soaking for a few hours in liquor potassse. Rows of spores of parasites seen on hair and between its fibres, splitting them and making hair appear thicker than normal. Para- site invades the hair bulbs on the one hand and the epidermis on the other, where mycelial filaments may be found between fine epider- mic scales. On the non-hairy parts of the body the affection is known as T. circinata or T. corporis. Slightly raised reddened patches are seen. These are frequently more or less rounded, and may at- tain an inch or more in diameter. Their margin is red and ele- vated ; often papules or vesicles seen on it. The centre becomes yellowish and desquamates. When the eruption attacks the inner side of the thigh, genitals, or perinseum, it is known as Eczema marginatum, and presents a some- what different appearance. Owing to the natural warmth of the parts and the friction of the opposing sur- faces, the presence of the parasite excites more or less inflammation (eczema), and this may persist even after the parasite has been destroyed. Not merely vesicles, but pustules and crusts are frequently to be seen on the margins of the patches. In T. circinata the presence of the para- site may usually be readily ascertained by scraping with a pen- knife some scales from the inner edge of the outer ring, placing A microscopical appearance of a section of the skin in which the trichophyton has made its appearance. Tinea capitis. 788 DISEASE GERMS. them in a drop of liquor potassae, and examining them under the microscope. Long slender irregularly-jointed threads of mycelium are seen and spores occurring singly or grouped. Ringworm of the nails is very intractable and is, fortunately,, not very common. The nails become thick, soft, opaque, and assume a yellowish tint. Of all the vegetable parasites of the skin, the trichophyton is the most common ; it produces three distinct forms of skin disease, tinea circinata, or ringworm of the body ; tinea tonsurans, or ringworm of the scalp ; and probably a special form on the face. This parasite gives rise to considerable irritation of the skin, which results in the formation of circular, circumscribed patches of various sizes, slightly elevated above the level of the skin, of a dull red color, and usually covered with brassy scales, while round the edges, there may be found vesicles, and sometimes even pustules. On the scalp, ringworm shows itself as one or more circum- scribed patches of a grayish or slightly ruddy color. The hair of the affected parts is short,, lustreless, easily drawn out, breaks readily, and the extremi- ties are ragged and uneven, the skin is covered with numerous thin white scales, and occasion- ally with crusts. In all these three situations the trichophyton presents simi- lar microscopic appearances. The parasite is frequently met with in both children and adults of both sexes, wherever over- crowding exists, schools, chari- ties, reformatories. It is highly contagious, but yet requires a suitable soil for its growth and development. The most com- mon methods of transmission are close contact, brushes, combs, sponges, towels, clothing, domestic animals, as dogs, cats. The indication for the relief of the disease is the destruction of the parasite, and the improvement of the general health of the individual. Prominent among the parasiticide remedies may be enumer- ated ozonized sulphur water, ozonized boroglyceride; solution of hyposulphite of soda; tincture of iodine; iodized oil; solution of thymol in chloroform ; ointments of iodine of sulphur ; ozone ointment ; ichthyol ; chrysarobin ; gutta percha, dissolved in chloroform with resorcin added and painted on ; iodine crystals Trichophyton {ringjvorm). BACTERICIDES. 789 -dissolved in oil of tar. Among the most recent and effective remedies in ringworm is the tincture seigesbeckie orientalis ; equal parts of this drug and glycerine rubbed into the affected parts morning and night, immediately kills the spores. The parasite breaks up into isolated dead patches, and these speedily peel off, leaving the skin underneath slightly red, which disap- pears in a few days. Older remedies are chrysophanic acid dissolved in chloroform ; may be painted on and will soon prove effectual. In ringworm of hairy parts, difficulty arises from impossibility of reaching seat of disease. Applications to surface of scalp do not reach roots of hair. To facilitate treatment, cut hair short; in severe cases, shave. Then apply some parasiticide regularly once or twice a day, Most authorities recommend frequent washing of 'head with soap and water ; others oppose. Various opinions of value of epilating broken stumps. Local remedies innumerable. Following amongst most useful : — Unguentum hydrargyri am- moniatum, unguentum hydrargyri oxidum rubrum, unguentum acidi chrysophani, ten grains to one ounce ; hydrargyri olea- tum, five or ten per cent, solution in oleic acid, sulphurous acid, U. S. P. acid used as a lotion with equal part of water, head being covered with cap to prevent evaporation, salicylic acid as lotion dissolved in rectified spirits, twenty to forty grains to one •ounce of acetic acid, painted on with brush. Any or all of these may be tried in succession in severe cases. Spontaneous cure sometimes by formation of kerion, which is the name applied to a boggy swelling formed by inflammation of the hair follicles. Resembles subcutaneous abscess. Parasite perishes in inflamma- tory process, and, not unfrequently, some destruction of hair- bulbs also occurs. In chronic cases it may be desirable to pro- duce kerion artificially by painting scalp with croton oil or other irritant, watching the process carefully. No case of ringworm of scalp must be pronounced cured till absence of the parasite proved by careful and repeated microscopic examination. If an; left it may spread again over the whole scalp and be as bad as ever. After the parasite has been completely removed a scurvy condition of the head is frequently left. This is a cutaneous affection occur- Parasite. ring chiefly upon the trunk, neck, upper i^Microsporon Furfur, and lower extremities of adults of both Tinea Versicolor}^ sexes, characterized by irregularly reticulated, macular lesions, yellowish or brownish in hue, over which the epidermis may exfoliate in delicate scales, owing to the presence of the cryptogamic plant, the microsporon furfur. ygO DISEASE GERMS. In warm weather it grows most luxuriantly, in beautiful, mot- tled, copper-colored patches over a portion or the entire body, which is covered ; in cold weather it contracts and often disap- pears. This vegetable parasite makes its habitation in the pigmentary gland. Hidden in its recesses, below the cuticle, it is difficult to reach with antiseptics. This also renders its capabilities for con- tagion far inferior to other vegetable parasites. The disease is propagated by scales or spores, prevails in mid- dle life, irrespective of social position and personal cleanliness. It is easily recognized by the microscope, by the history of the case, by the fact that it never invades hairy parts ; avoids light and air, its characteristic yellow, or fawn-tinted color, the exfoliation of the epidermis, which it excites by its superficial pene- y-^;^^!^ ^' %\o >«*fM^'/)>x tration of the outer layer, produc- hke exuvmm, will enable any one to diagnose i£ from chloasma or liver spot. The germ of syphilis upon the skin may be mistaken for this plant, but the microbe of Photograph of the micrococcus versicolor syphiHs cncroachcs anvwhcre, is — small cocci which are seen form in- j-rr i. r descent colonies— growing in the form of mOrC dlllUSe, CrCCpS OVCr the laCe, yellowish beads. ^^^^^^ ^^^^^ ^^^ ^^^^^ .^ j.j^^j^ ^^ ^^ either adenopathy, alopecia, mucous patches, palatine hyperaemia, polymorphic tendency. The nature of the sensations, with its initial growth copper-color patches might be due to liver torpor. The destruction of the microsporon iurfur is not invariably as successful as it might be, owing to its location in the pigmentary gland, below the cuticle. In order to be successful this must be either weakened or removed. For this purpose, for three or four successive nights, the patient should be immersed in a hot bran bath, in which abundance of bicarbonate of soda has been dis- solved — he should be thoroughly macerated, and subsequently well rubbed or scrubbed with a flesh brush, then dried and bathed with cider vinegar, in which boroglyceride has been dis- solved. This is often successful in an entire rooting out of the parasite. If this is not efficacious, proceed as above, but try half an onnce of the hypophosphite of sodium dissolved in a quart of water — this also often removes the last vestige of the germ. Other parasiticides, very popular, are ozonized sulphur water, sulphuret of potassium ; boroglyceride combined with resorcin ; iodine, chrysarobin. BACTERICIDES. 791 In all cases the inner clothing should not be worn after the bathing and application, until it has been immersed in water acidulated with sulphuric acid. When untreated, the parasite, after quite a lapse of time, undergoes spontaneous exfoliations,, the fungus fails to find in the epidermis the nutriment upon which it thrives. Parasite. {AcJiorion Schonleinii, Tinea Favosa^ A contagious disease of the scalp, due to the presence of the vegetable parasite achorion schonleinii. The scalp invaded by this parasite presents the characteristic appearance of a honeycomb in the form of small, dry, yellow, cup-like crusts, commonly traversed by hairs. Under the micro- scope, the fungus presents this ap- this pearance. Take a particle from any small scab or crust in the root sheaths, or bulbs, or the hairy filaments. It is easily de- stroyed in either of the following meth- ods. Packing the affected part for a few consecutive nights with boroglyceride paste, or chrysarobin is very effectual in an ointment, or sulphur in almost any form, ozonized sulphur water ; or thymol dissolved in ozone ointment, or painting it over every third day with iodine crystals, dis- solved in oil of pitch, or rhinacanthin rubbed up in petroleum ointment ; ichthyol also is of great service, naphthaline. Achorion schonleinii ; a, spores ; b, c, sporophores. Parasite. ( Fh ngus Trie J L ophyton . ) Tinea sycosis^ or barber's itch, due to the p-esence of the fungus tricho- phyton in the beard of the adult. This parasite is readily recognized by its location, its fig-like appearance, by the irritation or itching. Its presence gives rise to the presence of macula, papula, vesi- cular, pustular or tubercular lesions — it has greatest growth in devitalized individuals and blonds ; extremely contagious. The chin and beard are its favorite locations. 792 DISEASE GERMS. In the destruction of this parasite, the patient should for sev- eral consecutive days macerate the eruption with oHve oil, then shampoo it effectively, that is, wash off all crusts, with castile soap and water as hot as can be borne ; this tends to reduce the inflammation of the perivascular spaces, removes the incrustation. Beard to be shaved, and a saturated solution of boroglyceride should for several minutes be applied to the entire beard and face, followed by some one or other of the following ointments, to be kept ap- plied over night : either the iodide of sulphur ointment; or thymol ; or ichythyol ; naphthaline, chrysarobin, resorcin, sul- phuric acid ; gunpowder made into a paste by the addition of lem.on juice, and applied and reapplied. More recently equal parts of tincture of siegesbeckie orientalis and glycerine, The fungus trichophyton of barber's itch. rubbcd WcU intO thc partS affected, have proved wonderfully effective in destroying the germ, and promoting a rapid cure ; although any one of the above is brilliantly effective in destroying the fungus. In the morning, whichever application is used should be washed off and the boroglyceride wash reapplied ; when dry the anti-microbe powder should be freely dusted on during the day, and in the evening a re-application of the hot bathing, borogly- ceride and the selected ointment. This should be repeated for several weeks after all appearances of the parasite has ceased to exist. The following formulae are used by some : If the beard is not shaven, first wash with an antiseptic soap and apply night and Ung. simp., 20 parts ; resorcin, 2 parts ; hydrarg. bichlor., 0.05 part. If the beard is shaven, a zinc paste, viz. : Ung. zinc, benzoat., 90 parts; terrse siliceai, 10 parts may be substituted for the ung. simp, in the above prescription. If the disease is very superficial it may be sufficient to touch the part with sublimate or resorcin pencil, or use a spray of: Resorcin, 5 parts ; hydrarg. bichlor., O.05 part ; aq. cologniensis, spiritus, of each 50 parts; ol. ricini, i part. BACTERICIDES. 793 When the disease is deeper and nodes have formed, the follow- ing plaster mass should be applied and bound down : Empl. hydrarg-., lO parts; ac. carbolici, lo parts; sublimate, 1 part. Epilation should be practiced if pustulation has occurred, but not otherwise. A high standard of health is proof against this and other micro-organisms ; if it were not so the frequenters of our barber shops would be more generally affected. An eruption consisting of bullae (blebs, blis- Pemphigus. ters) of varying size, seated on a more or less erythematous base. Some vesicles may also be present, intermixed with the bullae. The eruption is often preceded by itching and tingling, and may be accompanied by some fever. The bullae are more or less flattened, frequently irregular in contour, and may reach the size of an egg. They contain serum, which, clear at first, soon becomes opaque, and contains pus. The serum is effused into the malpighian layer, where it accu- mulates between the filaments uniting the cells, but finally makes its way to the granular layer. The bullae are bounded externally by the horny layer of the epi- u ^^v dermis. In a few days they begin to 000(1 lessen in size. Many burst, allowing ^' n escape of their contents; the outer epi- Bacteria of pemphygus. dermal coat of bullae then drops off in a feV days, leaving reddened patch, on which epidermis soon forms again. The attack may be acute, and terminate in a few days in spontaneous recovery, or successive crops may occur, and the eruption thus be prolonged for days or weeks (chronic pemphigus). Pemphigus may occur on any part of the body ; the syphilitic form (syphiloderma bullosum) is more com- monly seen on the palms and soles. It may occur at any age. In new-born children it is termed P. infantilis^ and may proceed to gangrene, in which case it is generally rapidly fatal. Repeated attacks are not without danger, especially in old people, or where an extensive portion of the surface is attacked ; in such cases patients may emaciate, and be reduced to a very low state. P.foliaceus is a rare and peculiarly obstinate form, which may last for months or years. It is said to be incurable. Successive crops of bullae form and burst, but after the detachment of the epidermis in flaky scabs it is not reformed, but a raw surface 794 DISEASE GERMS. remains, to which fragments of epidermis may be seen adhering. In cases of long standing, almost the entire cutaneous surface may be affected, and but little epidermis be seen remaining. The patient passes into a hectic condition, and the eruption usually ends fatally. Another variety of pemphigus occurs on the hands (occasionally on the feet) and is known as cheiro-pomphylyx. It is termed dysidrosis, and is due to obstruction of sweat-ducts. It is now regarded as a neurosis. Consists of vesicles as small as a pin's head, or larger blebs, and makes its appearance on or be- tween the fingers. The vesicles or blebs have a peculiar translu- cent appearance, and burst in a few days. All varieties may be met with in either an acute or chronic form, and all characterized . by the production of a series of pea or egg-shaped vesicles, variable in size, the smallest being about a pea, the largest that of a large ^g^, irregularly distributed over the surface, from a few to some hundreds, filled with serum or blood, loaded with bacteria. The causes which give rise to this rare cutaneous affection are poverty of nerve force, nervous prostration or debility, mental worry, exhaustion from sexual excesses, the presence of syphil- itic germ in the blood, the empirical use of the mercurial preparations, vis- ceral disorders, impairment of nutri- tion, squalor, filth, uncleanliness. The presence of such prodigious herds of the bacteria in the blood and their migration in colonies to the skin is usually attended with either con- tinuous remittent or intermittent py- rexia, appearing with each crop of vesicles. There are always headache, pains in the back, gastric and intestinal disturbance. The contents of the bullae or blebs consist almost entirely of bacteria ; arranged in chaplets or joints interspersed through it are cocci. Like all morbid states dependent on the presence of a disease- germ, it is highly contagious and infectious. Bacteria are ubiqui- tous, ever present in atmosphere in a range of fifty feet around the patient. The treatment is essentially constructive and germicidal. The stomach and bowels merit attention ; diet should be rich, gener- remedies as iron, oats, quinine, nux^ Microbe of pemphigus typhilicija. ous, blood-forming ; such BACTERICIDES. •95 matricaria compound are unexcelled ; the latter remedy is deemed the best, as it destroys the micro-organism and stimulates a re- newal of vital force. The sulphide of zinc in alternation with ozonized sulphur water are the best remedies to give internally. The syphilitic form requires the general treatment for syphilis. Locally puncture the vesicles with a fine needle, and with a sponge saturated either with a solution of boroglyceride or resor- cin, wipe up the germs as they exude from the puncture. Then all over the collapsed bleb, dust on the anti-microbe powder. The aim of all treatment is to raise the standard of vital force, so a* to prevent further degrada- tion of bioplasm into a disease- germ. When tl>e microbes die in the vesicles, they dry up into black crusts or scabs, become flat- tened, then the affection re- ceives another name — rupia. Those crusts, after a time, may fall off, leaving deep, perforating sores, which* may heal, or again fill up. If the case is properly appreciated, by a reconstruction of vital power, they heal up rap- idly. They receive different ^"p'"' names, according to their size, consistency, and tendency to eat in, as rupia simplex, when the crusts are thin, small, superficial ; if crusts are large and prominent, rupia prorninens ; if deep, extensive and still penetrating, rupia eschar otica. Perineal Pressure. (The Disease of the Scythians. Horse riding causes com- plete impotence in the strongest and most daring men, with wasting of the testes, dropping of the beard, and change in the pitch of the voice. If, then, these sad results are the outcome of immoderate equitation, where there are an extensive seat and a stable foot rest, and where the adductor muscles of the thighs are used, what are we to look for, where our boys of ten and upward spend the greater part of their own time riding bicycles, and get 796 DISEASE GERMS. over thousands of miles in the year, perched upon a saddle no bigger than the hand, which conveys every jolt of the machine to the body; where the jolts are a thousand times more numerous than those experienced by the equestrian, and occurring with- out any approach to rhythm, are conveyed unexpectedly to the person ? Cycling is doubtless a very healthy and pleasant mode of ex- ercise when used in moderation, but now that tens of thousands of our boys ride bicycles daily, and '' get up records '' of thous- ands of miles in the year, it may not be out of place to point out some alarming evils which are likely to arise from this abuse of an otherwise healthy pastime. Some time ago it was pointed out that obscure nervous complaints would probably be devel- oped by the continual jarring, the succession of shocks conveyed to the spinal column in bicycle riding; and this, I believe, has proved correct in many instances, notwithstanding "Arab springs '^ and " rubber cushioned " machines. But it is to some- thing much more serious than this that I would now call atten- tion : it is to the amount of pressure brought to bear upon the perinaeum in growing boys, affecting directly the prostate, the muscles of the bulb, etc., and indirectly the whole generative system. The bicycle saddle is now reduced to the smallest possible limit. It is just wide enough at its posterior part to cover the ischial tuberosities, and it tapers off quickly to a long narrow horn in front, upon which the perinaeum rests. Let us consider the position of the body and limbs when the rider is mounted, and we can then appreciate the amount of body weight which must be thrown upon the perinaeum. In bicycle riding the legs are, when extended, vertical, and the pelvis is flexed upon the thighs or rolled forward. This rolling forward of the pelvis is slight in easy riding, and very marked in fast riding and hill climbing. Now, when the body and pelvis are bent forward, the ischial tuber- osities are raised from the saddle, and the whole weight of the body, save what is transmitted to the pedal by the then extend- ing leg, is thrown upon the perinaeum. It is not much of the body's weight that is conveyed to the pedals. In easy riding on the level the weight of the limb from the hip down is sufficient to move the machine, and in hard riding the extra pressure if gained not so much by throwing the body's weight upon the pedals as by pulling upward on the handle-bar, and so further increasing the pressure of the body upon the saddle. But even admitting that the pressure upon the perinaeum be only a few pounds, I hold that it must be injurious in the extreme, for were the pressure nil when riding upon a perfectly plane surface, it BACTERICIDES. jg^ must at times be considerable when the machine is ridden over an unequal surface such as is afforded by our best country- roads. Let those who talk of " the beautiful gliding motion of the bicycle " try to play a game of billiards after a ride of twenty miles, and then explain where all their " shakiness " comes from if their motion has been that of a skater. Now this pres- sure on the perinaeum, whether it be continuous and increased at every jolt, or whether it be made up of jolts alone and be nil '\w the almost imperceptible and irregular intervals, must be injuri- ous, more especially to growing boys. It must cause irritation and congestion of the prostate and surrounding parts, tend to- exhaust and atrophy the delicate muscles of the perinaeum, and also call attention to the organs of generation, and so lead to a great increase in masturbation in the timid, to early sexual indulgence in the more venturous, and ultimately to impotence in both. The deplorable effects of self-abuse in Perversion of the early life, and excessive indulgence in Sexual Sense. later years, give rise to seminal weak- ness, varicocele, nocturnal and diurnal emissions, impotency, sterility and phrenal bankruptcy. The prevalence of self-abuse, its widespread and destructive effects on mind and body, its degrading and ravaging effect upon the vital elements of nature, render the subject one of vast importance to our well-being as a nation. Its victims are found among the very young, before and after puberty of both sexes, in every vil- lage, town, and city, and, unfortunately, the religious, or so- called virtuous, are most addicted to it. The perversion of the sexual sense is much on the increase.. Our entire population, with their nervous constitutions and ex- cessive nervous susceptibility, leading to cerebral debility, tend to induce the habit of mental masturbation, as well as both natu- ral and unnatural excess in sexual indulgence. The creation of a purely nervous temperament in the people of our country, under their special mental strain of tension, operates disastrously upon the procreative faculties ; very different indeed from the well-balanced temperaments of those who live out of doors and work with the muscle more than with the mind ; these usually are strong, healthy, and are not, as a rule, tormented with sexual desire in the same degree as the sensitive and nervous. A perversion of the sexual appetite is the result of excessive nervous development. This perversion is a true monomania, a positive insanity, manifested in society under what is termed crankiness. 798 DISEASE GERMS. Some inherit this effeminacy, this deterioration of brain, this wiping out of the typical fissures of thought! Some come into it as soon as the sexual passion dawns ; some acquire it as the result of sexual debility. A perversion of the sexual appetite is usually brought about through excess, or masturbation, partial impotency, with cold- ness or indifference to the opposite sex. Confirmed, long standing masturbators, of either sex, care little for the opposite sex. Excess creates hate for the partners of excess ; perverts the sexual sense and the characteristics change ; men become women and women men. When a man suffers from sexual perversion he becomes feminine in his thoughts, ideas, tastes, occupations, dress, even permits his hair to grow, and is silly in his behavior. Disgust follows debauch ; repeated excesses create indiffer- ence, fear, and sexual perversion comes on. Many who perish from its effects are supposed to die from other causes, such as consumption, chorea, epilepsy, heart dis- ease, debility and failure of vital powers. It destroys the mind as well as the body. In its milder form, it produces loss of memory, melancholy, evil forebodings, timidity, loss of spirits and loss of energy ; tn its worst form, idiocy and insanity. Many maniacs owe their loss of reason to no other cause. In the tabulated reports of every insane asylum are a great number of cases in which the cause of insanity is set down as '* Mastur- bation." No affection so completely unfits for either the duties or the pleasures of life. The semen of those who have abused themselves in this way, or who have been guilty of excessive in- dulgence, is like that of old men, often scanty, thin and watery, and when examined under the microscope, the active principle (the spermatozoa) is deficient and imperfectly developed. Such semen cannot propagate healthy offspring. If the spermatozoa are absent, or imperfect, as is always the case if the emissions are frequent, the individual is either sterile, or the offspring is weak puny, deformed and short-lived. It is thus one of those sins which are visited upon the children. This alone is a powerful reason why no masturbator should marry before he has received competent medical advice. But there are other reasons. The sexual powers of such persons are not equal to those duties of marriage which appertain to perfect manhood. Owing to sex- ual debility, connection is imperfect ; the emission is premature, so that the wife cannot reciprocate ; or. erection is feeble, or will not occur at will, so that connection is impossible. Much do- mestic misery results from this cause, the lives of many a couple are passed in wrangling, misery and discontent from it ; many BACTERICIDES. ^qq divorces have their origin in it ; for if the wife is denied her natural rights, a divorce, or what is worse, unfaithfuhiess, is a logical sequence ; many men have become desperate upon find- ing themselves united to beautiful and lovely women, but in- competent as husbands. It is true, many other conditions or states of the body give rise to emissions — anything that weakens the nervous system, as fevers, affections of the brain and spinal cord. Amoncr some of the other effects of this vice are aversion to so- ciety, love of solitude, specks and spots before the eyes, pain in the back of the head, pain in the back, left side of breast ; frightful dreams ; sensations of falling in the sleep ; bashfulness ^ ^-- , ^ ^' a strong lactic acid. The packing of the vagina with borogly- ceride was performed every night for four consecutive times, wnen the polypus was expelled and the hem- orrhages in a great measure ceased. The vagina and neck of the uterus were syringed three times daily, after each a boroglyceride pastile was inserted up against the neck of the uterus and permitted to dissolve. This diagram represents the dual microbe of polypus and can- Diagram of polypus. Polypus, with infiltration of the neck with cancer germ. BACTERICIDES. 823 cer on the cervix uteri ; a nodular growth just rupturing, with a most offensive discharge, tinged with blood. Occasionally hemorrhagres. In this case there was the diathesis, anterior and Internal polj'pus, with epithelium of the neck, encroaching upon the cavity. posterior pain, infiltration of the lymphatic glands of the groin; the body of the uterus was considerably infiltrated. A micro- scopical examination of the vaginal discharge revealed the fact that it consisted almost entirely of liv- ing and dead germs. The local appli- cation in this case was the application of the contents of half a dozen jequi- rity wafers to the ulcerated surface, which caused a large mass to exfoliate, then following with the boroglyceride injections and pastiles. Twice a week painted the germ-laden parts as far as it was possible to reach with lactic acid. This illustration shows an internal polypus of the uterus, with epithelium of the neck ; the internal polypus was first diagnosed and neglected ; the daily hemorrhages became exhaust- ing, and latterly carcinoma appeared. This latter commenced as an indura- tion. The local treatment consisted in painting the parts affected with lactic acid, using the boroglyceride injections and pastiles. As the cancer microbe has a remarkable tenacity of life, and A large mixed polypus, fibroid and red, gelatinous, growing from the neck of uterus, cured by injecting with peroxide of hydrogen. 324 DISEASE GERMS. as the Chian turpentine mistura is antagonistic to its existence, nearly all cases may be readily cured with this remedy. The Chian turpentine mistura is composed of the best selected Chian turpentine, ethereal peroxide of hydrogen, resorcin, thal- lin and other germicides, which, when they enter the blood, come like an avalanche upon the germ, and destroy it. Urethral polypi, usually of the fibroid Polypus of the variety, are occasionally found protruding Urethra. from the male urethra, causing occlusion of the canal. Pathological products are sometimes met with in the fossa navicularis, which present a structure absolutely analogous to that of the vegetations seen on the surface of the prepuce and glands. They are slowly developed in the interior of the canal, where they preserve an elongated shape, but spread as soon as they have passed outside of the meatus. Polypoid growths in the urethra being of the character of papilloma (bacterium porri), are readily got rid of by the inter- nal and local use of thuja, filling the urethra, or inserting a gela- tinized bougie of the same. By the use of this remedy, all irrita- tion is avoided ; the oil is the best form. In all deviations from health, all Poison of Subjects, states of vital depression, bacteria (Cadaveric Alkaloids^ evolved from the normal living matter, and the microbes of disease from without are present and play an important part in the transition from life to death. When life, or the soul element, leaves our bodies, the corpo- real part enters a new sphere of existence in the form of micro- bial life. All forms of micrococci, streptococcus, bacterium and bacilli are evolved, they eat up all the pabulum obtainable for their growth and development and either die or are converted into other living organisms, dual, triple or quadruple germs, and this process continues until our bodies are reduced to their original constituents, water, carbonic acid gas, ammonia, and earthy salts. During this stage of microbial existence, of chemical change, of prodigious growth, we have every known micro-organism with its deadly alkaloid (ptomaine), present. If, at any stage of bacterial existence, the most minute particle be introduce into the living blood of man, it will breed with most extraordinary rapidity ; the germs indeed have their vitality augmented and BACTERICIDES. 825 produce in the living organism precisely the identical state of decomposition, which they were pushing forward in the dead. The olfactory nerve also, of an educated physician, recognizes ^in the odors of the cadaver the various micro-organisms present, •even the one which caused the death of the subject. The micro- organisms of the dead are keenly active in the subject, so much so that in the atmosphere for one hundred feet around it they can be detected, and within that radius they can also be found in mouth, eyes, hair and clothing of the attendants. With an open mouth, they enter the salivary glands of the oral cavity and descend to the stomach, giving rise to gastro- intestinal irritation. With regard to dissection wounds, we must bear in mind the following facts : that all subjects are but one mass of disease- germs, being more or less virulent according to the disease, or species of bacteria which induced the separation between soul and body. Injecting the subject with either chloride of zinc or arseniate of -soda solutions, or even the oil of cloves, or peroxide of hydrogen, does not destroy the germs and its spores, they simply for the time being induce a latency. There is no bacteri- cide which will destroy the comma-bacillus of epidemic cholera, or the streptococcus of diphtheria, or erysipelas, etc. It is also well to bear in mind that the more highly developed the dissector, the more finely organized the brain and muscle, the greater is his affinity or inhibitory power to take in germs. This is true of all animal matter. Inoculation, through a scratch, abrasion, indentation of or ^from the microbial mass, a subject will produce in the living the same growth of micro-organisms ; but if the subject has slid off his immortal through the agency of the microbe of phlebitis, erysipelas, typhoid fever, pneumonia, etc., then the case is bad, and an inoculation is followed by grave results. In the management of such wounds or inoculations, the per- oxide of hydrogen stands first among all remedies — applied locally, administered internally. No well-conducted dissecting room can afford to be without this bactericide. Its use supersedes all our old remedies ; students, nurses, washerwomen, should have it handy, C. P., and medicinally pure. Polyuria always indicates some affection of the Polyuria, parts of the brain situated in or near the posterior fossae, the cerebellum, pons, and medulla oblon- gata, but that the material on hand does not permit a more ex- act localization. It is a symptom showing an irritation of the cerebral parts 826 DISEASE GERMS. concerned, but it is never only a functional disturbance. Poly- uria, especially if not permanent, might, therefore, indicate a pass- ing hypera^mia, or an otherwise transiently irritated state of the portions of brain-tissue mentioned, but if continuous and not amenable to treatment, the same symptom would be an evidence of some organic lesion of the same cerebral parts. This theory is confirmed by the empirical observation, that ergot is the only remedy which has thus far resulted in a cure of polyuria. This drug has been tried in cases of that kind, where it has been suc- cessful. Ergot, as well known, causes a contraction of the capillaries and, therefore, a diminished blood supply mainly in regions specially rich in capillaries, as the brain and spinal cord. A transient hyperaemia will thus be relieved, and the polyuria, when due to the latter, disappear under the influence of ergot. But when the prolonged administration of this remedy does not diminish the flow of urine, the suspicion is warranted of an or- ganic change in the parts mentioned of the brain being respon- sible for polyuria. In such cases the symptom is of grave import, and usually predicts the fatal issue of the case. The fact that polyuria, if of long duration, occasionally ends in diabetes, also is explained by the statements above made. This is normal in old age and is Porrigo Decalvans. usually preceded and accompanied by {Baldness.) grayness {canities). Premature bald- ness may occur from failure of general health, as a consequence of eczema, seborrhoea or other disease of the hairy scalp, or without apparent cause. It often seems to be hereditary and is most common in males. It generally begins at the top of the head and tends to spread from thence. The hair gets thin before any patch becomes completely bald. Treatment. — Senile baldness is not very amenable to treatment. Premature baldness may be treated with more hope of benefit. Any disorder of the general health should be attended to, and any cutaneous disease present on the hairy scalp should be treated. When any obvious general or local affection has been attended to, local stimulants may to some extent promote the growth of hair. Various preparations of cantharides are often employed, and lotions containing ammonia have been recommended. The following formula may prove useful : Bay rum, one pint; tincture of lobelia; tincture of cantharides, of each one ounce ; boroglyceride, two ounces. Mix. BACTERICIDES 827 Wash scalp with castile soap, dry well. Use the above for a hair dressing-. Alopecia ar. differs from the ordinary form in several important particulars. As implied by the name it occurs in isolated patches, not as a general thinning and falling of hair. Rest of hair often grows with great vigor. It is not preceded by grayness. The patches attacked get perfectly bald and as smooth as the surface of a billiard-ball. It may attack the beard and whiskers as well as the scalp ; also the eyebrows and other hairy parts. The dis- ease is not one of old age, but of early life. Children are more often attacked than adults, and women more commonly than men. (Ordinary alopecia is more common in men.) Distinguished from ringworm by the absolute baldness and smoothness of the patches which present a marked contrast to the broken stumps seen in ringworm. A characteristic feature is the presence of short clubbed hairs at the margin of the patches. Recovery in in some cases spontaneous, but disease is apt to recur. It often tends to run in families. Often found associated with excessive brain-work (school children) and worry. Has hence been re- garded as a neurosis. Also been considered a vaso-motor, or trophic lesion,' but a microscopical observation shows a parasite. Treatment. — The general health should be attended to and tonics given if needful. Glycerite of kephaline and tincture of oats internally often gives good results if persevered in for some time. Local stimulation may do some good. The patches may be painted at intervals with jaborandi fluid extract, or equal parts of the liniment and tincture of iodine. An ointment or lotion containing cantharides may also be of service. Canities, or Acquired Whiteness of the Hair. — Grayness of the hair is a common precursor and accompaniment of baldness as already mentioned. It is due to deficiency of pigment. In those rare cases in which sudden blanching of the hair has fol- lowed great emotion it is said to be due to the formation of air- bubbles in the shaft of the air. Treatment. — Not very effectual. Tonics (especially oats) may be given and local stimulants used, such as cantharides. Kaposi recommends the use of fatty oils, as those of mace, walnut, or cassia. Persons wishing to conceal it very generally consult their hair-dresser and use some form of hair dye, which he finds it profitable to sell to them. Lead is a frequent ingredient in the popular nostrums sold and darkens the hair by chemically com- bining with the sulphur in it to form a sulphide. A lead comb is often used. 828 DISEASE GERMS. Conception consists in the fertilization of Pregnancy and the ovum or egg of the female, by the sper- Parturition. matozoa of the male in the ovaria ; then fecundation takes takes place. There must be a union of the two materials furnished by both sexes ; that is, the spermatozoa must unite with the egg in the ovary and fertilize Side view of viscera, female pelvis : r, vagina; 2, bladder; 3, Interior of rectum; 4, uterus ; a, fundus ; d. cervix : ,c,c, os uteri ; d, posterior portion ; g, anterior portion ; 5, rectum, here cov red by peritoneuiti ; 6, 6, 6, sacrum; 7, coccyx; 8, labia minora; 9,labia majora; 10, urethra; 11, symphysis punis ; 12, clitoris ; 13, mons veneris ; 14, urachus ; 15, section of peritoneum ; 16, last lumbar vertebra ; 17, broad ligament; 18, ovary. it ; and the embryo results from this union. The spermatozoa is ejaculated into the vagina ; the uterus, by inhibitory action and vermicular movements, takes it into its cavity, and passes it along the fallopian tubes to the ovaries. It may occur without the patient being conscious of its occurrence, or against her will. BACTERICIDES. 829 The most favorable period for conception to take place is either before or after a menstruation. After the ovum is impregnated, it increases in size and becomes prominent on the ovarium ; then absorption of the peritoneal coat takes place ; and when free, is seized by the fimbriated extremities of the fallopian tube, and carried into the cavity of the uterus. The ovum, as a general rule, is found in the uterus twenty days after impregnation, sooner or later. After the exfoliation of the ovum from the ovary, an effusion of blood takes place into the cavity in which the egg was em- bedded, and this is followed by a corpus luteum. The human impregnated egg is very small, about the size of a dwarf pea. When impregnation takes place, the internal os uteri becomes closed by a soft, gelatinous substance, and the internal lining membrane of the uterus throws out a flocculent A fair standard specimen of a virgin ureius ; 2^ inches in lenjth, 1% inches in width, and 2j^ ounces in weight. Interior view of the same uterus. enne cavity. or downy substance, which fills its cavity entirely. This is called the membrana decidua, and into this downy bed the ovum drops when it makes its exit from the fallopian tube, and, if not disturbed, will form its attachment near the point of ingress, and cause a growth of that part with which it comes in contact, and is called the decidua reflexa. So that the decidua is now divided into that portion lining and in contact with the uterus, called the decidua vera, and the other portion called the decidua reflexa. The embryo then becomes covered with two membranes — the chorion and amnion. The amnion is an internal lining of the serous membrane, which furnishes a fluid for the protection ot the embryo ; allows space, facilitates motion and development of the foetus, and wards off shocks, jars, concussions. The chorion, or outside covering, furnishes a means of communication with the uterus 830 DISEASE GERMS. The ovum, after its establishment within the uterus, consists of the decidua, decidua reflexa, chorion, amnion, hquor amnii, foetus, and umbilical chord, with one extremity attached to the child, the other to the membranes at the point of attachment in the after-birth. The after-birth, or placenta, is a plexus of vessels by which the circulation is maintained between mother and child, and by which the latter is nourished. When of full size, it is from six to eight inches in diameter, and in thickness varies from a line to one inch, or more, at its centre. It has two surfaces: one attached to the uterus, which is rough, spongy, traversed by ditches ; and the foetal side, which is lined by the amnion, which is smooth. For the first three months of intra-uterine existence, this twig of humanity is termed an embryo; the latter six, a foetus. As soon as impregnation takes place, the walls of the uterus become greatly infiltrated with blood, which increases the size of the vessels from being very small and convoluted, to that of large and straight ; the muscular fibres grow with perfect regularity. This increase of growth and development for the first three months is very great, .«o much so that the specific gravity of the uterus is such that its broad ligaments are unable to hold it up, and it descends very low into the cavity of the pelvis, often nearly protruding. After the fourth or fifth month this difficulty is entirely obviated, by the uterus floating above the pubes ; and at six months it is still higher. After the fifth month there is a gradual distension of the body of the uterus, which en- croaches upon the neck, distending it, merging it into the body, and causing it to become shorter and shorter, until, from the eighth to the ninth month, it is entirely obliterated ; that is merged into the body. Signs and symptoms of pregnancy are divided into rational and sensible signs. The rational signs embrace : First and Second Months, — A stoppage of the menses, nausea, vomiting, flatness of the abdomen, depression of the umbilical ring, tumefaction and tenderness of the breasts. Third and Fourth Months. — In addition to the above, there is now a slight fulness of the abdomen, augmented swelling of the breasts, prominence of the nipple, and discoloration around areolae. Fifth and Sixth Months. — The disturbance of the digestive organs usually disappears ; abdomen becomes well rounded and full, and the uterus can be detected above the pubes ; fluctuation can be detected; and the color around the nipples becomes brown. Seventh and Eighth Months. — Abdominal tumor large ; dis- BACTERICIDES. 83 coloration of the skin of the abdomen common ; often varicose veins of the leg, labia, vulva ; vaginal granulations ; leucorrhoea, pruritus, and real copper-color around nipple ; and suppression of the menses through the entire nine months. First Half of the Ninth Month. — Vomitings liable to re-appear ; the abdominal swelling is so great that the skin of the abdomen is stretched, tense ; there is difficulty of breathing ; oedema of feet. Last Half of Ninth Month. — Vomiting ceases ; abdomen re- laxes ; uterus descends ; there is less difficulty in breathing, but more in walking ; often difficulty of urinating — sometimes sup- pression, in other cases an inability to hold it ; often piles ; vari- cose veins of the leg ; pains in the loins ; cramps in the legs ; colic, etc. The sensible signs embrace : First and Second Months. — Augmentation in the size and weight of the uterus causes that organ to descend low down in the pelvis ; it cannot be moved easily ; its walls touch the neck, which is directed downwards ; the orifice or mouth is rounded, swollen, and a slight softening of the lips. Third and Fourth Mo7iths. — The fundus of the uterus rises above the pubes, and a rounded swelling can be detected by palpa- tion. Making the patient stand up, and putting the finger on the OS uteri, and lifting it up, it drops suddenly down on the finger. Fifth aud Sixth Months, — The fundus can now be detected below the umbilicus ; there are active movements of the foetus ; foetal heart can be detected distinctly, indeed, it is very percep- tible. The uterus can be mapped out, fluctuating, rounded ; and the lower half of the neck of the uterus is softened, and the neck now begins to lose itself in the distension of the. body. Seventh and Eighth Months. — The increased size of the uterus and abdomen ; the fundus of the uterus is three finger-breadths above the umbilicus at the seventh month, four or five at the eighth; movements of foetus stronger; foetal heart very clear; neck disappearing in the body. First Two Weeks of Ninth Month. — The fundus of the uterus reaches the borders of the false ribs, clear up to the stomach ; foetal heart very strong ; neck of the uterus gone entirely into the body ; the mouth of the uterus open. Last Fortnight. — Fundus sunk low down ; movements active ; mouth of uterus open, soft, dilatable ; the whole cavity of the neck becomes confounded with that of the body. The entire period of pregnancy occupies nine calendar months, or forty weeks. Time varies somewhat, as to whether concep- tion took place immediately before or after menstruation. 832 DISEASE GERMS. Pregnancy may be protracted in some rare cases ; that isy carried out beyond two hundred and seventy-eight days, the interval between the last day of the menstruation and the ex- pected confinement, and at least a fortnight more than this. There is no very exact time, or number of days, to which preg- nancy may be protracted ; still, it would be safe to maintain that in no case can it be prolonged over three weeks beyond the natural period. Development of the Foetus. — Fifteen days after the ovum or ^^^ appears in the uterus, it is a gelatinous, semi-transparent, floccu- lent, grayish mess ; at thirty days, the size of a large ant, and from three to five lines in length ; at six weeks, ten lines in length, about the size of a. bee, but some of the organs, in a very rudimentary state, visible ; at two months, two inches long^ weighs two ounces, and ossification has commenced at some points; at three months, three and-a-half inches long, weighs three ounces ; umbilical cord well formed, and genital organs Ovum and embryo at the sixth week, A foetus at fort' -five days and at two months. distinct ; at four months, five or six inches long, weighs from four to five ounces; at four and-a half months, c\mckQn'mg, or motion, is felt by the mother, or by placing the cold hand on the abdomen, and it is now from seven to nine inches in length, and weighs from nine to ten ounces ; at six montJis, parts pretty fully developed, and weigh from one to two pounds, and its length from nine to twelve inches ; at seven months, all parts are per- fectly developed; weighs from two to three pounds, and in length from twelve to fourteen inches, or more, and perfectly de- veloped ; at nine months, usually twenty inches long and average weight seven pounds ; bones of head firm ; ossification more complete, and all the organs capable of performing their natural function. Some variations in the above, but it gives the general average. There may be several eggs fertilized, so that there may be twins, triplets, or quartlets. Pregnancy may occur outside of the uterus, extra-uterine ; it may take place in the ovary, and the embryo develop there ; or it may be developed in the fallopian BACTERICIDES. 833 tube, or in the abdomen, or the ovum may find its way into the muscular coat of the uterus and be developed. The conse- quences of such are usually serious, causing inflammation, ulceration, suppuration, internal hemorrhage, and death to the mother. When pregnancy takes place, and the woman knows she is in that state, she should eat the best of food, take moderate exer- cise, but avoid hard work or any strain, and above all, keep her bowels regular by eating sufficient fruit, or using enemata of milk and water. She should make a regular habit of either sponging or bathing the entire body once a day. All gloomy or idle fears should be banished ; no tales of woe or sorrow told in her pres- ence ; her surroundings should be of the most agreeable kind, and she should ^lace her trust in the benevolence, mercy, and wisdom of her Creator. Her clothing should be flannel, next the skin, at all seasons ; she should have abundance of sleep, and all symptoms in this state should be managed with as few drugs Diagram of the fcEtus and membranes about the sixth week : a, chorion ; h, the larger absorbent extremities, the site of the placenta ; c, allantois ; d, amnion ; e, urachus ; e. bladder ; f, vesi- cular unibihcalis ; ^. communicating canal between the ^vesicular umbilicalis and intestine; h. Vena um^Jilicali^; t, i, ar erise umbilicalis; k, arteria omphalj-meseraica; /, vena omphor in front of the pelvis, par- tially covering the head and containing fluid. The fiuger passes easily posterior to the tumor, but not anteriorly, and the catheter cannot be passed in the usual direction, clearly indicating its nature. This, if it exists, occasions delay in the second stage, and danger to the mother from rupture of the organ. We should be active here, whenever we are aware of the im- pediment. A gum bougie should be at once introduced, the point directed backwards, and we shall very probably be suc- cessful in emptying the bladder; if necessary, raise the head a little with the finger, during an interval, to facilitate the intro* duction. We usually succeed, but, if we fail, the labor will be arrested by the obstacle, or pressure threaten a rupture. I have always been able to draw it off, therefore, I cannot, from experience, recommend tapping the bladder with a trocar, through the vagina, which is often done. If the quantity of urine be moderate, pres- sure not excessive, the head of the child not large, we may leave the case to nature. But, after the labor is over, we must imme- diately evacuate the bladder, and watch the patient. 858 DISEASE GERMS. Various minor operative procedures are in use for the purpose of aiding^ parturition. The vectis or lever. — The great variety of levers in use have only led to confusion and misunderstanding. The nature of the aid afforded by this in- strument is threefold : First. — To correct malpositions, or aid the natural rotations of the head at the brim, or in the cavity of the pelvis. Second. — As a lever, making a fulcrum of the pelvis, or the left hand of the opera- tor, external to the pelvis. Its employ- ment in making a fulcrum of the soft parts of the pelvis is extremely dangerous, besides the chance of injuring the soft parts, or the ^, . ,. , child's head. 1 he vectis applied. • 1 a • 1 1 Third. — As a tractor, it should not be em- ployed to wrench, but to hook or draw down. The cases in which the use of this instrument is indicated are: Those in which the head, having descended into the pelvic cavity, is arrested in its progress by the inefficiency of the pains, when the patient is beginning to exhibit symptoms of constitu- tional or local disturbance. This does not take place until the second stage of labor has advanced some hours. There is supposed to be space enough, but pains feeble, and a slight additional force will often succeed in bringing the infant into the world ; and as there is nothing in the nature of the operation to add to the danger, and more par- ticularly since the tractile force will be sufficient, it seems pecu- liarly adapted to these cases. In cases of convulsions, resulting from the head pressing upon the sacral nerves, the use of the vectis is specially indicated ; provided the pains continue, the aid of the lever may consum- mate the labor. Respecting the time when the instrument ought to be used» This is regulated somewhat by the object sought to be attained. If to assist the head in passing through the upper outlet, or to change its position there, then operate whenever the os uteri is dilated or dilatable ; but never use this extractive power during the interval of contraction, but during its continuance; and it is only as the result of considerable experience that the practitioner can, nearly always perceive whether or not a woman still retains the power of assisting her labor. Of course, in cases where serious constitutional disturbance exists, the vectis ought to be applied as early as possible. BACTERICIDES. 859 The forceps are invaluable in cases of inertia of the uterus, powerless labor. The object of the operation with the forceps is to facilitate delivery when its progress is arrested by certain malpositions of the head at the brim, or in the cavity of the pelvis. To supply the want of uterine action, or to render it effective for the expulsion of the child. To save the mother from the evil results of too long a labor. To save the child, or at least afford it a chance of escape from certain destruction. These objects are attainable by the nature of the aid afforded by the forceps, and that they have attained most brilliant results, experience has proved. TJie forceps possesses a twofold power : First. — It grasps and compresses the head of the child. Second. — It acts as a lever of the first kind and as an extractor. The compression exercised by it must be limited within the degree the head can bear without injury. The extracting force will be in propor- Application of the forcepT tion to the firmness of the grasp, limited by the resistance, by the danger of injury to the mother. If there be sufficient space, we may so grasp the child's head, without injury to it, as to enable us to extract it, and the ex- tracting force is not sufficient to injure the mother. Numerous cases occur where the transverse diameter of the child's head is rather larger than the antero-posterior diameter of the brim, or the transverse diameter of the lower outlet; but, if this does not exceed the amount of compression that the head will safely bear, and the force required safe to the mother, such extracting force maybe supplied by the forceps, which will likely render the uterine action effectiv^e. In inexperienced hands this might fail, but with ordinary care no mischief will be done. A sufficient grasp will almost always be obtained, where the head is not impacted, to enable us to alter the position of the child. There can be no doubt of the propriety of using these valuable instruments, as compressors within natural limits, if early used and properly applied. They are extremely valuable in tedious labors, for abnormal or diseased action of the uterus. In these cases they should be freely used, and the best period for their use is early in labor — as soon as the os permits — before the maternal system suffers. 86o DISEASE GERMS. It is a well recognized rule in obstetrics, that the forceps are not to be applied until we are satisfied that the obstacle cannot be overcome by the natural powers with safety to mother and child. In craniotomy our object is to secure the safety of the mother, by the destruction of the child, where both would be lost were no interference attempted. Cases of rickets, deformity, a dispro- portion between the foetal head and the pelvis, whereby a living child cannot be expelled by the natural powers ; distortion so great as to prevent its extraction. In distortion of the pelvis, when the antero-posterior of the brim is less than three inches, where we have no chance of delivery by other means ;. also, if the transverse diameter of the lower outlet is diminished to three inches. No approximation of the tuber ischii, if the forceps are applied antero-posteriorly, Use of the perforator. Application of the crotchet. Application of the crotchet is sufficient to move the head. We must have recourse to craniotomy. If the calibre of the pelvis is diminished to a certain degree by a fixed obstacle, as a fibrous tumor, exostosis, etc., it is neces- sary to diminish the head. It is also necessary, in certain cases of ovarian disease, where the tumor has formed adhesions within the pelvis, so as to prevent its being pushed above the brim, it has been found necessary to lessen the head before the child could be extracted ; but we must first ascertain whether the con- tents of the tumor may not be drawn off, in order to save the child. If the child be hydrocephalic to such an extent as to prevent its entering or passing through the pelvis, whether dis- torted or of the natural size, there can be no doubt about the propriety of opening the head. Mode of operating. — It is not necessary for the operation that the OS uteri should be fully dilated, though it is an advantage, BACTERICIDES. 85, for greater care is necessary when it has not taken place. The rectum and bladder are first to be evacuated; then place the pa- tient upon her left side, with the hips over the edge of the bed, and an assistant to keep his hand expanded over the abdomen. Then make an examination, and find the part of the head for perforation, which is best at the sutures, for the bones will col- lapse more readily. ^ Having decided upon the part or position, take the perforator, passing it along close to the palm of the hand, and inside of the fingers, so as to avoid injury to the soft parts of the mother. Once arrived at the point of insertion into the skull, carefully guided and guarded by the fingers, the perforator is to be pressed firmly forward, in a semi-rotating manner, until it pierces the bone ; it is then to be passed in, the handles opened, the brain thoroughly broken up, the medulla oblongata thoroughly cut across. The perinaeum should be carefully guarded, and the greatest care exercised that the soft parts be not injured. Phantom tumors are among medical curiosi- Pregnancy, ties. They commonly occur in females, who, {Black}) examined one day, might seem to have a large abdominal tumor, examined next day, nothing is felt. The size of these tumors varies much ; in some it amounts only to the size of a fist, in another it may amount to that of a fully distended uterus, near the full term of pregnancy. These tumors have not unfrequently been mistaken for a true pregnancy, and everything been prepared for the birth of a child. Nay, the woman herself has been apparently in labor, and yet there have been neither conception nor even enlargement of the v/omb. The shape of the tumor may remain long unchanged, or may vary from day to day. Sometimes the patient complains of acute pain on examination, at other times, she is completely insensible. Again, and perhaps most frequently, these tumors seem to disap- pear under prolonged and gentle pressure, but they return next day or the day after. ^ Now as to the cause of such tumors, or rather perhaps we ought to say their natures. In a goodly number of instances, they consist of flatus, limited to one particular portion of the bowel by contraction of the gut above and below. In other cases it is said that the muscular wall o£ the abdomen is concerned in their product'on, but the cases we have seen, have been of the former kind, especially if the walls of the abdomen and the omentum were loaded with fat. The diagnosis of these tumors is more a curious problem to 862 DISEASE GERMS. the physicians than of practical interest to the pubh'c. Their ex- istence is a fact, which, however, should never be forgotten. The same treatment as for neurasthenia. Constant and distressing erection of the penis, Priapism, may be caused by shocks, concussions, blows, fractures, injuries of the lower portion of the spinal cord, occurring at the lower portion of the lower dorsal or upper lumbar of vertebrae : or at the origin of the nerves sup- plying the sexual organs in the brain. The gonococcus in the urethra often penetrates deeply into the corpus cavernosa, breeds rapidly, excites an inflammatory process, with effusion of lym*ph or blood into that structure. The damaging effects of masturbation and of abnormal and excessive coition, upon the same parts, the reflected irritation to the spinal cord and brain, is productive of this difficulty. The treatment of such cases will depend entirely upon the cause. In all cases of shocks, concussions, injuries of the spinal cord, general principles must guide. When due to sexual excesses, or masturbation, our chief de- pendence must be placed upon the frequent administration of large doses of tincture of the green root of gelsemium in alternation with as large doses of the bromide of potassa as the patient can bear. From thirty to sixty drops of the gelsemium every three hours, in small, but often-repeated doses, watching it carefully, with from thirty to sixty grains of the bromide of potass, to which a little bicarbonate potassa is added every three hours. Enemata of a solution of boroglyceride, to which a few drops of the tincture of belladonna is added. Persistently repeat, and repeat the gelsemium and bromide until the erections are overcome. If the case is one dependent upon the microbe of gonorrhea, the same plan of treatment should be pursued, with the addition of belladonna suppositories. The various affections which are associated Prolapse of the with prolapse of the mesentery are a clue Mesentery. to its pathology. Given in the order of their^ frequency, they are prolapse of the transverse mesocolon, prolapse of the hepatic flexure of the colon, and prolapse of the right kidney, prolapse of the splenic flexure of the colon, and prolapse of the left kidney. The pylorus and duodenum are at times also prolapsed, with elongation of the BACTERICIDES. 863 lesser omentum ; but a mobile pylorus is such an ordinary oc- currence that it hardly deserves to be enumerated amongst the other complications. The co-existence of these affections has just been adduced as an argument to prove that when acquired hernia is associated with prolapse of the mesentery the prolapse is a cause of the hernia, and not an effect ; and now it may be argued that their co-existence proves that, with rare exceptions, prolapse of the mesentery is not due to a local and accidental condition, but that there is, except, perhaps, in simple prolapse, a more general deterioration, in which the suspensory apparatus of the mesentery merely participates. The nature of the lesion which permits the displacement of the kidneys is pointed out by Landau, in his excellent work on movable kidney. In my opinion that author clearly establishes that the prolapse of those organs is due to elongation of the fascia which descends from the diaphragm for their support. The cases in which I have seen prolapse of the kidneys, either with or without hernia, show that the displacement of the kidney is nearly always associated with descent of the hepatic or splenic flexure of the colon. Analogy would lead us to infer that prolapse of the mesentery was of the same nature as prolapse of the kidney, and was due to a failure in the suspensory apparatus. The question, how- ever, can be placed upon a surer basis, because there is no diffi- culty in ascertaining that when the mesentery is prolapsed its root becomes excessively movable and capable of being pulled downwards with significant ease ; and moreover, dissection shows that under these circumstances the tissues which compose its root are thin and scattered and inadequate to resist displacement. The suspensory muscle is one of the chief constituents of the root of the mesentery, and is, I think, mainly at fault. But there are other circumstances, which suggest that the peritonaeum ought not to be ignored ; for instance, I am not aware that either the hepatic or splenic flexures or the colon, or the transverse mesocolon, have other support than the serous membrane, and yet, as we have seen, prolapse of one or more of those structures is a common accompaniment of prolapse of the mesentery ; also when the pylorus is displaced the elongation of the gastro- hepatic ligament is very obvious. All of these circumstances point to the import- ance of the peritonaeum as a factor in these displacements, in- cluding that of the mesentery. With regard to the other struc- tures which are involved in this affection, namely, the mesenteric artery, vein, nerves and lacteals, we can only infer that they play a minor part, although, as in prolapse of the kidney, they are noticeably elongated. The causes of the deterioration of the suspensory apparatuses and peritonaeum which permits these 864 DISEASE GERMS. various displacements are not clearly indicated by rny investiga- tions, but age has without doubt an important influence, and it seems quite safe to add other debilitating influences, such as poverty, wasting diseases, certain occupations, and the like. Prolapsus of the rectum, or falling of the- Prolapse of tlie fundament, or a protrusion of the lower Rectum. bowel, may exist in various degrees ; it may be simply a protrusion of the mucous mem- brane near the anus, or the various coats of the bowel, or the bowel itself may be protruded several inches. The chief causes of these displacements in children are : in- herent weakness ot the parts, diarrhea, straining at stool, worms and any irritating disease of the rectum, or genito-urinary organs. The same causes may produce like results in adults, also chronic diarrhea, catarrh, dysentery, internal hemorrhoids, polypus, impacted faeces, diseases of the urinary organs, as irrit- able prostate and bladder, ca.culi, ulcer. Symptoms. — Usual ly in the early stages the prolapse takes place after the bowel acts. Insidiously, and pro- gressively the descent of the bowel or its coats follow any exertion, as running, jumping, coughing, strain- ing, laughing, crying, etc. A fold of the mucous coat at first, by and by the inverted bowel may be protruded to the extent of four or five inches. This usually follows defecation, and is easily returned ; but if not cured speedily, the sphincter ani becomes relaxed, and the pro- lapsus becomes permanent ; the intestinal mucous membrane being exposed to the air and subjected to various forms of irrita- tion, becomes thickened, indurated, often ulcerated; discharge of mucus tinged with blood; general distress, about the hips, back, with severe pain in defecating. The reflex symptoms are numerous, headache, mal-assimilation, nervous twitching, convul- sions, general impairment of the vital force. Treatment. — In the prolapsus of both children and adults, much good can be effected by improvin-g the general health in every possible manner. Daily bathing, massage, flannel clothing and the very best of diet, abundance of fresh air. The patient Prolapse of rectum, with its mucous membrane. BACTERICIDES. 865 should in all cases pursue an alterative and tonic course of treat- ment for some months. The best remedies for internal exhibition are Virginia stone-crop, collinsonia, bayberry, aromatic sulphuric acid and quinine; compound tincture of cinchona and nitro-mu- riatic acid, and for an alterative compound, saxifraga. The bowel, if possible, should never be permitted to remain protruded, if it can be returned ; if this is difficult, make a hot poul- tice of pulverized slippery elm, in which are incorporated some powdered lobelia and belladonna leaves. After this has remained a short time the bowel is usually very easily replaced by oiling the back of the hand and pressing it gently, but firmly, against the bowel, and replacing it. In some obstinate cases, it may be necessary to administer an anesthetic or place the patient under the influ- ence of a relaxant, as the compound lobelia. When the bowel is returned every precaution must be taken to prevent a recurrence or even a slight pro- trusion by applying a pad of lint firmly against the anus and a T- bandage. The bowels should be moved by a mixture of castor oil and glycerine ; a sufficient quantity administered to cause one evacuation of the bowels ; or fluid extract of butternut, or cas- cara sagrada lozenges might be tried for the same purpose. The patient for a few weeks should defecate in the recumbent posture so as to avoid straining. Immediately after the bowels have moved, a cold water hip bath should be used, parts well dried, and a teaspoonful of either the fluid extract of Virginia stone-crop, or collinsonia, or oak bark, or matico, or bayberry, added to one or two tablespoonfuls of water injected into the bowel, or if a mineral acid is deemed best, the following is of great efficacy : aromatic sulphuric acid, one ounce ; water, six- teen ounces. Mix. Inject one ounce. The best suppository to use instead of the enemata is one made of the Virginia stone-crop, pulverized opium and butter of coca. If these means fail, after a fair and prolonged trial, administer a large dose of castor oil before retiring to bed ; next morning, after the bowels are thoroughly emptied of their contents, the protruded portion should be well cleansed with warm water and 55 Prolapsus of three folds of the rectum with posterior tubercular ulcer — a most c«mmon condition in the diar- rhea of phthisis. 366 DISEASE GERMS. castile soap, and returned, then an ordinary anal speculum with a window its entire length, well warmed and oiled should be in- inserted its entire length, the vertical portion of the bowel ex- posed in the window of the speculum should be wiped dry, then C. P. nitric acid should be painted down its entire length. This should be repeated thrice, so as to be effectual. Then the speculum should be turned about three-quarters of an inch and another vertical streak made with the nitric acid, and this should be repeated so as either to make five or seven vertical streaks around the bowel. An interval of time should elapse between each turn of the speculum so as to permit the nitric acid to penetrate to the erectile fibres. Following this, one grain of pulverized opium should be ad- ministered every three or four hours to allay peristaltic action ; patient confined in the recumbent posture for about seven or nine days. Underneath each of the vertical streaks of nitric acid, a species of plastic inflammation is set up, lymph is effused, thickening takes place and vertical pillars, usually strong enough to keep the bowel erect, are established. Food must be taken in a concentrated form, as it is not desira- ble to have the bowels move for over a week. At which time they should be acted on with castor oil. This is the most effective method of affording a radical cure. The uterus may be displaced in various ways. Prolapse, the most common forms being simple displace- i^Uterus) ment in which it descends down and protrudes beyond the vulva ; anteflexion, where the fundus of the uterus is bent over on the bladder ; and retroversion, in which the fundus is bent over on the rectum ; besides it may be displaced laterally. The predisposing causes are inherent wealcness of organization, or debility. The exciting causes are a relaxed state of the vaginal walls, debility of the broad ligaments, added to which there is either tight lacing, Hfting, jumping, strains, fall, standing occupations, constipation, indefinite retention of urine, congestion, tumors. Prolapsus and procidentia are two terms employed to designate a descent or falling of the womb, as * it exists in two different degrees, or grades. Prolapsus means that condition in which the uterus falls below its natural level in the pelvic cavity. The term procidentia is used when the uterus slides down and pro- trudes beyond the vulva. It is simply prolapse or falling, ex- tended in degree, both conditions being the same. BACTERICIDES. mr Symptoms. — Leucorrhoea, pain in the back, sense of weight or fulness about pelvis, bearing-down pains. Usually no impedi- ment to menstruation, or conception, as uterus is generally re- placed when in the recumbent posture in bed ; irritation of blad- der and rectum. In prolapsus, uterus found depressed, resting on upper floor of perinseum ; in procidentia, a round or pear- shaped tumor, with os uteri visible at its centre, is seen project- ing beyond the vulva. Labia of os uteri, from exposure to air and clothing, often becomes excoriated; vaginal walls dry, harsh, cracked or ulcerated. Treatment, — As far as possible remove all predisposing and exciting causes, as debility, tight lacing, coughing, constipation, standing occupation, congestion ; carefully regulate bowels with either cascara sagrada or kola nut, so that the stools will be soft, and easy ; place the patient upon the best of food and a tonic course of remedies, embracing such medicines as wine of aleteris farinosa ; and coca erythroxylon, in alternation with comp. syrup of partridge berry and comp. tincture cinchona. A two-quart fountain syringe is an essential requisite of every lady's toilet. This must be used morning and night. The first thing in the morning, before getting up, it should be used in conjunction with a bed-pan, so as to keep patient strictly in recumbent posture. A selection from some of the following agents should be made for the purpose Proiapse of uterus (procidentia). of injecting : boroylyceride, resorcin, creolin, lime water and tincture of iodine, matico, oak bark , dis- tillation of witch hazel. A full quart or more be permitted to pass through — of a strength adapted to each particular case. Before the patient is permitted to get up, some form of mechani- cal support should be applied. This may consist of a silver, or gutta-percha cup, or it may be a fine silk sponge, cut in the shape of a small pear, with a silk cord fastened to it, which saturate with the last wash used, and then insert up the vagina, the broad baipe upwards and point or pedicle downwards, from which the cord hangs. Then patient to get up. The size of this pear-shaped sponge will depend on the capacity of the vagina ; it must be large enough to prop the uterus up in its proper place. This process of injection is to be repeated at noon and at bedtime. The patient can easily draw the sponge out herself, which should be thoroughly washed every time. After the night injection the sponge need not be 868 DISEASE GERMS. inserted, but should be laid to steep in a solution of boroglyce- ride. This is to be repeated every day, changing remedies every three or four days, and keeping the patient lying down as much as possible. Cold water hip-bath, morning and night, to give tone to the pelvis and its organs, especially the broad liga- ment. All treatment, except the tonics, to be discontinued during menstruation. If the case is an aggravated one of procidentia, the uterus must be returned, and the same plan pursued. Now, if this fails in eight or ten weeks, which is seldom the case if patient is faithful, and the injections cold and of proper strength, return the uterus, and resort to the radical operation of painting seven vertical streaks on the vaginal walls, as described under Vaginal Prolapsus. This is better than humbugging with belts, supporters, plates, pessaries, rings, and other trash that irretrievably ruin a woman. Any lady, with a very little in- struction, may cure herself in a short space of time. It will aid matters much if she is freed from all domestic care, or toil, or worry, so that when about she can either walk gently, or ride, for the improvement of general health. A most excellent plan in old chronic cases, with considerable irritation and thickening of the neck of the uterus, is to pack the vagina with boroglyceride every night on retiring to bed. This exercises a most beneficial effect, as it stimulates absorp- tion of the effused lymph, and exercises a highly vitalizing action upon the parts; it gets rid of the induration, drains off the super- fluous products of inflammation. If this does not operate speedily, or efficiently enough, the in- sertion of two or three jequirity capsules, say about once a week, will cause a complete exfoliation of dead tissue to take place, and lighten to a considerable extent the specific gravity of the uterus. The body or fundus of the uterus may be thrown forward on the bladder, or backward on the rectum, constituting anteflexion, or retroflexion. If the displacement backward or forward is not very great, there may be very few symptoms present. If the flexion is quite considerable, there is much suffering ; the uterine ligaments are unduly stretched, the circulation through the body of the uterus is interfered with, impeded, and the fundus immovably fixed on either the bladder or rectum. The leading features of those cases are great languor, lassitude, debility ; dull, wearing, aching pain in back; tenderness about the groin and inside of the thighs ; sense of fulness or obstruction in either rectum or bladder; pain in coition; fecundation prevented; BACTERICIDES. 869 severe dysmenorrhoea ; nausea, gastric irritation, loss of appetite. Great mental depression, reflex irritation, etc. The displacement is readily made out in all cases by the uterus sound. Antiflexion of the uterus gives rise, in addition to pressure on the bladder, to sterility, dysuria, dysmenorrhaea, dyspermasia. The kink produced in the cervical canal by the flexion of the cervix prevents the ingress of the seminal fluid into the uterine cavity. Until this obstruction is removed by straightening the canal, the sterility will persist. To effect this the introduction of an intra-uterine stem is the only certain remedy. Slight flexions may be relieved by the occasional passage of the uterine sound. Backivard displacement^ and uterus freely movable, the bladder should be emptied and the uterus fully replaced by bimanual manipulation in a position of complete anteversion, the fundus being directed to the pubes and the cervix to the sacrum. A Hodge pessary of sufficient size is to be now inserted to keep the cervix in this position. The use of the pessary in the posterior cul-de-sac is not to support the body of the uterus, but to sling the cervix upwards and backwards. When adhesions prevent reposition, and no activ^e disease exists, stretching and loosening the adhesions is to be recom- mended. Cases of this kind are not by any means Prolapsus rare. It is met with in women who have of the Vagina, practiced masturbation, or borne many children, or had numerous miscarriages. Tight-lacing, strains, lifts, coughing may produce it. When the front part alone is affected it draws down the back portion of the bladder and is called vaginal cystocele ; if the back wall of the vaginal falls down it is called vaginal rectocele. In the former case, urine is apt to accumulate tn a pouch formed by the bladder; in the latter, a pocket forms in which hardened faeces are retained, causing a sense of weight and irritation. In the treatment of prolapsus of the walls of the vagina there should be an avoidance of coughing, straining, lifting, and above all things, tight-lacing. The patient should be placed upon a general tonic and alterative course of treatment : the wine of the aleteris farinosa and coca erythroxylon in alternation with compound partridge berry, compound tincture of cinchona, avena sativa. Vaginal injections, with fountain syringe thrice daily, very copious, consisting of boroglyceride, matico, oak bark, glucozone, distillation of witch hazel. Pastiles are also of great utility. 870 DISEASE GERMS. An effort of cure should be tried by these and like means. All failing, then a radical cure should be tried, as follows : In diminishing the calibre of the canal, in exciting seven pillars of plastic inflammation, or effused lymph to prop it up. It is performed as follows : Bladder to be evacuated, rectum thoroughly syringed ; the vagina to be washed out with a quart of soapsuds ; the protrusion returned ; then introduce a proper-sized speculum, with a window ; wipe dry the part of the vaginal walls opposite window ; then take chemically pure nitric acid and paint a vertical streak one-quarter of an inch wide and two and a half inches long ; paint it neatly and carefully seven or eight times ; when finished, turn speculum half an inch and repeat the same process by making another, and another, until seven good streaks are made. Before re- moving speculum, fill it with a piece of lint, saturated with olive oil, which, hold firmly with a ramrod ; then withdraw the specu- lum, leaving the oiled lint in vagina. Administer one grain of opium every three hours, to lock up the bowels ; keep patient in bed ten days, with a catheter in bladder ; permit no straining, laughing, or lifting for some time ; bowels to be opened with enemata or cascara'sagrada. This is the most effectual method, if well performed. The oiled lint need not be disturbed for a week, unless there is some uterine difficulty above ; if there is, it may be necessary to remove it inside of twenty-four hours. On the removal of lint, injections of cold linseed tea or slippery- elm-water ; all through, pushing tonics and good diet. A more recent method is contraction of the calibre of the vagina by the use of the jequirity wafers, and occasionally pack- ing the vagina with boroglyceride. One of the most common of all maladies, a Prostatorrhoea. hyper-secretion of the tubular glands of the prostate, due to any irritation, such as mas- turbation, extension of the gonorrheal germ, to marital sexual excesses, sedentary habits; bicycle riding, etc., morbid sensibility of the prostate, aggravated by stricture, riding, alcoholic and malt liquors, with contraction of the perineal and other muscles during the micturition and defecation. Such an irritation, with sufficient discharge to barely cause a gluing of the lips up to several drachms, invariably depreciates the quantity and quality of the semen, so that under the micro- scope, the discharge is found to consist of cylindrical epithelial cells, countless refractory and colorless granules of lecithen, and minute, yellowish concentric, amyloid concretions, phosphate of BACTERICIDES. 871 magnesium, watery and colloid semen. When the secretion de- pends upon chronic inflammation of the glands of the prostate, it thickens, and contains in addition, pus, mucus, corpuscles, muco- purulent casts of the follicles and ducts. ' In addition, the local signs, urgent desire to relieve the blad- der, scalding in urinating, a sense of weight, fulness, even dull pain in the perinaeum. Aching, with darting pain in the hips, ex- tending down to the knees ; unsteadiness of gait ; and reflexly the irritation is carried to the medulla oblongata ; brain suffers, as we see by the vertigo, tinnitus aurium, haziness of vision and unbal- anced state of the sufferer. In all cases, it is an obstinate affection to treat. All causes that tend to produce or aggravate the trouble must be interdicted, and attention to the diet and secretions duly attended to. The oozing or leakage is owing to a swollen and irritable state of the pros- tate gland and a debilitated condition of the seminal vessels allowing that fluid to escape; consequently a general alterative and tonic course is indicated. This enlarged prostate is exceedingly common, and the older methods of treat- ment are of no utility whatever. , .^. . ^ ^, ^j The introduction of a seven-inch bougie, A Diagram of the Bladder, , . , , . , . , , ,*=» . ' showing the prostrate gland prepared from the glucoside 01 the black enlarged. willow, Stimulates absorption in the gland, reduces its size, and restores it to a healthy condition. The pro- cedure possesses many advantages over all other methods. In old chronic cases experience has satisfied me of the utility of this remedy in this form ; it has very many advantages, it does its work well, its use is not attended with pain, it does not require the patient to leave off his usual avocation, it has a peculiar and astringent action on the parts. Among the medicaments lately brought into very general use for restoring, the integrity of the sexual organs, none can excel the fluid extract of black willow ; it is a drug which is both sedative, tonic and astringent to the nerves and vascular structure. When the reproductive organs of both sexes are damaged in any way, it is the drug from which the most decided tonic action is to be obtained. By its use all leakages, great or small, are effectually checked. Its introduction at the present time may stem the current which is dwarfing humanity in its very essence. Every man or woman who has practiced self-abuse ; every one 8;72 DISEASE GERMS. who has had a gonorrhea, or suffered from sexual perversion, or ridden a bicycle, needs the vivifying influence of the salix niger. For a more elaborate descriptive article, the reader is referred to article Hypertrophy of the Prostate, page 475, of present volume. The most prevailing affection of American males, in all ages. A condition of heightened sensibility, with Pruritus, altered nutrition, with microbe evolution, in which the main symptom is an indescribable itching, affecting the whole or a portion of the body. Generally local, not infrequently a most troublesome, obstinate malady. Pruritus of the vulva frequently depends on uterine disease, and all remedies prove useless till that is removed. After vaginal injections of either lotions of boroglyceride or resorcin, try some of the following remedies : Carbolate of sodium in equal parts of cologne spirits and glycerine ; or the sozoiodol of mercury ; or strong peppermint water and borogly- ceride. Pruritus ani, lime water and fluid extract of belladonna, or ozone ointment with atropia ; salicylate of soda, with creosote and camphor, is most efficacious ; tincture benzoin, peroxide ot hydrogen, oil of rue, etc., painted on the part are of immense utility. A selection of one of the following formulae may be tried in pruritus: Saponis viridis; oil cadini ; alcohol, of each one ounce ; resorcin, two drachms. Mix. Sodae borate, two drachms ; chloride of morphia, sixteen grains ; dilute hydrocyanic acid, half an ounce ; glycerine, two ounces ; water, eight ounces. Mix. Add one ounce concentrated ozone to two ounces of ozone ointment. Mix. Muriate of cocaine, fifteen grains ; muriate of morphia, ten grains ; carbolic acid crystals, twenty grains ; tincture of aconite rad., three drachms ; rub the whole up in one ounce of ozone ointment. Apply lightly over the affected surface. Menthol, thymol, of each one drachm ; oil of sweet almonds, one ounce ; benzoated zinc ointment, half an ounce ; muriate cocaine, ten grains. Mix. Conium cerate, one ounce ; resorcin and salicylic acid, of each two drachms. Mix and apply. The local treatment should be BACTERICIDES. 873 commenced by the institution of the most perfect cleanliness. The patient should be instructed to wash his anus well with a cloth and cold water after each action of the bowels, and then to bathe his anus with the following wash : Hyposulphite of soda, half an ounce; carbolic acid, two scruples ; aqua destil., four ounces ; glycerine, two drachms. Mix. Sig. — Shake the wash well, and use freely after first thoroughly washing the anus with cold water. In addition to this treatment, the patient must every night or two, after undressing for bed and washing and drying his anus, lie upon his face, and with his hands behind him separate his nates as widely as possible, and be instructed to strain as at stool, and while thus straining the anus will protrude, and while the anus is protruding in consequence of the strong effort, five or ten grains of pulv. iodoform must be sprinkled upon the anus from a knife or spatula by an assistant. The minute eruption which causes this most distressing itching will be found most abundant at the junction of the mucous membrane of the rec- tum and the skin of the anus, and it is at this situation that the application does the most good. The patient should allow the iodoform to remain in the position of its application during the night, repeating- during the day his ablutions of the anus after each action. The probability is that after two or three nightly applications of the iodoform all pruritus will disappear ; but the patient should be directed to have the application of the iodoform continued three or four times a week until he is entirely relieved. Frequently we have occasion to try many medicaments in succession before we hit the right one suited to the case. The disease is always stubborn in pregnant women. External appli- cations are not always of permanent utility, constitutional treat- ment is often required, even then we have our hands full, for medicaments soon lose their effect. Gelsemium in full doses has done best for us of any single remedy. Skull-cap is often of eminent benefit in some cases. A combination of chloral and bromide of soda occasionally does wonders. In some cases euonymus and helonius act well. In one severe case, lady-slipper tea, made from the recent root, one ounce to a pint of boiling water, a wineglassful every two hours, worked like magic. Among local agents, balsam of peru stands first in our ex- perience, apply it full strength. Some cases will require it di- luted, then use vaseline as the diluent. When it fails, try an ointment made of balsam peru, two drachms ; quinine sulphate, one drachm ; extract belladonna solid, one drachm. Rub on the parts. Borax, two drachms, water, eight ounces ; oil of 874 DISEASE GERMS. peppermint, ten drops. Apply often to the parts. Nitric acid, ten drops ; water, eight ounces Apply to the parts. Bismuth subnit, apply dry to the parts. Iodoform, bismuth subnit, boric acid, equal parts. Apply dry to the parts. Boroglyceride and resorcin a most excellent application. In some cases, local applications to the os uteri will be needed to effect a cure. But few things are equal to carbolic acid di- luted with glycerine, applied at first moderately strong, then stronger. You may add solid extract belladonna with good re- sults. In one case we made a strong solution of salicylic acid in glycerine, applied to the os and cervix with a small swab. A second application was needed a week after, after which no more trouble was experienced. A medical friend says he has the best results from dry sulphur, rubbed on the parts and small doses taken internally twice a day. Keep the bowels soluble with mild cholagogues. There is often an intimate relation between pruritus in preg- nant women and liver inactivity, hence the benefit of such reme- dies as chionanthus, The causes of general pruritus is obscure, it is met with chiefly in elderly people, and is but very little amenable to treatment. When present in the middle-aged, it is generally associated with some other malady, especially jaundice, glycosuria, and albumi- nuria. In women, pregnancy and disturbance of the menstrual functions may also give rise to it. The disease, however, is more commonly met with as a senile change of an obscure kind, and as such is incurable. Treatment. — When the neurosis arises from, or is associated with, some other malady, such as jaundice, glycosuria, or dis- turbed menstrual functions, a rational and often successful mode of treatment is at once suggested. The cause of the disease should as far as possible be removed, and in addition, local reme- dies of a soothing kind may be used to give a little temporary relief from the intolerable itching. Amongst these, tepid gela- tine, and bran and alkaline baths are the most generally useful, some soothing ointment being always applied to the skin after the bath, to prevent it from becoming too dry and cracked. In senile pruritus the same plan of local treatment may be adopted, but the relief at best is only temporary. In all cases of pruritus, whether local or general, the microbe of neurasthenia is ever present, and all cases are greatly benefited, nay, cured by glycerite of kephaline and tincture of oats. Great cleanliness is essential. Stimulating food, hot, fiery drinks avoided. BACTERICIDES. * 8/5 A peculiar form of skin disease, characterized by Prurigo, itching especially when the body is heated, due to an altered state of nutrition of the skin. Generally no eruption visible. There are numerous varieties, depending upon the cause. Any remedy which will promote nutrition of the skin is the one to administer, as quinine, iron, sulphur, arsenic, oxygen. Locally, sulphur baths, naphthaline. A term applied to a condition, in which the Psilosis. leading features are bareness or rawness of the tongue and entire intestinal mucous membrane. The most prominent symptoms are remitting inflammation of the mucous membrane of the mouth and alimentary canal; diar- rhea, irregular action of the bowels, anaemia, general atrophy. During the exacerbation, tongue swells, papillae become elevated and red, shallow ulcers appear on the cheeks, tongue, lips, accom- panied with salivation, swelling and tenderness, with a tendency to bleed ; articulation is difficult. The acute stage passes off, and the tongue becomes small, glazed or shining, looks as if it was denuded of its epithelium. Taste and smell usually in abey- ance. The evacuations from the bowels are usually a gray pultaceous mass deficient in bile ; albumen, excessive debility. The pathology of the disease is obscure. What few cases have been seen have been amenable to an in- fusion of the Japanese persimmon with resorcin, and arrow root and beef tea for diet. This is a dry scaly disease of the skin ; it is Psoriasis, chronic in its course and characterized by slightly raised red patches covered by white, shining, opaque scales ; these scales often come off in great numbers, so that on waking iu a morning, the patient finds his bed full of little branny particles. Sometimes the spots are cir- cular, small and numerous, and scattered over the skin ; some- times they are ring-shaped and the centre is healthy, while the disease spreads at the circumference ; sometimes large patches of irregular shape occur, and most often they are seen at the knees and elbows ; at other times the patches assume a figure- of-eight form. The edges are always well defined and with a tendency to be circular ; when the scales are rubbed off, a dry and red surface is left. The name lepra was formerly given to ^76 DISEASE GERMS. the ring-shaped variety of psoriasis, but the term has now fallen into disuse. Psoriasis in all its forms runs a very chronic course, lasting not unfrequently for many years. When cured it is prone to come back again. Some persons have an attack of psoriasis every year ; spring and autumn are the seasons when it most frequently appears. The red patches of psoriasis are due to inflammation of the skin ; the scales are due to excessive for- mation of epithelium on the inflamed surface. The rash is often accompanied by much itching ; it occurs on the coarse and dry parts of the skin, and not where the sweat-glands are abundant. The disease is never communicated from one person to another, although a tendency to it is certainly hereditary ; it may come on as a consequence of syphilis. On the palms of the hands and soles of the feet it may be mistaken for eczema. The peculiar defect which gives rise to this form of skin dis- ease, is to be found in the presence of the bacillus of tubercle, syphilis, rheumatism, gout ; in the surroundings and general health of the patient ; in states or conditions of depressed vitality, overwork, relaxing climate, sexual excesses, or any excessive drain upon the system. In the treatment, the essential points are to build up the gen- eral health by every possible means, by a most nutritious diet, daily hot alkaline baths ; flannel clothing. General alteratives and tonics, as saxifraga, phytolacca ; alter- nated with avena sativa, kephaline. A selection of some of the following remedies are worthy of a trial. Large doses of Fowler's solution might be tried, and in order to facilitate its toleration. Oil of cadi is a most efficacious remedy as in the following formula. Glycerite ; starch ; oil of cadi, and green soap. This in suitable strength, is applied over the eruption. An ointment of thymol, or salicylate soda, or chrysarobin. Red, circumscribed, hyperaemic Psoriasis Linguae, patches on the tongue, and inner sur- {Leucoplacia) face of the lips and cheeks, may exist for a few days, weeks, or months, and then spontaneously subside, or become developed into circum- scribed grayish or white discolorations. There are many micro-organisms present, the oidium albicans usually taking the lead. Irritation has much to do with its pro- duction, especially smoking, which favors the development of epithelioma. The numerous micro-organisms are met with in nests, which BACTERICIDES. 877 bore their way into the epithelium, and deeper tissue, giving a thickened and fissured aspect to the patches. The whole pro- cess is characterized by infiltration and cell-proliferation of the corium, which explains the obstinate persistence of the patches and the readiness with which they undergo conversion into other processes. The early or hyperaemic stage of leucoplacia, as described by Professor Schwimmer, is not often seen ; the disease usually presents the appearance of milky white patches on the dorsum of the tongue ; sometimes these patches are slightly raised and rough, and have a sodden appearance ; in other cases they are quite smooth. I.eucoplacia is not confined to the dorsum of the tongue ; it is occasionally met with on the mucous membrane of the cheek and lower lip. Diagnosis. — Leucoplacia should be distinguished from a some- what similar condition produced by syphilis, and also from superficial scars of the tongue, which sometimes have a white appearance ; and, if I am right, it should also be distinguished from psoriasis of the tongue, which, like the syphilitic affection, is more amenable to treatment than ordinary leucoplacia ; but on this point I should be very unwilling to dogmatize. In the treatment, all irritation, including smoking, should be removed. The most favorable local treatment is the application of a saturated solution of boroglyceride. Many kinds of stomatitis have been described, but it is only necessary to refer to three : 1. Aphthous stomatitis, which is the commonest of all forms, begins as little yellowish spots of exudation; these subsequently form into small, very superficial ulcers with a red areola. When these ulcers are of larger size than usual, and the attendant in- flammation considerable, the disease becomes both very painful and troublesome, and the ulceration difficult to cure ; but under ordinary circumstances, when it does not assume this severe form, it yields readily to local and general treatment with boro- glyceride. The affection is very apt to recur. In all severe forms of ulcerating stomatitis the internal administration of opium is all-important. 2. Parasitic stomatitis, or thrush, is chiefly met with in un- healthy children, and in those suffering from exhaustive diseases. It is due to the micro-organism oidium albicans. The white patches seen on the buccal mucous membrane are found to con- sist of epithelium permeated by the spores and mycelium of the parasite. A weak resorcin lotion is useful as a wash for the mouth, and in addition the spots may be painted with glyceri- num boracis, applied with a small camel's-hair brush. Wandering rash on the tongue. It is usually seen as small 8/8 DISEASE GERMS. rings and fine serpiginous lines of a bright red eruption. The peculiar character of the rash is the quickness wito which it spreads centrifugally, so that it is appropriately described as wandering over the dorsum of the tongue ; the rings will some- times disappear and new ones appear in the course of a few hours. Subjective sensations of itching are always present. It has been compared in appearance to ringworm, but has no re- lationship to that disease. A varicose condition of the vessels of the inner Pterygium, canthus of the eye, giving rise to a triangular excrescence, usually the result of inflammation. The generally accepted theory of all authors is that pterygium has its origin in a marginal corneal ulcer, to which a tag of con- j unctiva has become attached ; it is thought to be untenable, because if this were its usual mode of origin, pterygium would be found approaching the cornea from every possible direction, since marginal corneal ulcers are not apparently more frequent in one position than in another. It is known, however, that such is not the case, but that pterygium is almost always situated directly over the recti muscles, and that in a very large proportion of cases it is over the rectus internus. The more recently proposed theory of Poncet, that pterygium is due to the presence of mi- crobia, which tunnel their way under the corneal epithelium, is open to the same objection, for this also assumes the existence of a precedent corneal ulcer. The view long held, that con- ditions which tend to induce chronic hyperaemia of the conjunc- tiva favor the formation of pterygium, is thought to be well es- tablished. Assuming that this view is correct, are there reasons why a localized hyperaemia of the conjunctiva should be of frequent occurrence where pterygium usually forms to the nasal side of the cornea? This is answered as follows: The close connec- tion between the vessels of the recti muscles and those of the anterior portion of the conjunctiva, were referred to, and it was pointed out that the determination of blood to these muscles might influence the blood-supply of the overlying conjunctiva, and that this would be the case especially with the recti interni, since they were the largest of the straight muscles and in close relationship with the conjunctiva, because attached to the scle- rotic nearer to the corneal border than any of the others. Ab- normality in the distribution of the blood-supply of the internal recti muscles, and of the overlying conjunctiva, and, more fre- quently still, disturbance in tihe normal relationship between BACTERICIDES. 879 convergence and accommodation, such as insufficiency of the of the internal recti muscles, the different varieties of ametropia ; these were regarded as the usual causes of pterygium through the localized hypersemia of the conjunctiva, to which they give rise. Brushing it over with a solution of nitrate of silver, thirty grains to the ounce of water, repeating a few times with proper intervals apart, is usually successful in effacing it ; if not, then it must be hooked up and snipped off. All chemical compounds, basic in character, Ptomaines, formed during the putrefaction of organic mat- ter. They bear the closest possible resemblance to vegetable alkaloids, but they are not all poisonous. All putrefaction is due to the action of bacteria; ptomaines are the result of the growth and activity of disease germs. The poisonous or non-poisonous character of ptomaines de- pends a great deal upon the individual bacteria engaged in their production, upon the temperature, amount of oxygen present, electrical states, etc. Each disease germ excretes or generates its own ptomaine. The bacillus of typhoid produces the ptomaine ty photo xine ; tetanus, tetanine ; which if injected into animals gives rise to tetanic convulsions ; the bacillus amylobacta, by its action on carbohydrates, gives rise to butyric. Bacteria are either aerobic or anaerobic ; the one thrives by the presence of air, the other by its exclusion. This quality in itself causes a difference in the chemical character of a ptomaine, besides there is a decided difference in the various stages of putrefaction. Ptomaines are transition products in the progress of putrefac- tion — temporary forms through which matter passes in its change from the organic into the inorganic state — complex organic sub- stances, as brain, gland, muscle, etc., are broken up into less complicated molecules — their original elements. Countless myriads of minute organisms are thus constantly engaged in transforming matter from the organic to the inorganic state. Besides being abundant in all putrefactive states, ptomaines, abound in all forms of shell-fish, in decaying sausages ; in im- perfectly cured ham ; in all canned meats ; in a large amount of imperfectly cured cheese ; tyroxicon is found in all milk partially frozen, then thawed, and re-frozen and used ; in ice cream ; in the mould of meal, flour or bread, ptomaines are found like in ap- pearance to the crystals of uVea. 38o DISEASE GERMS. Specific micro-organism are the cause of special disease. Each must be pathogenic of that disease and conform to definite rules. In order to be able to state definitely that any disease is due to the action of a microbe it is necessary to fiilfil certain conditions as formulated thus : 1. The microbe must be found in the body of the man or animal suffering from or dead of the disease. 2. The microbe must be isolated and cultivated in suitable media outside the body of the animal. The cultivations should be carried on through successive generations of the organism in order to insure its purity. 3. A pure cultivation when introduced- into the body of a suitable healthy animal, must produce the disease in question. 4. In the inoculated animal the same microbe must again be found. The cultivation of microbes. — In the examination of air, water, and the fluids and tissues of the body many kinds of microbes may be seen under the microscope, but it is possible to distin- guish them from one another only by comparing their reactions to staining fluids and their appearance and mode of growth in certain media. The media which are used are both solid and fluid; potatoes, peptone-gelatine, agar-agar (Japan isinglass), bread-paste, chicken-broth, milk, blood serum, urine, various chemical solutions, most of which contain sugar and phosphates. These media, as well as all apparatus with which either the mi- crobes or the media come in contact, must be thoroughly sterilized. It is found that some organisms grow better in one kind of soil, others in another, thus pathogenic germs grow best in an alkaline medium, putrefactive in an acid one : and at least twelve pathogenic forms will not grow in nutrient animal jelly. It is not every acid, however, which interferes with the growth of pathogenic germs, as the acid surface of a potato affords a favor- able nidus. Besides these points, their growth is influenced by temperature, by the presence of mineral matter (amount and kind), and by the presence or absence of oxygen (aerobic or anaerobic). Germs grow in nutrient jellies in a manner varying with the way in which they are planted, the usual methods in tubes are surface, depth, and streak cultivations. Gelatine jelly is used when the required temperature at which the tubes have to be kept is under 25° C., at which point it liquefies; agar-agar liquefies at 35° C. When microbes are cultivated in this man- ner, under favorable circumstances, they rapidly grow and mul- tiply ; this is done by simply dividing in two (fission), or by the BACTERICIDES. g^I production of spores, or by both means. The vitahty of many of the spores is so great that if circumstances favorable for im- mediate growth are not present, they will survive for very long periods ; outbreaks of diseases which seem spontaneous in their origin may be thus explained. The special bacterium must be present in all forms of the disease ; special micro-organisms freed from all extraneous matter. The micro-organisms themselves may be poisonous, or the poison may be an integral part of them, or the germ may pro- duce a poison, by splitting up pre-existing compounds in the body, or it may be intimately associated with or produce a solu- ble, chemical ferment. Ptomaines excreted from the microbes of anthrax, cholera, puerperal and typhoid fevers, often kill before the germ enters the blood. Ptomaines resemble, in all essentials, the vegetable alkaloids, poisons, Conine, nicotine, strychnine, morphia, atropia, digitaline, veratrine, delphine, colchicum, curare, aconitine. Besides the presence of disease-germs, with their alkaloids, ptomaines, there are another class of basic substances which are found in the living, either as the product of fermentative changes or of retrograde metamorphosis, alkaloidal products of physiologi- cal change found in the animal tissues during life, termed leuco- maines, in contradistinction to the ptomaine, a basic product of putrefaction. The leucomaines are derived from the urea and creatine group, and are called autogenous. The excretion of all living things, plants and animals are poisonous to the organism which excrete them. An individual may drink only pure water; eat food of the best; free from all adulteration, breathe the purest atmosphere, and yet his excretions will contain the most deadly alkaloid poisons, which are formed in the body, originate in the metabolic changes by which com- plex molecules are split up into simpler compounds. These woe-be-gone states of languor, lassitude, debility ; states in which there are headache, brown-coated tongue, termed biliousness, are due to the formation of alkaloids, shocks to the system from cold or wet or otherwise, retain effete matter, which poison the nervous system, which is speedily relieved by a Turkish bath, opening the bowels with a bactericide. Some febrile states are autogenous, due to the retention in the body of products which should be eliminated. Urine excreted during the hoursof activity is much more toxic than during the hours of repose. Physical and mental work give rise to the formation of numerous poisonous substances ; lengthen the hours of labor, shorten those of rest, and we have 56 882 DISEASE GERMS. toxical agents formed, which give rise to insomnia and fretfulness ; brain excited and refused to rest. Fever from fatigue, from pro- longed excretion due to like causes, often mistaken for malaria. The following is a list of ptomaines discovered, with their formula, up to the date of publication of this work : Name. Methylamine, .... Dimethylamine, . . . Trimethylamine, . . Ethylamine, . . . . Diethylamine, . . . Trietbylamine, . . . Propylamine, .... Amylamine, .... Hexylamine, .... Tetanotoxine, .... Collidine (?), .... Hydrocollidine (?), . Parvoline (?), . . . . Unnamed, Ethylidenediamine (?), Trimethylenediamine, Putrescine, Cadaverine, .... Neuridine, Saprine, Unnamed Methyl-guanidine, . . Unnamed, My dine, . . Neurine, . . Unnamed, . Choline, . . Betaine, . . Muscarine, . Mydatoxine, Mytilotoxine, Gadinine, . Typhotoxine, Unnamed, . Tetanme, . . Unnamed, . . Tyrotoxicon, . Mydaleine, . . Spasmotoxine, Peptotoxine, . Formula. H5 N . H7 N . Hg N . H. N . C3 Cs C9 ^: C5 C, Cl3 ^- iN . 5N . N . 3N . 5N . xN(?] iN . 3N . 3N . 5N . e^2 N, ,N, iN O 3N O 1NO3 5N O2 3N O3 5NO3 3N o. c: Ci3H,oN20, Cv H,3N,0, Physiological Action. Non-poisonous. Poisonous. Poisonous. Poisonous. <( (( Non-poisonous. Non-poisonous. Poisonous. Non-poisonous. Poisonous. Non-poisonous. Poisonous. Non-poisonous. Poisonous. Poisonous. In stercoraemia, or constipation or arrested secretion from the intestines, the poisonous alkaloids accumulated in the bowels in ■BACTERICIDES. 883 twenty-four hours would be sufficient to kill the individual, if it were absorbed. According to good authority, we resist incessant auto-infection by two distinct mechanisms ; elimination of the toxic principle, and its destruction by oxygen. Elimination by the kidneys can be proved, and the same experimenter has always detected alkaloids of the nature of ptomaines in normal urine, though in feeble quantity, and the proportion materially augments in certain pathological states such as typhoid fever and cerebral diseases. Elimination by the digestive tube is also probable. In the etiology of cutaneous hemorrhage, Purpura. the causes may be embraced under the foUow- {Ecchymosis}) ing : Certain blood changes, due specially to the presence of disease germs in the blood, abstracting the oxygen from the corpuscles, such microbes 2& the amylobacta of rheumatism and the tubercular bacilli ; to a want of tone in the nerve centres. In the chaotic condition, induced by the presence of these and other germs, the walls of the vessels rupture, and transudation of both red and white blood takes place. Although the appearance of the effusion of blood in the skin is usually preceded by lassitude, faintness, great prostration, pains in the limbs, etc., still it bears no relationship whatever to scurvy. Extravasation in both affections is liable to occur from the free surface of mucous membrane, into the skin, in serous cavities and within the parenchyma of organs. In purpura there is an entire absence of the swollen, spongy, pallid or livid gums, and peculiar foetor of the breath that we have in scurvy. Vital power is more depressed in scurvy than in purpura. Two varieties, acute, small hemorrhagic spots, like petechia on the body ; chronic, large patches, vibices and ecchymosis. The vital integrity of the lympathic system, spleen, pink mar- row, etc., is greatly impaired. In the treatment, complete rest in the horizontal position must be insisted on, bowels regulated with cascara sagrada lozenges. Digitalis in alternation with the mineral acids and quinine should be tried; if their effects are not speedily visible, try the following: Glycerite of kephaline, six ounces ; sulphate of strychnine, one grain. Mix. Half a teaspoonful every three hours, added to water. Ergot has met with good success ; also fluid extract hamamelis. Terebinthea in emulsion has also been of utility. 884 DISEASE GERMS. Pyaemia. The streptococcus pyogenes; the germ as seen actively breeding in the blood in pyaemia. localize themselves in During the process of inflammation, lymph or plasma is apt to be eflused from the blood in the part which has a partial death, and this lymph, provided the vital forces be low or the treatment inefficient, very liable to become pus — living matter of the very lowest organiza- tion, which if, by any accident, it finds its way into the blood, through an abrasion, scratch, wound, or otherwise, is liable to give rise to pycemia; a contagious and infectious disease due to the presence of the micrococci of pus. The entrance of this disease germ into that vital fluid, the blood, is most disastrous as it gives rise to extreme bacterial evolution with embolism, and the pus microbe breeds so rapidly, that entire colonies every tissue, gland, and organ of the body, attended by the formation of infarctious, metastatic abscess in which the protoplasmic elements of the pus germ proliferate. Rigors are indicative of pus growth ; its progress, its volume, rapidity. Its destructive action can be appreciated, nay, calcu- lated by the intensity, frequency, and violence of the chills. The cocci of pyaemia, strep- tococcus pyogenes, are seen occurring singly or in chain and in zoogloea. Pus when absorbed begins a new era 'of germ life, and microscopic organisms begin to breed and multiply in every tissue of the body and cause suppurative pyaemia. The microbe bears culture well in any rich animal broth'; cultures injected into animals give rise to the disease in all its malignancy. The formation of pus, its confinement within a cavity, in the cellular tissue, bone, carbuncle, pustule, or its reception by a dis- secting wound, or a laceration, all lead to pyaemia, colonies of micrococci everywhere, with thrombosis and embolism due to bacteria. This history of the case, with marked, decided rigors, followed by a great rise in the temperature of the body, being out of all proportion to the phenomena of chill. This is followed by pro- fuse colliquative sweats ; great irritability ; heart failure, with at Full developed streptococcus pyogenes ; genie microbe of pyaemia. BACTERICIDES. 885 first a small very rapid pulse and latterly intermittent ; conjunc- tiva and skin assume a yellow tinge ; later on, jaundice. The breath, sweat, sickly odor ; tongue, white, dry, fissured, later glazed, brown sordes on teeth, nausea, vomiting, great thirst; abscesses on all the internal organs, followed by dull apathy, delirium, labored respiration, face of a leaden color. In order to perfect a correct diagnosis of all cases of pyaemia, it is imperatively necessary to make a microscopical and chemical examination of the stools and urine for the strepococcus pyo- genes which is always present in great abundance. When the cocci are found in the urine, it may point to suppuration in the urethra, prostate, bladder, kidneys ; but when persistently present in the stools, isolated from necrotic patches in the liver, we can see the organisms, study their ameboid movements, witness their sprouting in the form of spherical outgrowths, looking like mulberries, full of live cocci in vio- lent, unceasing motion. In the treatment of this destructive germ malady, everything should be avoided that would favor the develop- ment of the micrococci. The most rigid antisep- tic precautions in all surgical and obstetrical procedures, cleanliness, good ventilation, sun- light, avoidance of all insanitary states. The strength of the patient should be well supported by the largest amount of nourishment possible, together with stimu- lants. The indication for nourishment and stimulants are most pressing. If possible the germ must be destroyed and elimi- nated by the intestinal tract. With this object in view, the annihilation and sterilizing of the germ, some of the following remedies should be tried ; quinine is the drug which is most extensively employed for its antiseptic, stimulant and antipyretic effect ; we endorse its use. In alterna- tion the most energetic effects are derived from the peroxide of hydrogen in one to three drops administered every hour ; wound, if there is one, dressed with the same. This failing, most excellent results have been obtained from ten grains of resorcin every hour combined with two of sulphate Streptococcus pyrogenes pus germs in the urine and stool in pyaemia. SS6 DISEASE GERMS. of thallin. The sulphites, hyposulphites of sodium, calcium, manganese, especially the two latter, have met with admirable success, and are worthy of a trial. The microbe of rabies exists chiefly within the mi- Rabies, grating cells of the plasma-spaces of the nerve cen- tres, and in similar cells found in the cerebro-spinal fluid ; and the mode of securing these is as follows : As soon as dog suffering from the disease dies, the skin and muscles should be dissected from the back of the neck, so as to expose the atlo- occipital articulation ; the carcass should then be placed on an inclined plane with the head downward ; then, with the thermo- cautery, an eschar should be made over the articulation, and with a sterilized bistoury the sheath of the cord is opened through the burnt space. The fluid is then collected in small spindle-shaped tubes with capillary ends, which have been, of course, sterilized when made, and the points melted, these are broken off at the moment of filling, and at once resealed. The rachitic fluid of a single dog will fill a dozen of these little tubes ; when charged they are placed horizontally in a box, and left for some time in complete repose. After a few days, at a temperature of 20° Cent, one sees in some of the tubes a pale line of deposited cells with one or more white points, extremely small, yet still visible to the naked eye ; these are colonies of the microbes in question. The groups are always few in number, and only one out of many tubes may contain them. This explains why animals may be inocu- lated with the cerebro spinal fluid of an unquestionably rabid dog, and yet not acquire the disease. And is probably due to the paucity of the pathophoric cells which contain the microbes, or that these latter have not always vitality enough to make their way through their walls. By succussing the tubes strongly the colonies can be broken up, and the fluid becomes opaline ; whilst healthy lymph from the same source, and treated in the same way, undergoes no change whatever. The activity of the poison used has been in every case proved by inoculation in a series of dogs and rabbits. A drop from one of the arachnoid shows cells filled with sarcinoid masses of coccus and glomerules separated therefrom. In other spaces this is not seen, but agglomerated microbes bacillar in form, which the author believes to be a transitional condition. These germs are easily cultivated in slightly alkaline broth, in gelatine and agar-agar with or without glycerine. The first cultivations should always be made in broth, and be afterwards transferred to solid media. Their liquefying action on the latter is slight, but in some BACTERICIDES. 887 cases it is complete, and may have been owing to some defect in the gelatine itself. In broth, after five days, at a temperature of 20° Cent, there are numerous globular or irregular deposits at the bottom of the tube ; in some it adhered firmly, like a myco- derma to the glass ; but in most a vigorous shake was enough to make the whole fluid opalescent. It would seem that there is some diastatic difference in these growths, but their pathogenic power is alike ; this was proved by physiological reactions — by the fatal inoculation of other animals. We have succeeded in isolating the microbe from the spinal fluid of rabbits dead through the disease communicated from dogs by corneal incision, and in others inoculated in series for the anti- rabic treatment. For instance, amongst twenty tubes filled from one of the latter, two or three have been found to contain the specific m.icrobe. It is very easily stained by gentian-violet and aniline-red — in diluted alcohol especially so. Pathogenic Action. — One of the incubating flasks is shaken so as to diffuse the germs ; then a drop of the fluid is allowed to fall into both eyes of a number of dogs, and a slight scratch is made in each cornea. The little wound heals very quickly without inflaming, although it has been the channel through which the poison has entered, and for eight or ten days the animals seem perfectly well ; then they become suddenly ill, and emaciate rapidly; are attacked by general paralysis, and, after two days of feverish hyperthermia, die exhausted. The eyes are throughout free from inflammation. It should be added that some of the same group of dogs become ill, but do not die, and that others may even be quite unaffected. The nerve-pulp, as well as the cerebro-spinal fluid of the animals which die will produce in indefinite series the typical rabies of the laboratory. But the ordinary tests of cultivation and microscopic examination have failed to show in any case the presence of the microbes in the humors and tissues of the animals killed by keratic inoculation with the artificially-cultivated germs. On the other hand, hypodermic injections in large doses {de dosis masivas), twenty to thirty cub. cent, of the sediment in the cul- tivating flasks have not the slightest effect on the animals so re- ceiving it ; no more, indeed, than if one had injected as much pure water. But there has not been time enough to decide if no remote effects follow. It should be observed that all these ex- periments were made with cultivations between the fourth and tenth in series, so that the effects of the germs contained in the cerebro-spinal fluid itself dropped into the first flask, should be eliminated. And it has been proved by experiment that this fluid has very little poisonous action. Nevertheless, it cannot be 888 DISEASE GERMS. denied that this fluid is more active when injected than the culti- vated microbes from the original tubes. This leads one to believe that the microbe of rabies during its intercellular life may undergo some modification which renders it less fit for subsequent seg- mentation in cultivating media. Apart from this, the success of the first trials therewith depends upon the presence in sufficient numbers of the phytopherous cells in which the microbe may multiply freely after, probably, the digestion of their envelopes. (See Hydrophobia}) Distinct races of men exist all over the earth ; the Races, living witnesses are before us in the Mongolian, the Negro, the Malay, the Indo- American, and the Cau- casian — essentially different types of mankind ; different in color, organism, construction, physiognomy, and blood. Besides the difference in complexion and physiognomy, there is a marked variance in their anatomical and physiological structure, an in- comparable, impassable difference in bones, brain, nerves, senses, vessels, glands, and in language, which latter alone, when con- sidered, makes a distinction, a perfect line of demarcation, so that neither race can be traced to a common source or origin. One group or family of languages form a class known as the inflectional, and are distinguished from all others on the globe as the only languages that are adapted to and possess a literature, a science, art, progress. This is the property of the Caucasian, the sole civilizing race in the world, and was doubtless taught to him in the Garden of Eden. The other groups of languages are monosyllabic, and are destitute of all grammar; the nouns have no number, declension or cases, and the verbs are without con- jugations, moods, tenses or persons. The variety of races is no mystery ; each is a separate, dis- tinct creation, for a gradation of species is absurd and inconsis- tent. A changing, a negation, an amalgamation, is death and extinction to all concerned in the effort ; a change from black to white an absolute impossibility. We have abundant evidence to show that the different races existed four thousand years ago, as distinct as they are to-day ; accurate likenesses on monuments and other historical evidences are prolific and available on the subject. Incontrovertible evi- dences — geological, archeological, philological, physiological, psychological, anatomical, and historical — all tend to establish the proposition, that of all the distinct races of men which are now and which have been on the earth from time immemorial, and inhabited its respective sections, the Caucasian was the last to make his appearance ; a masterpiece of creative mechanism, BACTERICIDES. made out of God himself. The record of Moses does not in any way contradict the existence of other races before Adam. AH attempts to trace the different races in a degradation from Noah result in glaring failure. It is well known that both the Chinese and African nations existed centuries before Adam. There can be little doubt but that the intermarriage of the Adamite daughters with the adjoining races was the real cause of the flood. God foresaw the terrible results of incompatibility of races ; that the stock produced was inferior to either of the mingling parents ; derogatory to the welfare of His people, and would tend to extermination. The Bible should be regarded as the history of a particular race — the Adamite. His creation, his fall, his restoration to paradise, are the themes of holy writ. Salvation is proclaimed to the heathen by faith in Christ, and as it is free and bountiful enough, other races are permitted to participate in its benefits. Truth, in whatever department of science it appears, cannot be contradictory of Revelation. There oftentimes may be an ap- parent antagonism, but it is not real. When they are not recon- cilable, either Revelation or science is misunderstood. The word of divine truth stands sure. Scientists may err, but the ultimate deductions that we, the Adamites, are to infer, are, that the mix- ture of races does not produce a true hybrid condition, but something analogous to it. It degrades the bioplasm of both races concerned, by producing stock highly tubercular ; so much so that it will inevitably terminate in the utter extinction of any given race concerned or implicated, and as the mixture of races was the cause of the flood, so it will, if persisted in by our peo- ple and government, infallibly produce a condition of national decadence and ultimate annihilation of all the parties. Words fail to express the supereminent degradation inflicted on any race by a deterioration of its original properties, its organic elements. If space permitted, we could easily show a perfect distinction of races in other points, as construction, craniological develop- ment, difference in bones, senses, etc., and their perfect incom- patibility. We have an excellent national example in Mexico, where we have the noble Spaniard coupling with the aboriginal Indian, giving us a race much inferior to either of the mingling parents ; a rate that must inevitably die out. Marriage, to give a good stock, must be consummated within the race. And marriage among the Caucasians of individuals of the same temperament, identical in color of hair, skin, eyes, conformation ; or persons related by consanguinity, should be prohibited by law, as they entail on their offspring tuberculus, an element of deterioration and death within the races. Still. 890 DISEASE GERMS. withal, a morbid race cannot be established in the true sense of the term, for the evil cures itself by non-procreation. No sensible deterioration in size, beauty of form or expression, can take place, for the moment the boundary line is reached the evil cures itself in non-procreation, so that the Caucasian to-day is a perfect fac-simile of our prototype, Adam. It seems to be a difficult matter to get the hide-bound, or so- called orthodox. Christians to appreciate the essential difference of races, but as they are distinct in their anatomy, so are they different in all other attributes ; their sympathetic systems are imperfectly developed ; that is, it exists in a more rudimentary condition ; consequently, they are incapable of taking on the dis- eases of the white man. It is impossible for them to take yellow fever, acute laryngitis, pneumonia, carditis, typhoid fever, etc., and if it is true that the soul of the Caucasian is located in his great sympathetic, and his moral nature there developed, where could there be a more decided element of disparity of race. The very senses and their organs are different, being more highly de- veloped in the colored race than in the white. This distinction of race comes home to us most strikingly in the aggravation of the types of all our diseases, when two or three dissimilar races are living in close proximity. Suppose the child of white parents contracts measles, scarlatina, small- pox, from the convalescing child of the Negro or Mongolian ; the so contracted disease, even though of a mild form in the colored, will become virulent and mahgnant in the white, and vice versa. Let a white man contract a gonorrhea from a colored woman, and he has something that no known drug will stamp out for months or years. The fact of two antagonistic races residing in close proximity is detrimental to the prosperity, health, happiness, longevity, and freedom from disease of either race. All physiologists and naturalists agree in asserting that the sexual instinct is much stronger in the male than in the female, so this fact must be accepted. In countries in which women keep their normal sphere, the number of male births exceed the female by five or six per cent. But that represents the children born alive, if we take the miscarriages and still-born, the male rate exceed the female forty or fifty per cent. The germ cell, or female, transmits the form and general he- reditary qualities of a race, while the sperm cell, or male, intro- duces the variations which fit the race to survive under new con- ditions of life, the sex being determined by the greater vigor and maturity, or greater fitness for survival in either parent. Where the ordinary conditions of life are uniform and constant, the BACTERICIDES. 891 germ cell will predominate and females be produced in excess ; where women leave their sphere and take on the strong-minded element, the offspring are all females ; where the conditions of life are variable or injurious to the race, the acquired vigor in the struggle for existence, the sperm cell will predominate, and an excess of males be the result. In the civilized condition the two sexes are of equal value, inclining to the side of the male, provided each keeps its proper sphere. Austria and Great Britain afford us an example in which the two sexes are on an equal footing or basis, and we find on examination of their birth- rate, that there are born one hundred and ten males to one hun- dred females, which shows an absolute excess of male births, and this excess occurs at the earliest and most vigorous portion of married life. The sex rate, also, seems to be largely dependent on the rela- tive maturity of the parents, as well as their vigor, the more mature parent being the most potent in determining the sex ; the sex being the same as the most mature parent. The follow- ing figures exhibit the proportion of male births in one hundred females : Father younger than the mother, 90 Father and mother of equal age, . . . . = 94 Father older by one to six years, 103 Father older by eleven to sixteen years, 147 Father older by eighteen or more, 175 As females attain to maturity five years earlier than males, it is probable, from the above table, that with a difference of age of five years in favor of the father, the two sexes would be about equal. The hereditary physical and mental qualities are transmitted by the female, and that variation and adaptability to new condi- tions of life are introduced by the male ; we do not wish to imply that the germ cell is not modified by external conditions, but only that it is subject to fewer causes of variation — that it possesses a strong inherent disposition to resist change, and that it will be destroyed rather than accommodate itself to any marked changes in the condition of life. It is most tenacious of vitality, indeed we see the female embryo resisting violence of all kinds, action of drastic drugs and constitutional taints in the parents, living in spite of danger and disease. From statistics of the two countries mentioned (for our own are not reliable, being full of the strong-minded element, which by-and-by will render us a nation of girls,) it is probable that the proportion of births, marriage being properly regulated by age, should be the proportion of three males to two females, and this 892 DISEASE GERMS. number would be a typical family, which would admit of the sacrifice, not necessarily the destruction, of one male, to accom- modate the race to the ever-changing condition of life, and to assure the constant accession of fresh vigor and maturity. The wealthy, living under the most favorable conditions of good liv- ing, of natural and sanitary surroundings, no struggle, have the two sexes equal, females slightly predominating. In embryonic and infantile life, boys do not possess near the vitality of girls, which may account for the unusual destruction of males at birth, their heads are larger and the diseases incidental to childhood always prove more fatal to male than female children. Races being distinct creations, are antagonistic to each other, so to pre- serve the vigor and vital integrity of a given race, its members must marry within it, for if they mix with other races, they im- plant deterioration, disease, and death on their offspring. Individual members of the Caucasian race must maintain and utilize their vigor, and in order to do that should not marry one of sim_ilar temperament and physique, nor in similar conditions of life ; a literary man never should marry a literary woman, nor a tailor a seamstress. Cross fertilization within the race produces the best stock. There should be no m-and-in breeding in tem- perament, nor in similar conditions of life, far less than among blood relationship. There is a growing error in the public mind on maturity. It is a great error to suppose that puberty in either sex is a sign of fitness for marriage. Growth and reproduction cannot go on beneficially together, reproduction being a diversion of growth or development in a new direction, namely, from the individual to the race. Men do not cease to grow until they are twenty-five, women till they are twenty-one, according to the good or bad nurture they receive, the best nourished attaining maturity first. It is obvious that those ages are the very earliest that marriage should be consummated, and, indeed, the father should be much older, if male children are desired. The best way of increasing the male births is to keep women in their proper sphere and di- rect our energies to the preservation of males at birth. This has been done to some extent by the grand improvements in the art of midwifery, but the mischief lies in the disproportionate size of the head of the male foetus and the mother's pelvis, which has been constricted by dress, tight lacing and abnormal mental cul- ture. For the curve of the sacrum and crook of the coccyx is a true index of the mental culture of the mother ; the higher the one the greater the other. It is impossible to estimate the great loss the race sustains in superior and mental qualities by this unnecessary destruction of its finest products. BACTERICIDES. 893 At birth, in children born aUve at full period, the average length of male infants is nineteen and one-half inches, and of females eighteen and one-quarter inches ; while their average weights are : males, seven and one-half pounds ; females, six and one-half pounds. The waste of male children, owing to the large size of their heads and the contracted condition of the modern civilized female pelvis is immense. The remedy for this is apparent, and to be found in direct improved development of the girl's physical education and dress, an avoidance of the defects of civilization and a more careful guarding of the sexes in marriage. The average stature of the American woman is five feet two inches to five feet three inches, and of man five feet seven inches to five feet eight inches. The difference between the two sexes being four to five inches ; and as stature carries with it other re- lative proportions of the body, it is probable that if these limits .were observed all through the scale of heights there would be fewer male still-births. It was at one time thought that the intellectual struggle going on caused an increased develop- ment of the brain. in children and consequently larger heads in male children, but this has been found to be erroneous, for ever since the introduction of w^oman's rights movement the heads of boys and consequently men have become notoriously small, and the male children of such women effeminate, so that the recent impetus given to the so-called education of girls and the em- ployment of women in intellectual pursuits is adding to the diffi- culty, and if it does not end by producing sterility, as is probable, or in the birth of female children only, which is still more prob- able, it must at least tend to the destruction, more and more, of males at birth. It is obvious that whether we consider the health and happiness of the individual or the future prosperity of the race, the healthy physical development of girls is of first and supreme importance. The boy is father of the man, the girl is the mother of the race, for to her is entrusted the hereditary characteristics of our forefathers. She has the means of trans- mitting them and indirectly of acclimating and accommodating the race to new and varying conditions of life. The reproduction of characteristics resembling those of the father in the son, is in a large measure effected through the agency of the female where there is a strong affection on the part of the mother for her husband ; his likeness, physical and mental is impressed on the son through the agency of the mother's psychic force. The feeling, impulse or sentiment which pervades the mind of the mother controls and influences the development of the child. Peculiarities of feature and 894 DISEASE GERMS. form that impress her powerfully, whether with admiration or abhorrence, are reproduced in the offspring, and if her mental conditions be particularly strong, the impression may be trans- mitted in exaggerated intensity. These things happen in male children, which are specially the mother's. The likeness which female children bear to the male parent is the direct effect of re- production in kind. The maternal influences are less evident in a female than in a male offspring. Perhaps a good view to take of the subject would be the following : sex is the result of an arrest or repression of the force of development in the case of the female. The male of every family in the animal kingdom is the best and fullest specimen of development, having regard to the purposes and habits of life of the species, class or family. The arrest in point of development which characterizes the female, has nothing in common with immaturity, and is no proof of inferiority. It is simply a repression of the formative force, and the physical result of that repression is a perpetual effort to develop or reproduce. The force arrested in the individual gathers intensity and expresses itself in a perpetual and char- acteristic longing to produce a perfect animal. The perfection denied or inhibited in the individual is sought for in the progeny. Hence, the natural tendency of the female to produce male chil- dren, and as a necessary result most of the children born are males. It is not a question of ardency in the two sexes, but of the direction or force of intention or purpose of nature, that is, the inner working of natural laws. The tendency of what is called ardency in the performance of this function is to neutralize or control the productive force of the female, and thus determine that arrest of development which results in female offspring. Here, again, there is no question as to the comparative amount of ardency in the two sexes, because the ardency of the male may be dissipated by the extent of its activity so as to be in no instance dominant, or it may be restrained or intensified, and, therefore, when it acts, assert supremacy. The way constitutional strength comes into play, as it un- doubtedly does in sex determination, is by giving vigor to the natural action of natural laws, not by changing the operation of these laws, so as to make them non-natural. Throughout the organic kingdom, we see nature preserving and developing the germ cell, while on the other hand, we are constantly reminded of her lavish production and apparent wastefulness of sperm cells. The function of the male is not one of production, but fecun- dation. The laws governing the development of monsters are BACTERICIDES. 895 laws of development, rather than of procreation, and they come into play after conception.^ The natural tendency of the female is, if she does not exhaust her brain force, to produce male chil- dren in excess, and, as a result, when mothers live properly a large percentage of the children born are males, but let the child- bearing mother exhaust her mental powers as a teacher, preacher, astronomer, or other literary avocations, her children will be all females, and if there should occasionally be males, they will be effeminate, have small heads and feeble brains, and resemble girls in their actions. Woman may be more perfect in her anatomical construction than man, but her great sympathetic is merely rudimentary, so she needs a man to complete her component parts. The practice of women engaging in literary pursuits and learned professions is well enough, if they maintain celibacy ; but if they ever marry and bear children, then they are sapping and deteriorating the elements of national growth and vigor. The ill effects following injuries met Railway Injuries, with in railway accidents are of a some- what peculiar nature, irrespectively of such forms of accidents as are mentioned elsewhere, such as fractures and dislocations. These injuries consist of concussions of the spine and spinal cord, and from the frequent absence of outward signs, and the obscurity of the early symptoms, are of a very insidious character, and their diagnosis is of the utmost im- portance to a medical man, as they so frequently are the sources of medico-legal inquiry. A well-known author, speaking of this class of injury, says : — " That in no ordinary accident can the shock be so great as those that occur on railways. The rapidity of the movement, the momentum of the person injured, the sud- denness of its arrest, the helplessness of the sufferers, and the natural perturbation of mind that must disturb the bravest, are all circumstances that of necessity greatly increase the severity of the resulting injury to the nervous system and that justly cause these cases to be considered as somewhat exceptional from ordinary accidents. This has actually led some surgeons to designate that peculiar affection of the spine that is met with in these cases as the 'railway spine.' Injuries of the spine and spinal cord have been already treated of generally, and it is hardly to the purpose to reconsider them specially in reference to the subject in hand, and we shall therefore pass on to such matters as relate to those cases where the fact of injury sus- tained on a railway has been the cause of litigation." Concus- sion of the spine from a direct and severe injury to the back may 896 DISEASE GERMS. terminate, according to the same authority, m four way: — i. In complete recovery, after a longer or shorter time. 2. In incom- plete recovery. 3. In permanent diseases of the spinal cord and its membranes. 4. In death. It is a very remarkable circum- stance that, although the patient has apparently sustained in many cases a very trifling injury, the result is widely dispropor- tionate, the reason for this being that the symptoms indicative of concussion of the spine and of the subsequent irritation and inflammation of the cord and its membranes are so slowly pro- gressive. A patient is often quite unaware that anything serious has happened, feeHng perhaps only violently jolted, and a little giddy or confused. After a while, however, when he has reached home, the effects of his apparently simple injury begin to declare themselves. " A revulsion of feeling takes place ; he bursts into tears and becomes unusually talkative, and is excited ; he cannot sleep, or if he does, he wakes up suddenly with a vague sense of alarm. The next day he complains of feeling shaken or bruised all over, as if he had been beaten or had violently strained him- self by exertion of an unusual kind. This stiff, strained feeling chiefly affects the muscles of the back and loins, sometimes ex- tending to those of the shoulders and thighs. After a time, which varies much in different cases, from a day or two to a week or more, he finds that he is unfit for exertion and unable to attend to business." Such is generally the early history of a case of railway concussion. Sometimes the serious symptoms begin to develop immediately after the receipt of the injury, and ins some cases not till long afterwards, and most marked and distinct changes are visible in the countenance, the state of the memory, the thoughts become confused, all business aptitude is lost, the temper becomes irritable, the sleep disturbed, restless, and broken ; there are often loud and incessant noises in the head, the vision is frequently affected in various ways, the hear- ing, taste, smell, and the sense of touch become perverted ; the sense of speech is rarely affected, and usually the attitude of those afflicted is peculiar. There is a loss of freedom in the efforts of motion or movement, and the individual appears afraid to make such efforts ; the gait again is very characteristic ; he walks un- steadily, and in a straddling manner; the power of walking is very limited, and he is unable to ride ; the nervous power of the limbs will be found to be affected ; sensation and motion, or both, may be impaired. Coldness of one* of the extremities, owing to loss of nervous power and defective nutrition, is often noticed. The prognosis in these cases is very unfavorable, and patients have never been known to recover, completely and en- tirely, so as to be in the same state of health as before the acci- dent. RACTERICIDES. 897 With regard to the treatment of concussion of the spine brought on by such injuries, the first thing obviously is complete rest, and the patient should be compelled to lie on a prone couch, and the mind must be kept as much as possible at rest also; ice bags over the injured part of the spine ; internally the glycerite of kephaline in quinine or bark ; nux vomica, strychnine, and iron are all of great value in certain cases. Salt-water douches to the spine, and galvanism, are recommended in some instances. The great thing to be done is to endea\or to improve the gene- ral health, and " prevent the development, if possible, of second- ary diseases, such as phthisis, dependent on mal-nutrition, and a generally broken state of the health." Brain shocks, especially in men over sixty-five, are unusually common. This is undoubtedly due to the atrophy, induration of the brain incidental to that period of life. Such jars give rise to white softening. is a tumor situated below the tongue, bluish in color, Ranula translucent, and cystic in character. It sometimes attains such a size as to displace the tongue and im- pede its movements, causing serious inconvenience in mastication, deglutition, and articulation. It may be caused either by ob- struction of a salivary duct, or by the occlusion and dilatation of a mucous cyst, or dilatation of a bursa mucosa said to exist on the outer surface of the genio-hyoglossus muscle; or it may be a new growth of itself, a myxomatous cyst. It may be healed by simple incision, or by cutting out a portion and evacuating the contents, an3 to prevent premature closing a strip of lint should be introduced ; or frequently the introduction of a seton suffices. In the case of cysts containing a thick putty-like ma- terial, the cyst wall must be dissected out entire. The injection of iodine is sometimes followed with good results. The contents of the cyst are gummy or albuminous in character, containing simple round mucous globules as their only structural element. Occasionally phosphatic concretions are met with. The terminal portion of the alimentary canal is Rectum, thus named from its being comparatively straight. It is situated in the pelvis, or lower portion of the abdomen, behind the bladder, and in front of the sacrum. It measures from six to eight up to ten inches in length in average sized individuals, its outside diameter is about one to one and a quarter inches when moderately distended, but capable of very 57 898 DISKASE GERMS. great distension, or dilatation, or it may be contracted by strictures to an infinitesimal degree, even to occlusion. Its lowest portion is closed by a strong band of muscular fibres, about an inch broad, which is termed the sphincter muscle. The upper and lower edges of this band are very much thickened and are technically called the internal and external sphincters. These muscles are abundantly supplied with nerves, which are highly sentient and to some extent under the control of the will. The walls of the rectum consist largely of longitudinal and circular muscular tissue, with a lining of smooth, mucous mem- brane. Blood vessels, nerves, absorbents are numerous, but nerves of sensation are limited, except in the sphincters, where they are abundant and highly organized. The chief source of nerve supply to the rectal walls is from the spinal and sympathetic, which in a state of health are not sensitive, and this fact exposes it to abuse, grave, injurious, hid- den lesions, without apparent suffering to the individual. The administration of remedies by the rec~ Rectal tum for the cure of disease is of the greatest Medication, importance. It is not, however, as well appre- ciated as it should be, neither is it taken advan- tage of in those grave emergencies where human life could often be saved by its use. Every remedy in the materia medica has a distinct chemical composition, the atoms of each are arranged in a certain way, in definite proportions, has an affinity either to depress or elevate certain tissues or glands of the body; every germicide has special definite action on each disease-germ respectively ; any change in its atoms or chemical composition changes, or destroys its action. The juices of the stomach are acid, those of the intestines alkaline. Remedies administered by the mouth into the stomach, thence to the bowels, thence to the blood, and finally to the tissue or germ for which it has an affinity, meet with numerous chemical changes, which alter its composition beyond recognition, and often renders it wholly worthless for the proper purpose. This is not, however, true of all remedies. Medicinal agents do not require digestion, but when they are submitted to that process, many of their best properties are destroyed. The rectum possesses the most active absorbent system, and all the requisites for perfect assimilation, in a more rapid, ener- getic and effective degree. BACTERICIDES. 899 The most decided impressions can be made on the nervous system and blood by remedies administered through that organ — the most efficacious way in which to reach the uterus, bladder, prostate gland, urethra, seminal vesicles. All these organs can be reached when in an irritable state ; they can be vitalized by remedies inserted into the rectum; in all cases with less disturbance than through the digestive tract. It possesses all the requisites, every essential for the specific treatment of disease, with the success never dreamed of in oral medication. The method is unsurpassed in reaching disease- ^erms in the blood and nervous system. The power of the medulla oblongata Reflex Irritation, to receive irritation or stimulation from different points in the body, is generally conceded ; that if either is of sufficient intensity it is indelibly fixed there ; in the one case raising vitality, in the other lowering it. Slight or low grades of irritation simply depress or enfeeble the medulla, the seat of life, causing defects in nutrition or a degradation of primary molecules, an alteration or change in living matter into the tubercular bacilli. An irritation of the gray or sensient nerve tissue in any part of the body is transmitted to the medulla oblongata, where it sets up an irritation similar in kind and degree, which if it be of sufficient intensity, is reflected back by the \\ hite or motor nerves that supply the muscles, causing a contraction or spasm. A general weakness, an impairment of vital force, predisposes to the reception of the irritation, and it is necessary that the irri- tation be great in degree. Irritation, great in degree or intensity, reflected according to this reflex law, sets up an analogous irritation in the medulla to what exists in the periphery. The most common causes are laceration of nerves, or their neurilemma, a tooth merging through the indurated gums, a worm nibbling at the periphery of a nerve in the bowels, the presence of the head upon the sacral plexus of nerves in labor. Our best remedies to wipe out irritation of the medulla and -also to suspend its impressibility, are ozonized fluid extract of musk root; Scutellaria. is the process by which the air enters and Respiration emerges from the lungs, and in doing so causes the aeration of the blood, and converts the 4)lack venous blood into the scarlet arterial blood. QOo DISEASE GERMS. Respiration consists of two parts, inspiration and expiration^ and as a rule an individual breathes fifteen times in a minute. The lungs always contain air, and no expiratory effort, however forced, can empty the lungs ; the amount of this air, which can- not be got rid of, is called residual air, and is on the average from 75 to lOO cubic inches. About as much more in addition to this remains in the chest after an ordinary expiration, and is called supplemental air. In ordinary breathing, from 20 to 30 cubic inches of air pass in and out of the chest; this is called tidal air ; thus, at the end of an ordinary inspiration, about 230 cubic inches of air are contained in the lungs; in addition, by taking a very deep inspiration, another 100 cubic inches, called complemental air, may be added. Of the 230 cubic inches con- tained in the lungs at the end of an ordinary inspiration, about one-seventh of this amount goes out at every expiration, and is taken in again at the next inspiration, and so on ; thus it will be seen that it is important that the air in a room should be con- stantly renewed, or else a person would be breathing over again his expired air. Now this expired air is less pure than the in- spired air, because it is deprived of some of its oxygen by the action of the blood, and it has received in return carbonic acid and moisture; the more oxygen there is in the air of a room the better it is for health, for if carbonic acid accumulates, it pro- duces headache, lethargy, and, if in large quantities, a fatal re- sult, (See Asphyxia by carbo7tic acid gas) About 350 cubic feet of air pass through the lungs of an ordinary man in a day; in pass- ing through the lungs, the air would lose from 4 to 6 per cent, of its volume of oxygen, and gain 4 to 5 per cent of carbonic acid. During twenty-four hours there will be consumed about 10,000 grains of oxygen, while 12,000 grains of carbonic acid will be produced, corresponding to 3,300 grains of carbon. Dur- ing this time about 5,000 grains, or 9 oz. of water, will be ex- haled by the lungs. In twenty-four hours an ordinary man would vitiate 1,750 cubic feet of pure air to the extent of i per cent., or 17,500 feet of pure air to the extent of i in 1,000. Tak- ing the amount of carbonic acid in the atmosphere at 3 parts, and in expired air at 470 parts in 10,000, the body would require a supply per diem of more than 23,000 cubic feet of ordinary air, in order that the surrounding atmosphere might not contain more than i per 1,000 of carbonic acid ; and more than this pro- portion is injurious; every one ought, therefore, to have at least 800 cubic feet of well-ventilated space. In all works on physiology a description has been given of their structure, and of the various changes which the air and blood undergo. The mechanism of respiration need not be fully described BACTERICIDES. 901 here. During inspiration the diaphragm descends, and the depth of the chest from above downwards is thereby increased ; at the same time the ribs move upwards and outwards, so as to increase the cavity of the chest from side to side and from front to back. Thus the chest-walls expand in three directions during inspiration, and at the same time the lungs follow the expansion and become inflated with air. During expiration, the lungs, being elastic, re- tract, and the reverse movement of the diaphragm and chest- walls takes place. Any thing, as tight lacing, etc., which interferes with the due expansion of the chest, is therefore very injurious; any deformity of the chest, a habit of stooping, a curved spine, a pigeon-breast, etc., all act in diminishing the breathing area of the lungs. As a rule, the wider a man is round the chest the better is his state of health and capability of exertion. Exercise, gymnastics, drilling, rowing, etc., are all excellent means of expanding the chest and promoting good respiration. When a man runs he gets out of breath because the circulation of the blood is increased, and ne requires more air in a given time to aerate it. Through the nasal, laryngeal, bronchial lining membrane, no ■disease-germ can find ingress to the blood. All microbes, factors of disease, find their way into the body through the skin and mouth. The great secret then, aside from a high standard of vital force for the prevention of disease is hoiv to breathe. Man should breathe exclusively by his nose in order to avoid all contagious disease germs. This is apparent from the following anatomical facts : The nasal chambers in man are remarkable for their ir- regularity of surface and anfractuosity, and consequently for the enormous area of mucous membrane they present within a very limited cubic space. The greatest ingenuity has been displayed in the construction- of the nasal fossa to give this immense sur- face without increasing bulk or weight. In pursuance of this principle, all the bones about the nose are hollowed out and the chambers so formed that the so-called sinuses or channels of those are brought into direct communication with the nasal pas- sages, and constitute supplementary air chambers or crypts, and every portion is utilized for its proper purpose. The entire sur- face of this extensive tract is covered with mucous membrane, remarkable for its vascularity and high nerve endowment. The upper or olfactory portion of the nasal surface proper, amounts to about one-half of the whole, and this is provided with an epithelium composed of non-ciliated columnar particles inter- spersed with fusiform or olfactory cells, whilst the lower half, which is essentially respiratory, is furnished with a ciliated col- ^2 DISEASE GERMS. umnar epithelium, same as that which lines the upper surface ot the bronchial tubes. Over this extensive tract, supplemented by the accessory sinuses, the eighteen or twenty cubic inches of air which constitutes the volume of one inspiration, passes and is dispersed in thin layers and fine streamlets. The air in this act of nasal respiration diffuses itself into the chambers and recesses, and thus becomes heated to the temperature of the body, by coming in contact with the vascular lining. The greatest por- tion of the air that enters the lungs in ordinary nasal breathing; is drawn from those chambers and recesses after it has beea heated. The inhaled air is supposed to take the sides, and the expired air to occupy the centre. No doubt to some extent they mix and thus become vitiated, for the expired air is loaded with carbonic acid gas and is heavier than the lighter and static air lodc^ed in the nasal cavities. The initial portion of the nasal respiration is devoted to dif- fusion through the sinuses and chambers, where it is raised la temperature, thoroughly cleaned before it is transmitted to the lungs; it is thus freed from disease germs, mechanical impurities,, by a process of sifting which it undergoes by means of the cilia of the respiratory portion of the tract, where these extraneous elements become fixed by the abundant viscid mucus secreted in those passages. When such impurities are in excess as in the case of a miner, cotton operative, knife-grinder, wool-sorter, the natural protection is not sufficient, and irritation and disease is the result. But under all ordinary circumstance the natural pro- cess is sufficient to catch or filter, or sift the breathed air from all disease germs. The crusts that form in the nose when not due to ulceration, are the product of sifting, filtration and depo- sition. The air inhaled through the nostrils is hygrometrically altered by coming in contact with moist mucous surface and thus be- comes charged with a percentage of aqueous vapor inversely proportioned to its previous hygrometric condition. This effects a most salutary change in softening, mollifying a dry or parched atmosphere, such as we often experience in our violent wind currents. The dry air, if breathed into our lungs unchanged, would cause too rapid evaporation from the lining surfaces of the bron- chial tubes, lower their temperature inordinately and interfere with gaseous exchange within the lungs and give rise to asthma, bronchitis, and pneumonia. The cavity of the mouth of man presents none of these advan- tages for breathing, indeed, it is not adapted for breathing at all The mouth, the buccal and laryngeal portion of the pharynx are BACTERICIDES. 903^ covered with stratified squamous epithelium, and like all surfaces so provided are, by comparison with columnar and ciliated sur- faces, lowly endowed with vascularity and sensibility. There are no subdivisions in the mouth into chambers, recesses, sin- uses. No multiplication of surfaces by projections and depres- sions of surfaces as in the nasal cavities. Hence a column of air breathed through the mouth is not searched, cleansed, sifted and filtered of foreign bodies, neither is it warmed and moistened as if breathed by the nose. The saliva will not impart vapor to the air passing through the mouth, not to any appreciable extent, neither does air furnish a reflex stimulus for the secretion of saliva. This is readily perceived in those who habitually sleep with their mouths open during the night in the dry, parched state of the mouth in the mornings. During the seven or eight hours of sleep with an open mouth, no stimulant other than air is applied to the incident or excitory nerves of salivation, hence the parched state of the mouth. The inferences to be deduced then are: that the nasal passages are the natural channels for the entrance and exit of air, and if judiciously employed, they are as air passages adequate for the purpose of respiration and warding off disease. They are the natural channels for the introduction of air into the lungs and its expulsion therefrom. Their con- struction and organization are such as to keep man free from all contagious diseases. The preservation of the nose is of great importance ; it should not be injured by snuff, smutty atmos- pheres and dust. Breathing through the nose in the great prophylactic to all contagious or bacterial diseases. The mouth and fauces are the natural passages for food ; if used for breathing purposes there is great risk of disease. An open mouth is mischievous, it is a re- ceptacle for all noxious germs ; a closed mouth in breathing is a sure preventive of all diseases of the lungs as well as a proper safeguard against all living disease germs. Man can face the most deadly living poison with a closed mouth. To guard against disease germs floating in the atmosphere, breathe exclusively by the nose ; but it is very difficult to lay down rules for the prevention of the ingress of disease germs by local contact. It is impossible to say how cancer, syphilis, tuberculae, small-pox, typhoid fever, scarlatina, diphtheria, etc., can be restrained as these human pests can be communi- cated — By living in close proximity, sleeping on the same bed, using the same blankets in a sleeping car, or the sheets or towels of a steamship, or hotel. By wearing bathing suits, ball or funeral dresses hired out. 904 DISEASE GERMS. By drinking water, but especially milk, from a farm where those diseases exist, the use of cups, tumblers, spoons. By the water in cars, by the use of water closets, car seats,j bedding, by breathing the dried sputum of tubercular patients. By brush, comb, hats, dentists' tools, or vaccination. By handling ordinary articles as car straps, brooms. By toys sold to children on the streets — the seller, probably syphilitic, tests the whistle in his mouth and hands it to a child who is at once contaminated, as the saliva of diseased persons is full of germs. By the handling of books, cards, car tickets, canes, gloves, pipes, and specially by cigars, the makers of which may be dis- eased, and wet the wrappers with their saliva. By kissing, in all ages. Seeing that there are a thousand channels through which liv- ing contagion may reach man, it behooves all to eat the best of food, wear woolen clothes, and daily to cleanse off the entire body with a bath. To have a variation in diet, in exercise, in occupation, in amusement, as change is most conducive to a high state of mental and physical existence ; as essential as pure air is to oxygenate the blood. During the process of dying, there is Rigor Mortis. a perfect struggle between vital force {^Cadaveric Rigidity}) and microbial life. In the condition known as death, vital force succumbs, microbes conquer. For some time after death the same mi- crobes, which were instrumental in its causation, continue to live and excrete ptomaines, until they have used up in their own nutrition all the elements fit for their nourishment and growth. During this process of microbial existence, ptomaines germ excreta, cadaveric alkaloids, cause a coagulation of the myosine of the muscle. Ptomaines differ in their chemical constituents, the more toxical, such as the comma-bacillus of cholera, or the mi- crococci of tetanus, or hydrophobia, effect rigid contraction ; that the disease from which the patient dies, or rather its ptomaine ex- ercises an influence over the rigor. When the coagulation takes place, the acids, which are being constantly formed, and as continuously removed during life, ac- cumulate in the muscle and gradually effect a solution of the myosine, and then the azotized matters undergo decomposition and develop ammonia, which in its turn dissolves the myosine, and thus occasions the disappearance of the rigor. BACTERICIDES. 905 In this process, when rapid, great heat is often evolved, espe- cially when the rigor is being established ; the rigid muscle slightly diminishes in volume. Following that the body returns to its natural earths or gases, all except the cadaveric alkaloids, which remain as permanent salts, and are not destroyed even by cremation. The amount of indestructible cadaveric alkaloids present in an ordinary sized human being, varies from six to eight grains, de- pending greatly upon the development of his intellectual capacity or powers. ^ Vomiting is due to forcible and repeated Retching contraction of abdominal muscles, the dia- and Vomiting, phragm being pressed by closure of the glottis ; the stomach is thus compressed against the diaphragm, and by this force, together with its own contraction, the pylorus being closed, and the cardiac sphincter relaxed, the gastric contents are expelled upwards. In retching there are fruitless attempts to empty the stomach, the cardiac sphincter being contracted, or the stomach empty. Nausea, vomiting and retching, are present as symptoms in many diseases, as in cerebral, spinal, pulmonary, biliary, gastric, pancreatic, intestinal, uterine, ovarian disorders. They are often reflex, as in pregnancy, irritation of pneumo-gastric nerve, as in poisons and irritating substances. To disease-germs in blood, as small-pox, scarlatina, yellow fever, ichoraemia, etc. To acute or chronic gastritis or peritonitis. To abdominal aneurisms, tumors, ascites, to invagination of bowels, strangulated hernia, or some latent, morbid state. When the vomiting is due to some derangement of stomach, liver and intestines, it is likely to be preceded by nausea, discharge of contents of stomach, biliary matters, offensive secretions, acid matter, pus, blood ; tongue usually coated, breath foul, white of eye tinged, abdominal griping pain, fetid eructations, diarrhea, -iinhealthy stools, and the headache is frontal. When due to some brain difficulty or reflex condition acting on a weakened bulb, there is no nausea, tongue clean, breath sweet or pure, and if there is headache, is mostly behind ; no belching of foul gases. ]f vomiting and retcJdng is due to disordered stomach, liver, pancreas, bowels. Lobelia emetic, cleanse out bowels, saline purge, or compound licorice powder, and follow with cinchona and nitro-muriatic acid ; a bland, simple diet, rest. If due to diseased-germs in fevers, give antiseptics, as ozone- ^water, carbolic acid and tincture of iodine, yeast and milk. go6 DISEASE GERMS. // dne to inflammation, as acute gastritis, peritonitis, yellow fever, green root tincture gelsemium and morphia, mustard over region of the stomach. The increasing prevalence of cere- Rheumatism, bral disease, due in a great measure to {Bacillus Amylobacta.) neurasthenia, defects of civilization, and the daily increasing struggle for existence, with other causes which engender a feeble vitality, under which we have slow or retarded digestion, the starcliy or saccha- rine elements of the food undergo fermentation, with their con- version into acids ; if gastric catarrh, with its sarcinae ventriculi has not preceded, it very soon follows, and acts as an addi- tional ferment in the elaboration of lactic and butyric acids. These morbid elements enter the blood, and have an especial affinity to the white fibrous tissues of the body (if they are weak- ened), such as the membranes of the brain, pleura, pericardium of the heart, synovial membrane of joints, periosteum of bone, sclerotic coat of the eye. In acute and chronic rheumatism, there are invariably present numerous other microbes due to the degraded bioplasm of nutri- tion, which are always present in mal-nutrition, these are bacteria, sarcinae, the bacillus amylobacta, the microbe of butyric acid, etc. The microbe when present in any given A A \ \ M case of rheumatism is usually found on the v^ ^V^ I ^' tongue, tonsils, breath, sweat, urine, faeces %% B *"***** ^"^^ ^" ^^ atmosphere for over twenty feet \^ ^ y^ A around the patient. This evolution of fer- ^ 1^ ^ ^ n mentation, vegetates in the form of slender * « f ^ cylindrical rods, united at most in short rows ^ and usually in a state of undulating motion. ^Srped^'"fSmrtncTuding ^^ vcgctatcs luxuHantly in patients whose oval spores. vital forccs arc at a very low ebb. The fer- mentation of which butyric is the primary product is invariably accompanied by other micro-organisms, of a different species, which ^\\f^ rise to special chemical changes among lactates; The bacillus amylobacta excrete ptomaines freely, and is pathogenic of rheumatism. The isolation of this microbe in all cases of acute and chronic rheumatism marks an entirely new era in therapeutics. The predisposing cause of the evolution of this microbe is an impairment of the integrity of the nerve centres, which gives us feeble vital power, weak digestion, the generation of acids, lactic and butyrics. Add to this isolation, sameness, monotony, dele-^ BACTERICIDES. 907 terious trades, insanitary abodes, tobacco, whiskey, excess of starchy or saccharine food, and other states which in some mys- terious way alter, change, degrade certain primary elements of nutrition into a disease-germ, the bacillus amylobacta. This microbe is in the blood in all cases of acute and chronic rheumatism, but it has a special affinity to localize itself in and on the white fibrous tissues of the body, if that tissue or struc- ture is weakened by mechanical irritation, injury, cold, damp ; the weakening of the white fibrous tissue renders it obnoxious to the deposit of the germ and affords a suitable location for its growth and development. The bacillus and its ptomaines are the factors of the disease. In the acute form, either vital power is greatly shattered or the aggregation of germs is prodigious, for we have rigors, fever, with temperature, and rapid full-bounding pulse, with local joint pain, or in some white fibrous tissue. The fever and inflamma- tory local microbe-ptomaine evolution are due to excessive spore development. Symptoms are extremely variable ; temperature high, with joint pain very great, are common, with heavy ptomaine ex- cretion, coma, delirium and profuse sour-smelling fetid sweats. Urine high specific gravity, loaded with urates. Tongue and breath, the former heavily coated with the bacillus amylobacta, the latter, sour smelling. The fever is of a continued type^ corresponds to the ratio of germ growth. Some cases present anomalous symptoms, verging on gout, others truly rheumatic. Others, whose nervous systems are damaged by alcohol, with delirium all through the severity of the diseases. The microbe of rheumatism mostly pursues a very definite course or form of its own, and deviations from that bodes no good. So long as the symptoms follow the usual and orderly evolution, though that may be severe, there is not much danger ; but when unusual or strange s^^mptoms arise, when dangers threaten from unknown quarters, we do not like it. Articular rheumatism, though severe, when confined to joints or w ith but moderate cardiac complication, is a tolerably straightforward matter ; but rheumatic fever, with little joint affection and much delirium, or lung cedema, is quite a different thing. Individuals of all ages are attacked with this microbe, but most common between fifteen and thirty. The heart is affected in about seventy-five per cent, of all cases, and the cause of death in nearly all cases is cardiac trouble. Mortality is greatest among the young. Acute rheumatism most common among males. 9o8 DISEASE GERMS. In the treahnent of all cases of rheumatism, the indications are to endeavor to restore the tone of the nervous system ; improve digestion, kill and sterilize the microbe, and neutralize its pto- maines. The condition of stomach and tongue points to the utility of an emetic, which should be administered, followed by a saline cathartic and a vapor bath. Following which the patient should be kept in the recumbent position in bed between blankets. Silk or woolen underclothing. If tne heart suffers, apply over it concentrated ozone. Suitable doses of tincture of aconite, veratrum, and gelsemium should be at once administered, so as to quiet the circulation and lower heat. Pain should be allayed with small doses of pul- verized opium and diaphoretic powder. It is a sound and whole- some rule in practice, that no patient should experience pain, far less one suffering from the ravages of the bacillus amy- lobacta. After attending to the general preliminaries, such as bathing the patient thrice daily ; to a milk and beef tea diet ; to maintaining an active condition of the bowels ; to keeping bac- tericides over locations or parts in which the microbe is domi- ciled ; where the pain exists, for where that is, the bacillus amy- lobacta is there, giving rise to the irritation. How such a good- sized microbe penetrates those closed sacs through the blood currents into the joint liquid, is a mystery which bacterial inves- tigation has not yet made clear. A local germicide is needed, the concentrated ozone wherever applied sterilizes the microbe ; ozonized tincture of iodine, iodized oil, iodoform, iodol, sulphur compresses, are excellent local bactericides, and can be used with most satisfactory results. Then a selection of two of the following remedies should be made and administered alternately in the treatment of the case in sterilizing and annihilating the bacillus amylobacta. A mixed course of treatment is the best, and what the reme- dies are to be, we must leave to the judgment of the physician in charge ; we simply give a brief synopsis of each. Although the peroxide of hydrogen is the great scavenger of microbe-laden blood, and will, if carefully administered in rheu- matism, do great service, still from some unknown cause, it acts most energetically upon the amylobacta, administered either in the form of glucozone, or better still, in the uric acid solvent. The uric acid solvent is composed of the extracts of pichi, chionanthus virg., iris, cleavers, triticum repens, acetate of soda, nitrate potass and peroxide of hydrogen. ' It forms a most effi- cient, elegant preparation. When administered either in acute or chronic rheumatism it does excellent work in perfectly annihilating.the amylobacta. BACTERICIDES. qOq Still, excellent as this preparation is, most destructive to the microbe, we would strongly advise it to be administered in alternation with another germicide, as salol, glycerite of winter- green, manaca, etc. From extensive experience, we very strongly urge a mixed treatment of all cases. The uric acid solvent ozonized, is a complete destroyer of the germ ; it is an efficient stimulant to the neurasthenic liver; neu- tralizes the acidity upon which the microbe lives and breeds ; it •flushes the kidneys, blocked up by debris, and dissolves and washes out the uric acid crystals which had been, and were accu- mulating in the nephritic glands. The glycerite of wintergreen with the peroxide of hydrogen^ or as it is termed the ozonized glycerite, give us an active,, energetic germicide in killing and sterilizing the amylobacta, by the annihilation of the germ ; pyrexia is controlled, and the joint, pain ceases. The best method of administration is in moderate doses, frequently repeated and continued in diminished doses throughout convalescence. Its use possesses many advantages, its prompt action, unattended with any toxic effects, produces no irritation of the stomach. The ozonized glycerite of wintergreen, that is, the combination ofe oil of wintergreen C. P. glycerine and negative ozone, has a mar- vellous effect in annihilating the microbe of rheumatism. One teaspoonful administered every two or three hours, speedily^ causes the death of the germ, for in a few hours after repeated doses have been given, the germ disappears from the breathy saliva, sweat, urine, and a lowering of temperature, pulse, respira- tions is the inevitable result. The great superiority of this remedy consists in its rapid destruction of the germ, the preven- tion of cardiac complications, the infrequency of a recurrence of the microbe in the blood. The derivatives from the wintergreen oil, such as salicylic acid, salol, are inferior to the glycerite. In summing up the results of our experiments with the oil of gaul- theria, a brief recapitulation of the most important points brought out will recall more clearly to mind the advantages of this drug as an anti- rheumatic agent. We have found that it has all the valuable properties of salicylic acid, to which it is closely allied. Its action is more prompt and efficient in obstinate cases. It has a more agreeable taste. Relapses under its use are less frequent. The unpleasant effects of over-dosing are no greater, and it is less depressing. Cardiac complications are no more frequent. It is important not to substitute the oil of birch or a diluted article for it. Large and frequent doses are necessary to get the best ^jQ DISEASE GERMS. effects. It is an efficient palliative remedy in chronic and irregular forms of rheumatism. It is a local anodyne to in- flamed joints. Whatever may be the peculiar action of the bactericide, sali- cine, salicylic acid or soda, there can be little doubt entertained that it has a remarkable affinity for the microbe of rheumatism to unite with it and kill it. That it acts most efficiently when combined with the acetate of ammonia. An extended experience has confirmed this idea. By administering from fifteen to thirty grains every two hours we cleanse the germ-laden blood in a short time, and in that way the urgent symptoms are relieved. As soon as temperature., pulse and respirations become normal, both the dose and frequency of administration of the drug can be reduced until it is safe to discontinue it entirely. The true salicylic obtained from the vegetable kingdom should only be used ; the artificial product obtained from carbolic acid, however much it may have been purified and dialized, an impure acid, will very quickly produce symptoms resembling delirium tremens. While administering the salicylate keep bowels open with cascara sagrada. The salicylic acid administered in the acetate of ammonia; the best acid, say from three to twenty grains to four drachms of the ammonia acetate, administered in small but repeated doses, kills the micro-organism ; hence temperature, pulse, respirations are lowered. In all patients under thirty-five the bactericide action of the salicylates is most decided when the microbe is in the joint sacs. If cardiac symptoms exhibited themselves before either of those remedies have time to kill the microbe, then the following mix- ture should be given : nitrate of potass, one drachm ; acetate of potash, three drachms ; water, eight ounces. Dose one ounce every two hours. The good effects of alkalies are immediate, and afford time to push other remedies, to thoroughly kill the microbe. In the treatment of acute rheumatism, as also in acute gout, the salicylate of lithium is quite as effective as the salicylate of ' sodium. In certain cases of acute articular rheumatism treated with the sodium salt, there comes a period, after rapid and con- siderable improvement, when the joints still remain somewhat painful, stiff and swollen, notwithstanding the fact that the remedy is given in doses sufficient to cause toxic phenomena. Under these circumstances the salicylate of lithium will cause the last traces of the affection to disappear promptly. It is also more effective in the treatment of progressive subacute articular rheu- BACTERICIDES. gj j matism. In patients attacked with this most tenacious and trou- blesome form of rheumatism, Prof Day has employed, with the utmost perseverance, the most various medication, including large and repeated doses of the salicylate of sodium, without producing other than the most temporary and insignificant amelioration; and yet he has seen the salicylate of lithium bring about notable improvement in ten to fifteen days. Four grammes (about sixty grains) a day is the quantity of salicylate of lithium usually required. The effects cf the remedy begin to be mani- fest in a half to one hour, and consist in headache — which, however, disappears within a few hours — and vertigo and dulness of hearing, which are more persistent. In some subjects it also causes colic and diarrhea. The curative effect of salicylate of lithium is due in large part to the salicylic acid ; for, if the other salts of lithium are substituted for it, the same results are not obtained. Some portion of the beneficial effect is, however, due to the lithium, for the salicylate of lithium is more effective than the salicylate of sodium. The rheumatismal manifestations which resist the action of six and seven grammes (one a half drachms to two drachms) of salicylate of sodium yield to four grammes (about one drachm) of salicylate of lithium. To these observa- tions of Prof Day, the writer will add that he has found the salicylate of lithium very effective in myalgia or muscular rheu- matism, given in the quantity mentioned above — fifteen grains four times a day. Salol, as is well known, is a compound of salcylic acid, sixty parts, and phenyl, forty parts, and, according to the analysis of Tate, the ordinary commercial salol contains about thirty-six per cent of phenyl. Hence the question arises as to whether its action as an antirheumatic is simply due to the salicylic acid it contains, or whether salol possesses other properties which make it superior to salicylate of soda. At the present time, different observers are not agreed, since according to several it is stated to be superior to salicylate of soda. Others, however, consider that the only advantages of the use of salol are that its taste is not so unpleasant, and that its use is not so liable to be followed by toxic effects, as so frequently occurs with salicylate of soda. Whereas the latter usually subdues pain and fever in the first twenty-four hours, salol requires three or four days, though pain was greatly ameliorated within the shorter period. In conse- quence of its many advantages salol was adopted as the routine treatment by Aufrecht, but on the occurrence of a fatal case of acute endocarditis under its use — a thing not met with among 600 cases treated by salicylic acid — it was discontinued. Since then what might be called mixed treatment has been followed. ^12 DISEASE GERMS. In this, acute cases receive during each of the first two days ninety grains of the acid, after that the same amount of salol. Later, the patient still remained in bed, the salol is reduced to sixty grains daily. As salicylic acid is usually well borne for two days, but frequently no longer, this recommends itself as the best routine treatment If possible the acid can be continued , if, on the other hand, it cannot be taken, salol alone may be used. In chronic articular rheumatism salol is preferable in every respect, not only avoiding the dangers attending prolonged use of salicylic acid, but offering more positive assurance of cure. Salol does cause cerebral disturbance, as noises in the ears, and is well tolerated by the stomach. Betol, which is composed of naphthol and salicylic acid, is often efficacious. Peroxide of hydrogen is of especial value in all cases of rheu- matism, its use aids other remedies materially, administered in alternation with either of the remedies selected, militates disas- trously to the growth of the bacillus, cuts short the disease most effectually. Its energetic action upon the stomach, intestines, and kidneys as the great scavenger of nature, freeing those important blood- making organs from all disease germs, is besides a most valuable aid to digestion. The dose of hydrogen peroxide is from a half to one teaspoon- ful of the fifteen volume solution, added to the same quantity of glycerine, and then administered in water every four hours. Ozonized cascara sagrada lozenges. — Till recently the great value of the cascara sagrada was a tonic and stimulant to the liver and intestines in all cases of habitual or obstinate constipa- tion. The nauseous and persistent bitter so characteristic of the bark and its ordinary preparations have been a great drawback to its more general use ; we have by means of the peroxide of hydro- gen an almost tasteless extract. The destruction of the bitter- principle does not militate against its efficiency but rather in- creases the action of the drug, at the same time rendering it more palatable and elegant. Each lozenge contains a dose, equal to twenty drops of the fluid extract with saccharine lacta and kola nut. For constipation of all varieties they are invaluable. The remedy in this form, besides rousing up the liver, in- creasing the peristaltic wave, has the remarkable faculty of steriliz- ing and annihilating the bacillus amylobacta, the microbe of butyric acid, the tactor of rheumatism ; hence its value, its great eflficiency in all cases of rheumatism, acute and chronic. Un- paralleled success attends its administration in rheumatoid BACTERICIDES. gi^ arthritis, muscular rheumatism, pericarditis, and all forms of the malady. Irrespective of its germicidal action on the bacillus amylo- bacta, it also effectually sterilizes the sarcincB ventriculi and sar- cince intestines and the numerous cryptogams on the cutaneous surface. For constipation, one to two at bedtime, in rheumatism, from one to two thrice daily, according to the advice of the attending physician. The hepatic functions are generally defective ; this may be due to the excessive use of nitrogenous foods and the accumulation of waste products interfering with healthy function. These cases require careful dieting and the use of remedies to secure elimina- tion of bile, and disgorgement of the portal veins. There is in those cases a sort of neurasthenia of the liver, that is to say, the hepatic functions are sluggish, imperfectly performed, as a part of the general want of tone in the nervous and vascular systems ; here hepatic stimulants, like the cascara lozenges, are indispen- sable, together with massage. The patient may appear plethoric, but look at the case care- fully the arterial tone is weak, the blood hydraemic, decidedly impoverished. In the most ordinary cases, the blood is decidedly impover- ished by the microbe, and the patient needs generous diet and tonic treatment. In spite of the general practice of prohibiting this and that, the better plan is to be liberal in dietetics, and let the patient have what he relishes and digests well. Another important point is to secure a healthy action of the skin. This is invariably defective. It is necessary to secure free perspiration once or twice a week, but a healthy 'tonicity of the cutaneous surface should be maintained. The very variable character of the symptoms, together with many points of similarity, with wide points of difference, which are increased by variations in constitution and temperament. To treat such cases successfully requires an adaptation of method to the individual condition, and this the skill of the physician will supply. Manaca, the root bark is the part in which the medicinal properties of the plant reside^ and which yields the active prin- ciple in abundance. Its properties are that of a powerful bactericide, being capable of destroyincr the microbe of syphilis, cerebro-spinal meningitis and rheumatism. In a mixed treatment of rheumatism, manaca operates well, and becomes a very valuable drug. It should be administered in 58 gi^ DISEASE GERMS. small doses, every three hours, beginning with five-drop doses of a fluid extract, gradually increasing the dose until it operates on the bowels. It has a most decided action upon the bacillus amylobacta of rheumatism, killing the germ and subsequently eliminating it from the body. Manaca when thoroughly impregnated with four volumes of peroxide of hydrogen has a strong affinity for the bacillus of rheumatism, being in this state highly germicidal ; besides it is purgative diuretic, stimulant to the lymphatic system, eliminating the dead germs from the blood by the skin, kidneys, and bowels. Its administration requires great care, beginning with small doses of from three to five drops or more thrice daily. Cautiously increased. The so-called elixir of manaca and the salicylate, which is said to combine the virtues of the manaca with the salicylates of soda, potassa and lithia, is a most unreliable form for administra- tion ; the manaca in all cases should be given alone, as its effects can be more carefully watched. Comp. tincture serpentaria, or jaborandi, gives rise to an activity of the sweat glands ; gives a determination of live or dead microbes to the skin, and lowers temperature. The amylo- bacta themselves usually give rise to copious perspirations, and their elimination when killed should be promoted, and those remedies administered which will facilitate and assist cutaneous transpiration. In all cases the skin should be bathed thrice daily, so as to remove all the stagnant, fetid matter on its sur- face. Even the body, linen and bed-clothes should be changed daily, so as to remove the putrefying germ-laden perspiration — sour, stench smelling, which de-appetizes the patient. The next in*(iication in the treatment of all cases of acute rheu- matism is to augment vital force, increase vital stamina, so as to cut off the evolution of the microbe. A great variety of reme- dies have been pushed forward for this purpose, as tincture of cimicifuga, apocynum, bryonia. Preparations of cinchona, or its alkaloids, con. tincture kurchi- cine, Warburg's tincture, etc. Of these, cimicifuga, alternated with the hydrobromate of qui- nine in four grains, is undoubtedly the best. Kurchicine acts well. Precisely the same condition, same germ, Rheumatism, but of long standing, as the acute. Chronic. It may follow as a sequela from a more active state of microbial evolution, or it may come on of itself BACTERICIDES. pic The fibrous textures around the joints, or the fibrous enve- lopes of the nerves, or the aponeurotic sheaths of the muscles, coverings of tendons, periosteum, etc., are those that sufifer most. It receives different names from the locality of the irritation ; as neuralgia, when it attacks the nerves ; lumbago, when the muscles of the loins are affected ; sciatica, when the sheath of the great sciatic is involved ; pleuradynia, when the pleura and intercostal spaces are implicated. In any case there is usually little consti- tutional disturbance ; but the sufferer is constantly annoyed and his existence made very miserable from chronic pains, causing him to be restless at night and destroying his comfort in the day time. In some instances the pains are worse at night, being ag- gravated by the warmth of the bed ; in others, warmth affords the greatest relief. The blood in chronic rheumatism is usually thoroughly charged with the bacillus amylobacta, but the germ does not breed so actively as it does in the acute, neither does it produce such havoc with the blood discs, nor is it of such an erratic char- acter. There is little difficulty in the recognition of chronic rheuma- tism — the mal-nutrition, the microbe on or in the scraping of the tongue ; urine loaded with lithiates, the character of the tissue affected (the white fibrous), etc. The management of all cases of chronic rheumatism requires a general alterative and tonic course of treatment, comp. saxifraga and Phytolacca, in alteration with tonics, as compound tincture cinchona, and hydrobromate of quinine, con. tinct. kurchicine, etc. Some bactericide should also be invariably administered, either the ozonized uric acid solvent, or manaca, or the salicylate acid in the acetate of ammonia, or the glycerite of wintergreen, or guiacum or salol. Pain in all cases must be alleviated, and local germicides over the seat of pain (damaged white fibrous tissue) are always in order, as con. ozone, menthol, ozonized iodine, iodol. The general health should be improved by every possible means, by daily alkaline baths, sulphur and iodine baths, mas- sage. The diet should be generous to a fault, restricting saccharine, starchy, and animal food. If the case does not yield promptly, the sphere of remedies should be enlarged. Much good is often derived in chronic rheumatism from such remedies internally as iodide of potassa, chlorate of carbon, cimicifuga, bryonia, iris, phytolacca, saccharated sulphur, colchi- cum, dulcamara, terebene, sulphur- water ; and locally, con. 9i6 DISEASE GERMS. ozone with chloroform and menthol, oil of stillingia, solidago, turpentine, hemlock, sassafras, etc. ; all failing, a persistent appli- cation of the irritating plaster. Rheumatism and gout are often associated together, although both are essentially different. In rheumatism we have a bacillus to deal with, and microbicides must be used to kill it, whereas, in gout we have a mechanical source of irritation in the urate of soda. This, no drug can remove, but by a long persistent use of the uric acid solvent ozonized, it often melts away. Clinical observation has established a pathological connection of great practical interest. It has been long known that chronic rheumatism and gout may prepare the way for osteo-arthritis by lowering the textural force of the joint structures, and thus lead- ing to morbid change of degenerative kind. In people of the so-called tubercular diathesis, or who have near kinsfolk dis- tinctly *' consumptive," repeated rheumatic attacks may beget a condition commonly called rheumatoidal ; and this, -again, may gradually pass into the more complete and incurable state which enjoys the official title of osteo-arthritis. When the structure of the larynx Rheumatism. is weakened and the amylobacta (Rheumatic Laryngitis}^ present in the blood, it often local- izes itself upon the vocal cords. Its presence here gives rise to pain, hoarseness, aphonia, and fatigue of the parts after talking, and sometimes to obstruction of the glottis. It is met with in both the acute and chronic form. Its diagnosis is not difficult, occurring in persons of a rheu- matic diathesis, attended by no erosions or ulceration, by little congestion or swelling. Patients commonly refer the pain to one side of the larynx, when this organ alone is involved, but in some cases it is also referred to the trachea, the region of the greater cornu of the hyoid bone, to the base of the tongue, or to the lower part of the tonsil on the corresponding side. In similar cases we sometimes find the pain confined to these latter regions, there being no in- volvement of the larynx, but even in these the patient is liable to experience fatigue of the vocal organ after talking. Hoarseness and loss of voice are also frequent symptoms. Rheumatic laryngitis is most likely to be confounded with neu- ralgia or para^sthesia of the organ. In distinguishing between these, the history must be carefully scrutinized, and rheumatic or neuralgic pains must be looked for in other parts of the body. BACTERICIDES. 917 In the rheumatic affection there are usually slig^ht redness and swelling ; not so in neuralgia. For confirmation of the diag- nosis, we must sometimes await the result of treatmeit. Rheumatic laryngitis nsually runs a chronic cojr^e, extend- ing over periods varying from two months to one or more years. In most cases, if not in all, there are periods of immunity from the soreness, but at other times there are quite severe exacerba- tions of pain. I recall one case which was troublesome at times for four or five years. Recovery may be expected ultimately, and the patient may and should be assured that the disease does not endanger life. In the treatment of chronic laryngitis, great benefit is derived from the use of hot atomized sprays of resorcin, creolin, benzoate of soda, peroxide of hydrogen, together with electricity, although as rule our main reliance is placed upon internal remedies. In- variably, splendid results follow the use of the glycerite of winter- green, manaca, and cascara sagrada. The amylobacta impairs both the blood discs Rheumatic and walls of the blood vessels, and permits an Purpura. extravasation of blood, and gives a form of purpura, due to rheumatism, closely allied to scurvy, but in which we have the cutaneous hemorrhages and joint affection as the prominent features. An infectious and contagious granuloma, Rhinoscleroma. affecting the skin and mucous membrane of the nose and contiguous parts, characterized by the formation of ex- /2^" — ^ ceedingly dense, painful, flattened or elevated ^^^^'^S^y"^ nodules, or tubercles, which may be isolated K^lr**^^^^^^ ^ ** or confluent. ^(^^^(^ ^* An examination of these lesions, microscopi- ^ ^ cally, reveals a bacterium in the tissue, rod- ^p9 shaped, one and one- half times longer than they are broad, with micrococci in their centre. Bacteria of rhinosciero- ^ . , , . -,..., nia ; rods surrounded This neoplasm admits of cultivation in almost ^'th their capsules , any nutrient fluid ; cultures injected into ani- foSaded b*y^T\ingre nials cause a series of ivory nodules to appear f^XtbU'Todis^m" on the nasal septum, hence it is pathogenic of wing a coccus. the disease. The favorite habit of this microbe is either the septum or alae of the nose, in which it breeds slowly, but, progressing, en- 91 8 disease: germs. larges, becomes as dense as ivory, without any inflammatory symptoms being present. The special lesion, or microbial colony, or patch, or nodule of germs, gradually grows either flat, or indurated or elevated, while respiration is often impeded by stenosis of the nares. This neoplasm is met with in both sexes, between fifteen and fifty, in all social positions of life. The micro-organism, imbedded in the nasal tissue, can never be mistaken ; its location, the disfigurement it occasions, the induration, the ivory-like elasticity, its transformation into osseous formation and the extreme rarity of ulcerative de- generation. The future of the patient is one of great gravity, as the growth and organization of the microbe is slow, but progress- ing and persistent. The old treatment of extirpation, dilatation of the nares, has been entirely superseded by the local application of peroxide of hydrogen externally and in the nasal fossae, and by the adminis- tration of Chian turpentine and peroxide internally. Ozone oint- ment, resorcin and salicylate soda externally. These seem fo be our most effective germicides in rhino- scleroma. Rose rash resembles eruption of measles, but Roseola, there is no watering at the eyes and nostrils, neither is there cough. The skin is mottled, of a rose-color, the patches being of no great size and of irregular shape ; sometimes the eruption appears as a cross of small slightly raised rose- colored spots. At first the eruption is bright red, but gradually it fades and finally disap- pears. The constitutional symptoms are slight. The rash fades in from three to six days. Sometimes the throat is affected slightly as in scarlatina, which has led some to believe that the malady consists of a mixture of scarlatina and measles, but of that there is no proof whatever. Various maladies give rise to roseola, the most important of these is syphilis. Usually syphilitic roseola is the earliest of the constitutional symptoms ; it commonly makes its appearance within six weeks of the primary attack, but it may be so slight as to give rise to no inconvenience, and so frequently escapes observation. Syphilitic roseola ordinarily consists of a number of rose copper-colored spots, completely isolated and even with the sur- face, but sometimes they are fused together so as to give rise to BACTERICIDES. 919 patches which are above the surface, and so merge imperceptibly into the papules which commonly follow in order of secondary symptoms. At the same time the fauces present a rim of redness corresponding to the external rash. Belladonna sometimes pro- duces a roseolar rash, but not very often. Various microbes give rise to roseola, as the bacteria of mal- nutrition, dyspepsia, rheumatism, dentition. An alcoholic vapor bath ; opening the bowels and administer- ing some microbicide as glucozone, or salol ; ozone tablets are usually sufficient. A rare skin affection, in its typical form, a denizen Rupia. among the dregs of humanity, always syphilitic. It consists of masses of the germ syphilitica with that of pus, in the form of hard, conical, laminated crusts of a limpet- shell shape ; when these crusts are removed, an ulcer is exposed crowded with the microbes. Same treatment as for syphilis. Rupture of the heart may occur from Rupture of the previous disease, or it may be caused by Heart. external violence. It may take place at any part, left or right side, walls of ven- tricles, rupture of valves, etc. Laceration of muscular walls, generally due to fatty degeneration, or to rupture of aneurism in ventricular wall. It is a common termination in dilatation with thinning of its walls. Embolism of the blood, such as we have in acute laryngitis, pneumonia, and also in ergotism in labor, as well as that due to eating bacterial food, as sausage, is a com- mon cause of rupture. The condition of embolism is so common from sluggish livers, non-aeration of blood by lungs and skin, and the muscular structure, feeble by excesses and tobacco, that rupture of the heart as a cause of sudden death is fearfully prevalent. If a muscle be weak, perhaps slightly degen- Rupture of erated,someof its fibres usurped by fatty nodules, Muscles. and it be subjected to violent, sudden, severe exertion, it may rupture, or its tendon may give way. It is readily recognized by the sudden snap, severe pain, loss of the use of the ruptured muscle. 920 DISEASE GERMS. Muscle, like bone, nerve or other structure, will unite, if it is kept at perfect rest and apposition, keeping the limb in such a position as will relax the ruptured muscle ; bandages and splints. A tumor or swelling, formed by the protrusion Rupture, of more or less of a viscus from its natural cavity. {^Hernia}) Thus, there may be hernia of the brain, iris, mucous lining of windpipe, lungs, liver, spleen, bladder, uterus and intestine. But when the word stands by itself it is restricted to signify protrusion of the abdominal viscera. The predisposing cause of hernia is some inherent weakness of organization ; some parts of the abdominal walls weaker than others, as about the navel, inguinal and crural rings ; or there may be a weakness from congenital deficiency, or from disease, wounds, abscess, bruises, distension of the walls by the pregnant uterus, dropsy, or from the relaxing effects of exces- sive solar heat. The exciting causes are compression of the viscera by the laction of the muscles that surround them, especially the dia- phragm ; hence, bodily exertion, lifting, hoisting, straining, jumping, coughing, hallooing, shouting. A hernia is composed of a sac and its contents. The sac of a hernia is a portion of the reflected layer of peritonaeum, which the protruded viscera push before them in their escape, and which forms a pouch containing them. It is very liable to contract adhesions to the surrounding tissue, and in consequence may not return into the abdomen when the hernia is returned. As the hernia increases in size the sac also increases, partly by growth, partly by distension, slight laceration or unraveling, and partly by fresh peritonaeum ; sometimes it diminishes in thick- ness, while increasing in capacity ; sometimes it becomes thick and divisible into layers. The narrow part that communicates with the abdominal cavity, is called its neck, usually becomes thickened, constricted, and sphincter fibres are often developed in it, which, on slight irritation, causes it to contract. Some hernias are destitute of a sac. This may happen if the viscus is not covered by peritonaeum, if the hernia is the result of a wound. Symptoms. — Usually the patient can speak of it as of some- thing having given way, and on examination a soft, compres- sible swelling can be detected at some part of the abdominal walls, which increases in size when he stands up ; diminishes or disappears when he lies down ; dilates when he coughs or makes exertion, and, when properly directed pressure is made upon it, BACTERICIDES. 92: it may disappear. When it contains only intestine it is termed Enterocele ; when only omentum, Epiplocele. The former is smooth, round and elastic, and flatulent croakings are heard in it, and, when pressed upon the bowel, returns to the abdomen with a sudden jerk or gurgling noise ; the latter is flat, inelastic, flabby, unequal to the touch, and when pressed upon returns without any noise and very slowly. A large number of hernia contain both omentum and bowel, and are called entero-epiplocele. Division. — Hernia is divided into several varieties, according to its location, as umbilical, inguinal, femoral ; and according to the condition of the protruded viscera, which may be reducible, irreducible, or strangulated, or subject to some constriction that prevents its return, interferes with its contents or circulation. Pathology of Hernia. — But few attempts have been made to investigate minutely and exactly what was meant by that condi- tion which we so frequently see, but so rarely thoroughly appre- ciate, and which we call hernia. We divide it, according to its clinical appearances, into inguinal, femoral, umbilical, or into congenital and acquired hernia, but of the conditions which went to produce each variety we have been up till quite recently com- paratively ignorant. It has been assumed, because the intestines in the case of hernia protruded more easily from the abdomen than is normally the case, that therefore we had to do with the elongation of the mesentery. Many authors do not take this statement for granted, have measured a large series of abdomens and mesenteries, both healthy and unhealthy, and have come to the conclusion that elongation of the mesentery is a compara- tively rare event. Perhaps it will be more easy to follow these conclusions and to estimate them at their true Value if we first consider congenital hernia, and afterwards those forms which are acquired. It has long been known that many cases of congenital hernia yielded to the treatment of a truss, underwent cure before adult life, and did not show any special tendency to return again later on. Perhaps the most obvious instance of this is afforded by umbilical hernia in childhood. Of the innumerable cases which one sees in children in the large out-patient departments there is scarcely one which ever survives to the adult life of its possessor, and this notwithstanding the fact that the treatment of these cases is notoriously conducted by the parents on the most slipshod prin- ciple. As age advances and fat accumulates on the mesentery umbilical hernia again acquires prominence ; but we do not remember to have ever come across a single case in which it could be shown that the possessor of one of these hernise in old age had previously been troubled with a similar affection early 922 DISEASE GERMS. in life. To a less extent these remarks also apply to femoral and to inguinal hernia, chiefly to the latter, because femoral hernia is almost unknown in childhood. There are certain periods of life at which the pelvis grows with great rapidity as compared with the rest of the abdomen, namely, from about the second to the fifth year, and again at the age of puberty, and it is at these two periods that we have to record the greatest number of cures of congenital hernia. It is extremely interesting to find that measurements fully bear out and support these facts to which we have alluded. Elongation of the mesentery is practi- cally unknown in children, whilst that other condition which has been mistaken for it, namely, prolapse of the mesentery, and which we shall come to further on, is apparently without exist- ence at all in childhood. The fault of growth which has given rise to hernia in childhood lies with the abdominal wall, and is due to imperfect closure either of the inguinal canal or of the umbilical orifice. It is clear, then, that if operative interference is of any avail at all in the cure of such a condition, the best results ought to be obtained by operating on those herniae which occur early in life. This conclusion has also been arrived at independently by other writers on the subject, who have ap- proached it rather from the practical side than from the patho- logical. One writer has, we believe, gone so far as to state that if operations were confined to childhood there would be no failures to record; and from these facts we may at least draw this comforting assurance, that should a congenital hernia prove rebellious to treatment by a truss or other simple means, we can give the very best hopes possible of its complete cure by opera- tiv^e interference. If we turn, however, from the consideration of the congenital cases to those which occur in adult life, the pathology at once becomes more complicated, and as a consequence the results of treatment will be less certain. The method which as been em- ployed to solve this question, is one to which no exception can be taken, though it is quite possible that those will not agree to all the conclusions. In order to take a fixed point from which to start measurements, a base line which could be fixed by some bony prominence or prominences required to be taken, and this was insured by drawing a line from the level of one anterior su- perior spine of the ilium to the other. By this means it was possible to ascertain with ease whether the mesentery lay in its normal situation or not. A true elongation of the mesentery is rarely found, and when it exists, appears only to be the result of long tension on a hernia which had existed for some considerable time. BACTERICIDES. 923 A further and more important fact has been pointed out, namely, that it is perfectly possible to ascertain during life, from the shape of the abdomen, whether prolapse of the mesentery and the rest of the viscera has taken place or not. This is, how- ever, equally clear from the resulty of these measurements, in which, as we have just seen, only eleven per cent, of the whole hundred individuals had their intestines so fixed up that hernia could not possibly occur, viz. : that the abdominal walls must be of considerable importance in the prevention of hernise ; in other words, hernia is the result of two conditions — (a) weakness of the abdominal walls ; (d) prolapse of the mesentery. To effect a radical cure both of these conditions must be reckoned with, but it is probably only in the severer cases that any operation for fix- ing up the prolapse of the mesentery should even be entertained. In all the slighter cases a complete closure of the abdominal wall is all that is required, but there are many points that go to make up this complete closure. In the first place, the operation must be conducted with aseptic precautions, otherwise, not only will the life of the patient be endangered, but the result of the opera- tion will not prove to have been so satisfactory as it ought, for the cicatrix which is formed will have a greater tendency to yield than if union by first intention had taken place. In the next place, the sac itself must be completely and absolutely re- moved, the canal which the hernia has made for itself must be, as far as practicable, obliterated ; if these two conditions are in- sured, then, and then only, can the operation be rightly described as radical. Such in the main are the points brought forward on this sub- ject, and the conclusions which are derived from them. For our own part, it seems to us that there is one source of fallacy in the measurements which have been taken. The majority of them have been drawn from bodies in themselves pathological, that is to say, from those who have died from disease rather than from accident ; and it is probably questionable whether a similar pro- portion of disease would be found in those who may be described as healthy individuals. Not that we wish by any means to imply that great credit is not due to Mr. Lock wood for drawing atten- tion to prolapse of the mesentery as the cause of hernia, but we think it possible that he has over-estimated the frequency with which it occurs. We are none the less sure that those who care to peruse the pages of his lectures, will derive much instruc- tion from the manner in which the investigation has been carried out, as well as from the results arrived at. I. Reducible Hernia. — One that can, by well adapted pressure or manipulation, be returned into its natural cavity, forming a 924 DISEASE GERMS. swelling that dilates on coughing, diminishes or disappears when the patient lies down. In the treatment of this rupture, the hernial mass should be returned to its natural cavity, smeared over with the Mexican liniment,* kept in its p(3sition by a pad or truss, or other appa- ratus ; and if the liniment is applied daily, compression moder- ately firm, it will contract the canal, excite adhesfve inflammation and a cure. 2. Irreducible Hernia. — A hernia is said to be irreducible when the protruded viscera cannot be returned into the abdomen. Causes. — Adhesion of the sac to the bowel, by a deposit of lymph bands ; enlargement of mesentery, or omentum, or other organic changes. Symptoms. — Besides the ordinary symptoms, there is likely to be a dragging pain in the back and abdomen ; occasional at- tacks of vomiting, or obstinate constipation, and a feeling of ex- haustion. Treatment. — This may be either palliative or radical. The palliative treatment consists in the application of a hollow bag truss, or else a truss with a hollow pad, that shall firmly em- brace the hernia, and prevent all further protrusion. Violent ex- ercise, exertion, excess, or constipation, should be guarded against. The radical operation consists in cutting down upon the parts, breaking up adhesion, returning the bowel or omen- tum — an operation that is not justifiable unless strangulation has taken place. J. Strangulated Hernia.- — A hernia may be said to be strangu- lated when it is constricted in any way, so that the contents of the protruded bowel cannot be propelled onwards, and the return of the venous blood is impeded. Causes. — A sudden protrusion of bowel or omentum through a narrow aperture, as a result of some violent exertion, or disten- sion of the protruded intestine by flatus or faeces, or a tumefac- tion of the omentum, a swelling or contraction of the muscular fibres at neck. * This great remedy is in the form of a healing and strengthening ointment, whicli invigorates the weakened, flabby membranes and muscles stimulating natural secre- tions and causing healthy granulation, thereby contracting the hernial aperture and making the abdominal wall normally sound and solid. It is generally used in connec- tion with a truss, because most persons can more conveniently wear some kind of truss or supporter for a few weeks while a cure is being effected, than they can stay abed or hold the bowel in place with the hand during that time. Evils incidental to the wearing of a truss, such as induration or callousness, atrophy, chafing, etc , are counteracted by the remedy ; the pressure can be relaxed gradually as the cure pro- gresses, and eventually the use of a truss may be entirely discontinued. Children in arms are cured by the same remedy. BACTERICIDES. ^2$ Symptoms. — In addition to the ordinary symptoms of hernia we have, when it is strangulated, those of obstruction of the bowels and peritonitis. There is flatulence, colicky pains, a sense of tightness around the abdomen, a desire to defecate, and ina- bility to do so. Vomiting, first the contents of stomach, then mucous bile; and lastly, matter from small intestine. The hernial tumor cannot be returned ; it is uneasy or painful, tense and incompressible. There is a perfect obstruction ; the swelling does not now dilate. The neck of the sac becomes tender, and this tenderness diffuses itself over the entire abdomen, which becomes painful and tympanitic. Peritonitis sets in ; face white, pinched, anxious ; vomiting constant ; pulse small, hard, wiry ; patient restless and despondent, and after a variable time parts begin to mortify. There may be much variety in the symptoms, death taking place early or remote. Treatment. — The indications here are to return the intestine, and if this cannot be done to cut down upon the neck and divide it, and return the bowel and omentum. If inflammatory symp- toms have not appeared, the best plan is to relax the miiscular system by one or more of the following methods, and then per- form the taxis : To cause profound relaxation, you must be guided by what you can procure the quickest, and if it fails, then the others, one or more. We shall enumerate the best first, and so on ; they are simply auxiliary measures to aid the taxis. Let patient inhale a little chloroform, and when he is just going under, insert a hypoderniij injection of one-quarter grain of morphia into the cellular tissue. This causes very profound muscular relaxation, and lasts long. Or let the patient inhale alcohol, chloroform and ether, till anaesthesia is procured ; enemata of an infusion of lobelia or tobacco, with warm bath, with a little tobacco or lobelia, or an infusion or fluid extract of jaborina could be given. If there is any time to spare, large doses of opium and hyos- cyamus ; the latter drug has a remarkable influence over all the hollow viscera; and its liberal use in hernia often spares the surgeon's knife, and saves many lives. As a local applica- tion, heat is superior to cold ; hot poultices of belladonna, lobelia and linseed. Once thoroughly relaxed, patient free from all clothes, an intelligent assistant should be selected, and instructed to knead, or press the bowels gently well up to the diaphragm ; head and shoulders well elevated, and knees drawn up. Blad- der and rectum carefully emptied before relaxant is ad- ministered. The taxis is a term employed to signify the manipulation of 926 DISEASE GERMS. the hernial tumor by the hands of the surgeon. In performing the taxis the tumor should be drawn gently forward, between both hands (assistant kneading actively to diaphragm), in the aeris of the neck. Hold in this position a few minutes ; if patient is awake cause him to make a deep expiration, and hold his breath. Then press tumor between both hands, so as to squeeze out its contents, or gas and venous blood ; then manipulate with the fingers at the neck ; by pushing a little you will likely have the satisfaction of feeling it leave your hands and hearing a gurg- ling noise accompanying the return of the bowel into its natural cavity. To effect this, the position of the patient should be such as will relax every muscle ; the kneading must be vigorously car- ried out, and the tumor in all cases drawn gently forward. In all cases the taxis must be performed with gentleness ; no force or violence to bruise or injure. If not successful by the above plan, which is rarely the case, after a trial of fifteen or twenty minutes, it is often better to rest a little, and try again. Try every means, even to introducing copious injections up the rectum, or hanging up the patient by the heels. Good common sense, kindness and patience are great elements of success. When once returned, if insisted on by the patient, and his friends concurring, a radical cure should be effected by some of the following methods, each one having the same object in view, to wit : to excite a slight irritation, so as to cause inflammation, with effusion of lymph, which will block up the orifice and render the descent of the bowel again impossible. For that purpose the following are suc- cessfully used : If the parts are hairy, shave off, and apply the irritating plaster for about six weeks, and over it the truss, or pad, or compress. This plaster is to be spread fresh ev^ery morning, and applied, in size from three to four inches square. A good method, some- what painful and tedious, but safe. Another plan is to introduce a small knife and scarify around the ring. Still another method, and a favorite one with many, is to inject right against, or in the inner surface of the ring, some irritant, such as fluid extract of oak bark, tincture of cantharides, tincture of iodine ; this is done with the ordinary hypodermic syringe, or one specially prepared for the purpose. If those are used, case must be watched for peritonitis. Still another plan is the introduction of sutures of saddlers' silk, iron or silver wire, and other methods of a similar kind. If strangulated hernia cannot be reduced, an operation for its relief must not be too long delayed ; and when that is done, if successful, it invariably effects a radical cure. Although we say do not delay the operation, still, in aged people, witli large BACTERICIDES. ^2/ hernias, wait as long as possible and use remedies, and never forget the magnificent action of hyoscyamus and opium on the hollow viscera. The operation is a simple one, free from danger, if the sur- geon knows the parts and does not cut an artery or wound the bowel — dividing layer after layer over the tumor near its neck, down to the bowel, and then dividing the neck and returning the bowel or omentum, or both, into the abdomen, stitching up wound in the usual manner and applying a firm compress. In ail cases avoid purgatives in the management of cases, as irri- tating and injurious. Inguinal hernia is that which protrudes through Rupture, one or both abdominal rings. There are four Inguinal, different varieties — oblique, direct, congenital and encysted. The oblique is the most common. It takes precisely the same course as the testicle takes in its passage from the abdomen into the scrotum. It begins as a fulness, or swelling, at the internal ring, a little above Poupart's ligament, and passes into the inguinal canal, and, if the protrusion increases, it descends into the scrotum of the male, or labia of the female. The cov- erings of this hernia are skin, a layer of condensed cellular tissue, a tendinous layer, cremaster muscle, a cellular layer and the sac. The internal epigastric artery is always internal to the neck of the sac, the spermatic cord behind the sac, but in old cases parts are somewhat changed. The direct inguinal bursts through the conjoined tendon of the internal oblique and transversalis muscles, just behind the external ring. Its coverings are the same as the oblique. The epigastric artery runs external to the neck of the sac. The congenital hernia is a variety of the oblique, and is so called because the state of the parts admit of it at birth. The encysted is a variety of the congenital. The protruding bowel pushes before it a sac of peritonaeum, either into or behind the tunica vaginalis, and this tunic and sac adhere together, so that this hernia has two sacs. Diagnosis. — This hernia is to be distinguished by dropsy of the scrotum, as follows : Hydrocele begins at the bottom of the scrotum ; there is fluctuation ; if the serum is not turbid it can be seen through ; does not dilate on coughing ; whereas, hernia begins at top, is not transparent, does not fluctuate, dilates on cous^hing. In varicocele, where there is a varicose condition of the veins of the cord, it resembles hernia, as it 028 • DISEASE GERMS. dilates on coughing, increases in erect posture, may disappear at night, but it feels like a bag of worms. Undescended testicles are very easily recognized. TreaUnejit. — If reducible it should be returned and kept in its place with a truss or other mechanical support ; if irreducible, a hollow bag or truss should be worn, to prevent further protru- sion ; if strangulated, relaxants and the taxis should be resorted to, and if it fails, and trying every expedient, an operation should be performed. In performing the taxis Yor this hernia, patient should be placed on back, head and shoulders well elevated, knees drawn up and thighs close together, the hernia drawn gently down ; then the assistant actively kneading the bowels well up to diaphragm and the pressure by the operator made upward and outward. Femoral hernia is that which escapes behind Rupture, Poupart's ligament, passes through the crural ring Femoral, and descends on the thigh. This hernia is cov- ered by skin, fascia of the thigh loaded with fat, a layer of cellular tissue and sac. From its surroundings it never can become of great size. It is almost peculiar to females, on account of the extreme breadth of their pelvis. It is easily recognized by its location, increasing in size when she stands up, dilating in coughing; it is usually small. Psca^ abscess also dilates when she coughs, diminishes or disappears when the pa- tient lies down ; but hectic and disease of the spine are always present in that form of abscess. Varix of the femoral vein bears some likeness to it, as it dilates when the patient coughs, dimin- ishes or disappears when she lies down ; but a careful observa- tion will reveal the difference. It would certainly be a person grossly ignorant that would mistake it for bubo. Treatment. — The reducible should be returned and kept in position by a truss. The irreducible supported by a hollow truss. If strangulated, the taxis must be tried, and in performing this the patient should be placed in the usual position on back, head and shoulders elevated, knees drawn up, with the thigh of the affected side rolled inward and crossed over toward the other side. The tumor should be drawn downward, the kneading vigorously carried out, and the tumor pressed with the points of the fingers backward and upward. If the taxis and chloroform do not succeed, the operation should be resorted to. BACTERICIDES. 929 Rupture at the navel is most common in chil- Rupture, dren at birth, and in women who have been fre- Umbilical. quently pregnant; although in the so-called hernia of adults, the hernial aperture is really not at the umbilicus, but a little on one side of it. The cover- ings of this hernia are skin, superficial fascia and sac. They are always thin and rarely become adherent. Treatment. — If reducible, there should be strapped over the ring or neck a convex piece of some hard substance, its convex side toward the abdomen, strapped to the abdominal walls by adhesive plaster, and over all a bandage or belt; The irreducible should be supported by a hollow bag or truss. If strangulated, the taxis should be resorted to*; patient in usual position ; all failing, an operation should be resorted to. Ventral Hernia. — When the protrusion occurs at any other part of the abdominal walls, save at the ordinary places, usually a consequence of wounds or bruises. Perineal Hernia. — Descends between the bladder and rectum, forcing its way through the pelvic fascia and levata ani. Vaginal Hernia. — In which the tumor projects into and blocks up the vagina, displaces the uterus, obstructs the rectum. Very common cause, usually, tight lacing or wearing belts, in order to have a small abdomen. Labial or Pudendal Hernia. — Descends between the vagina and ramus of the ischion, and forms a tumor in one of the labia. It is to be distinguished from inguinal hernia by the absence of swelling at the abdominal rings. These hernias are to be re- placed by pressure with the fingers, and kept in place by pads and trusses. Obturator, Ischiatic, and Diaphragmatic Hernia, so-called from their location, are very rare. This is very prone to take place during Rupture labor, provided there be some obstruction, of the Uterus, and ergot administered too freely during the first stage. The principle causes of obstruc- tion are tumors, hardened faeces, exostosis of the promontory of the sacrum, deformed pelvis, an abnormal presentation, turn- ing during a pain. Some pathologists are inclined to the theory of degeneration of some of the muscular fibres oi the uterus, or a thinning of its walls. It is easily recognized by the sudden cessation of pain, faint- ing, pallor, death-like coldness, and on placing the hand over the 59 930 DISEASE GERMS. abdomen, the child can be detected out of the uterus, in the cavity of the uterus. If such an event should take place, the abdomen should be slit up, its cavity exposed, the child, after-birth, blood, clots and water carefully sponged out, the cavity of the uterus cleansed, the whole stitched up and bandaged. An effort should be made to rouse up the patient by the administering diffusible stimulants ; and if she rallies, treat like vietro-peritonitis. Literally speaking, the best means of pre- Sanitary Science, serving health and avoidance of all condi- tions which would be likely to impair vital force. A science of immense utility to man, or it teaches how to resist the action of disease germs. What are disease germs ? What are bacteria ? Vegetable and animal organisms, each consisting of a single cell, microscopic in size, usually colorless, capable of rapid, enor- mous growth by fission, or by spores produced in their interior. Under a magnifying power of from five hundred to two thousand diameters, they are seen in three forms, globular (micrococci), cylindrical (bacillus), and spiral (spirillum). These germs are found whenever organic matter exists in the process of decay ; and decay begins where life ends ; they are to be found in the earth, air, water, food ; the spores of some being indestructible unless under a great heat. Quite a large number of microbes have been isolated and separated by culture and inoculation experiments and proven to cause each a particu- lar disease and no other, and are termed pathogenic. What diseases are they ? • Amongst the diseases thus proven, beyond a doubt, to depend upon the presence of special bacteria are : Anthrax or splenic fever, tuberculosis or consumption, relapsing fever and glanders ; cholera, typhoid fever, small-pox, vaccine disease, measles, diph- theria, leprosy, septicaemia and some others. The question now arises — If the bacteria of a given disease, tuberculosis, for instance, are almost universally present, n'hy do some contract the disease whilst others escape ? It is evident something more than the mere presence of the bacteria is involved in the production of infectious disease. Like many other things of which we know little or nothing, however, it has several names. We call it vitality, idiosyncrasy, etc. ; in effect it is the resisting power of living organic matter to the agents whose duty it is to reduce it partially or wholly to inor- ganic matter. BACTERICIDES. g^I We may consider then, as the two factors in the problem of in- fectious disease : (i) diminished resisting power ; (2) the bacteria. In other words, the soil and the seed ; either being inoperative without the other. To put the problem another way : It is as manifest that pathogenic bacteria, coming in accidental con- tact with healthy tissues, will fail to multiply in sufficient numbers to cause disease, as that com sprinkled upon a bouldered street will fail to produce a corn crop. But, we hear it argued, ^* Here is a man in perfect healthy stricken down with cholera, or small-pox, or some other infectious disease '' — how do we account for this ? Inquire into that man's history for a week, a month or perhaps for years — Has he in- herited a feeble organization ? Has he been underfed or over- worked ? Is he dissipated in his habits ? Have business or domestic affairs weighed too heavily on his mind? Does he sleep in a well- ventilated room ? — in short, Are his tissues, to use a commercial phrase, " beloiv par " from any cause whatever ? The cases of infections disease in ivhich some preceding anti- Jiygienic influence cannot be traced are certainly rare if not unknown. What then, is the most practical lesson we may learn from our present knowledge of the causes of infectious disease ? Simply this : The preservation of the normal integrity of the tissues is equivalent to depriving the bacteria of a soil in which they can mid- tiply to a dangerous extent. How may this be effected ? In a word, by hygiene, possibly by vaccination ; the future possibilities of the more extended application of this principle are great. Of all the routes by which the cause of infectious disease reaches any community, none perhaps are more important and less regarded than the food and water supply. The water supply then may be regarded as one frequent source of infection. A second source is the milk ; this may be a source of infection by reason of the water with which it is adulterated — or in v/hich the vessels containing it are washed ; or it may be a product of tuberculous cows. As we cannot well watch all sources of infection by fluids, what may we do to protect ourselves against them ? The most effective weapons then, with which we may resist the onset of infectious diseases are: (i) Hygiene, which renders unproductive the soil. (2) Heat, which destroys the seed. The idea that infectious disease will ever cease to exist is, of course, Utopian. It is a well-known fact, however, that these diseases are, in themselves, self-limited — that is to say, the bac- teria cease to multiply after a time, and favorable cases recover spontaneously within a definite period. Q^2 DISEASE GERMS. We may now ask the question, How do pathogenic bacteria produce disease ? Some affirm that by the rapid increase in numbers simply, the normal operations of the economy are so interfered with that disease is the result. In support of this, it is well known that blood-vessels are sometimes actually choked by the myriads of these organizations, and further, that the vast amount of oxygen required for their development must interfere with the physiological requirements ol the body. Others believe that the blood-globules, particularly the white cells, are greatly injured or entirely destroyed by the entrance into them, in too large numbers, of these organizations, as has been shown ; this power of the white cells, ordinarily so favora- ble, being now overwhelmed and themselves destroyed. No doubt in some cases this is a powerful factor. Still other theorizers, and particularly those who are opposed to this germ theory of disease, maintain that septic products are formed in the body by ordinary chemical or vital action — these poisonous ptomaines, as they are called, sometimes forming in quantity sufficient to react upon the body and produce disease. It is improper here to follow the successive steps taken in the evolution of this theory, largely brought out by the researches of M. Gauthier. It is at the present time well known that, as shown by this observer, such toxic products are formed and found in the animal body, and that while some of them are formed by the oxidation of tissues within the body, other like products, even more toxic, are the result of the agency of bacteria. Koch is of the opinion that the comma-bacillus secretes or excretes a ptomaine whose reaction upon the tissues may be the efficient cause, or one of the efficient causes, of cholera asiatica. In carefully studying these various theories in answer to the question. How do bacteria produce disease ? the opinion seems justifiable that all these agencies are combined in inducing the general result, namely, what we call disease ; that the bulk of numbers, the urgent demand for, and great consumption of, oygen not supplied from the external air, the injury or destruc- tion of the blood-globules, and the poisonous action of the bac- teria secretions called ptomaines, all together act to produce the pathological result. We may take it for granted, then, at least, for the present, that disease results from (i) great numbers of bacteria; (2) great waste of oxygen ; (3) injury of the blood- cells ; (4) the toxic action of one or more of the ptomaines. We now come to the more practical part of our subject, namely, the management of gynecological cases of disease induced by micro-organisms. The indications seem clear (i) to prevent the entrance of pathogenic microbes into the body ; (2) to aid as far BACTERICIDES. g^j as possible all the efforts of such infected body to rid itself of them, and of their effects. Nearly the whole subject of treatment is therefore included in what is known as antisepsis. Water in my hands serves as the safest and most efficient anti- septic. Water is the great cleanser, and may be used freely and everywhere. Fortunately for our race and for the advancement of true science, hygiene is asserting her lofty position in the conservation of human life. The power acknowledged for antiseptics may wane, hygienics never. Gynecologists, as well as others, have learned this well. Cleanliness cures septic diseases by forbidding even the presence of any and all noxious agents. Keep ourselves and our patient clean, and fear not — waiting, however, for the ideal germicide and antiseptic that may be discovered to serve as the handmaid of cleanliness. Sanitary science teaches us that the air of all our large cities is heavily loaded with micro-organisms of a most deadly character ; that these germs are most numerous close by and in sewers ; that the class of micro-organisms which preponderate are chiefly micrococci ; the saccharo-mycetes or yeasts, and the moulds. The schizomycetes include : bacilli (yo'l shaped), e.g., B. anthracis, B. tuberculosis ; micrococci (round), e.g., M. scarlatinae, M. vacciniae ; spirilla, or spirochaetse (twisted in spiral form), e.g,^ S. oberme- iera, the microbe of relapsing fever. The examination of the air of sewers is carried out as follows : five gallons of sewer air, from the centre of culvert is aspirated into a sterilized rubber bag. This air is pressed into liquefied, steri- lized, nutrient gelatine, and then poured out into a glass plate, covered with a bell-jar, and kept at a constant temperature for a few days when the germs have developed into colonies, which may be counted and their characteristics noted. If liquefaction of the gelatine be produced round a colony, it does not neces- sarily show that the germs there are pathogenic. Under the microscope the colonies may be separated into the different va- rieties of bacteria, moulds, or fungi. To distinguish which are pathogenic, pure cultivations must be made of each colony sepa- rately, and animals inoculated therefrom. Every disease-germ within the entire range of bacteriology is to be found in the common sewer air. Microbes in the atmos- phere ; ptomaines, possessing the most extremely poisonous properties in the liquid contents of the sewer. Five gallons of air were aspirated from a sewer in Fourth street, New York, at lowest level ; after two days' cultivation, numerous colonies, moulds. The colonies appear as minute, yellow, liquid 934 DISEASE GERMS. points, on the third day the plate liquefied, and the microbes proved to be the sarcina aurantiaca ; the mould was the penicil- lium glaucum. Sarcina Aurantiaca — Sewer air after three days' oiUivation. It appeared as yellow circular liquid colonies, cocci in masses. Saccharomyces. Five glallons of air were aspirated from a sewer on Fourth street, near Broadway, New York, one week later, at lowest level^ with most offensive smell ; numerous colonies and moulds, all white, raised, non-liquid and circular ; after five days' cultivation,, non-liquid colony appeared. Five gallons of air aspirated from sewer, later on near Broad- way, New York. Rain during the previous twenty-four hours ; after three days' cultivation, numerous colonies formed, together Aspergillus albus. — Sewer air. A species of Bacillus subtilis frcm sewer air. with moulds. A large number of the colonies were of a grayish- white, sharply-defined circles, with granular centre, and a point in the centre, liquefying the jelly (bacterium termo) ; some of the colonies were gray in color, irregularly circular, and liquefying BACTERICIDES. 935 the jelly. Moulds were nearly all aspergillus albus. One large one was mucor mucedo. A large number of micrococci. Five gallons of air aspirated from sewer, later on, on Lafayette Place, New York, colonies and moulds ; the colonies appeared as cream-white, non-Uquid, and yellowish-white liquid. The cream-white were bacilli ; the yellow- white are micrococci. The entire populace of the street, whose closets emptied in the sewer at this time, were afflicted with hay fever. Five gallons of air were aspirated later on from a sewer on Third street, New York ; after five days' cultivation, yield colonies and moulds. One whitish-yellow colony, liquid in centre, consisting of diplococci and short rods. One large white colony which is bacillus loevis. Most of the moulds aspergillus albus, the others penicillium glaucus. /:5 Spirillum identical with that found on vegetable in- fusions, found in the same air, in dense swarms. were Bac llus Lcevis. — Source,sewer air magnified looo diameters. A form of yeast plant magnified 750, found in sewer air. tv*» Five gallons of air were aspirated from a sewer on Lafayette Place ; from six to nine days' cultivation, colonies of micro- organisms and moulds formed, with spore- like bodies. Very small cocci. After five days' cultivation, they appear as small circular, non-liquid colonies. The moulds were penicillium glaucum ; mu- cor mucedo, and aspergillus glaucus. Five gallons of air were aspirated later on from a sewer on Fourth street near Broad- way, New York ; a most offensive smell issued from the opening. After six days' cultivation, colonies and moulds formed, saccharomyces, yellowish-white, non-liquid, raised colonies ; cocci. The moulds were penicil- A smaller form of the yeast plant in the same sewer. 936 DISEASE GERMS. Hum glaucum. A large number of micrococci, mixed with the aspergillus glaucus. \ Saccharomyces liquefaciens, magnified looc, from sewer air. ,fi),r^-:"i Air aspirated from a sewer connected with a brewery. Deposit under ttie microscope filaments of various microbes (bacillus), which produce disease; young microbes in an ever active state ; others incrusted in acids. -cf*^^ Air aspirated from sewer in Greenwich avenue. New York, near a brewery. After six days' cultivation it shows lactic ferments of ale, putrid wort, chaplets of mycoderma aceti. ^* Putrid Blood Serum. — Ttie evolution of numerous ba- cilli, all factors of disease from aspirated air, as well as the liquid contents of the sewer. Asperated air from a sewer in close proximity to a vinegar factory. Deposite seen on the microscope Mycoder- ma aceti still young, and older ones. Air aspirated near a beer brewery, showing microbes which produce disease. Young Bacillus Anthrax, muigling with the young broods of the malarial germ in a sewer. Bacilus of Typhoid Fever, aspirated .' ,!$«« '-X Q44 DISEASE GERMS. Sanitary science teaches us that the prevention of endemic ma- laria by extensive drainage is a sanitary fact. The mortality caused by the malarial germ does not indicate the amount of misery caused by it. It usually takes from twenty to thirty at- tacks before the germ, with attendant fever, produces a fatal re- ^'^:::<^ suit, and then its sequelae, its anaemia, leucocythemia, diabetes, dropsy, enlarge- ment of spleen and liver, and other conditions which ultimately terminate the existence of the patient. In malarial sections, the number of yellow, sallow A bacillus found in stagnant water; wrctchcs, inhabitants of sucli districts, '?::tuy^^L'::t^^oL':^&::^x with their Umbs shrunken, their muscles g""^' wasted, nervous and physical wrecks, can have the microbe of all their ills blotted out by a drainage of the soil;, a perfect system of drainage will get rid of this microbe, and localities decimated with ague become perfectly healthy. Sanitary scie7ice teaches its that nearly all our domestic animals in and near our large cities are saturated with the bacillus an- thrax and actinomycosis ; that milk and meat poisoning are very common, cases being daily recorded. The inhibition of these microbes often cause immediate death from the reflex presence of the microbe, or from its spore, or the toxical effect of the pto- maine. So prevalent and fatal are those cases becoming, that efforts are being made to stem the evil, but with poor results. Death before these germs can enter the blood is deplorable, and worse still when pustules, abscess in lymphatic, and pyaemia occur. The microbe actinomycosis is a denizen, in its early stages, of the jaws; just how far it has spread among the human family cannot be correctly stated, but its prevalence is in a great measure due to the imperfect cleansing of the dentist's hands, forceps and other tools. We cannot always tell, until the microscope reveals its presence or absence. That pus from an alveolar abscess is necessarily septic we cannot be sure ; but there are three facts worthy of notice: 1. Pus from an alveolar abscess is often of foul odor. 2. As a consequence of alveolar abscess, necrosis of a por- tion of the jaw-bone is not at all uncommon. 3. There are cases recorded of patients who have died from pyaemia and septicaemia, as the result of alveolar abscess, with or without the actinomycosis. In a case of anthrax, from eating diseased meat from an infected animal, the pus from the lymphatics was extremely fetid, and BACTERICIDES. 945 when examined showed abundant presence of micrococci. Agar-agar plate cultiv^ations were made on two consecutive days, but no development ensued. Thus, while the microscope re- vealed the presence of crowds of micro-organisms, the cultiva- tion experiment showed that they were all dead. It would seem as if the microbes had been the cause of their own death; that is to say, they had multiplied so rapidly as to exliaust the soil upon which they had to live, and had produced products which were poi- sonous to themselves. The result of the investigation struck one with some little surprise. It is, perhaps, hardly what one would expect, that a patient should survive with such a quantity of putrid material in his body, in which even mi- crobes were unable to live. Sanitary science teaches its that from our drinking water we are suf- fering unconscious suicide, and this exists all over the land. A number of cemeteries drain into Brooklyn's sources of water supply. Long Island City pumps its water out of an underground frog pond. Jersey City, Newark, Elizabeth and Hoboken secure their water from the dirty Passaic river. Albany and Kingston have muddy supplies of water. Phi.adelphia pumps up Schuylkill graveyards. St. Louis is burdened with mud and filth from the Mississippi, which has rotted its water pipes. The same is true of cities de- riving their water supplies from the Mississippi, Missouri and Ohio to an alarming extent, such as Louisville, Memphis and New Orleans. Boston's water system is polluted by a poisonous vegetable growth. Chicago sewage so completely invests lower Lake Michigan that in summer time the hydrant water actually smells of the 60 Section through a Kidney of a Case THAT DIED AFTER MeATPoISO-MNG. The figure represents part of a glomerulus of a Mai jighian corpuscle, in which some of the cap-llary blood-vessels are filled with the bacilli Magnifying power 700. i. Capsule of Malpighian corpuscle. 2 Ca pillaries filled with bacilli. 3 Capillaries empty. 4. Bacilli contained between ca- pillaries. sewage and drainage of 946 DISEASE GERMS. filth. In winter, the water, being taken from a considerable depth, is void of oxygen, the h'fe-giving gas, and under the high pressure of the pumps, remains a dead liquid, injurious to the health and productive of malaria and winter cholera. New York might have tapped Lake George for less money than the total expense attending Croton water, which has cost Ophidormnas sanguinea of stag- nant water ('^lightly magnified), often present in our drinking water of all our large cities. Crenothrix Kuhniana. — This micro-organism, magnified 600, is taken from water pipes, rendering drinking water very foul. Comma-Bacilla — Spirillum as found in sewage, as it enters the river. The Comma Bacillus as sten in river water into which sewers enter. The drinking of such water, even five miles below whtrc the sewers enter, gives rise to diarrhoea. Upward of ^80,000,000. Croton water, politically and physically, is probably the most corrupt supply extant. Mineral matter is always visible in it ; in the summer it is impregnated with a green and poisonous vegetable matter. Grand Rapids, Michigan ; Waukesha, Wisconsin, and a few other and small places are probably the only ones known having perfectly pure water supplies. At Grand Rapids, the Hydraulic Company's works, and those at Waukesha, are fed by enormous springs, cases exceptional and singular in the water-works history of this continent. Nearly all farm wells in the rural districts receive the drainage of the barns. Not long ago, nearly all the wells and water-works supplies in our State were found laden with germs, which if corrected, would decrease the mortality of our country. As a general rule, the water which supplies all our large cities contains a large number of microbes in a perfect state of vitality. The rivers and lakes receive most of them directly from sewers even most of the wells in the rural i^, - Spirillum volitans which •met with in marshes. which discharge into them BACTERICIDES. 947 -districts receive them by infiltration through the soil. During epidemics of measles, scarlet fever, variola, typhoid fever, cholera, etc., the microbes of each of those diseases are to be found in all running and stagnant water, in close proximity, and therefore they often become sources of contagion and infection. Well-water near a barn, a cess-pool close to a dwelling, owing to its stagnant nature, and to the infiltration of microbial matter, is much more dangerous than running water. Bacteria magnified 1500 diameters found in the vom disease are essentially those of J * v-s - ^ ^ -^ ^ about th( j> • •^ "^z* Jj^ \ vesical irritability, resemble ^ '^ ' " ^ '^ ^ ^^..ofo.(-;f;s^ consist in uneasiness e perinaeum, painful de- 'N ) r\^ -A ^OJS^ v^'.. fecation, frequent painful mic- "^ ^.^ r -» ^- turition or retention, nocturnal Perfect Spermatozca. Imperfect Spermatozoa, emissionS, pCrslstent moisture Or Sprightly, active. as^^seej. injnflamma- ^gCping pCnis, with SOmC priap- vesicies. opaque, mo- Jsm. All the symptoms are easily explained: The distended vesicle produces a degree of pressure upon the back of the bladder in the neighborhood of the trigone, and this gives the frequent desire to urinate. Pain or uneasiness increases as the bladder BACTERICIDES. 961 fills : nocturnal emissions, undue erections are always present, owing to the irritation or hypersemia produced by the distended vesicle, and reflected irritation to the deep urethra and its connections. Prolonged or ill-treated gonorrhea, masturbation, perversion of the sexual act, bicycle riding, etc., are frequent common origina- tors of this malady, which is affecting a very large proportion of our male population. Modern therapeutics, which rests upon a scientific basis, has crystallized a treatment of infinite value, one in which definite results are obtained. In all cases an efficient alterative and tonic course, with atten- tion to secretions, bathing, diet, etc., should be pursued. Specially the green-root tincture of gelsemium in doses rang- ing from five to fifty drops, three times daily is a genital sedative of the highest order ; alternated with the ozonized extract of the black willow in doses of from a half to one teaspoonful thrice daily, acts as a true sedative, astringent and vitalizer of the ejacu- latory ducts, and the entire reproductive area. In the entire materia medica there are no two things which can excel these in allaying irritation of the seminal vesicles — directly sedative, nay, anaesthetic to this part of the organism. They not only control inflammatory action, but effectually check all leakages and emissions.' Their activity can also be greatly increased, and the deep- seated urethra entirely rejuvenated, by the introduction every- other night into the urethra, well up to the prostate, of a bougie prepared from the glucoside of the salix niger. Still further, a cocaine suppository could be introduced into the rectum, to render treatment still more effective. There is a great variation of sight among the dif- Sight. ferent races of men ; the sense of sight, like that of hearing, is much greater and keener among all colored races than the white. Vision, or sight, is performed by the brain, through the most perfect optical apparatus, the eye, by or through which the brain looks at the exterior world. In normal vision in the Caucasian, between fifteen and forty^ five, with a healthy brain and eye, he can distinguish an object the six-one hundreth part of an inch in size, at a distance of six inches. Myopia, short or near-sightedness, may be said to exist when the distance at which ordinary type can be read is less than 61 962 DISEASE GERMS. twelve inches, and when near objects can be seen distinctly, bright light aggravating the condition. Near vision may be hereditary, a typical type of conformation ; usually too great a convexity of the cornea or crystalline lens, or both. It may also be due to lengthening of the eye-ball, to an undue density of its refractive media. The rays of light from objects at usual distances are brought to a focus before reaching the retina, instead of being concentrated upon it. Overcrowding in our public schools in large cities is most pro- ductive of myopia. It is brought about by a low form of puru- lent ophthalmia, which is always present where density of popu- lation, insanitary conditions prevail. Want of phosphates in children's food is a common cause. This is often caused by the introduction into bread of alum, to whiten, but which destroys the elements of brain and bone nutrition. Adulterated food (cerebral starvation) and overcrowded schools are manufacturing a myopic race of children. Masturbation in both sexes is a cause. Permitting lights in sleeping apartments deprives the eye of its natural rest in dark- ness, hence this is a common cause. Overwork, excesses, read- ing by gas-light and oil lamps, etc., are causes. Long-sigJitcdness ; an alteration in the refractive power of the eye, producing presbyopia. It is always associated with weak- ness of vision, an indication of cerebral atrophy, of approaching old age, often a precursor of glaucoma, vision imperfect for near objects ; distant ones clearly seen. Weakness of vision, asthenopia^ eyes weak, but appear normal ; inability to read or write for any length of time, usually asso- ciated with headache and muscse volitantes. Color-blindness, an inability to discriminate between certain colors, an affection of vision of the greatest interest to the gen- eral public, as regards the exclusion of affected individuals from the position of engineers on railroads, signal-men, pilots. Quakers and Jews are- most affected with it ; in the former it is brought about by a marked characteristic, a general coalescence of the typical fissures of the brain, induced by monotony, same- ness, isolation ; a condition often present in insanity, epilepsy and other low types of the human brain ; in the latter class relation- ship or consanguinity wipes out the mental characteristics and obliterates the convolutions. This in-and-in breeding, as well as solitariness, predisposes to suicidal mania and causes color- blindness. The average per cent, of color-blindness among any given peo- ple will depend upon the preponderance among them of Friends and Jews, or persons who possess the same characteristics. It BACTERICIDES. 963 always diminishes as we ascend the social or educational scale. Among deaf mutes the percentage is even greater than the two classes mentioned. Intermarriage is not only a great factor, but the same law extends to temperament and races. Intermarriage not only creates the defect, but aggravates it, causing the most intractable form, which is red blindness. There is also to be found an unusually high average of color defects among the children of either fathers or mothers who work among colors. Trades requiring great concentration of sight, as engraving and watchmaking, seem to bring it about. Women are equally affected with m^en. The average percentage in people of low civilization or culture is great ; among deaf mutes, ten per cent, and among Friends and Jews, about six per cent. Color-blindness is a defect which is quite compatible with perfect vision in other respects. Color-blindness is found to exist in three forms : 1. Inability to distinguish any color, properly so called ; black or white, or light and shade. 2. Inability to distinguish between nicer shades of more com- posite colors, as brown, gray and neutral tints. 3. Inability to distinguish between primary colors ; red, blue, yellow; or secondary and tertiary colors, as green, pur- ple, orange. In the latter form there is a defective appreciation of all colors. Little good results from any treatment ; and as there is about one per cent, of the entire population affected, care should be exercised by railroad officials, pilot boards, etc., that no affected person be employed, so as to avoid serious accidents. Convexity of the cornea from above downwards, or from side to side, gives rise to an inequality of the refractive power of the several meridians of the eye (astigmatism). It is often con- siderable, and interferes with the sharpness of sight. Oversight ; a condition in which the refractive power of the eye is too low, or the optic axis too short ; consequently when the eye is in a state of rest, parallel rays are united upon the retina, but behind it, and only convergent rays are brought to a focus upon the latter. Distant objects are not seen clearly ; eyes look smaller and flatter than in health ; likely to be head- ache, dull pains in the eyes, with heat and fulness ; when reading words run into each other. There are a very large variety of drugs which affect the brain disastrously, and cause weakness of the optic nerve, ''amblyopia," such as morphia, tobacco, chloral, and the long list of hair washes and dyes. Double vision may be due to the use of drugs, such as gelse- 964 DISEASE GERMS. mium, or to some irregularity of density, or paralysis of the muscles of the eye-ball. Night blindness, or day vision, hemeralopia, is common among travellers, soldiers, sailors, in tropical countries, brought about by long exposure to intense sunlight, or to the reflection of the sun's rays on the white sand of the desert ; this exhausts the sensibility of the retina. It is occasionally a symptom of scurvy, of sexual excesses, masturbation, and organic changes in the brain. Intolerance of light, photophobia, is a constant prevailing symp- tom of all inflammatory conditions of the eye and brain. A dilated pupil^ mydriasis, is invariably present in all states of cerebral anaemia, and gives rise to imperfect vision. It may be induced by the use of acro-narcotic drugs, especially belladonna. A contracted state of the pupil is present in all states of conges- tion of the brain (myosis), and it can also be induced by the use of calabar bean. Certain trades, in which they are compelled to look at minute objects, as watchmakers, wood engravers, acquire it. Great obscurity of vision in a weak light. Vision is often most powerful or acute during twilight, myc- talopia. Specks or spots before the eyes — muscce volita7ites are present. When the vital integrity of the brain is lowered or depressed, and either anaemia or hyperaemia is present, the nerve filaments that supply the aqueous humor and vessels of choroid are re- laxed. If the debility be great, vessels take on varicosity ; and when the brain looks through the eye at the external world, it sees the varicose vessels, tortuous, and anastomosing in every conceivable form, and it then compares them with objects seen or described in the external world ; if depression be not very great they will be compared to small objects, as flies, specks^ spots ; if depression be great, the vessels are greatly engorged ; then the patient will compare them to large objects, as men, devils ; they are real, no hallucination, as the patient sees them in his own eye. It indicates brain exhaustion, in a mild or aggravated form. Protuberant eye-balls are present as a symptom in tuberculosis, in all its varied forms. Why we sleep, and how we sleep, are questions Sleep, still awaiting solution. The periodic suspension of the activity of the superior nerve centres is the domi- nant character of sleep ; even the automatic centres for the re- spiration and circulation are less energetic, so that the breathing is slower, pulse quieter. BACTERICIDES. 965 The variations of the cerebral circulation present a certain re- lation with the alternation of sleep and wakefulness, but these variations require an explanation, they do not suffice for any theory of sleep. The great, nay vital, importance of oxygen in keeping up the activity of the tissues once recognized, its less absorption, giving rise to anaemic states of the brain. An active state of the brain cells necessarily gives rise to waste, a sensation of fatigue ; and those fatigue substances ope- rate by monopolizing the oxygen, sleep follows by default of this agent. The products of exhaustion are continually forming within the brain when active ; that their accumulation brings on sleep, and that during that process they are eliminated by the blood which passes through that organ. All organic activity gives rise to products of exhaustion, to the formation of a substance termed ^' ponegenes,'^ which accu- mulates in the brain during wakefulness, and being very oxidiz- able, terminate, by diverting to their own profit, the oxygen destined to keep up the activity of the different glands, muscles and brain, in such a fashion as that the mental acts and voluntary movements are depressed, the organism falls asleep. Among the ponogenic substances are lactic and uric acid, and a group of bodies closely allied to them. In would thus appear that there is a sort of self-regulating mechanism in the body, by which sleeping and waking are made to alternate. During the waking hours soporific products are formed, and these, gradually accumulating, will by-and-by induce sleep, while during sleep stimulating products are formed which, after a certain number of hours, will stimulate the brain to wake- fulness. Microbes in the throat are common in all Sore-Throat, diseases. From breathing microbe-laden air, from re- laxing and damp weather, or living badly and working hard, will in the end produce a relaxed condition of the throat. For this, pure air, better food, and swabbing or garghng the throat with a solution of tannic acid and chlorate of potassa, to which a few drops of peroxide of hydrogen is added, is the best remedy. Sore throat is common among those exposed to the vicissitudes of weather. It is a common, universal symptom or indication of the presence of the micrococci of scarlet fever or the streptococcus of diphtheria ; it may follow a shock from cold, damp, or excessive talking. It is common in 99 cases out of TOO in all persons who have had syphiHs or tubercle; in 966 DISEASE GERMS. all individuals who are close to or near by any syphilitic or tubercular individuals. The hoarseness, or soreness, or the ulceration are due to the inroad or deposit of those two bacilli. It is preposterous in this microbial age to look for anything- else. Look for the brown copper-colored mucous membrane, with yellow flakes of pus ; the impress, the stamp of syphilis ; or the pale mjottled mucous membrane, with cheesy specks or particles, the insignia of the tubercle bacilli. Those microbes work silently, there is neither pain, nor rawness, nor redness. hilialations of glucozone are most effectual in killing and root- ing out those microbes. Its daily use sterilizes the mucous membrane, renders it unfit for their deposit and growth. Convulsions in young children, subject to laryn- Spaisms. gitis (spasmodic laryngitis) ; they are respiratory convulsions, but may become universal. I suggest that the age of the patients, the fact that there is a manifest im- pediment to respiration at the gateway of the respiratory appa- ratus, and the occurrence of the attacks mostly at night (in sleep), point to an over-stimulation of the respiratory centres by too great venosity. If so, the hypothesis that attacks of laryn- gismus are similarly caused is favored. " Spasmodic '^ laryngitis usually occurs in children under two or three years of age ; the attacks usually occur suddenly during sleep, and the next day the child maybe seemingly well, except for a little hoarseness and cough ; the attacks are sometimes mistaken for laryngitis. Treatment of Imvard Fits. — Let us now see if the results of treatment favor the hypothesis put forward. It is good practice not to let the child who is the subject of laryngitis sleep too long at a time ; not to let it remain too long in a condition favoring venosity ; I suppose the same applies to laryngismus stridulus, to which morbid affection I confine further remarks on treat- ment. It is understood, of course, that attention is given to diet, di- gestion, and state of the bowels. No one fails to treat the rick- ets, the approved medicine being kephaline. The good effect of the highly valued remedy, cold sponging, favors my hypo- thesis ; manifestly it will stimulate the respiratory centres. So do the good results of carrying the child out, even in cold weather, and change from town to country air. The several remedies will tend to reduce venosity. Now for drugs, more especially in the treatment of what we BACTERICIDES. 967 call laryngismus itself. The best remedies should, on the hy- pothesis, be those which stimulate the respiratory centres. Of special drugs fl. ext. musk-root and belladonna are most useful in laryngismus stridulus. The former can be given to a child of twelve months old in doses of one-half teaspoonful every six hours, and will be found to have a powerful influence in check- ing the tendency to spasm. Belladonna, to be of service, must be given in sufficient doses. The comp. tincture of lobelia is a never-failing remedy ; it should be administered in small doses, frequently repeated ; con. ozone applied to the throat and chest is good. Musk is a stimulant to the respiratory centres, as is also belladonna. It is well known that children tolerate large doses of belladonna ; bearing in mind Soltmann's researches, this may be because in them it acts more as a stimulant, or rather that the parts it can render negative (inhibitory and secretory nervous arrangements) are not largely present in the infant to be para- lyzed. Chloral is a remedy for fits of laryngismus lauded by high authorities. It is the best remedy for a rapid succession of fits of any kind ; for putting an end to the seizures, that is. It is not, I presume, actually curative of the morbid condition induc- ing them. It may be given when fits of laryngismus are frequent. Now for treatment after the paroxysm. When the fit is over, the child usually comes round spontaneously. But supposing that after a severe attack respiration.no longer goes on. The respiratory centres are exhausted, or what remains of them un- exhausted is not enough to produce respiratory movements ; the child is seemingly dead. There is paralysis of the respiratory apparatus after respiratory convulsions, just as there may be of a limb after an epileptiform convulsion which had affected that limb first and most. Here we must bear in mind that after asphyxia fits produced in lower animals, the heart, as a rule, con- tinues to beat for a short time after respiration has stopped. Hence if luckily present when a child is seemingly dead after a fit, we should give him a chance of recovery by artificial respir- ation. We should not waste time to see whether the heart has or has not stopped. means the violent and uncontrollable action Spasm of the of some particular set of muscles. Spasms Bladder are generally described as of two sorts, viz., tonic and clonic. In tonic spasms the muscles of a part contract violently, and remain rigid and im- movable by the will of the patient for a greater or less length of 968 DISEASE GERMS. time. Such contractions occur in tetanus and in ordinary cramp. Clonic spasms again consist in sudden contraction and relaxations regularly alternating. The jumping of the legs and arms, which occur under certain conditions, are examples of this. All muscular structures are liable to attacks of spasmodic action ; the bladder having such a coat is frequently affected with spasm. Spasmodic attacks are accompanied with great pain, as well as contraction. Causes. — The presence of a stone in the bladder ; disease of the rectum or uterus; abscess of kidney ; an inordinated amount of uric acid; ulceration of the walls of bladder; disease of pros- tate gland ; excessive sexual congress ; hysteria ; the use of drastic diuretics or emmenagogues, as oil of turpentine, juniper, cantharides, savin. Sympto7ns. — Severe pain in the lower part of the abdomen, extending to urethra. There is either continence or inconti- nence, or dribbling of urine. The difficulty is not so great when the urine flows involuntary; when there is retention, with urgent desire to micturate, and tenesmus, with inability to do so, suffering is great. If allowed to continue, may terminate fatally. Treatment. — If patient is seen during the attack, hot baths, enemata of warm water and lobelia ; fomentations or poultices, with belladonna, linseed poultices, with lobelia and belladonna ; suppositories of opium and belladonna. Internally, mucilaginous drinks, with cream of tartar and nitrate of potass; either the compound of lobelia, valerian and capsicum, or else sumbul and tincture of green root gelsemium. When attack is over, removal of cause, alteratives and tonics, iodide potass and sulphate of quinine. Diet regulated, an avoidance of all stimulants ; tea, coffee, warm clothing ; forbid horseback exercise, or sexual intercourse; use appropriate remedies as to cause. Spasm of the rectum ; contraction of the Spasm of sphincter muscle accompanies ulcer of the mucous Rectum. membrane that cov^ers it. The spasmodic condition is distinguished by the absence of pain after defecation, and an examination of the bowel will show no stricture. The treatment of spasmodic contraction of the bowel is best effected by a general course of nerve tonics to remove the nerv- ous irritability of the system, and the use of the cocaine sup- positories. BACTERICIDES. 969 There is very frequently met with in highly developed and intellectual ladies and in neurasthenic males a neurosis of the nerves of the rectum, which gives rise to frequent spasm, with painful defecation, and constipation ; a state which is either brought about or aggravated by emotional states, without any ulcer or breach of surface. This state yields to alteratives and tonics with the use of the cocaine suppository. If this treatment fail, seclusion, rest, forced feeding, massage ^nd electricity. Some of those cases are very troublesome. Lack of nervous co-ordination of the sphincters and irritable bladder; painful coition, asthma, difficulty of breathing, aphonia. In strict neu- rosis the sphincter develops chronic spasm as well as neuralgia, which gives rise to great exhaustion after any motion of the l)Owels. This term is applied to the flowing away Spermatorrhoea, of the seminal fluid, and designates all varieties and forms of spermatic losses, which occur beyond the limits of health. True spermatorrhoea, or seminal incontinence, the flowing away of the spermatic fluid, is primarily dependent upon weakness, or exhaustion, or neurasthenia, with increased impressibility, mobility, or excitability of the genito-urinary spinal centre, phe- nomena usually induced and perpetuated by hyperaesthenia of the nerves which supply the prostatic portion of the urethra, induced in nine cases of out of ten by masturbation. In seminal incontinence there are three conditions which may exist separately or be blended together. 1. Nocturnal emissions, which occur during sleep, attended with an Qv^cXXon, pleasurable sensation, erotic dream. 2. Emissions during the day, excited by slight mechanical or physical causes ; incomplete erections, diminished sensation, and no erection. 3. Spermatorrhea proper, in which there is a continual flow of semen from the urethra, without erection, sensation, or during urination or defecation. In the first form, namely, involuntarily nocturnal seminal dis- charges, we have the bulk of the affection. This is common to all men after the epoch of puberty, especially if they lead a chaste and virtuous life. Their frequency may vary with the con- dition of life, age, climate, habits, constitution, temperament, diet, precocity. Their frequency varies greatly. Single men, who live a moral life of contentment and possess an inherent vitality, sound 970 DISEASE GERM nervous system, healthy occupation, mental and physical, strictly avoiding all the unhealthy literature and debasing amusements, may have no emissions, no leakages of any kind, still, if he had an emission not more frequent than one every two or three weeks, it might not be inconsistent with a high standard of health. If such were the case, it would merely exhibit a slight weakness, or merely a reflex sign of fulness or distension of the seminal ducts. Ungratified sexual instinct in those whose nervous systems are slightly impaired is apt to be followed by emissions, but if these are not any more frequent than what has been stated and are not followed by languor, headache, backache, dimness of vision, and noises in the ears, with . mental depression, etc., they are not regarded as very materially wrong, although we see in them a precursor or indication g( an impairment of the sexual appetite at the base of the brain. In the second form, where the afflicted individual has emis- sions, or ejaculations, or leakages during the day, we have a clear case of nervous bankruptcy, combined with weakness of the genital organs and of the reflex nerve centres. In such cases, the slightest degree of peripheral irritation, as the friction of the clothes, the crossing of the legs, horse-back or bicycle riding, driving on rough roads, reading libidinous dime novels, attending variety theatres ; looking at indecent pictures ; or the fu// bust of a beautiful zvoman excites in their mind lascivious ideas, and emissions. In such a case, if there is an erection, it is but partial, as the penis is flabby and flaccid. In the third form there is a true condition of seminal incon- tinence ; there is a moisture, or leakage all the time, a passive loss, without the concurrence of the organism, and this oozing, leakage or partial ejaculation is associated with positive physical symptoms, such as a dilatation of the orifices of the ejaculatory ducts, from atony of their muscular fibres ; great and unconscious discharge of semen at stool and in urinating ; an irritable weak- ness of the seminal vessels and dilatation, with atony of the ejac- ulatory ducts. Spermatic fluid escaping all the time, and the spermatozoa are so feeble, so infertile, that they die in their escape, and we have azoospermorrhagia, or the passive loss of barren semen. Inflammation of the prostate urethra invariably exists, which leaves the mouths of the ejaculatory ducts open, patulous ; this is very frequently a result of masturbation, or chronic inflamma- tion from gonorrhea, or bicycle riding, or from lifting heavy weights, the seminal vesicles are injured, and the semen oozes out. Any of those three forms may exist separately, or they may be BACTERICIDES. 971 blended together, or the one pass into the other, beginning with the mild form and proceeding from bad to worse, giving rise to a general train of symptoms. Emissions increase in frequency and severity, erections become most feeble, ejaculation on coition is precipitate, general nervous debility, pain in the back of the head, dilated pupils, muscular languor, mental incapacity, slight paresis of the brain, dulness of perception ; impairment of memory ; vertigo, mental dejection ; weakness of vision ; trembling of the limbs ; palpitation of the heart ; shortness of breath ; a sense of oppression in the chest ; flatulence, constipation, dyspeptic symptoms. Daily losses, due to mechanical or psychical causes, are soon followed with leak- ages all the time, with no erections, no pleasurable sensations whatever, sexual intercourse is impossible, being impracticable either from the flabby or feeble premature erection ; or the wasted state of the parts, or the general nervous bankruptcy present. The patient becomes progressively worse, he broods over his lost virility, great mental depression, which passes into hypo- chondriasis. His gait becomes unsteady, he is erratic, he suffers from neuralgic, rheumatic pains; headache; hands and feet habitually cold and clammy ; insomnia ; shuns society ; fears to look any one in the face ; utterly incapacitated for mental and physical exertion ; thinks of nothing but his genital organs, dejected, vertigo, noises in the ears, specks and spots before the eyes, muscular weakness, trembling of the limbs, crackling of the joints, chilliness, indigestion. There is increased irritability of the prostate urethra, and brain and spinal cord ; these suffer fearful exhaustion from the persistent and constant oozing, which daily becomes augmented. His mental status merges silently into epilepsy, chorea, ataxia, insanity, or other nervous disorders. Spermatorrhea then or the flowing away of semen, however, induced, terminates in a functional derangement of the nervous system, which is apparent from the increased sensibility of the brain and cord, or feebleness of the powers of life. No one can shut their eyes to the fact that our literature, amusements, exciting erotic ideas, are powerful factors in the production of an irritable state of the genital organs. Seminal incontinence is usually ac- quired by those erotic ideas, superadded to which masturbation, sexual excesses, or unsatisfied sexual decire, produced by toying with females, or sexual perversion if the act of coition can be consummated, and like conditions, give rise to exaggerated irri- tability of the genital organs, which is soon followed by inflam- mation of the prostate, patulous, dilated, or relaxed state of the ejaculatory ducts, with the nerves of the part morbidly sensitive, and out of gear. 972 DISEASE GERMS. In addition there are numerous local exciting causes, as phy- mosis, retention of the sebaceous secretion around the corona glandis, tetter, narrowness of the meatus, diseases of the rectum, especially ascarides, or fissure, or pruritus, or piles. The rectum being supplied with the same nerves there is the finest degree of sympathy between it and the seminal vesicles. Promiscuous sexual intercourse debilitates the sexual organs and inevitably brings about an oozing of semen. Certain trades, as photographers. The only correct method of diagnosis in all cases of sperma- torrhea is to make a microscopical examination of the discharge which constantly oozes from the urethra. A microscope of five hundred diameters is sufficient. Their urine, if there is no moisture appafrent, will demonstrate or exhibit a class of objects devoid of living spermatozoa, but will show numerous dead or vari- ously deformed small, motionless bodies, incapable of fertilizing any ovum, how- ever vigorous that may be, or a No. 12 catheter could be inserted up to the prostate urethra^ and enough of fluid obtained to exhibit an exhausted, watery fluid, devoid of living elements. If not cured insanity is the termination. A chemical examination of his urine will demonstrate the state of his brain, and very likely show that instead of there being six per cent, of vitalized phosphates that it is reduced to two and a half, a state of things which exist only in incur- able cases of insanity.* Self-abuse is an etiological factor in a large number of cases of insanity, but only those cases should be designated as insanity of masturbation in which the connection between the excesses and the symptoms is direct. Self-abuse, to produce insanity, must have been carried very far, or the subject must be predisposed. Often onanism can be traced in other members of the family, and very often it is found that the maternal ancestry is a weak one. Mania, melancholia and epilepsy occasionally occur in young masturbators, the former two usually having a favorable prog- nosis. Stuporous insanity and katatonia are both common, and the former presents good prospects. The forms thus far men- "^The chemical constituents of the average brain of man, in health, is in one hun- dred parts : Water, seventy-tive and a half; albumen, seven; fat, eleven and a half; various salts containing phosphoric acid, six. Spermatozoa as seen in the urine of patients suffering from seminal weakness. BACTERICIDES. q7-> tioned when occurring in masturbators present no essential differ- ence from the typical psychoses. They should therefore be desig- nated as mania, melancholia, stupor, etc., from masturbation, and not as masturbational insanity. There is a chronic delusion of in- sanity in grown persons who have been devotees of self-abuse, and it is usually a hypochondriachal paranoia. Clinically, it is very like typical paranoia, and etiologically it is not the direct result of self-abuse, but rather of an intermediate neurosi.^, a cerebro- spinal irritation which is due to self-abuse. Finally, there is a form of insanity developing about or after the period of puberty which does merit the name " masturbational insanity ;" it is chronic, has a tendency to agitated dementia, is characterized in its early period by anxiety, timidity, suspicion, fear and a cow- ardly, mean disposition. Later there are confusion, meddlesome, aggressive behavior, vague delusions, loss of memory and de- terioration. After these are observed spells of fury or destruc- tiveness. This form is never due to any other cause, and resembles no other form of insanity than the one already alluded to. In forming an accurate prognosis of the case it is not by any means so unfavorable as many would think, as a rule they yield readily to treatment, provided the prostate is not hypertrophied, or there is no stricture, haemorrhoids or no chronic inflamma- tion of the seminal vesicles, or sexual hypochondriasis. Cases brought on by bicycle riding, the use of chemicals, as in pho- tography or gonorrhea, or sedentary habits ; any cause but mas- turbation. Spermatorrhoea from onanism, sexual perversion, are more intractable than from any other cause, as the brain waste is greater. We give a synopsis of the treatment of spermatorrhoea. In all cases of involuntary seminal emissions there are certain rules which must be observed, such as bathing the entire body daily, followed by brisk friction or massage, the shower bath ; the diet should be light but very nutritious and easily digested ; all stimu- lating articles of food carefully avoided, as well as alcoholic and malt liquors. Before retiring at night the bladder should be com- pletely emptied, and the patient should sleep upon the right side, on a hair or straw mattress with as little covering as possible. An alarm clock should be set, so as to awake the patient at an early hour, so as to empty his bladder, as a full bladder induces erections. Interdict sedentary habits, horse or bicycle riding, or driving over rough roads, or toying with ladies, or reading sex- ually exciting literature or shows. Everything calculated to excite erotic thoughts or dreams avoided, mind and body should gy^ DISEASE GERMS. be occupied with healthy exercise. Causes, as far as ascertained, should be removed, the corona glandis should be bathed two or three times a day, the anus and rectum should be be thoroughly syringed out with a solution of boroglyceride or infusion of Vir- ginia stciie crop. Remove all sorts of irritation ; even an elon- gated prepuce keeps the sensitive glands of the penis constantly moist, and favors the collection of sebaceous secretion. Herpes of the prepuce, stricture, piles and fissure, puritus, habitual con- stipation, variocele should if possible be speedily cured. True, of all the exciting causes, the most common is an inflamed or irritated prostate, urethra. In all cases of seminal incontinence the remedies to commence with are those which would be the most likely to overcome the sensibility of the mucous membrane of the urethra, the ejacula- tory ducts and seminal vesicles — to diminish the reflex excita- bility of the genito-urinary spinal centre. To accomplish this, a sitz-bath morning and night, drying the parts well and then bathing them with a distillation of hamame- lis, we*aring a suspensory during the day. The remedies which have a calming, sedative effect are to be selected from some of the following, which we arrange according to our idea of their efficacy : The green root tincture of gelsemium in doses from a (gw drops up to such a dose as will give its peculiar physiological action, administered on retiring, diminishes the sensibility, the reflex mobility of the genito-spinal centre, paralyzes the move- ments of the cells of the acinous glands, and checks their secre- tion, so it can on no account be dispensed with. It is an invaluable remedy. Numerous acro-narcotic drugs have a very similar action, such as digitalis, belladonna, hyoscyamus, coca erythroxylon. Another invaluable remedy for the cure of spermatorrhoea, and the arrest of diurnal or nocturnal emissions, is the salix nigra, or the fluid extract of black willow bark. This is a sexual sedative of the first order, superior in its action to the bromides, but with- out their depressing or deteriorating qualities. This drug is a tonic, carminative, stimulant and germicide, with a special action upon the sexual appetite in the brain, and when this centre of inhibition gets out of gear, it gives excellent results. It is a remedy of great value in all forms of prostration and spermatorrhoea, controls emissions most effectually. The appropriate dose is about half a teaspoonful thrice daily. The resinoid of the black willow bark is also made into a ure- thral bougie and applied, and into a suppository, and used with marked success. BACTERICIDES. gj ^^ The use of the ozonized extract of black willow bark is indi- cated in every case of spermatorrhea whatever other remedies are being used, a mixed treatment is always the most salutary. The cocaine suppository is a preparation especially adapted to weak, nervous debilitated men, who have suffered from those dis- charges for an indefinite time. The very celebrated spermatorrhoea pill which is composed of the following abstractse : Cocaina, jerubalum, hypophosphite of lime, gelsemium, and extracts of ignatia and leptandra. Tonics should follow the sedative plan of treatment. A gen- eral tonic course, embracing such as columbo, stone crop, cin- chona and mineral acids, coca. Oats in the form of a phosphated tincture is an admirable tonic for those cases ; alone its action is unsurpassed, but better still when alternated with damiana and ignatia. Of local remedies, the organized soluble gelatine bougies are the best ; they hold the first rank, especially if there is a limited or circumscribed area of infiammation and tenderness including the openings of the ejaculatory ducts. Those bougies have entirely superseded all the older methods of treatment — they are most efficient especially when prepared fresh, from thallin, beberine, brucine, arbutin. Under good management recovery is the rule, but in some few rare cases, it may happen that the reflex genital centre is still impressible, in which case a few doses of the ozonized sumbul will prove highly serviceable. If there is reason to suspect dilatation and atony of the ducts, the bougie should be run right up to the prostate-urethra and retained there, and permitted to dissolve and be absorbed. SpennatorrJuva, if not cured, will give rise to wasting, and atrophy of the generative organs ; to white softening of the spinal cord and brain ; to suicide, insanity, and death. A healthy man, who never masturbated, may have unnaturally small or atrophied organs of generation, and be able to perform the duties of married life, although rarely in a satisfactory man- ner. Very different however with the masturbator, he not only has seminal disease, or impotence with either dwarfed sperma- tozoa, or none at all, with wasting and stringiness of the testicles and smallness of the organs. It is true some cases of smallness of the genital organs may be congenital, but its common origin is the damaged inflicted by masturbation, by unnatural excitement without gratification ; by withdrawal, non-completion of the act ; by wearing condums ; mumps ; gleet ; stricture ; paralysis ; blows on the head and spine. These, and numerous like causes, produce wasting and 976 DISEASE GERMS. imperfect development. No one can be surprised that it is very- prevalent, as nine-tejiths of all patients suffering from sperma- torrhoea are its victims. This is an appalling truth, visible in marital infelicity, quarrels, dissension, desertion, suicide, or else a life of shame and disaster. Eminent chemists, scientific physicians of all schools, men of profound intellectual calibre, are earnestly and vigorously at work in the discovery of remedies to destroy the germs of dis- ease, and to some extent have succeeded in revolutionizing the art of medicine by their discoveries. The time is ripe for important discoveries in new remedies to vitalize the genito-urinary tract. Spermatorrhea and impotence are now being cured by eminent specialists, who bring to bear on their cases a class of powerful drugs which wipe out every symptom of lost vigor, and cause the weak, debilitated victim to become strong, healthy, and vig- orous. The vitalized principle of the brain, *' cercbrin " in keph- aline ; the " avena " in oats ; the vital element of thought ; the glucoside of the saw-palmetto and damiana are growth-fostering remedies to the genital system, to the ganglia and plexus of both penis and testicle, and do good work in sexual atrophy. Elec- tricity must not be despised. Cold water hip-baths, retracting the prepuce, and bathing the corona-glandis with castile soap, thrice daily, and then drying. After each bath, the following developing powder should be applied ; rubbed all over the penis and scrotum, and kept constantly in close approximation by means of a suspensory bandage. The formula for this developing powder is : Take the oil of saw-palmetto, and digest it in peroxide of hydrogen for two weeks, then evaporated to a resinoid, which is triturated in pul- verized boroglyceride until it makes a fine powder. How well, how efficiently this powder acts is proven by ex- perience in a large number of cases. It causes a determination of blood to the penis and testes ; promotes molecular growth in a large number of cases ; it is rapidly absorbed by the vessels, and would almost seem to furnish nourishment to the parts. Although it is a powder, the moment it touches the skin it is taken up by the absorbents, permeates every cell and fibre of the part, acts with increased force and rapidity on the wasted vessels and tissues ; fostering growth, imparting power and vigor, with acuteness of sensation ; in short, restoring the weak and wasted muscles to tone, vigor, strength and size. The practical application of this principle and the internal use of vitalized kephaline and oats, meet the wants of a large class of men, helpless and useless (sexually), and the attention of the mem- bers of our profession to this subject is a step in the right direction^ BACTERICIDES. 977 \M'>' Human semen (healthy), as seen in the Spermatozoa, field of the microscope, magnified 600 diame- {Healthy.) ters, five minutes after ejaculation. The seed of a Caucasian, the fertilizing agent secreted in the epithelial lining of the tortuous seminal tubes of the testes. At puberty in man, the seminal tubes are filled with cells, from which the sper- matozoa are developed, they are set free by the bursting of the cell walls, and arrange themselves in parcels, symmet- rically placed, with the so-called heads in one direction, and the tails in the opposite. The spermatozoa are clear hyaloid bodies, each of which consists of a dilated portion (the head or body), from which a long tail or filament issues. The head is flattened from side to side, Spermatozoa. and of a conical form, the pointed ex- tremity being anterior, terminating in a long tapering tail which is in rapid undulating motion, and which propels the head di- rectly forwards. These movements may continue for twelve hours or longer, after they are ejaculated into a healthy vagina, but if they are exposed to cold or acidity, they seldom live over thirty minutes. A, the bladder; B, B, the lower bowel; C, the spermatic chord which conveys the seminal fluid from the testicle to D, the vesiculse seminales or seminal reservoirs ; D, the vesiculge seminales ; E, the seminal ducts entering the urethra through the prostate gland ; F, the urethra; G, a part of the penis showing the urethra cut open; I, the prostate gland. Fig. i, shows the prostate gland and the seminal ducts in their healthy state. The recognition of different discharges from the urethra is of vital importance. Spermatorrhoea, or the flowing away of semen, is readily dis- tinguished, although complicated, by the general bankrupt state of the nervous system, the careworn, haggard appearance, the withered, wasted, pendulous state of the testicle, the indurated 62 978 diseasp: germs. epididymis ; besides, there is always a slight, almost impercep- tible discharge from the urethra, most frequently seen after uri- nating, or defecating, or when in the society of females. A, the body of the testicle ; B, B, the tubuli testis ; C, the rete testis ; D, the vasa de- ferentia; E, E, the epididymis ; F, the vas deferens; G, the ducts which convey the seminal fluid to the prostatic portion of the urethra, and when open allow the seminal fluid to escape with the urine, and on going to stool ; H, the vesiculse seminales, showing the spermatozoa conveyed by the vas deferens from the testicles ; I, I. I, the rectum ; J, J, the division of the vertebrae; K, K, the skin divided; L, the bladder ; M, the bulbous portion of the urethra ; N, the corpus spongiosum ; O, O, the urethra ; P, P, the corpora cavernosa; Q, the body of the penis ; S, the sym- physis pubis ; T, the anus ; U, the epididymis indurated, which explains how impo- tency is produced by preventing the seminal fluid passing to the vesiculse seminales. Seminal discharges are frequently mistaken for gleet and pros- tatorrhoea, especially if the patient has had repeated attacks of gonorrhea, or indurated chancres in the urethra, whereby the urethra has become thickened, or if the prostate has lost its tone. It is a matter of great importance to know in all cases what we have to deal with, to distinguish the gonococcus of gonor- rhea ; the spermatozoa of the seminal secretion ; the discharge present in gleet, or that peculiar to catarrh of the prostate ; or to a concealed urethra chancre, as each requires a different mode of treatment. To the microscope we are indebted for the means of unequivo- cally being able to discriminate between the different discharges. It may, however, be remembered, that the gonococcus is never present in the urethra without some pain, heat, redness, swell- ing, due chiefly to the micrococci burrowing in the follicles of the mucous membrane ; when the discharge is chiefly spermatic, it is glairy, starchy, like the white of an ^^%y glueing the lips of the orifice of the urethra together; whereas, when from ulcer, either in the urethra or prostate, or stricture, usually greenish. As we have just stated, no reliable diagnosis can be effected, without the microscope, aided by urinary analysis. BACTERICIDES. 979 The annexed diagram shows the appearance and the location of the three principal discharges. A, C, and D, represent the appearance of the discharges in spermatorrhoea, gonor- rhea, and syphilis. The dotted Hnes on each side of F point to the seminal ducts. True, the spermatorrhoea are often mutilated and mixed with the other secretions, and are difficult to detect. This may be looked upon as a prolongation Spinal Cord, of the brain downwards. It lies within the spinal column in the vertebral canal safe from any external violence, unless the injury be very severe. It sends off on each side numerous nerves which supply every part of the body. Like the brain, it is covered by three membranes, and it consists of two portions, a gray matter, where various nerve-cells are met with, and a white portion, which is formed of nerve- 980 DISEASE GERMS. fibres, which convey motion and sensation. Any injury to the cord will cause more or less loss of motion and sensation in the parts below, and then paraplegia is said to occur. The cord is liable to inflammation, and the patient is said to have myelitis ; to chronic degeneration, causing progressive locomotor ataxy ; to cancerous and other tumors, causing paraplegia ; to destruc- tion, through fracture or dislocation of the vertebrae surrounding it ; to concussion, as in a railway accident, and to inflammation of its membranes, or spinal meningitis. The medulla oblongata, the seat of reflex action, is the con- necting link between the brain and the cord, and all nerves of the body, have more or less a common connection with the medulla, the bulb of which is the common centre or fountain of nerve supply, the spinal cord being but its prolongation, not so highly organized as the medulla, but nevertheless a reflex centre from bulb to sacrum. All irritations from organs are transmitted here by the gray or efferent nerves to the root or origin of the nerves that supply that organ, in other words, the same kind, quality, or intensity of irritation is transmitted to the origin of the nerve which sup- plies it ; the same irritation exists in the cord as is present in the periphery or terminal end ; that when the disease in an organ is removed, it is still necessary to wipe out the irritation at its central origin in the cord. Like the brain proper, the cord is covered with serous tissue which secretes a nervo-vital fluid for its protection, when the structures are so devitalized that they fail to secrete this fluid, and the brain and cord rest against their bony casement, there is trouble and often a puzzling problem to the physician. There are thousands of weak, nerveless men, who do not know what ails them ; thousands of invalids, whose physicians are puzzled and perplexed by their symptoms and cannot account for the rapid waste of strength, energy and vitality, much less check it; and thousands of others, on the street, in the pulpit, on the bench, in the counting room, whose nervo-vital troubles, illness and misery are due to losses of vital fluid. Some know it, many more do not. Some are being properly or improperly treated for it, many are being dosed and drugged for malaria, neurasthenia, consumption, overwork, brain troubles, paralysis, etc. They sicken, die, destroy themselves in hopeless despair of ever getting well and strong again, verge into hopeless idiocy or go raving mad, simply because their trouble is not understood ; because day by day and hour by hour there is draining from them in their urine, at stool and otherwise, that precious nervo- vital fluid that represents life, health and energy to them. BACTERICIDES. 981 And is it surprising that the continual losses do drain away strength and vitality ? This fluid is the most vital, intrinsically, the most valuable in all nature ; is the only one charged with life — actual life ; capable of producing life ; of creating offspring ; of impregnating and developing into perfect being with thinking and reasoning brain and mind, pulsating heart, expanding lungs, sentient nerves, motive muscle, and all that beautiful, minute, and co-ordinate mechanism that forms a perfect human being ; the only secretion in the body capable of propagating species ; carrying life within life. Surely this was not meant for waste. Surely the influence of its loss upon the system, especially of a boy or young man (growing and not fully developed) must be great, and it is. Many and many a young man thus wastes away before the eyes of his friends from no other cause. How much better if all this false modesty, social hypocrisy, and blundering medical dosing and drugging, without thorough examination and full under- standing, were wholly done away with, and the young men and old men too, were brought to understand two cardinal facts : The causes of spinal irritation, poverty of the nervo-vital fluid, spinal bankruptcy, are to be found in both sexes in irritation transmitted to the cord. The recognition of spinal irritation, or exhaustion, or neuras- thenia is, as we have said, often difficult. The acquisition of strong nervous temperament, with great prostration, persistent headache, dyspepsia, constipation, phos- phates and chlorides in the urine are significant. Then by pass- ing a sponge electrode from a good running battery, we are al- most invariably assured of the seat of the irritation. This may be complicated with neuralgia or spasmodic affection involving the organs supplied with spinal nerves. If the irrita- tion is on the dorsal portion it is generally referred to one side, frequently the left, and is only felt below the mammae, often complained of as a constriction, or tightness, or suffocation, with accelerated action of the heart, with spasmodic cough. If the irritation is in the lumbar, there will be spasmodic action of the viscera ; numbness, cramps and excessive tenderness, with im- paired motion and sensation in the lower extremities, with con- stipation, retention of urine, irritable bladder and uterus, with disturbed menstruation. It is not common in the cervical portion, still if it took place there it would give rise to neuralgic pains in the neck and face, difficulty of swallowing, loss or impairment of voice and affec- tion of speech, cough and altered sensibility; partial paralysis; coldness and numbness of both hands, or a pricking sensation. 982 DISEASE GERMS. In the treatment of spinal irritation, we must endeavor to ap- preciate the immensely destructive effects of an impairment of this nerve centre, it tells upon every organ, every secretion, so that the bowels are constipated, and require the action of the cascara sagrada lozenge ; daily bathing followed by brisk fric- tion ; massage ; gentle exercise in open air if strength permits, and when not exercising, rest in the recumbent position. Comp. tincture matricaria to stimulate the stomach, improve the appe- tite ; diet to be very generous, consisting of the elements of the blood. Local stimulation the entire length of the spine by keeping applied two strips of irritating plaster, or the application of the electrical brush, or some other convenient stimulant. The internal medicaments are of two classes, green-root tincture of gelsemium, belladonna; ozonized fl. ext. musk root, to induce sedation ; glycerite of kephaline, tincture of oats, cerebrin, to vitalize and reconstruct the cord. The materia medica affords an abundant class of remedies which operate directly on the cord, as rhus rad., ergot, nux, calabar bean, atropia, ignatia, etc. The simple stretching of parts is often attended Sprains, with much suffering. Of the back. — Commonly caused by a fall from a height, or from a weight coming down suddenly on neck and shoulders. The structures suffering are the fibrous ones generally, such as the muscular fascia, tendons and ligaments. There is con- siderable swelling in the loins soon after the accident, and great pain on any attempt at motion. The inconvenience arising from a severe sprain in the back lasts a long time; so that a person may be confined to his bed or sofa for a fortnight, and it may be many weeks or even months before he completely loses pain. There may be some transient effect produced on the kidneys, and blood may be found mixed with the urine for a few days, but rarely any bad effects ensue. The treatment consists in perfect rest in the recumbent pos- ture ; the application of either the arnica or marigold lotion, or ozonized iodine to the stretched muscles Pain must be relieved by large doses of hyoscyamus. Knee. — Sprains, or twists of the knee joint are very common, often setting up great irritation, inflammation, and the damaged part is slow in recovering. Having had considerable experience with the older methods BACTERICIDES. 983 of treatment, clay is now the favorite local remedy. The ozon- ized clay is simply mixed with water to form a paste of a thick and moist consistence. This is spread on muslin to the depth ot a quarter of an inch thick, and applied entirely around the part. Over this a rubber roller bandage, just light enough to keep the dressing from shifting, and to retain the peroxide. At the end of a few hours the joint and all its structures is com- pletely saturated with a powerful bactericide, microbe evolution prevented, resolution is perfect. Rest is all important. Ankle. — The lower extremity is the most frequent seat of sprain of all the limbs, and particularly the ankle joint, and the ridiculous fashion of wearing high-heeled boots, whereby the base of support for the body is diminished, is a frequent cause of the accident. In the slighter sprains of the ankle the liga- ments are stretched, or, perhaps, a little lacerated ; but in the severe ones they are completely torn. Severe sprains are often mistaken for fractures, and should the case be one, when from swelling and pain there be any doubt, it should be treated as a fracture, bearing in mind that proper treatment of fracture is the best that could be adopted for a sprain. Impediment of speech (stuttering) in nearly Stammering, all cases is a nervous affection ; having as its origin a want of equilibrium of the gray and white matter of the cervical portion of the cord, resembling chorea. The vocal apparatus is usually perfect. It may be con- genital, but more likely to be the result of some shock in a fright, blow, or reflex condition, or follow some fever, worms, masturbation. White skin, dilated pupils, soft muscles, debility, point to a neurasthenic condition of the nerve centres ; or when it appears as a sequel of microbial disease, the spores of the germ cause the difficulty. The treatment consists in the removal of the cause ; improv- ing the general health by bathing, clothing, frictions to the cervical portion of the spine, thus raising its standard of vitality. Same remedies as for chorea. Make the child speak slowly and distinctly. Let him fill his chest well before he articulates a word, and then enunciate one word after another. If unable to do that, let him beat time for every word he utters in talking or reading. A persistent course of measuring the words until the stammerer can read and talk straightforward for an hour, daily, will soon overcome the habit. Let the diet be brain-food, boiled fish, oatmeal porridge and massage. 984 DISEASE GERMS. By this term is meant an unnatural protru- Staphyloma. sion of the tunics of the eye-ball. It occurs in the cornea and sclerotic. Staphyloma of the Cornea. — Of this condition there are two varieties. In one the cornea, rendered soft and weak in conse- quence of a slow inflammatory process, yields to the pressure of the clear aqueous fluid collected in the anterior chamber of the eye, and forms a rounded or conical prominence in front of the globe which presses upon and, in some cases, protrudes between the eyelids. This condition is usually associated with more or less marked corneal opacity. In cases where the cornea remains clear the patient complains of impairment of vision and is often short-sighted. In the other variety of staphyloma a portion of the cornea has been destroyed by ulceration ; the gap thus formed is filled up by portions of protruded iris, which become adherent to its margins. The protruded and exposed iris is sub- sequently thickened by the formation of delicate scar tissue on its surface, but still yields to the pressure of the aqueous fluid and forms a projection in front of the globe. Tne most marked instances of this kind of staphyloma may be observed in patients who have had an attaek of purulent ophthalmia, which has caused sloughing, and removal of nearly the whole of the cornea. Patients afflicted with the latter form of staphyloma usually suffer from frequent attacks of ophthalmia, and of pains and in- flammation in the displaced iris. Distension of the staphyloma by accumulation causes much pain and irritation, which is gen- erally relieved for a time by rupture of the protruded membrane. This, however, is always followed by closing of the orifice and reaccumulation of the aqueous humor. Sympathetic inflamma- tion often attacks the opposite eye. The palliative treatment consists in guarding the eye against possible causes of irritation, and in applying the ordinary means of relief during the recurrent attacks of ophthalmia. When there is painful distension of the staphylomatous cornea and iris in consequence of a great accu- mulation of aqueous humor, considerable though temporary- relief may be effected by making a small puncture into the thin- nest and most prominent part of the projection. When the oppo- site eye is affected with sympathetic inflammation it become* necessary to remove a part or the whole of the damaged globe. Staphyloma of the Sclerotic. — This term is applied to protrusioH of a portion of the sclerotic, due either to thinning of the mem- brane itself, or to thinning or rupture of the subjacent tunics — the choroid and retina. This condition may be caused by wounds of the sclerotic, blows on the eye-ball, or slow inflam- matory changes, resulting in a loss of firmness and diminished BACTERICIDES. 985 resistance in the tunics of the eye. Staphyloma may affect the anterior, lateral, or posterior portions of the globe of the eye. In cases of anterior or ciliary staphyloma, may be perceived one or more bluish, small and irregular-shaped prominences, which con- trast strongly with the surrounding portions of white and smooth sound sclerotic. The cornea and the walls of the anterior chamber generally remain healthy. The same changes occur in staphyloma of the lateral portions of the sclerotic. This affec- tion, which is called equatorial staphyloma, is often associated with much impairment of vision and severe recurrent attacks of ophthalmia. Posterior staphyloma generally occurs at that part of the sclerotic which corresponds to the optic nerve and yellow spot. This is frequently a congenital condition, and is the cause of that defect of vision known as myopia, or short-sightedness. The generative act on the part of the male im- Sterility. plies the completion of sexual congress, with an ejaculation of fertile semen, and its deposit in the -upper part of the vagina. The capacity for copulation depends •upon the perfect erection of the penis, the failure of which renders man impotent. Sterility includes certain distinct states, or conditions : As one in which no semen tvhatever, or nnproductive or infertile ^emen is secreted, termed, azoospermism. Another in which the spermatic fluid is secreted but not ejacu- lated, termed aspermatis7n ; Aud still another, in which there is a failure to deposit fertiU semen in the upper portioi of the vagina, called mis-emission. In the first form, intercourse and ejaculation are natural, but the essential elements of life, of fecundation, are dead ; in the second form, the power to ejaculate is prevented by an impedi- ment, and in the third variety, coition and emission are perfect, but fruitful semen, fails to reach its destination, in consequence of some congenital or acquired deficiencies of the urethra. I A man having no semen at all, or at the best unproduc- tive semen, may be due to maltormation or disease of the testes, obstruction of the vas deferentia, and abnormal conditions of the semen ; with no testes, and the accessory organs rudimentary, is unable to ejaculate a drop of semen. If the parts are mutilated in early life, the individual may have an erection but is absolutely impotent and sterile. When the testes are retained in the abdo- men, that is have not descended in intra-uterine life, they may have erections and perform the sexual act but they emit a fluid, thin, watery, devoid of spermatozoa ; other abnormal deficiencies 986 DISEASE GERMS. which obstruct secretion, as atrophy of the seminal vesicles, vari- cocele and morbid states of the blood in which disease germs are present, more especially the microbe of syphilis, or the bacilli of tuberculae; the lithiate of soda of gout and the like, are prone to set up iit the testes a process of interstitial disorganization and degeneration, which destroys the secreting cells, causes oblitera- tion of the excretory ducts of the testes, and abrogates their func- tional activity. Besides, the quantity, quality and composition of the ejaculated semen, may be altered or poverty-struck by sexual excesses,, masturbation, exhausting diseases, inflammation of the seminal vesicles, and prostate urethra. There may be an entire absence of spermatozoa in the ejacu- lated fluid, induced by grief, worry, struggle, excesses, nervous bankruptcy. Neurasthenic masturbators suffer from emissions, seminal and prostatic discharges, the result of their violation of divine law, venereal excesses, or ungratified desires, with no spermatozoa, or if any be pres- ent they are motionless. The vitality of the spermatozoa is dependent up a healthy secre- tion of the prostate, when ex- cess or pollutions damage that gland, overstep a natural limit,, the spermatozoa are liable to suffer, become few, small, and their place is usurped by sper- matic crystals. Among our physically drained young men various diseases of the spermatozoa are met with, such as fatty degeneration, abnormal density of the semen or purulent state of that fluid, watery or colloid. In masturbators, or men who have committed excesses, or prac- ticed sexual perversion, the semen is thin, watery, and the sper- matozoa few and motionless, incapable of impregnating the ovum. When their semen is permitted to dry and placed under a 300 diameter power a considerable number of transparent, variously modified, rhombic prisms, with their bases in apposition, the ends of these terminating in fine points, composed of ammonio-mag- nesium phosphate. The more numerous those crystals are they denote a diminu- tion of the spermatozoa or their entire absence. Among the same class of patients the semen is often watery,. Spermatic crystals. BACTERICIDES. 987 having a whey-like appearance, destitute of all spermatozoa, except a few deformed and motionless, but a few spermatic crystals, lymph corpuscles. Disease, acute or chronic, impairs the vitality of the semen, renders the spermatozoa scarce, small, motionless, infertile. The semen of men, after fifty years of age, becomes gradually less and less charged with spermatozoa, until about eighty, when few are visible, hence their inability to procreate arises more from impotence than sterility. Sterility in the male is far more frequently the cause of barren marriage than is generally "believed to be the case. Asper- matism is associated with complete impotence, but azoospermia or absence of spermatozoa in the semen, a condition by no means rare, may exist with perfect potency, and on that account is very easily overlooked. With few exceptions, azoospermia is caused by obliteration of part of the seminal ducts. This condition is generally caused by double gonorrheal epididymitis, or inflam- mation of the vas. After that malady, the chances are nine to one that azoospermia will follow. Prognosis appears to be hope- less when the condition in question is not discovered until three or four months after the onset of the local inflammation. The chief importance of the management of the case lies in accurate diag- nosis. True aspermatism is traced to arrested development of the ejaculatory ducts. In several cases of sterile marriages under our own observation the unfortunate wife had been sent from physician to physician, or from hospital to hospital, and her cervix divided, or her endometrium scraped, until a glance at the microscope proved that nothing was wanting to insure the bless- ing of children, except spermatozoa. No doubt the increase of intemperance involves the relatively greater frequency of those forms of gonorrhea where the earlier symptoms are very mild. Hence the first stages may now be as much neglected by patients as they have ever been wont to neglect later stages. The more a case of gonorrhea is neglected the greater will be the chance of serious secondary complications. Of all germ diseases that of syphilis is the most destructive to spermatozoa. Of all drugs which will annihilate it, the use of morphia and bromide of potassa stand pre-eminent ; of all morbid states, catarrh of the prostate; the micrococci and cryptococci of fever kills the most vigorous semen. TJie correct diagnosis of sterility must in all cases be made by the microscope, or by a bulbous sound. It must always be borne in mind that sterility does not include impotence, but is often met with in vigorous subjects, who ejaculate a fluid which presents all the visible properties of normal semen, hence it is difficult for them to realize that they are the result of a barren marriage. 988 DISEASE GERMS. Semen is the mixed product of the secretion of the testes, vasa deferentia, seminal vesicles, sinus pocularis, prostate, Cowper's glands, mucous follicles of the urethra, etc., presided over by the brain. The thick, white, pasty secretion of the seminiferous tubes con- sist mainly of seminal cells, out of which the spermatozoa or fertilizing elements are developed ; but the spermatozoa first make their appearance in the rete testis and constitute nine-tenths of the glutinous mass. In the epididymus and vasa deferentia, the zoosperms are per- fectly motionless, from the density of the medium in which they are contained, but when they reach the seminal vesicles they are in active undulating motion. 2. When sexual intercourse is not finished by the ejaculation of semen, that is, does not enter the urethra, because its ex- pulsion is prevented by some obstruction, or obstacle in the ejaculatory ducts ; or perverted sexual appetite in the brain, or deficient excitation of the spinal centre, or a blunting of the nerves of the glans, congenital occlusion of the ejaculatory ducts is rare, but a damaged condition of these ducts, brought about by wearing condums, or the act of withdrawal during ejaculation to avoid impregnation, retards an emission ; acts most disas- trously on the entire force of erection and ejaculation. Tight or adherent foreskin, stricture, induration of the corpus spongiosum. Lethargy, loss of passion through fear, disgust, suspicion of infidelity. 3. A failure to deposit fertile semen in the upper portion of the vagina may be due to mechanical obstruction, owing to which it regurgitates into the bladder, or slowly oozes away from the urethra as the erection subsides. Ejaculation may have a faulty direction, owing to malformation of the urethra, although de- formity does not always involve sterility. Fistulous openings above or below, congenital or acquired, malposition of the urethra, or its orifice located far back, will prevent the ejaculated semen from reaching its destination. Again, all depressing emotions, desires, affections, passions ; all acro-narcotic drugs ; alcohol, gout, syphilis, impair the ejacu- latory power. What is meant here by " atonic sterility" is a state of prostra- tion of the nerve-centres which preside over the genital functions, so that the sexual act is not performed naturally and completely. There may not be an absence of spermatozoa in the testicles or the fluid ejected, but they fail, on account of the incomplete sexual act to reach their destination. BACTERICIDES. 989 Now, assuming that an inflamed prostate urethra will produce the class of symptoms described above, and finally atonic sterility^ it is well to look for the cause of the local inflammation and irri- tation of that portion of the urethra. The cause that I have usually found was stricture ; often not a close one, but a con- striction sufficient to retain behind it a few drops of urine at each time the bladder is emptied. These few drops of urine decom- pose and act as an irritant. This irritation constantly kept up' soon excites an inflammation which extends to, and often into, the bladder. This inflammation of the bladder is often the first symptom that calls the attention of the patient to his urinary ap- paratus. Constant excitement of the genitals by over-indulgence in sexual intercourse or masturbation may cause a state of hyperaesthesia of the urethra. No doubt that strictures are often caused by masturbation, an inflammation being excited and kept up by free indulgence, and eventually the same results are obtained as arise from a gonorrheal inflammation. Sometimes congenital discrepancies serve as an exciting cause. The treatment of the first form is as a rule most unsatisfactory.. Nevertheless, much can often be accomplished if the cause can be removed and the patient placed upon a prolonged alterative and tonic course, together with daily massage, followed by faradiza- tion of the entire body, and the administration of the glycerite of kephaline and tincture of avena sativa. The treatment of the second form is much more hopeful ; in- variably good is to be derived from the use of alteratives and tonics, massage, baths. If the ejaculatory ducts are obstructed, a No. 12 silver catheter may be introduced into the bladder, and retained there for ten days, so as to excite a dissolution and effusion of the lymph in. their mouths. Add to this introduction a No. 12 rectal silver bougie, its presence may possibly squeeze out the coagulated lymph. If stricture be a cause, then it must be dilated and absorbed. If the chemical secretion of the prostate be changed through inflammation, or the prostate urethra sensitive, then urethral bougies of thallin. The cocaine suppository per rectum, and internally such drugs as nux, saw palmetto, damiana, should have a trial. The treatment of the third form is chiefly by surgical proce- dure ; faulty or mal-formed states of the urethra ; fistulous open- ings above and below, adherent prepuce, all admit of prompt relief. Even atrophy of the organ admits of a cure by judicious- management. ggQ DISEASE GERMS. Sterility is rapidly increasing and it is important that a clear idea of the physiology of reproduction should be disseminated. AU the factors concerned in the process of conception must operate in harmony, the woman must produce healthy ovules and the man normal spermatozoa. These products must unite ; there must be no abnormal condition that will destroy their vi- tality before or after they come in contact, nor after fixation to the uterine mucous membrane. Many women are potentially fertile, yet practically sterile, as* a result of the prevention of conception ; a practice common in all stations of society which is undermining the health, morals, and our very national existence. All means of prevention are prejudicial to the mental and phy- sical health of husband and wife, and the moral effect of with- drawal before emission is nearly identical with that of masturba- tion, and the physical disturbance may be greater, as the vasa deferentia remain partially filled, producing an irritation that causes a more frequent desired for sexual connection than is healthful. When the semen is not deposited in the vagina, and the connection is imperfect or unfinished, the active congestion of the female pelvic organs finally become passive, resulting in engorgement, hyperplasia, displacement, etc., entaiUng various local and reflex disturbances, or even insanity. Women in so-ca/led refined, religious, and cultivated society, being controlled by a desire for social pleasure, and for position and wealth for their children, practice prevention more than women in the ob- scure walks of life. Their daughters are taught nothing about the anatomy or the physiology of their generative organs, but are trained to abhor offspring, and are told how to avoid becom- ing pregnant. The higher education or dram-cramming; of girls nowadays, with the absence of exercise, and other hygienic measures, and the reading of sensational or love novels, destroy their power to bear well-developed and healthy children, or to supply them with enough nutritious milk for the natural period. As woman ascends in the scale of education and refinement, child-bearing becomes more difficult. She is more sensitive to pain, and bears children with greater cranial development. Her mode of dress distorts or displaces her thoracic, abdominal and pelvic viscera, and so weakens the abdominal muscles that the auxiliary forces in parturition are very much impaired. Sterility may be absolute or relative, congenital or acquired. In absolute or congenital sterility, the ovule is not impregnated, or if impregnated, conception does not follow, the ovule being destroyed in the tubes or uterus ; or conception may occur, but the woman aborts before the child is viable. In relative or ac- BACTERICIDES. ^q I quired sterility, the woman has had one or more living children, but in number not according to the duration of married life. A woman may marry successively, two or more men, and have children by only one of them ; or a man may marry two or more childless widows, and have children by each of them. This is sterility from incompatibility, these women being potentially fer- tile. One-child sterility exists in one out of thirteen marriages. The average time from marriage to the birth of the first child is seventeen months, and between the birth of children nineteen months, and women, upon an average, bear children from twenty- five to thirty-eight years of age ; less than fifteen years. As one in thirteen women bear their first child after having been married three years, no woman should be considered sterile until the fourth year of married life. Sterility may result from mechanical obstruction, from uterine or pelvic diseases, or from constitutional disturbances, or from some defect in the husband. The spermatozoa may be prevented from entering into the uterus by any congenital or acquired de- fect that interferes with sexual connection, such as imperforate hymen, vaginismus, atresia vaginae, etc., or by constriction or obliteration by stenoses or flexure of any part of the cervical canal, or by an elongated cervix. The vitality of the spermato- zoa may be destroyed by secretions from diseased mucous mem- branes of the vagina, cervical canal or uterus, but the most poisonous secretions result from glandular cervical endometritis, and from latent gonorrhea. Tumors connected to the uterus, and in the parenchyma of the uterus, or any disease of the mu- cous membrane and walls of the vagina. Difficult breathing may be due to Stertorous Breathing, a number of causes, as inflammation of the fauces and tonsils ; from the presence of the microbes of croup, diphtheria, tubercle, syphilis, cancer, irritating the nerves of the larynx; also from the presence of foreign bodies ; growths in the same locality ; to ulceration ; narrowing or pressure of the trachea; to bronchitis ; asthma, emphysema, and consolidation of the lung ; to organic disease of the heart; to the presence of ptomaines in tetanus, cholera, typhoid, whereas, stertor, or stertorous breathing is due to one or other of three states : Nasal or Palatine Stertor, when the air is rushing through the nose or mouth, causing a vibration of the soft palate. Pharyngeal Stertor, when the air passes through the narrowed interval between the base of the tongue and the posterior wall of the pharynx. pQ2 DISEASE GERMS. Muais Stertor, when there is mucus in the air tubes, and the air in breathing bubbles through it. Stertorous breathing is a mere mechanical condition, and in a large number of cases can be got rid of. Mucus stertor, when unaccompanied or unconnected by living engorgement, may occur in serious cases, when the nutritive process of the lungs are interfered with by some injury to the seat of life in the medulla oblongatata, injuries to the brain, con- vulsions, poisoning with opium, drowning, epilepsy, apoplexy, and the so-called death rattles of profound prostration, whether there be fluids in the bronchi or not. Snoring in these and other states shows that there is an impediment to the ingress of air, so that the blood and tissues fail to be oxygenized ; a condi^ tion of non-aeration of blood and embolism ; a failure of the hearths action and death. It is very doubtful whether a large percentage of death does not really occur from this cause, and most of those mysterious deaths that occur during sleep. When snoring or stertor forms a symptom it should be treated by placing the patient on either side, and keeping him there. This seldom fails to give instant relief to this distressing and danger- ous symptom with its consequences, and death in many cases can often be obviated. Squinting, or strabismus, is a want of har- Strabismus. mony in the muscles of the eye. The common form met with in young persons is where the eye is turned inward, or, convergent ; the other form, in which the eye is turned outward, or divergent, is more rare, and is chiefly met with in elderly persons, from paralysis of the internal muscles. Both eyes may be affected, but this is not common. The causes of squinting are very numerous. It may be con- genital, or induced by bad habits, by imitation, by looking at pimples on the nose ; or it may come on from a stye, which often interferes with the motion of the eye ; by the use of one eye to the neglect of the other, or by shading one ; it may also result from slight opacities of the cornea ; from a variety of nervous causes, and it is often the result of reflex irritation in morbid conditions of the stomach, worms, teething and constipa- tion; disorders of the sympathetic system, as fright, passion, etc., and also to disorders of the brain, as convulsions, congestion, effusion, hydrocephalus, etc. Treatment. — If it be recent, that is, not over a few weeks' standing, the difficulty can be frequently overcome by the re- moval of the causes, as teething, worms, disorders of the stom- BACTERICIDES. gg^ ach and bowels, by the proper remedies ; b}' avoidance of study and reading; by proper exercise to the eyes, and by wearing glasses for the purpose. But if the squint be of long standing, and is habitual, and above all, if there is the slightest disparity in vision of the two eyes, very little good can be effected, unless the internal rectus muscle be divided. This is a very simple pro- ceeding, consisting in placing the patient under chloroform and placing a blunt hook under the muscle and raising it, and then dividing it. If the squint depends on some opacity of the cornea, or organic disease of the brain, no interference should be per- mitted. The orthopoedic treatment of paralyzed muscles has been re- cently tried in strabismus with marked success ; this treatment consists in seizing the conjunctiva over the affected muscles by a pair of forceps, the eye being under cocaine, and moving the globe in the line of action of the paralyzed muscle and its antag- onist. Protrusion of the eye-ball is a general symptom of wasting disease, as consumption, anaemia, but it maybe due to aneurisms, tumors, fatty deposits, osseous and encysted growths. The danger of tumors are twofold : destruction of the eye from con- tinued pressure ; and protrusion through the roof of the orbit into the cavity of the skull, with compression of the brain. The diagnosis is most important. This may be met with in either a spasmodic Stricture or organic form. In the former it comes and of the goes ; in the latter there is effusion of lymph, (Esophagus. which forms a permanent obstruction. The oesophagus being made up of circular muscu- lar fibres, or rings, each of which is supplied with both sensient and motor nerves, renders it susceptible of the slightest irritation, which gives rise to contraction, and repeated contractions give rise to effusion of lymph ; thickening. Spasmodic stricture is that which is not permanent, but comes and goes away. This may originate in two ways. There may be some weakness or irritation of the cervical nerves, issuing from the spinal cord, which supply the circular muscular fibres of the oesophagus, a sortof neurosis, or extreme sensibility, when in hastily swallowing a cold fluid, like ice water or beer, it acts as an instantaneous depressant to the weakened nerves, which causes contraction of the circular muscular, a sort of spasm, which prevents deglutition. It is more apt to come on in swal- lowing a cold fluid than otherwise, for fluids are much more diffi- 63 994 DISEASE GERMS. cult to swallow than solids. In the act of swallowing a liquid all the rings of the oesophagus are brought into active exercise; whereas in swallowing a well masticated solid, it will slip down without a movement. In the other class of cases the integrity of the nerves are normal, no neurosis, no nervous irritation, but it may come on from decided carelessness in the hurried drinking or suddenly gulping down large draughts of ice water, cold beer and other cold drinks in hot weather. The pungent coldness and haste produces the shock, followed by contraction, which once induced is liable to be repeated, if the same cause is brought to bear on it. It is most generally met with in beer drinkers and among young ladies who bolt large quantities of ice- cream. Symptoms. — Difficulty in swallowing ; at first confined to fluids, usually cold; then it extends to warm drinks and solid food ; but the difficulty is not always; it comes on by spells ; often a sense of fulness and choking under the influence of excitement. It cannot be confounded with permanent stricture, because the difficulty of swallow- ing is only now and again, and a bougie will pass down without a particle of obstruc- tion. In the treatment of spasmodic stricture the greatest possible care should be exer- cised in eating and drinking; food should be bland, soft, nutritious ; well masticated and swallowed slowly. All liquids taken should be warm and sipped with caution. Forbid strictly cold or iced drinks, iced lemonade, beer, ice-cream. The medical treatment should consist in daily baths, massage, electricity, sumbul, kephaline, avena, matricaria. Organic stricture is a condition in which lymph is effused in or on the circular muscular fibres of the oesophagus ; thickening produced ; it m.ay involve the entire ring clear round, or only a part, and forms a permanent obstruction to the descent of solids, and often liquids. The effusion may be mere lymph, or even cartilage. The cause is some irritation, as spasmodic stricture or the swallowing of some irritant, which gives rise to the effusion of lymph. Stricture of the oesophagus and human alimentary canal: /, oesophagus; b. stomach ; c, cardiac orifice ; d, pylorus ; e, small intes- tine ;/, biliary duct; ^, pan- creatic duct; A, ascending colon ; i, transverse colon ; J, descending colon ; k, rec- tum. BACTERICIDES. qqc Symptoms. — Vomiting after taking food which descends to a point, and apparently sticks, and is thus rejected ; or if the diet is very bland or soft, or the drink mucilaginous, it may pass through the obstruction. If case is seen here, and proper treatment in- culcated, a cure may be effected. But if neglected, after the end of six or eight months the inability to swallow becomes greater, until little can be swallowed. Then emaciation, debility, takes place, and increases rapidly. The stricture can be felt, its size and shape well made out by bougie. If not cured, starvation takes place in spite of nutrient enemata. In the treatment of organic stricture there must be great care exercised, in order to m.aintain the nutrition of the patient. The diet should be of the most nutritious and blandest character, such as the juice of meat, raw eggs, cream, with enemata of the same. The seat or location of the stricture can be easily made out by the introduction of a bougie and feeling for the stricture. Once its location is determined, put an irritating plaster four inches square over the seat of stricture on sternum, another on the spine ; spread fresh every morning and applied. The patient must be placed upon an alterative and tonic course of treatment, such as compound saxifraga and phytolacca, alternated with matricaria. Three times a week the patient should swallow a bolus of thirty grains of papoid, large enough to be stopped by the obstruction ; while so obstructed a bougie should be intro- duced which should push the papoid closely against the obstruc- tion of the effused lymph. On this the papoid acts as a solvent, a digestive agent. By this is meant a narrowing, or a dimin- Stricture of the ished calibre of the canal. It may be so Rectum. slight as not to attract attention, or do ap- preciable harm, or it may be so complete as to close the canal and prevent the passage of any substance whatever. It may involve the entire ring, or a half, or a part of it. Causes. — Usually an effect of acute or chronic inflammation ; lymph is effused, generally about two and a half inches from the verge of the anus, or more properly speaking, at the spot where the tenesmus is experienced. It rarely exists without ulceration, and this alone may cause stricture. Congestion around an ulcer- ating surface, and the constant effusion of lymph in attempts to heal the ulcer, very soon form an undue deposit of lymph in the rectal walls, whereby they become thickened and hardened. In 996 DISEASE GERMS. patients of feeble health this process goes on till the elasticity and contractility of the muscular coat is lost, and the rectum be- comes passive, a steadily narrowing tube through which faeces pass when liquefied or semi-liquefied, forced through by the stimulus of cathartics and spasmodic effort of the intestines. Symptoms. — These vary considerably in the early stage, but, as the stricture becomes more marked, there is constipation often alternated with diarrhea. Stools if solid are passed with great difficulty, in small, flattened, chopped pieces, usually about two and a half inches in length; in other cases they are long, slim and cord like ; severe straining efforts in voiding the motions if solid ; pain in the loins and sacrum ; flatulence ; often mucous discharges stained with blood ; if there is ulceration above the stricture, burning pain and ten- derness about sacrum and funda- ment ; discharges of blood and pus. ' The reflex symptoms are often very decided and severe, languor, lassi- tude, debility, headache, constitu- tional disturbance, burning; in hands and feet, brain disorder, vertigo, fits, impairment of the general health, depression of spirits, hypochon- driasis. TJie diagnosis is easy, the history of the case, the constriction of the bowel can be felt by the finger about two and a half inches from the anus, so that it cannot be confounded with spasmodic constriction caused by spinal irritation. Treatment. — This necessarily varies according to the state of the stricture, the condition and circumstances of the patient. In all cases one thing is essential, every possible means should be resorted to to build up, im^prove and maintain the highest standard of health possible ; to effect this the patient should resort to daily bathing, flannel clothing, a most generous diet, an alterative and tonic course of remedies. The most appropriate alterative is the saxifraga comp. ; as a tonic no remedy can excel the Vir- ginia stone crop, coUinsonia, mineral acids. The stools should be kept soft and liquid by a dose of kola- tina ; or olive oil and glycerine; or juglandine before retiring at night. Then an absorbent action must be excited in and around the Stricture of the rectum, usually found 2 J^ inches fiom the verge of the anus; the effusion of lymph may be all round or only partial. BACTERICIDES. ^^7 stricture by some one or more of the following methods : The introduction of a metallic bougie, well warmed and gelatinized, with belladonna and salicylate soda, a size that will pass easily through the stricture should be inserted first, and permitted to remain at least a half an hour. These bougies should in length be twelve inches long, and inserted gently up for eight inches. From week to week they should be gradually increased in diam- eter, until the largest size pass easily. This method will take from three to four months. To aid this treatment, various sup- positories should be used, as the cocaine ; belladonna and opium ; salol. The idea which must be rigidly carried out is absorption of the effused lymph, which constitutes the stricture, never dilata- tion. It is useless to experiment with sponge tents, sea tangle, or to torture the patient by cauterization, incisions, forcible rupture or tearing, for they may be for a week or two of utility, but the stricture returns under those methods. We might enumerate other methods by which absorption of the lymph can with some degree of success be effected, such as electroysis ; suppositories or bougies six inches long, in which papoid, trypsin, boroglyceride, salicylate soda, salol, creolin, are incorporated. The development of blenorrhagia takes Stricture of the place in the following order : The micro- Urethra, coccus deposited on the anterior portion of the mucous membrane of the urethra encounter there a very thick epithelium, upon which they fer- tilize. Perhaps here we have an explanation of the theory of incubation, for the micrococcus only develops well in the globules of pus. The epithelial cells desquamate, allowing the germ to penetrate into the chorion and thence into the lymphatics ; then true suppuration commences, propagating itself little by little to the deep parts of the urethra, always following the course of the lymphatics. At the close of the malady, either because the soil is exhausted or the pathological modifications of the tissues ren- der them unsuitable to the growth of the germ, the latter returns to the superficial parts of the mucous membrane, and locaUzes itself on the surface. This is found to be done in nests, on the inferior aspect of the canal, and signalize the points where lymph is effused to form stricture. Stricture in the urethra is essentially due to rapid microbe DISEASE GERMS. evolution, in points with foliaceous colonies, which present them- selves in the form of diplococci, forming masses of greater or less extent, render the canal narrower than what it is by nature, and incapable of resuming its ordinary capacity. When the urethra contains the micro-organisms of morbid action, they produce one or other of three conditions, either a weakness of some of the circular rings, which give rise to spasmodic contraction, or when the germs are freely elaborated in urethral pus ; inflamma- tory or when the cultures have given rise to a permanent effusion of lymph. All forms of stricture, whether they be spasmodic, inflammatory or permanent, arise either from microbe growth, a specific cause, and capable of being removed by one uniform and easy treatment. As a rule, few persons take little notice of a stricture till some inconvenience arises therefrom. A man may have a slight moisture, or gleety discharge, ar a diminished flow of urine, from which he experiences little or no inconvenience, he may not even suspect the existence of any other complaint, and therefore gives the matter no thought, till at length prostatitis, inability to micturate drives him to seek professional advice, and an exami- nation of the urethra being submitted to, the presence of a stric- ture is detected, which may have existed for a length of time. Spasmodic stricture arises from the circular muscular fibres of of the urethra being weakened in times gone by or by the sapro- phylic bacteria of masturbation or the gonococcus, the slightest stimulus will cause the weakened part to contract, and thus cause the stream of urine to be suddenly obstructed, or if able to pass it, it will be spiral, corkscrew, or split ; cold, damp, exposure, microbes in the canal may act as exciting causes. The difficulty micturition comes on suddenly. In, or during inflammation, nests of micrococci weaken the nerves and circular fibres by burrowing in the follicles and lacuna. Permanent strictures are always due to effusion of lymph, and its organization either into a band across the inferior aspect of the canal, or a flattened exudation. The cause of this effusion is due to a microbial nest, and effusion of lymph over the germ colony, which gradually diminishes the calibre of the canal. Among the earliest symptoms of permanent stricture is the retention of a few drops of urine in the urethra, which drops soon escape and slightly wet the linen ; the bladder becomes irritable, necessitates frequent efforts to urinate, as the lymph in- filtration increases^ there is a discharge of mucous from the urethra, attended with a sensation of itching, heat and pain in making water; the steam of urine becomes forked, spiral, flat- BACTERICIDES. 999 tened, or scattered, which, if let alone, eventually grows worse, until the urine is voided drop by drop. At this period the slightest irritation, cold or wet, intemperance in diet or otherwise, may be immediately followed by a complete stoppage of urine. Stricture of the urethra may arise from any form of irritation, but ninety-nine cases out of one hundred are due to the micro- organisms of gonorrhea. Independent of the symptoms enumerated, the stricture must be felt by a metallic bougie. Two urethral strictures, the posterior one in the deep urethra. Three urethal strictures. Treatment. — The general treatment should consist in placing the patient upon a general alterative and tonic course, saxifraga in alternation with cinchona. The local management of the stricture is somewhat varied; some believe in burning them out; others in cutting them with the stilleto ; while another class ad- vocate forcible dilatation ; some are believers in their dissolution by electrolysis ; while others again believe in the old and best method, exciting absorption in them by the persistent introduc- tion and retention of graded metallic medicated bougies ; three days in the week for ten or twelve weeks. The merits and demerits of all other methods, it is unneces- sary to discuss, suffice it to say, that after its removal by those methods, they invariably return. This method is the best as there is no recurrence ; by the other methods, the disposition to recur after removal, originates in the stricture itself; thence to the bladder and contiguous parts 1000 DISEASE GERMS. and anteriorly in a less degree in the urethra ; smearing the bougie, or using bougies of thallin, belladonna, papoid, trypsin, operates like a charm. In the management of the case, the simple bougie should be increased in size weekly, according to the facility with which it is absorbed. A little and little is gained by its passage every other day or twice a week. Following the use of the bougie, an iodol gelatinized bougie should be inserted and permitted to dissolve. The good effects of frequently and gently stretching a con- stricted part, is the true successful method of cure ; a perfect cure can be effected, without pain or inconvenience; and no re- currence demonstrates the superiority of the simple metallic overall other forms of treatment. The treatment of stricture of the urethra by electrolysis has, within the last few years, been brought before the profession, and from its success, we may fairly conclude that in the near future, it will occupy an important place. In the application of electrolysis to the urethra, a battery of thirty cells, and a gal- vanometer to measure the strength of the current, together with filiform bougies and electrodes of various shapes and sizes, are required. The bougie electrode used for passage into the urethra has a metal point, usually of olive shape ; its stem is covered with isolating material, and is connected with the negative pole of the battery. The other electrode, connected with the positive pole, is of a convenient shape to hold in the hand or apply to the back. In all cases it is absolutely essential that a galvanometer should be in the circuit of the electrical current, so that its strength may be known and regulated. The usual current strength employed is five milliamperes, though it may sometimes be increased to ten milliamperes without the patient feeling any discomfort. The time occupied at a sitting varies from about five minutes to half an hour. The modus operaitdi of electrolysis on the stricture does not seem to be clear ; hydrogen gas is dis- engaged during the operation, and a thick, granulous discharge comes from the urethra. That electrolysis produces a change on the tissue forming the stricture, seems to be proved without doubt, from the alteration which is found to occur after the elec- trode has passed through the stricture, as compared to what ob- tains after the passage of an ordinary metallic bougie. If a metal instrument be pushed through a stricture which grasps it tightly, and is immediately withdrawn, it will be found that about the same amount of force is required to withdraw the instrument as was required to pass it. With the electrode the case is different. Although a considerable time may have been taken and some pressure needed to pass through the stricture, it can always be BACTERICIDES. lOOI withdrawn with ease, being no longer grasped firmly like the metallic instrument. With it, with care, a permanent cure can be effected, but too often it is neglected, and the stricture will re- turn, unless an instrument is passed and retained for some time. By weekly electrolysis, resiliant or non-dilatable stricture, or those which are impassable, can be successfully got rid of Follicular irritation, efTuslon of lymph, with sup- Styes, puration in one or more of the sebaceous follicles, at edge of eyelids. The cause is invariably mal-assimilation, perversion of nutri- tion, which gives rise to the same micrococci that we have in boils. In hordeolum or stye, there is great fetor of the breath, brown- coated tongue, constipation, slight pyrexia. These cases are benefited by an emetic, opening the bowels, and administering some germicide. Locally, to the lids, if it is just about to appear, painting the lids with saturated solution of boroglyceride ; if it has progressed to near the point of suppuration, pack the lids with the same. Boroglyceride solution is death to the microbe in all cases and under all conditions. Suicidal mania is a peculiar morbid state of the Suicide, brain of civilized man in which its typical fissures coa- lesce. A deviation from the normal type takes place, termed atypic, which is present in hereditary insanity, and in the boy children of mothers who have exhausted their mental powers in literary pursuits, over-stimulating their nerve-power a-^d thus causing a defective power of brain assimilation in their offspring. It is a low state of human brain in which the facial angle is lowered. Maternal impressions also give rise to it, as the witnessing of the slaughtering of cattle and killing of fowls ; the insatiable desire of some mothers during pregnancy to have criminal abor- tion performed, or in taking emmenagogue drugs to destroy and evacuate the contents of the uterus, thus impressing a suicidal disposition in her child. The true influence of our present trashy, demoralizing literature can scarcely be adequately appreciated as a prolific cause; besides, we have most important factors in isola- tion, solitary confinement, masturbation and supposed loss of sexual power. The worry, the struggle for existence, is supposed to be a prominent cause ; but this is not correct, because suicide 1002 DISEASE GERMS. is more prevalent among the unmarried and the widowed than among the married, in whom the struggle is greatest. The anaemia of the brain and cord induced by excess of study and sexual losses is an important factor. Infidelity, Darwinism have an important bearing in its production. It is also to be regarded as epidemic. There is a singular regularity of the law which governs the return of suicides. The regularity is conclusive. There is a perfect uniformity with which the numbers of suicides are repeated from year to year in each country, especially in those countries in which the rate of suicides is high, such as France, Germany, England, the United States. Side by side with this remarkable regularity is a progressive in- crease of this morbid condition during recent years in the above- named countries. It has, besides, a seasonal distribution, the first months of the year, being few, but a steady increase to June, when it is at its height, and from its maximum there is a steady decline to the end of the year. The variations in the prevalence of suicide in dif- ferent localities depends a good deal on their moral, social and religious status and absence of monotony. The influence of sound, honest Christianity (no sham) retards it. In Scotland, where the rigid Presbyterian has a hold ; in Ireland, Spain and Portugal, where Catholicism is pure, the affection is rare. The number of suicides increase in countries where religion is a mere show or trade-mark. The proportion of suicides to the popula- tion is less where the tenets of the Bible are absolute, whereas the largest proportion occur where infidelity is rampant, as in Germany and the United States. In Europe the pure Germanic race shows the highest proportion of suicides, followed closely by the Scandinavian races ; whereas, among the Latin race, all except France, the rate is low, in Russia seldom known. In the present state of pathological anatomy, the old theory of suicide being the effect of the struggle for existence and of human selection, which works according to the laws of evolution among civilized people, will not stand good. The proportionate relation between male and female suicides is pretty constantly from three to four males to one female. The proportion of suicides is largest between forty-five and fifty-five, very few taking place later in life. The humanizing effects of an implicit faith in God, of man being part and parcel of that immortal existence, and of endless immortality well grounded into a people, seems to be the best prophylactic. When the malady is suspected, rest to the brain, freedom from care, worry ; liberal administration of cerebral tonics of great utility. BACTERICIDES. 1003 Micrographic germs are to be found in both the Sweat, insensible as well as the sensible perspiration of the skin, probably most numerous when the sweat glands are devitalized, as in — Hyperidrosis, in which we have an excessive effusion of sweat. In this we make no reference to normal sweat, the physiological result of active exercise or excessive heat, but to general or par- tial pathological sweating. The latter is common in the adipose, the feeble, the victims of microbial disease, as in the tubercular, S3/philitic rheumatism, fevers, etc. ; partial sweating in hands and feet due to neuras- thenia, or where it may follow the course of a special class of nerves, and may or may not be accompanied with foetor. In all cases the integument is weakened, its nu- _ ....'..-.-, trition impaired, being constantly mace- rated, it becomes painful, tender, exfoliates and becomes loaded with disease germs. Sudamina, confluent or discrete, superfi- cially seated, of the size of a millet seed, or larger, translucent vesicles, each one contain- ing a droplet of sweat, with a germ lurking in the serum, often due to the same causes. ^""^ '^^"^"^ of feet-sweat. No localized centre in the brain for excito-sudoral or inhibi- tory effects has yet been recognized, although we have very posi- tive evidence that a bankrupt, nervous system, especially the sympathetic branches, give rise to it. When the sv/eat centre is weakened, sweating all over is usually mitigated by either the tincture of oats, or mineral acids, or nux vomica, matricaria, quinine, belladonna, agaric, ergot, jaborandi. Localized sweating, in which a pathogenic microbe is present, such germicides as lycopodium, boroglyceride, quinine lotion, ichthyol, naphthol, microbe powder in socks, etc. Anidrosis, a state in which there is no sweat secreted, owing to some pathological condition of special nerves, or to destructive changes in the skin, produced by burns, blisters, cicatrices, keloid and other growths. Bromidrosis ,itt\d or stinking sweat is invariably due to microbes, as the brood of syphilitic germs in an ulcer, or swarms of the micrococci in small-pox, but in a sweaty foot, the odor of which is so offensive, there is a specific microbe which is pathogenic. It consists chiefly of short rods, which are aerobic, and anaero- bic, develop rapidly in beef tea or broth ; will retain its offensive odor even after numerous cultivations and inoculations. Any one of one of the following germicides brought in con- I004 DISEASE GERMS. tact with the microbe will cause its instant death : Solutions of boroglyceride, peroxide of hydrogen, ozone ointment, microbe powder, resorcin jelly. Other antiseptic precautions are bathing the feet, twice daily, with solution of boroglycide, washing the socks, saturating them before drying with some germicide. Chromidrosis. — Sweat of an abnormal color, is often attributed to the presence of drugs, as antifebrin, antipyrine, indican, pre- parations of phosphorous and of iron, vegetable parasites or vegetations. The red, malodorous, sweat of the arm-pit is due to the presence which is found in the sweat, or massed in the form of zoogloea and adherent to the hair of. the skin, which it causes to become brittle. This microbe bears cultivation well at blood heat, on white of ^gg. In its growth it retains its original color, odor and microscopic appearance. In excessive and odorous perspiration of the feet and axillae, a variety of remedies will either sterilize or kill the microbe, almost incredible relief is at once experienced, and both the odor and sweating gradually disappear by bathing the parts with boro- glyceride solution, or a wash of peroxide of hydrogen. Sudden prostration from some shock ; a partial Syncope, suspension of vital power. {Faintmg.) Best treatment recumbent posture, one-drop doses of nitro-glycerine on tongue, head low, cold air; cold water dashed over the face and chest; smart beating hands, feet ; friction ; mustard plasters over the region of heart ; aromatic spirits of ammonia or brandy. If the syncope be due to or associated with anaemia or chlo- rosis it must be cautiously treated with brandy, ammonia and beef-juice, administered both by mouth and rectum. The recum- bent posture should be maintained until the action of the heart is nearly normal. consists of water, albumen, soda, chloride of sodium. Synovia phosphate of lime, a fluid to lubricate the joints, but one of the very best culture fluids for very many disease germs, especially the micrococci of scarlatina ; amylo- bacta of rheumatism ; bacillus of tubercle ; the syphilitic germ, and others. This joint-fluid is a most nutritious pasture field for those germs, affording them all elements suitable for growth and repro- duction. BACTERICIDES. IO05 The micrococci of scarlet fever, when oxygen is deficient in the blood, take to the joint water, where they can receive nourishment and protection more frequently than is generally supposed ; it goes there alone and has neither identity nor affinity for any other microbe ; it may possess eccentricities, but it alone is the cause of the joint-lesion. It is impossible to describe or state the time of migration, or joints affected, but smaller joints, as the fingers, wrists, etc., in which the synovia is richest, and pink marrow abundant, are those generally affected. The synovitis caused by the presence of the micrococcus of scarlatina in the synovial sacs, and other white fibrous tissue, in which it breeds, evolve spores and ptomaines, should invariably be treated by the local application of bactericides, as concentrated ozone, sulphur, ozonized tincture of iodine, iodoform, iodized oil, or some of the essential oils, menthol, thymol, etc. The bacillus amylobacta of rheumatism germinates most actively in the larger joints ; it is an active germ, leads to an accumula- tion of effete material in the system. Occupies joints in which pink marrow is not so abundant, therefore in its immediate results is not so productive of anaemia ; the excretion of ptomaines are considerable, hence the joint pain is usually great. The treatment same as rheumatism, with local bactericides. Uie favorite location of the tubercular bacilli in joints is around the cartilaginous ends of the bones, and the joints selected are the knee, hip, wrist. (See Tuberculosis?) The syphilitic and other germs often localize in the joints. A term used to distinguish peculiar or- Temperaments. ganizations of the body in different indi- viduals. It is customary to arrange them in four principle groups. 1. The sanguine temperament, characterized by plumpness of body, fair or red hair, blue eyes, a soft, thin skin, active circula- tion, and a full, quick pulse. 2. The phlegmatic temperament is distinguished by a round body, soft muscles, fair hair, pallid skin, and slow, languid circu- lation and pulse. All the functions, mentally and bodily, are torpid. 3. The bilious temperament, known by firmness of muscle and flesh, defined sharp features, black hair and dark complexion, a full, firm, and moderately quick pulse. 4. The nervous temperament, characterized by a small spare frame, quick, impulsive movements, and a delicate constitution ; the pulse is small and weak, and easily excited ; the whole nerv- IOo6 DISEASE GERMS. ous system is susceptible, the thoughts quick and imagination lively. Some physicians place great reliance on the indications of temperament in the treatment of disease, and find that those who possess a sanguine temperament are m©st liable to acute inflam- matory diseases ; the phlegmatic inclining to scrofulous com- plaints; the bilious to affections of the liver and digestive organs; and the nervous to mental disorders and diseases of the nervous system generally. A microbial disease of great intensity, capable of Tetanus, destroying .life in either a few hours or from three to five days, patient conscious but in a state of rigid spasm, said to be idiopathic or traumatic, whichever it is a spe- cific contagious disease, due to the action of a specific virus, which exists in the tissues at the seat of infection in the blood and in the central cerebro-spinal nervous system. The conclusions arrived at with reference to the origin of tetanus, is that it is an earth poison, or microbe. I. Tetanus is transmissible, not only between animals of the same or different species, but also from man to man and from man to animals, and vice versa. 2. The demonstration is estab- lished as regards solipedes. 3. The contagion from horse to man may be made directly or indirectly, the latter being most frequent. 4. Intermediate agencies, whether in prolonged or slight contact with a tetanic horse, receive without destroying the poisonous element, consequently enlarging the sphere of infec- tion. 5. Living beings may serve as the means of transmission without being themselves affected, but are constantly in danger of traumatic auto-inoculation. 6. A wounded man may receive infection of tetanus from surrounding objects, but of all these the horse and all his belongings are the most dangerous. Next in order is cultivated ground and its products. 7. The earth case acquires tetanic virus when contaminated by a tetanic horse. 8. Statistics show that tetanus occurs most frequently among those persons whose calling brings them in contact with horses — that human tetanus is parallel with equine. 9. The equine theory is confirmed by a majority of facts. In view of the experimental evidence which we possess at present and of numerous unassailable observations of many sur- geons and veterinarians, there seems to be ample warrant for the admission that not infrequently tetanus in man is acquired di- rectly and indirectly from some of the domestic animals which surround him, notably the horse, and also from newly cultivated ground. BACTERICIDES. jqq-t When this microbe enters the body, it is by the nerves, and makes directly, as if by magic, for the medulla oblongata and its membranes, where it breeds with amazing rapidity. The germ is contained in the medulla and spinal marrow, and spreads along the cord, being strengthened in its progress, and grows more intense all the time. Such an active microbe breeding freely, with a deadly ptomaine excreta, even greater than rabies, runs along and implicates all nerves in connection with the medulla and cord ; first the micro- bial chain traverses the nerves that supply the muscles of the jaws and throat, they become rigid, fixed with the mouth firmly closed, giving what is termed trismus^ or lock-jaw. As the microbial colony spreads, descends the spinal cord, the muscles of the face, throat trunk and extremities become involved in the spasmodic contraction. Angles of mouth drawn outward and upward ; muscles of neck, back and abdomen, hard, tense, con- tracted, and from time to time violent contractions occur. Spasms never entirely cease, except in some cases during sleep ; aggra- vated every quarter of an hour or so, increased, cramps lasting for a few minutes and then partially subsiding. When the nerves that supply the strong muscles of the back are most implicated or affected, they draw or bind the body in the shape of an arch, the patient resting on the occiput and heels, which is called opis- thotonos. If the nerves that supply the anterior or front muscles of the body are weakened by any cause, the irritation may ex- hibit or spend itself there and thus bend the body forward by strong contractions of the muscles of the neck and abdomen ; this is called emprosthotonos. If the nerves that supply the mus- cles on either side be affected or weakened, the irritation may spend itself there and the body be drawn sideways, which has been designated pleurosthotonos. By and by, the nerves that supply the involuntary muscles become affected. Frightful suf- fering, caused by tetanic spasms ; face pale or as white as snow ; brows contracted ; skin covering forehead corrugated ; eyes fixed and prominent, sometimes suffused with tears ; nostrils dilated ; corners of mouth drawn back ; teeth exposed and features fixed in a grin — ristis sardonicus. Respiration performed with diffi- culty and anguish ; severe pain at the sternum or pit of the stomach ; great thirst, but agony increased by attempts at deglu- tition; pulse feeble and frequent; temperature very slightly raised ; skin covered with perspiration ; patient cannot sleep, or ii he does, it is only for a few minutes at a'time. In spite of all the suffering the patient's intellect remains clear and unaffected. It terminates either in death or recovery, or by a breaking up of the spasm into chronic, from which, with proper management, recovery is almost certain. IOo8 DISEASE GERMS. The duration of an acute attack is usually between three and five days, death taking place partly from suffocation, partly from exhaustion. It is very easily recognized by its history and symptoms, the absence of fever, the clearness of intellect and the continued spasm. No other disease like it. The appearances after death are great serous effusion in ventricles of brain, around the spinal cord ; the whiteness of skin and laceration of muscles by the spasm is also present. In the serous effusion around the medulla oblongata and spinal are to be found the bacillus of tetanus. Rods, very fine, like thread forms, mostly collected in irregular masses, with characteristic spore formation. Inoculation of garden earth subcutaneously into rabbits in- duces tetanus. The baciUi found in their blood is Identical with the microbe in man. The germ is pathogenic of the disease, bears cultivation well, and is as active after several generations of culture as in its primi- tive state. Pre-eminently contagious and in- fectious, it has an uncertain period of incuba- tion, depending upon the status of vital force of the inoculated. Cases occurring twenty- four, thirty-six or forty-eight hours after injury rarely survive the third day, but comparatively few are lost when it comes on the ninth or eleventh day. The excretion of ptomaines is most active in and around the medulla, decth often takes place from them before they have time to enter the blood. As tetanus has thus been clearly shown to be a disease due to the presence Of a pathogenic bacillus, its curative treatment de- pends almost exclusively upon the administration of bacteri- cides, but before any drugs can be given the spasm must be relaxed. For this purpose move the bowels freely with com- pound powder of jalap and senna with one drop of croton oil. Apply at once the galvanic cautery at a white heat every three quarters of an inch on both sides of the spine, from the nape of the neck down about ten inches. After its thorough application, poultices, composed of equal par<-s of flaxseed meal, pulverized lobelia and stramonium should be applied as hot as can be borne and changed every three hours. While this is being done, an effort must be made to relax the spasm, as the recovery of the patient depends upon that. For that purpose, take one heaped teaspoonful of lobelia seed, fresh crushed, one teaspoonful of the BACTERICIDES. lOOQ fresh plant of lobelia, one tablespoonful of American valerian, and one tablespoonful of pulverized capsicum ; place all in half a pint of brandy, shake well, let it settle a few minutes, then begin to give a teaspoonful every few minutes until the spasm relaxes. If there is a hot bath handy, put the patient in it (97° Fahr.) Throw in the bath a pound of lobelia, and while in the bath enemas of a strong infusion of lobelia should be given. The lobelia, by the stomach, bath and rectum should be pushed to thorough relaxation of spasm, avoiding emesis if possible. If there are no facilities for a hot bath, then cloths wrung out of a decoction of lobelia should be applied to chest, abdomen, thighs. Half an hour is sufficient for the bath, but if cloths are applied they should be constantly used, keeping them hot and moist. If spasm breaks, the case may be considered pretty safe, if well managed, and the proper bactericide administered. The dioxide of hydrogen is the germicide combined and alternated with sumbul and bromide of potassa. Other germi- cides might the tried, as resorcin, sozoiodol, concentrated ozone, etc. ; sulphur water ozoned ; par-aldehyd, etc. The lobelia, antispasmodic, must be still persevered with in small does, and small doses of calabar bean added to it. If there be a wound, a scratch, an abrasion, or laceration, from a rusty nail, with the microbe from the earth or from something in use near a horse, it should be attended to ; all irritating parti- cles should be removed and the wound sterilized ; the nerve, if lacerated or torn, might be divided, and poultices of either creoline or naphthaline, or ozonized jequirity applied. Otherwise, treat on general principles. It is folly to think either of dividing the nerve high up in the limb, or amputation, for once the microbe reaches the medulla (vital force slightly impaired) it will breed in the nervo-vital fluid and cause the disease. Spasm well broken, and microbicides administered, acro-nar- cotics, like belladonna, conium, might be tried. Inhalation of ether, chloroform, hypodermic injections, alka- loids of opium, chloral, are decidedly hurtful and likely to cause death. Infantile tetanus, or as they are sometimes termed, nine-day fits, occur in infants after birth, from cutting of the cord with scissors which had been on the ground or earth, or old linen rags, trichinous lard, etc. Great care is necessary to guard the new-born from cold, foul air, poisoned lard to skin, imperfect cleaning of sebaceous secretion, retention of the meconium. Cord should in all cases be properly cared for, never left in the hands of an ignorant nurse. Puerperal tetanus often makes its appearance during and subse- 64 10 lO DISEASE GERMS. quent to labor. Pressure of the fcetal head on the sacral plexus of nerves is said to be the common cause, true of an irritation transmitted to the medulla oblongata, but the disease is most common in spring and fall, when the accoucheur for pleasure is occasionally working in his garden or with his horse. Here we have all the symptoms of the disease; the peculiar germ-laden medulla ; the germ excreting ptomaines, the tetanine irritating motor nerves, which supply the muscles, causing rigid spasm. In our diagnosis it must not be confounded with ansemia or hyperaemia of the brain, which are very common. The mode of management here is to deliver quickly and pur- sue precisely the same treatment as one of general tetanus. The coagulation of blood in the heart or Thrombosis, blood vessels during life, is predisposed to by malaria, carbonaceous food and drinks, in- door life, sedentary habits, non-aeration of the blood, breathing deleterious gases, germ-laden air with sewage, pregnancy ; such drugs as ergot. The blood thick, clotty, is prone to attach itself to some neo- plasm, some calcareous body on its inner lining of the vessel, some atheroma, or some weakened or inflamed patch, or dilated vessel ; agents that will slow the heart's action, hasten the co- agulation. The nature of the clot is most variable ; the coagulated fibrine may fill the vessel, and the thrombosis may be uniform ; the blood may coagulate along the inner walls of the vessel only, flowing freely in its centre. When once formed it may organize or undergo shrinking, softening or suppuration. The symptoms will depend upon its location, the size of the vessel and the amount of clot ; for example, when the blood in the femoral vein is clotted it gives rise to phlegmasia dolens ; thrombosis of the cerebral vessels gives rise to special phrenic symptoms ; clotting of the blood in the vessels of the lower ex- tremities gives rise to anaemia, necrosis, hemorrhagic infarction, dry or moist gangrene. IVi the treatment of thrombosis, rest, abundance of fresh air, alkaline bathing, friction or massage, with stimulating liniments ; internally a judicious use of alkalies in alternation with belladonna and general treatment for embolism. Precautions. — As nearly all the new coal tar preparations, as exalgine, antipyrine, antifebrin, salol, etc., cause thrombosis, great care must be exercised in their administration. BACTERICIDES. [Oil In structure the tongue consists essentially of Tongue, muscular tissue covered by mucous membrane. The muscular fibres, omitting those of muscles inserted into the organ, are arranged in two horizontal and several verti- cal layers, the former set lying immediately underneath the mu- cous membrane, and the latter passing vertically from between the horizontal layers, leaving intervals which are occupied by gland structure. The mucous membrane is furnished with pa- pillae. I. The circumvallate, which are a dozen or so in number, and are arranged at the base of the tongue like an inverted V; these papillae are greatly concerned in taste, and are supplied by the glosso-pharyngeal nerve. 2. The fungiform ; these are scat- tered over the tongue, and are specially observed at the sides and tip. 3. The conical or filiform, are distributed all over the tongue. The tongue is divided into two symmetrical halves by a fibrous septum, the existence of which is marked by a raphe in the median line. Diseases, — Tongue-tie is a condition in which the fraenum, or fold, seen on the under surface, extends to the tip, and ap- pears to tie the organ down to the un- derlying structures ; its division, by means of a pair of blunt-pointed scissors, readily remedies the defect. Inflammation of the tongue (glossitis) may be caused by wounds, or stings, or by the application of some acrid substance ; occa- sionally it comes on without any apparent cause. If the symptoms are not peculiarly urgent — i. e., if there be no great pain or swelling, or threatening of occlusion of the fauces, a leech or two under the jaw, and a smart purgative, usually afford relief If the inflammation be very sudden, its pro- gress rapid, and suffocation threaten, then a few longitudinal incisions should be made on its surface to allow of the escape of fluids. In very severe cases, where these measures afford no relief, and the symptoms are very urgent, tracheotomy must be performed. Glossitis is sometimes brought on by the excessive use of mercury; the treatment in such cases consists of purga- tives, astringent lotions, and careful bandaging of the organ, and full doses of chlorate of potash internally. Ulceration. Ulcers of the tongue may have their origin from several causes, either from local irritation, such as decayed teeth, The upper surface of the tongue showing the papilla, and the dorsum on which disease germs localize. IQJ2 DISEASE GERMS. or from some derangement of the digestive organs, in fevers, or from syphilis, or from the prolonged and mal-administration of mercury. In all cases there is a marked foulness of breath. The constitutional treatment of course varies with the case, and re- moval of all obvious irritation, attention to the bowels, and lo- cally the application of a solid stick of lunar caustic, the sucking a few crystals of chlorate of potash, and in syphilitic ulceration, the application of a little calomel powder diluted with flour, are about the best remedies. Those connected with microbe of syph- ilis are the most intractable, and frequently defy all treatment. Malignant ulcers of the tongue are epithelial in their character, and their development is frequently ascribed to local irritation, such as a sharp stump of a tooth, the habit of smoking short clay pipes, etc., but such causes are very questionable. The margins of such ulcers are composed of hard granulating masses, impli- cating the substance of the tongue, and ultimately involving the glands at its base ; under the jaw and in the neck they are at- tended with great pain, and are usually deeply excavated. The prognosis in these cases is very unfavorable. The treatment is very unsatisfactory, and consists in removal as the only chance for the sufferer. Enlargement (hypertrophy) occurs in young persons, and is nearly always congenital. The tongue pro- Organisms found in the human mouth, trudcS frOm the mOUth, bcCOmCS almost invariably present. _ • i i i ulcerated from contact with the lower teeth, and there is a constant dribbling of saliva. The treatment consists in attention to the state of the digestive system, ban- daging the organ, and astringent lotions. In cases where this '-reatment is of no use, removal of a portion, or the whole of the protruded part, must be performed. Tumors in connection with the tongue are sometimes met with. Of the most frequent occurrence is ranula, to which a special article is devoted. (See Raniila.) Encysted tumors, closely resembling ranula, fatty tumors, and naevi. The ducts of the salivary glands, the parotid, and submaxil- lary, are sometimes the seats of concretions composed of phos- phate of lime and animal matter, oval in shape, of a brownish or yellowish color, and of variable size, sometimes being as large as a small ^^^. Occasionally they come away of their own accord by ulcerating through their confines, but their treatment consists in their removal by the knife and forceps. Wo?mds of the tongue almost always bleed very freely ; in slight cases, iced water, or styptics, will arrest the hemorrhage or occa- BACTERICIDES. 013 sionally a vessel may be tied, or pressure may be kept up by a pair of common forceps, the blades of which are kept together by an elastic band. The edges of a severe cut or laceration should be approximated with sutures. All pain, swelling, etc., should be allayed by iced drinks, and astringent and disinfecting gargles or washes. The tongue is a most valuable index of the state of the stom- ach, bowels, liver, kidneys, etc. In the mouth, but especially on the tongue, are to be found al- most every pathogenic microbe. By taking the mucus, or coat, and placing it under a micro- scope, we see the sarcincs ventriculi of gastric catarrh ; the bacillus of typhoid fever; the micrococcus of measles, scarlet fever and variola, are all 'to be found on the tongue. The bacillus of tubercle and amylobacta of rheumatic syphilis, cancer, are invariably found on the dor- sum or root of the organ. Even simple mal-assimilation can be detected in the myriads of bacteria and oidium albicans present. The physician of the future will not only tell that transverse cracks and fis- sures mean intestinal irritation from Different forms of the baciiius . , - , amylobacta found in the microbes or parasites, but what those momh and tongue in rheu- really are ; that elongated papillse at matism. root or edge, are the starved-out crepta syphilitica seeking nu- trition. The frequency with which bullous erythema and hydroa at- tack the mucous membrane of the mouth, especially the lower lip and cheek, is one of the characteristics of these diseases ; whether they ever also attack the mucous membrane of other parts of the alimentary canal is, I think, doubtful. No doubt, however, exists on this point with regard to pemphigus, for the disease not only attacks the mouth and vagina, but also the whole of the large bowel except the lower part of the rectum ; this has been placed beyond doubt, not only by general symp- toms and dysenteric diarrhea, but also by the results of post- mortem examination. (See Pemphigus). Urticaria is especially liable to attack the mucous membrane of the throat, producing sometimes most alarming symptoms, with great dyspnoea and difficulty in swallowing. Violent symptoms of gastric irritation are also not very uncommon in cases of acute urticaria. In our present state of microbial surroundings, the human I0I4 DISEASE GERMS. mouth should be kept aseptic by .washing it out with a few drops of the tincture of the soap tree bark, and dioxide of hydrogen ; or some anti-microbe powder, added to a little water; boro- glyceride also is excellent mouth wash. A very favorite anti- septic gargle consists of thymol ; benzoic acid ; eucalyptus, added to water. In quinsy, so called in various Tonsils, the forms of irritation of the tonsils, from abode of Pathogeniq inflammation to hypertrophy, there Microbes. is found in addition to the ordinary bacteria of mal-nutrition, the bacillus of tubercle and syphilis, the streptococcus of diphtheria, the mi- crococci of scarlatina and variola, a special pathogenic microbe of quinsy. Requires bactericides ; exalgine for fever. Chlorate of potash alone, or in combination with hydrochloric acid in the form of gargles, or taken internally, is so often disap- pointing in the treatment of enlarged tonsils that better means are desirable. The disease is of parasitic origin. Whilst the harmless, if not very active boroglyceride has pretty well dis- placed the chlorate in domestic practice. Then salicylic acid was used, and with excellent results when appHed judiciously. In the form of gargle it is least satisfactory, and often fails to reach the affected surface ; a spray of glucozone is better, but to use that effectually trained hands are needed. The best and simplest rnode is to apply the powdered acid directly by means of a rather large camel's hair pencil, which may be slightly moistened. In this way it is brought directly in contact with the diseased surface, and but {(t^^ applications are necessary. And it may be used with very young children after a little coaxing. When the tonsils are covered with a thick mucous coating, which may be diphtheritic, it is necessary to previously remove it, and the following liquid, to be also applied with a brush, acts extremely well : Pepsine, thirty grains ; dilute hydrochloric acid, one drachm ; water, five drachms ; glycerine, four drachms. The coating is quickly dissolved (digested) in this solution. Besides applying the acid locally, it is advisable to give it in- ternally .at the same time, thus : Salicylic acid, thirty grains ; mucilage of acacia, one ounce ; simple syrup, half an ounce ; water, four and one-half ounces. Mix. A tablespoonful every two hours. In the more chronic forms it is well to pencil the tonsils over BACTERICIDES. 015 with tannin, fifteen grains ; ozonized iodine, two drops ; glycer- ine, five drachms ; water, one pint ; or it may be used as a gargle still more diluted. For the prompt dispersal of threatened quinsy, apply with a brush three times a day, the following solution : Tannin, fifteen grains ; ozonized iodine, three drops ; carbolic acid, half a drachm , glycerine, five drachms ; water, two and one-half ounces. Invariably the result of disease germs, either Toothache, the microbe of dental caries, or the amylobacta of rheumatism, the former going for the body of the tooth, the latter for the fang. There are numerous others, one especially which forms lactic acid in a substratum containing sugar or starch. The salts of calcium in the sub- Do, ^ Sn •.-• \l /? Bacterium of dental caries. Bacterium of dental caries as seen in the dentine of spon- taneous caries; as seen in tissue-starved teeth from precocious brain evolution. stance of the tooth are dissolved by the excreted acid, and the micrococcus is thus constrained to force its way into the tooth ; as more and more of the calcium is used up in the tubuli of the dentine of the tooth and ultimately spreads through and destroys the tooth. ] The microbe of dental caries is due to a degradation of the dentine, predisposed to by a want of phosphates, in the blood and brain of tissue-starved precocious children, imperfect nutri- tion; the presence of heat and cold, and of sweets, with the for- mation lactic acid in and around the tooth, add to the progress of microbe growth. The microbe of dental caries is a polymorphic micrococcus, the chains and filaments being but different phases of the same 10 16 DISEASE GERMS. germ. Deposited in and around sound teeth, the germ will con- taminate the most healthy, and induces caries. The microbe bears culture well in beef tea and phosphates of lime, is pathogenic, for the injection of the germ into animals gives rise to caries of the teeth. The germ is sterilized by the microbe powder ; by soap tree bark and resorcin ; by peroxide of hydrogen. This term is used to designate a state of body Tubercular in which the tubercular bacilli is being con- Bacilli, stantly evolved in the blood. The disease germ tubercular bacilli is simply a change or an altera- tion, or degradation of the embryonic or primary elements of the blood. The precise method of degradation is unknown, but all states inimical to a high standard of vital force are productive of it. The primary cause is some inherent defect, or depreciation of the nerve centres, especially of that portion which presides over organic life and the elaboration of the blood, some adverse state either within the body or out of it, which causes the degradation of the primary molecule or cell into a disease germ, which when once formed is capable, either in the blood and tissues, or out of the body if in a nutrient menstruum, of a new and independent existence, with endless, nay prodigious power of reproduction to multiplication. The causes that bring about the defect of the nerve centres, this vital deterioration of the human race are very varied, races are distinct, therefore are incompatible, just like age and tempera- ment ; the use of alcohol and tobacco ; vaccination, isolation, monotony, or sameness; vice, immorality, debasing literature; deleterious trades, as factory labor; operatives in lead, phos- phorus, mercury ; masturbation ; drastic drugs ; meagre, un- wholesome and insufficient food ; insanitary surroundings ; ab- sence of sun light ; contaminated water, or water loaded with sewage ; drinking snow or ice water ; disease, or irritation in the body reflected to the nerve centres ; reflex emanation, or assimi- lation of morbid states; city life or overcrowding; immoral amusements. Observation and experience confirm the fact that the children, the product of two distinct, opposite antagonistic races are all tubercular ; individuals identical in temperament, the same in all physical and mental traits, are really consanguineous, and their union is equivalent to in-and-in breeding offspring highly tuber- cular. In a series of observations of the brains of drunkards. BACTERICIDES. IOI7 decided effect in depreciating tobacco users, monotonous, or isolated persons, there was noted a general coalescence or obliteration of typical fissures of thought, a state present in hereditary insanity, epilepsy, idiocy, and other low types of the human brain, the offspring of all such are tuber- cular, and notably of a brain type. Vaccination directly from the heifer, or drinking the milk of cows may convey the tuber- cular bacilli direct, as two-thirds of all domestic animals are loaded with this disease germ. The vitalizing effects of virtue and morality, the depreciating effects of vice and immoral literature, produce their reward : in the former, health ; in the latter, tiiberculce. The absence of sun- light ; the isolation of the sexes, solitary confinement, drinking water laden with disease germs; insanitary states and other de- fects of modern civilization have a vital force and causing tuberculcE. The children, or progeny of all operatives in lead, mercury, phos- phorus, tobacco, cotton and woolen factories are tubercular. The loss of important secretions, as in masturbation, render all the outcomes tubercular ; re- flected irritation operates keenly in children, such as teething, worms, gastric catarrh, every- thing that has a lowering, or levelling, or pruning influence may be enumerated as a cause. The tubercular bacilli as seen in the blood and during cultivation, consists of rods, occasion- ally long, very thin, and rounded at the ends. They are both straight or curved, and frequently beaded ; occur singly, in pairs or in bundles. They are found in the cells of tubercles, espe- cially in the interior of giant cells. Propagate by spore for- mation. A tubercle bacillus consists for the most part, ot a very deli- cate sheath, with protoplasmic contents which have a great ten- dency to be broken up, or coagulated into little segments or roundish granules. The best medium for cultivation is solid blood serum of cow or sheep, with or without the addition of gelatine. The most favorable temperature for their development is 98° F. They grow slowly in cold latitudes. The bacilli are found in all tubercular deposits of man, ani- mals, and birds. The bacilli can be detected in the sputum and excretions. Bacillus tuberculosis in the blood. IOi8 DISEASE GERMS. Strictly contagious and infectious ; food, such as milk, flesh- eating, inhalation, close contact ; the bacilli or their spores are inhaled from the air, or taken in with food, find ingress by the pulmonary or intestinal mucous membrane. Morphologically identical bacilli are seen in lupus, tabes, etc. The tubercular bacilli is pathogenic of all forms of tubercular disease, its inoculation into animals reproduces the diseases, and vice versa into man. Ptomaines excreted give rise to fever, diar- rhea, and other symptoms. Individuals having these microbes of tuberculae in their blood and tissues, can communicate it to all with whom they come in contact, that is, it is contagious and infectious ; this fact is indis- putable. When once this constitutional deterioration has been acquired, the peculiar type of deterioration can be transmitted to the off- spring, and thus become hereditary, as well as acquired. There can be little doubt from the peculiar characteristics of the tubercle bacilli in those affected with it, that not only the blood but the breath is germ-laden, and it is this breath which is the principal means of spreading the disease. Nearly seventy-five per cent, of all cows and other domestic animals are also tubercular, man imparts his germs to them and they to him by their breath, exhalations, milk and flesh. A human being may live along to a good old age, his blood and tissues loaded with the tubercular bacilli, with a very feeble vital force, and unless there be some local weakness, some par- tial death, the germ growth may not be apparent, but let some organ or gland be damaged or weakened, the germ will, by ex- osmosis, pass through the walls of the vessels, deposit itself in the devitalized part and grow with the greatest activity. In this manner, the bacilli of tubercle find their way in or on the mem- branes of the brain in infants, who have received falls, blows, shocks, giving us tubercular meningitis ; lesions of joints ; ivhite swelling; coxalgia ; an inherent weakness of bones due to starchy food and absence of phosphates, rickets ; a feeble mesen- tery, due to diarrhea or cholera infantum, the bacilli tuberculae will localize in the mesentery, giving rise to tabes mesenterica ; if living structure is feeble or damaged, microbes will localize there, giving rise to pulmonary consumption. Although this diathesis is extremely common, seventy-five out of every hundred being affected, there is no immunity or protection against it except to maintain the highest standard of health possible. Although it is essentially a most contagious malady, transmitted from parent to child, from husband to wife, blended and interwoven through society at large, still it is in- BACTERICIDES IOI9 capable of establishing a morbid race, which is an utter impossi- bility, the evil curing itself by non-procreation. When tubercle escapes from the blood through the walls of vessels that have lost their contractility, it appears under the microscope to consist of small round cells or cysts, imbedded in a cellulose membrane, and it can be seen growing like other germs by a proliferation from the walls of the nuclei. If the mother cell or cyst be squeezed lightly between two pieces of glass, so as to rupture it, in its contents can be detected millions of minute tubercles, their mode of life, progress, death, or de- generation depending upon their number, character of tissue, or structure in which they are effused, and the amount of partial death present in the part ; all influence or modify the progress and vitality of the germ. From the degraded cell or mother germ, the growth is by a budding or duplication, and when it dies, either from age, want of nutrition, or some adverse state, its albuminoid* contents become first milky, then cheesy, then calcareous, and in any of these three stages it may break down and be thrown off or absorbed. Its color may be influenced by particles of coloring matter in the air or food. Its ultimate de-. generation is phosphate of lime. Symptoms. — As these germs eat up the pabulum, the liquor sanguinis of the blood, there is always great debility, indigestion, torpid liver, defective pancreatic secretion, paleness and white- ness of the skin, general feebleness, with rapidity of pulse. The debility and loss of flesh are progressive, correspond with germ evolution, for as vital force grows more and more feeble, tuber- cle bacilli make a rapid growth, temperature rises. The devel- opment and growth of the microbe is favored by all and every condition which is inimical to a high standard of vitality. The part in which the bacilli are exosmosed from the blood, invari- ably suffers some depression. Generally there is a dryness of the hair, puffiness of the face ; swelling of the lips and nostrils ; purulent discharge from the ears ; vesicular eruptions about the head and orifices ; enlargement of tonsils, and glands of the neck, and throat; often fetid odors from the axillae, groin, feet ; en- gorgement of any gland with the bacilli will give rise to special symptoms of tubercular growth, fever, increased pulse, with some impediment of structure. If the blood is charged with those microbes, a migration into a weakened structure will take place at any period of life, although from three to fifteen, or from eighteen to thirty, are the critical periods, ages when the system can least resist depressing influences. The state of nervous bankruptcy, the blood germ-laden with the tubercular bacilli, does not seem to be antagonistic to high I020 DISEASE GERMS. intellectual culture, or gigantic mental attainments, but those possessing this diathesis are incapable of long, persevering efforts. To prevent the development and transmission of tuberculosis, no diseased person should be permitted to marry, and State en- actments should be made forbidding opposite races, or persons identical in temperament, from marrying. Great care taken of mothers, no drain or strain on their physical and intellectual resources, especially during pregnancy or lactation. Strictest attention paid to the infant's food, quality of milk, clothing, and air it breathes. Avoidance of all insanitary states, as bad venti- lation, ill-drained or damp houses. No tubercular mother should be permitted to nurse her child. An avoidance of all that tends to deteriorate, as sexual ex:cesses, bad food, or imperfect diges- tion. The diet should be of the best and blood-manufacturing ; dress, exercise, repose, and association, should be looked after; the function of skin and bowels to be aroused, the powers of di- gestion increased and everything done to increase brain vigor, correct faulty nutrition and promote the formation of healthy blood. As to the cure of tuberculosis, v/e would merely state, that all cases are curable before it has taken up a local habitation, except those cases due to a mixture of races ; for these there is no hope, as no sanitary arrangement, no amount of bathing, no kind or quality of food, no climate either on sea or land, and no known drug or method of trestment that can stamp it out — it is indelible. To cure it, we must resort to every means of restoring or building up vital force, and the germ must be annihilated in the blood, as no living disease-germ, can be eliminated. Digestion, assimilation and secretion merit our first attention. Daily bathing, using iodine freely in the water, temperature regulated by vital force of patient, followed by inunction of a few ouhces of olive oil into the body. Sleep should be prolonged to eight or nine hours, in harmony with the earth's magnetic law ; head of bed to north, foot to south, insulated by glass castors; clothing woolen, a good non-conductor and vitalizer. Diet varied, abundance of fresh, wholesome animal and vegetable food, embracing oatmeal, milk, cream, egg, boiled fish, beef, mutton, poultry, game, with abundance of bread and butter. As to location, one where there is an abundance of fresh air, pure water, and no insanitary surroundings ; free ventilation. Change is essential to a high grade of physical and mental vigor. The patient should be surrounded with a vitalizing, religious, and high moral atmosphere, and his reading, history or science. BACTERICIDES. J02i Medical agents to be used embrace two classes — one to strengthen, construct nerve power, restore lost vigor; the other to destroy a living disease-producing germ in the blood. The two classes of drugs should be administered alternately two or three hours apart, and changed weekly, as man becomes habitu- ated to any one drug long continued, it becomes in a great measure inoperative. Phthisis pulmonahs is due to Tubercular Bacilli in the tubercle bacilli depositing Lung Structure. itself either on the laryngeal (Pulmonary Consumption}) mucus, mucous membrane, or in the substance of the lung — the germ being a denizen in the blood prior to the lung damage which permitted its exudation. The tubercular diathesis must exist in the individual, either inherited or acquired. The typical form of depression of the nervous system v/hich gives rise to tuberculosis, to the degrada- tion of normal living matter or bioplasm into other living mat- ter, a disease germ is not yet fully elucidated ; suffice it to say that it is essentially a germ^ disease, and consequently is both contagious and infectious in the true sense of the term. Destructive changes in the lung may take place from other causes, other microbes, but their irritation there invariably modi- fies the nervous system reflexly, that the tubercular diathesis is created. In the glucose diathesis, and chronic alcohoHsm., states or conditions in which the blood and tissues are loaded with the sugar-fungus, the grape sugar so devitalizes or weakens the whole nervous system, besides irritating the large aerating sur- face of the lower lobe of the right lung, in the imperfect combus- tion of sugar, that an intense tubercular diathesis is created, and the bacilli of tubercle effused into the irritated lung, pulmonary tuberculosis is the result. Patient does not die from diabetes proper, but from the microbe-smitten lung. Again, in pneumonia, the pathogenitic micrococcus of that in- flammation, not being annihilated between the microbe in the blood, its irritating action in the crypts of the lung tissue, the imperfect aeration of blood due to the germ-smitten congested lung speedily creates a tubercular diathesis, and tubercle are thrown out alongside the pneumococcus, and a destructive mi- crobe eating process is set up. Perhaps from a lift or strain, or from the inhalation of irritating noxious gases, or other causes, a small blood vessel might rup- 022 DISEASE GERMS. ture in a healthy individual, the blood congealing in the air cells will irritate, depress, the nerve centres, normal living matter will be degraded into other living matter — tubercle ; this will become deposited around the clot, and a germ-eating process established, and so with foreign bodies, solid particles in various occupations of life, as miners, grinders, factory operatives. Besides, the dis- ease germs of cancer and syphilis often set up an irritation. These, of course, are accidental cases, to which we simply refer. I^^/One thing is necessary; there must be a typical state ot ner- vous depression, which gives rise, under adverse condi'tions to vitality, a degradation of normal bioplasm, into a disease germ, or that state must be inherited or acquired in some way. Once the bacilli tubercle are in the blood, then all that is necessary is some irritation either in the larynx, or bronchi, or in the substance of the lung; when this state of irritation or debility is produced, p*-> ; .pi y^j% ?igS -•4# . -3f r^»?% )' '";6.V> q w% % ■^M ^' y^-^° P 1) '"o 0, • \yl .■ W%f * i& '■i\ Acute tuberculosis, as seen around an air-cell. Acute tuberculosis. A small portion of the most exter- nal part of a yellow tuber- cle from the lung. a process very similar to inflammation is set up — congestion, ef- fusion in the weakened part; in the effusion there is the blood serum, lymph, and the bacilli. For the sake of convenience, it is well to divide pulmonary tu- berculosis into acute and chronic — the former when the bacilli are effused on the larynx or bronchi ; the latter when they are ef- fused into the substance of the lung. Acute phthisis pulmonalis commences suddenly, with slight rigors, fever, rapid pulse, dififlculty of breathing, cough, bleeding from the lungs, hoarseness, loss of voice, profuse sweating, diar- BACTERICIDES. 1023 rhea, rapid emaciation, tubercle being only effused on the bron- chial mucous membrane, called mucous or laryngeal phthisis. There is another rare acute form — lungs pretty clear, but mottled all over with tubercle, like grains of barley, chiefly in middle and lower lobe ; patient dies early in both forms from apparent ex- haustion. Chronic pulmonary phthisis. — This is a common form generally met with in the germ tubercle finding its way into the weak structure of the apex of the upper lobe of the left lung, spreading downwards on the apices of both lungs, and growing and effusing from above downwards. There is first effusion of tubercle in weakened structure, then growth, prodigious multiplication of germs, which soon interfere with passage of air into air-cells. Then nature desires to protect herself from the presence of those bodies; she excites less or more inflammation around them • Several alveoli are seen filled with debris ; in the centre of this are numerous nuclei, and amongst them the tubercle-bacilli. Tubercle-bac'lli interspersed through the lung structure. lymph is effused around the germ tubercle, and encloses or en- cysts it; and between the disease-germ and inflammatory pro- ducts, the lung becomes solidified in its substance, and does not permit ingress of air. After an indefinite period the germ dies, yields to the influence of adverse conditions, and is expectorated or absorbed either in its albuminoid, milky, or cheesy state, leav- ing a cavity in the lung. In more rare cases there -may be de- posit of tubercle in the middle of a lobe ; it may grow by aggre- gating other germs, or of its own innate property, and form a mass albuminoid, milky, cheesy, and finally calcareous, and break down and be expectorated, leaving a vacuum, cavity or cavern in the lung ; the formation of such a cavity is called a vomica. The germs of tubercle may be deposited in the nerve centres, sub- mucous coat of stomach and bowels, in mesenteric glands, liver, and kidneys. 1024 DISEASE GERMS. The predisposing cause of pulmonary consumption is tht presence of tubercle in the blood ; the exciting cause is some irritation, as cold, damp, dust, foreign bodies, mechanical strains, lifts — any thing we can imagine that would weaken the vital ca- pacity of the bronchial mucous membrane or lung substance. Symptoms. — Languor, lassitude, debility, with increased heat ; respirations and pulse ninety to one hundred ; emaciation, pro- tuberant eye balls, clubbed nails, loss of hair ; cough at first dry, subsequently expectoration, difficulty of breathing, haemoptysis or spitting of blood, night sweats, hectic flush on cheeks, burning sensation in hands and feet, indigestion, loss of appetite, loathing of fatty articles, weakness of voice, hoarseness or loss of voice; a festooned appearance at reflected edge of gums, often diarrhea ; often a dull, aching pain in shoulder blades. The increase of heat and wasting bear a direct ratio to the germ growth and de- posit. When tubercle is deposited in the sub-mucous tissue of the bronchi, or on its free surface, symptoms are greatly aggra- vated, and bleeding from the lungs more common ; often slight congestion of liver and kidneys, so that urine often contains sugar or albumen. In women, cessation of the uterine function is common. As the case progresses, the debility, wasting, sweats, and other symptoms become worse and daily more marked. Di- arrhea, at first due to altered or acid secretions, is now dependent on the germs in the coats of bowels, and to ulceration about ilium and colon ; aphthae about mouth and the fauces ; tender- ness and oedema of extremities ; mental faculties usually remain clear until death. Now all the above symptoms are easily explained by the pres- ence of a disease-germ in that fluid. This germ may have lain quiescent for many years in the blood, ready to spring into activ- ity the moment conditions favorable for its growth should take place, and the pabulum adapte'd for its nutrition should be at hand. It is also true that if a high standard of health could be maintained by the affected individual, the germs would undoubt- edly die out. The tubercular germ in a state of activity uses up in its own nutrition, growth, and development the vital elements of the blood and tissues. The microbe wedged into a nook or corner, as seen in this illustration, after a time dies or else goes through various forms of transition, caseous, calcareous and then expectorated, leaves a cavity or vomica, as seen in this diagram. In some cases, where the vital forces are greatly shattered and the bacillus is making extremely rapid growth, the work or energy of the germ is so efficient as to make nests for the spores. BACTERICIDES. 02$ The occupation of a patient, especially if there be dust inhaled, gives a coloring to the lung, the microbe and sputum are colored. This illustration shows the coal dust of the miner. T/ze predisposing causes of pulmonary tuberculosis are the presence of the bacilli, and there must exist in all cases a local weakness, which forms a predis- position, or germ bed ; this predisposi- tion is an impairment of the vital force of the part ; a state which favors germ growth. The soil in which the germs are implanted exert some influence on their growth. In all cases of pulmonary phthisis the quantity of germs on which the disease starts with is never very large, the vital tonicity of lung retards their growth, whereas if the lungs are weak they grow prodigiously fast. Every human being must have either inhaled the microbe tubercle from his fellow-man or swallowed it in milk or other food, and the reason we are not all affected is simply the fact that our vital force is good, we Miners' phthisis, with melanotic matter interspersed through- out the lung. Cavitities, or vomica in the limg, made by the tuber- cular bacilli ; showing lung structure eaten out. Diagram of infarction of lung tis-ue with tubercular bacilli. Nests of tuberc'e bacilli in the lung; acute form of phthisis pulmonalis. have not a suitable patch of weakness for their settlement and growth ; a lack of resisting power, with a local weakness, enables the microbe to thrive. The exciting causes are irritation of all kinds, cold, wet, inhala- tion of noxious gases, dust, mechanical violence. The effects of the presence of this microbe in the blood and in the respiratory tract are to eat up for its own nutrition all the vital elements of being ; the germ is pathogenetic, its tendency is ta destructive metamorphosis in lung tissue, and like all other disease germs the bacillus itself secretes a special ferment, which by certain changes gives rise to morbid action ; a cadaveric alka- loid whose very presence gives rise to volcanic disturbance, fever, diarrhea, sweats, etc. It is this alkaloid which is excreted by the tubercular bacilli.^ 65 1026 DISEASE GERMS. which gives rise to very many of the symptoms of fever, hectic, diarrhea, sweats. The ptomaine of the tubercular bacilli is peculiar in its toxical effects. Morbid Anatomy. — Human beings and domestic animals in a state of normal existence placed in or under states adverse to the maintenance of a high standard of health have the primary elements of th- ir blood altered, changed, degraded into the disease germ tubercle, which floats in the circulation and passes by exosmosis through the walls of the bipod vessels in weakened parts of the body. From this germ-laden blood it is thrown out or passes through in an albuminoid form, as seen in the annexed cut, aggregated together in round masses by the law of affinity, and goes through a process of fecundation, growth and death — being first albuminous, then cheesy, latterly calcareous. When those degraded ele- ments are in the blood they are capable of pas-ing out of the body by the breath, saliva, sweat, urine and alvine evacuations and propagate the disease tuberculosis, (fP li'^^^P^^^ ® & by contHgion and infection; besides **3 ©k;t3^i^^^iM^a ftA fatheis and mothers having this diathesis can transmit it to their offspring. Whether the evolution of this microbe in the human blood of 80 per cent, of our people in large cities be due to incompati- bility of temperament, or to meagre, adulterated or deleterious food, or insani- tary states or surroundings, to the abstnce of sunh'ght, or hygiene, to isolation, monotony, deleterious trades or deba>ing habits, use of alcohol, drugs, disease, poverty of nerve force, we are not going to discuss. Sufficient it is, an adverse state being brought about wears out the vital force and evolves the germs and soon becomes a pilpable reality in a depreciation of the human stock Fe^rble vital force, degraded elementary molecules into the bacilli of the tubercle, a disease germ floating in that life-giving fluid, sooner or later gives a manifestation of speciil disease in a loss of strength an el flesh, in a protuberant eyeball, clubbed nails, night sweats, which are exhausti ig ; as the exudation is the serum of the blood, rich in phosphates and chlorides, there is a ■failure in the lymph canals and pink marrow to raise the standard of the blood, and the organism becomes still further impoverished. The bacill BACTERICIDES. 1027 Persons who lose flesh or lose tone should not procrastinate an hour, should not wait for nitill, caseous. After the preliminary exos- mosis, the tubercle consolidates itself, and if the defective nutri- tion of the lung is not t Section of the lung sHmu,,,- the ravages of the germ, with the bacilli encysted. )0 great the baci ^7 - -i 's^' 3 xm li becomes encysted in a fibrillated net work and microscopically has the appearance as in the annexed dia- i These again, are the especial seat of the tubercle bacilli. May not the bacilli have something to do with the degeneration ? How do the bacilli act in producing a tubercle? It cannot be merely a mechan- ical action ; I con- , , 1 • , w ^'^^^ ^^ ""'O'^t proba- bly a chemical one. You see in the above diao-ram a dark central ma^s ; a mass of micrococci; a clear ring'' around and then, beyond, an inflammatory ring. The course of events is 6i, -^-:^sr^^O Another pe. im-n of the micohf rein.*rkat)ie gr.wth of the gen ;!•- ', -Ivnving the cakciicd liiigs. I028 DISEASE GERMS. clear; the micrococci, growing in mass, have produced a poison which has killed the tissue around, but further away has been more dilute, and has there set up inflammation. I need not enter into the details. Now, I conceive the state of matters in phthisis to be the following ; and, of course, the view as to caseation applies to tubercles anywhere. Bacilli are inhaled into the air- cells of a lung which is in a fit state, whether by predisposition or otherwise, for their growth. They at once attack the epithelial cells, and in the first instance, cause their hypertrophy and mul- tiplication. The bacilli growing in these cells produce poisonous chemical substances, and the cell, which, in the first instance, was stimulated to increased growth by a small quantity of the poison, soon succumbs to the increasing amount, and undergoes casea- tion. Some cells, or groups of cells, are, however, stronger than the others, and go on growing, so as to form giant- cells. These, generally, also ultimately succumb, though in some instances they may get the upper hand, and the bacilli may disappear. While this is going on, inflammation occurs around, and the pro- cess creeps from air-cell to air-cell. I believe, also, that this view of the production of a poisonous substance by the bacilli may explain the fever and wasting of phthisis. The pathology of piilmonayy tuberculosis. — The tubercle bacilli consists of several round cells or cysts, in a cellular membrane floating in the blood, ready the moment any weakness takes place in an organ or tissue of being effused, with other products. Once a local lesion is established, a state of vital depression pro- duced, the germ thrown out from the blood, countless millions of the microscopical progeny of the bacilli in the mother cyst or cell, penetrate its walls, hatch out, grow, multiply, and undergo a process of degeneration and death. Tubercle differs from all oth^r germinal matter in its process of death ; when effused by exosmosis through the walls of the blood vessels, it is an albu- minoid body, no effort at repair, they become milky, then cheesy, and latterly ?:n inorganic body, phosphate of lime. // is a well attested jact that the living germs of tubercle, though weighty, leave the body of the infected by the breath, sweat, u ine, stool, and are carried from individual to individual. This living contagion is to be more dreaded in our country than in any other, because we live among mixed races of men, distinct in certain great characteristics of being, and the passage of a dis- ease germ from race to race increases its virulence or activity. All domestic animals who are the victims of adverse states, inimical to their vitality, as overcrowding, insanitary conditions, meagre or poor food, exposure, have their normal bioplasm de- graded into the microbe " tubercle,'* which passes to the human BACTERICIDES. 1029 race by close contact, and gives rise to a virulent form of tuber- culosis. The bacillary origin of phthisis is now very generally acknowl- edged. A proof of such origin is furnished by inoculation, but it has been recently still further established, especially by the experiments of Cornet, that the disease — at all events in certain animals, as guinea-pigs — may be produced simply by the inhala- tion of the dried dust of the sputa. Now the fact that the dis- ease may be communicated in this manner is of immense prac- tical importance, for while, on the one hand, it proves the extreme danger of such a mode of introduction, on the other it indicates the measures and precautions which should be adopted to reduce that danger to a minimum. It is, of course, where the expecto- ration most abounds, and where it is most liable to become dried, that the danger is greatest — as in the rooms, hotels, and hospitals occupied by consumptives. Again, it has been experimentally shown that but little if any danger is to be apprehended from the inhalation of the breath of the phthisical, or of the air of streets, towns and promenades frequented by them. In the first place, the expired air has been found to be free from bacilli ; and, in the second, although the sputa may be expecto- rated on the ground, etc., the dried particles or dust of these quickly become dispersed and scattered through the air to such an extent as to be rendered practically harmless. Moist and freshly expectorated sputa consist in great part of water, and when dried become not only very light but very friable, so as to be easily broken up into dust and so scattered about by slight currents of air. The rate of drying depends not only on the temperature and state of humidity of the air, but also on the nature of the material on which the sputa fall. Thus, if they come into con- tact with any absorbent material, such as carpets and pocket- handkerchiefs, they quickly dry in consequence of the with- drawal of the water by capillary attraction. Hence, the great danger which arises from expectorating into handkerchiefs. Etiology. — When tuberculosis is either created or acquired, that is when some adverse condition exists; the peculiar de- Diagram of the dead germ undergoing calcareous degeneration ; the cheesy, cretaceous, chalky material into which the dead germs merge are very generally encapsulated. I030 DISEASE GERMS. pression of vital force, under which the germ tubercle is evolved, and is freely elaborated in the body, or vital force being some- what feeble, the germs from another infected body find ingress into the body and blood, and there bre^J in the lymph spaces, every structure in the entire body becomes changed, weakened, deficient in viral force. The tubercular bacillus eats up for its own nutrition, the vital elements of being, the blood, brain, all the important accessories of life are poverty-struck. The hair is dry, like tow, the .>>kin thin, muscles soft arid flabby; bones deficient in phosphates; secretions sluggish, acidity and dyspepsia; general impairment ^'if Y m'^A. 2) Tii'ienle b u illi ftoin phthisicl spu- tum ; A, i.-ol.itcd Liicilli ; B. groups of ihe same ; ihc uii>t.nntu gi..iiiilar clei'ris '.f t..iiN coi puselc.> ami mucus are seen taiiiily at C, D. x 500. Thr microbe of syphilis a^ .seen in the inter-cnrpuscular spices, irom the blood of an affected individual, i^co diameters. of the nervous system. Even the marrow of the bones is eaten up by the microbe. T/ie diagnosis or recognition of tins micro-organism in the blood tissues^ and Inng : The recognition or diagnosis of tuberculosis is not altogether dependent on tlie symptoms we have enumerated; we have the remarkable appearance of the skin, loss of hair, hectic fever, cough, hemorrhage, consolidation of lung; or, if upon the bron- chi, loss of voice, general nervous bankruptcy, with ihe' presence of an excessive amount of phosphates and chlorides in the urine. The microscopical examination of the sputum and blood is never failin'^ in a diagnostic point. The faeces are valuable in the lat- ter stages, when the rectum becomes germ-eaten. Sputum. — Human tubercular sputum is infallible in diagnosis, BACTERICIDES. lOjI as the germ retains all its virulent characteristics, even when dried. The germs in the sputum will bear cultivation well, will even isolate and clear themselves of all extraneous matter. Pure bacilli, from their original breeding ground, introduced into some nutrient medium, will produce their characteii^tic offspring. Physical Signs. — If the tubercular bacilli be deposited or^ the larynx and bronchi, the lungs on percussion may be clear from apex to base, but shortness of breath, loss cf voice, and haemop- tysis, will be predominant. If the bacilli have been effused in the substance of the lung, probably the apex of the left, or both lefc and right, beginning at the top aid proceeding downwards; if consolidation is not perfect, feeble or harsh respiratory mur- murs may be detected, audible and prolonged ; perhaps a faint crepitus, or dry crackling ; if the germ deposit is heavy, flatten- The bacillus of tubercle in the spuium ot phihi.>ical patitnts. Tubercular bacilli as seen in the sputum, mag- nified 750 diameters. in£f of the ribs and lack of intercostal movement. The dulness on percussion is decided, and as germ deposit progresses, chest movement becomes more deficient. As tubercles die and are be- ing expectorated, large and small crepitation ; if tubercle has eaten away lung substance, there will be a sinking in, a retrac- tion of the intercostal spaces, and there will be an unusual clear- ness on percussion. The respiration will be cavernous, 'as com- ing from an empty cavity. It must always be born in mind that there exists in nearly all cases of hepatic disease, dulness of the apex of the right, passive congestion without tubercle. As a general rule, tubercle de- posits itself in the apex, and proceeds davvnwards ; whereas, nflammation begins at the base and proceeds up ; tuberc.e may I032 DISEASE GERMS. be deposited at the base, in conjunction with the germs of pneu- monia, or the sugar fungus of chronic alcoholism or diabetes. Tubercle may be deposited in a weakened patch in the centre of a lobe ; germ growth may be active or slow, it spreads in every direction forming a round mass, breaks down, is expecto- rated, leaving a cavern or vomica in the lung, as seen in the Illustrating the advent of the The tubercle bacilli, having finished its career, has tubercular bacilli in the left a cavity or vomica in the substance of the apex of the lung in the fii st lung, stage of pulmonary tuber- culosis. annexed diagram which illustrates a cavity in the centre of the middle lobe of the right lung. Germ is effused from a weak point in its centre, they multiply rapidly and form a large patch ; often increase in size by peripheral disintegration, or there might be several small colonies in the lobe, they might coalesce and form one large, irregular mass, which proceeds through the usual metamorphosis, albuminoid, milky, caseous, and phosphate of lime ; this latter breaks down, is expectorated, forming an ex- cavation, a cavern or vomica. When a cavity forms, the tissues around become indurated, resisting, the cavity itself contains air, and a grumous purulent fluid of a yellow or greenish color. As a rule, cavities are quiescent, and frequently contract by an ap- proximation of their walls. Often before there is any appreciable lesion in the lungs, the following signs give a warning note and tell of the threatened mischief, and before there has been any deposit of tubercles that can be detected : stoop ; anemia ; arthritis ; micrococci ; hoarse- ness ; hectic flush; sore throat; bad breath; rapid pulse; haemoptysis ; amenorrhcea ; family history ; red line on gums ; rheumatoid pains; pityriasis versicolor; weak, tired feeling; shortness of breath ; acromial depression ; prolonged expiration ; hacking night-cough ; cog-wheeled breathing ; thin ear, nostril, and lip; harsh vesicular murmur; congestion of vocal chords ; brilliancy of eyes ; general feeling of apprehension ; curved nails ; BACTERICIDES. 033 ■clubbed finger-ends ; emaciation, while appetite is good ; con- stant high evening temperature ; insufficient expansion of the side to be affected. It is customary to divide the presence of tubercle in the sub- stance of the lung, into stages: (i.) effusion of tubercle; (3.) perfect consolidation of lung substance from tubercular deposit or growth, or both; (3.) death, or breaking-down of the microbic mass. Often numerous complications exist, as asthma, bronchitis, pleurisy. It is impossible to speak correctly of its duration, the laryn- geal or bronchial form is rapidly fatal, unless extremely well managed ; when the microbe is in the substance of the lung, it is essentially chronic, admits of retardation, and very frequently a cure by germicidal remedies. Prophylactic measures. — In a state of perfect health, man is proof against all micro-organisms; he is proof against the degra- dation of his own living matter into microbes ; proof against their ingress in any form ; if it were not so we would rapidly fall victims to this bacilli, which we are inhaling at all hours with impunity. If we are susceptible to the ingress of a germ, we can also be rendered proof against it by maintaining the highest standard of health possible. To increase vital force, we must ward off all agents within and Avithout which lower it; change, avoidance of monotony or sameness, is essential to a high grade of vitality ; insanitary con- ditions avoided ; and all things which are calculated to weaken the human mind. Treatment. — This embraces three essential points; (i.) every possible means to maintain and restore vital force ; (2.) the use •of remedies to palliate the prominent symptoms, and (3.) the use of germicides to destroy the microbe, the factor of disease, (i.) Every possible means should be resorted to acquire increased vital force ; to improve the general well-being of the affected ; every comfort within reach should be supplied, his or her sur- roundings should be looked after, the body should be sponged off morning and night, well dried ; massage from a highly vital- ized nurse, the clothing should be flannel next the skin, other- wise woolen. A climate in which ozone abounds is the most beneficial, as the sea shore, high, dry altitudes in summer, while the city probably in the winter is the best ; gentle open-air ex- ercise, never to fatigue. The sleeping apartments well venti- lated. The diet should be very varied, nutritious, and consist as much as possible of articles rich in blood elements ; the most 1034 DISEASE GERMS. nutritious, animal and vegetable, with abundance of ripe fruits ; if stomach fails to digest, follow with ptpsine; warm milk from the cow drank before the vital elements escape, cream, raw eggs. Tonics aie indiccted, as phosphated tincture of oats, quinine wine, comp. matiicaiia, to build up and promote an appetite. Remedies to palliate prominent symptoms. If wasting be a prev^ailing and persistent symptom, germs active, metamorphosis great, try inunction of warm olive oil into the body at bedtime ; extract of malt, brandy and cream to arrest excessive waste by sterilizing germs ; sterilized malted milk. If there be fever, increased heat, respirations, pulse, try either antipyrine, or tincture of aconite, strophanthus; comp. syrup of tolu and resorcin. If there be great acidity, indigestion, try comp. tincture cin- chona and mineral acids; aromatic sulphuric acid, and quinine; American columbo ; comp. tine, matricaria, papoid, triturated with bicarbonate of soda. Jf there be diarrhea, and this most exhausting, it must be arrested at once by administering a piil of equal parts of tannin and pulverized opium, one grain of each after every motion of the bowels, when they exceed one per day. As this diarrhea usually depends upon a migration of the microbes to the mucous coat of the bowels, and as the rectum is literally miciobe-eaten, completely riddled, it will be essential to place the patient upon the great intestinal vitalizer, the Virginia stone-crop, and alternate that with fifteen-grain doses of resorcin. In nearly every case this will kill the tubercular bacilli in the bowels and the stone-crop restores and heals the ulcers, naphtha- line, creolin, salol, should have a trial. If there be Jicsmoptysis, or bleeding from the lungs, try first either strophanthus or digitalis, erigeron, gallic acid; spirits of turpentine, sulphuric acid and alcohol. The patient is usually seen after the first burst of hemorrhage ; and if the bleeding continue after quiet is secured, astringents may be found useful. Gallic acid is believed to be one of the best of them, but it must be given in large doses of twenty grains. The most effective remedy, however, we believe, is the hypo- dermic injection of ergotin. This will often arrest the bleeding at once, when other means fail. Inhalation by the atomizer of a solution of sub-sulphate of iron will often act almost magically. Unless, however, active bleeding is going on, we may be content to give nitro-muriatic acid and ipecacuanha, the acid serving, we fancy, to give tone to the relaxed vessels which have yielded the blood. BACTERICIDES. 1035 The subsequent treatment of these cases requires the greatest care, and may be rewarded with briih'ant results ; for they are cases in which the disease is often in the smallest sense constitu- tional, and therefore in which recovery is always to be hoped for, while in no kind of condition is neglect attended with more un- fortunate results than in haemoptysis. If there be night siveats, try either aromatic sulphuric acid and quinine, or atropia, agaric. To relieve coiigJi, renelcr expectoration easy, try first ozonized tar syrup; if that fa-Is then use either pfunia, or mixtures of syrup of senega, squills, ipecac, tolu, lobelia, marshmallow, slippery elm, flaxseed tea and lemon juice, raw eggs and salt, syrup of poppies, with chloride of ammonia. A mixture of aconite, belladonna and camomile; compound oxygen. If expectoration be excessive, inhalations of either carbolic acid or turpentine, or terebene ; or beech creosote combined with com- pound syrup of tolu, which is so very effectual in destroying laryngeal and lung microbes. To rid the system of dead germs, compound saxifraga; small doses of iodol. To relieve Jiectic^ phosphated tincture of oats, glycerite of kephaline, aromatic sulphuric acid, chlorine water, salol, naphtha'ine. As the hectic is due to ptomaine poisoning the remedy to get rid of hectic must be a powerful bactericide. To procure long-cojitinued refreshing sleep, try first sulphonal ; that falling, then either of the following remedies; cnloralamid in thirty to forty-grain doses. 3. 77?^ most important class of remedies in the treatment of pul- monary tuberculosis are germicides, locally over the germ- smitten lung; by inhalation; bv the stomach and rectum. (a) Local germicidal applications to the chest are of great effi- cacy, the remedy acting as a local vitalizer ; by endosmosis ; as a stimulant. They should be applied over the germ-laden or eaten part. The common tar plaster, made of lobelia, bloodroot, capsi- cum, Indian turnip, mandrake, stimulates, raises the standard ot vitality, promotes absorption, sterilizes germs. Ozone ointment, iodol, resorcin, added, make a splendid germicidal application;- chloroform, in which benzoic acid, thymol, and other antiseptics are incorporated, is of great efficacy in 'the annihilation of mi- crobes. Painting over the seat of consolidation nightly with con. ozone, and when the skin assumes an erythematous blush, sprinkle over it iodol, and keep re-applying. (b) Tuberculosis being infectious and contagious, many 1036 DISEASE GERMS. germs emanate from the body by the breath, and the propriety of disinfecting the bronchial tract and killing those microbes can- not be doubted. The fever of pulmonary tuberculosis is due to the germ, to its protoplasmic changes, and the respiring volatile antiseptics, as the nascent chloride of ammonia, is attended with most salutary results ; or such formulas as iodol, resorcin, naph- thaline, distillation of the pine, comp. oxygen, ozonized iodine. The inhalation of these agents either sterilizes or destroys the germ, and an appreciable improvement is at once visible. An ordinary steam atomizer is the most available mode of using any of the above remedies. (c) Germicides introduced into the stomach pass into the circu- lation, and coming in contact with the bacilli in the blood, de- stroy it. We will enurherate a few of the most efficient. When used, one might be administered one week, then another, and two or three selected from which the best results are obtained. Glycerite of ozone, in doses of from twenty to thirty drops, added to a little water, three times daily, is one of the best, most active, of all germicides — it is the best because it has a chemical affinity to the bacilli tubercle ; it seeks it out and kills it. While doing this it imparts oxygen to the blood and tissues. Besides, it is nature's great scavenger to diseased blood, destructive to all micro-organisms, while at the same time it is highly vitalizing to the blood. It is a good plan while administering this remedy for the anni- hilation of the microbe, to administer very small doses of the ozonized tar syrup, to cause the dead germs to be freely expecto- rated. Comp. oxygen is another remedy which might be tried with advantage, especially in cases of laryngeal or bronchial cases ; can be given internally, used as a mouth and throat gargle, and in the inhaler. Chloride of lime, in doses of three or four grains, triturated in sugar of milk, and added to a teaspoonful of glycerine, taken after meals, has great efficacy in destroying the germs, arresting the night sweats, healing pulmonary lesions. Hypophosphite of potassa, in five grain doses, thrice daily, ad- ministered in meat juice, often operates well in killing the germs. Carbolic acid, in this form, is of utility ; say, carbolic acid, tincture of iodine, muriatic acid, of each, two drachms, rubbed up in sugar of milk; then add to one ounce of alcohol. Mix well, and add to fifteen ounces of water. Dose, one teaspoonful every two hours. Creosote is, in some cases, invaluable. BACTERICIDES. losr A few years back creosote was a widely advertised remedy in consumption, used by inhalation. After a season the use of it fell into the shade. Perhaps too much was expected of it, as is so often the case when new or novel remedial agents are first brought into notice. Of the value of creosote in the treatment of consumption by inhalation I have some experience, though limited, yet it is of fairly decisive kind. Two cases of confirmed phthisis, I am pretty sure, have been cured by using the steam atomizer with creosote. For one sitting of half hour, twenty drops of creosote, dissolved in a tablespoonful of alcohol, this was added to two fluid ounces of water and atomized. The patient breathed a dense fog of atomized creosote water during the time. A small apartment six and one-half feet square and seven feet high was extemporized by placing four screens in form of a square, and covered over at top by another ; the screens were made of slats, like a sash frame, and thick cloth of cotton was tacked over each ; the outside of this cloth was given several coatings of boiled starch, in which a little glue was dissolved. This served to make it somewhat light. In this little apartment was placed a small table and a chair. Air entered, of course, throughout all the cracks and crevices. The treatment was re- peated twice, sometimes thrice a day. The time extended over six months. The effect of the treatment was first a speedy betterment of the bronchitis and purulency of the expectorations. After two weeks the fever was much milder, and in a month the night sweats, hectic, and cough were both under certain and positive control, so much so that they hardly troubled the patient. After six weeks they were gone. The appetite soon became better, digestion gradually improved. Among the troublesome symptoms that worried the patient grievously before commencing treatment, were fermentation of the food in the stomach, caused, no doubt, by gastric catarrh, a trouble I find quite constant among consumptives in this climate. Another symptom was dumb chills that seemed to come on every day or two, accompanied by lowness of spirits ; these chills were followed by a slow fever that lasted the entire day, and termi- nated at night in an exhaustive sweat. All these symptoms dis- appear under creosote inhalations. The internal use of creosote is efficacious, best given thus : creosote, one drachm ; tinctures of elecampane and spikenard, of each, four ounces ; tincture of cap- sicum, one ounce. Mix. One teaspoonful every three hours, and increase it to one every two hours. It makes an excellent change for a week at a time, from the glycerite of ozone. We enumerate a few bactericides used by some physicians. 1038 DISEASE GERMSJ The only successful remedies are of the germicide class, as glycerite of ozone, creosote, guaicol, and oil of black mustard. The bacteriologists have made numerous celebrated experi- ments with this agent, and found it to rank next to dioxide of hydrogen. The oil of black mustard prevents the development of bacteria, and destroys them. The initial dose must be small, as It is somewhat irritating. Its administration destroys the ba- cilli of tubercle, lowers temperature,- slows the pulse, and retards perspiration. It must be highly diluted, and administered at regular intervals, keeping up a feeling of warmth over chest and abdomen. If properly given, there is an improvement all the time, without an exception; reduces cough and expectoration; arrests night sweats; and exhibits a marked diminution of the bacilli in the sputum. Ozonized iodine, in very small doses, added to a little water, has been most successfully used in both lung and laryngeal tuberculosis, with most beneficial results. Same remedy by inhalation. Its use causes the tubercular bacilli to disappear from the sputum. lodol alone is an excellent local remedy. Ulcerations in the inter-arytenoid re^^ion have cleansed and healed up completely, and the characteristic arytenoid oedema diminished under its influence. Tuberculous ulcerations of the epiglottis and pharynx have benefited by it and been arrested, and the distressing pains on deglutition, which accompany this condi ion, are much relieved by iodol. In some patients, in whom solid food was entirely interdicted by reason of the pain on swal- lowing, deglutition has become comparatively easy, under daily laryngeal insufflations of iodol. If the iodol is carefully and accu- rately applied over the ulcerations it will completely heal them. I hive cases now under treatment in which there was oiiginally extensive laryngeal ulceration, but in which now all active mis- chief is arrested. Iodol remarkably diminishes the cough of this conlition. It is not to be supposed, of course, that insufflations of iodol, or of any other substance, will cure extensive phthisical disease of the larynx, but they will certainly arrest ulceration, relieve pain and cough, and allow the patient comparative com- fort. The iodol remains for a long time in contact with an ulcer- ated surface. Sprays of glucozone are most effectual and salutary combined wiHi any form of iodine treatment. Terebene.five to ten drops on sugar every two or three hours ; or terpin hydrate in two-grain doses, often works marvellous re- sults in pulmonary tuberculosis. Sulphurous acid, fumes or in water, is an excellent bactericide BACTERICIDES. IO3Q The bacillus tubercule locab'zing^ Tubercular Bacilli itself in the nasal fossa, which may in the Nasal Fossa, breed and run through its different stages of growth and death. Etiology. — This affection is extremely rare, and is correlated with the presence of tubercles in the lungs or other organs. The symptoms diVQ chiefly those of coryz i ; but recognition o\ the affec- tion depends on rhino^copic examination. Tubercles varying in size from a grain of millet to one of wheat, and yellow in color, may be seen as isolated masses, chiefly on the septum, and tur- binated bones. As elsewhere, the tubercles may soften and leave an ob-tinate form of ulcer. The surrounding mucous mem- brane will be more or less tumefied, and covered with purulent secretion. The prognosis is necessarily bad, and similar to that of tuber- cles elsewhere. The diagnosis is founded on the appearance of the ulcers and the presence of other phthisical symptoms, the history and progress of the case being tiki^n into account. The microscope will also give valuable aid. not only by showing the formation of the growth, but also by demonsrating the existence or otherwise of the special bacillus of tubercl*". The treatment must necessarily be palliative, and will consist of detergent irrigations, ozone et chlorine, chloride of gold and Hydrastis canadensis, followed, if necessary, by excision, scraping, or burning of the nodes with the galvanic cautery, the use of nitrate of silver and insufflations of iodoform with or without morphia. All operative interference will be aided by a preliminary applica- tion of cocaine. General treatment for tuberculosis pushed with energy. Weakened throat and larynx, affords Tubercular Bacilli a suitable nidus for the deposit, growth on the Larynx. and settlement for the bacillu--. {Laryngeal P/u/usis) The bacilli may be deoosited at a portion of the lung ; e. g., the apex ; ill supplied with blood and air. or in altered pulmonary tissue, the result of acute inflammation, a^ at the base. Larynx. — Bacilli ma\' be carried into the general circulation by the lymphatic system, or. in the case of cavities, may be con- veyed to the larynx by means of the sputa. The former, since it, does not involve a previous breach of surface, is the most proba- ble route in the commoner f )rms of laryngeal tuberculosis. The tuberculous process is manifested in the larynx, as in the [040 DISEASE GERMS. lungs, in two ways : first, as the result of anaemia, in which case the marginal and apical regions are primarily attacked ; secondly,, as the result of an inflammation frequently induced by functional abuse, in which case the vocal chords and ventricular bands are situations in which the disease is not infrequently first manifested. Erosions, non-tuberculous in character, may appear in the larynx of a tuberculous patient ; doubtless some of those that heal are of this nature. Clinical evidence has long warranted the supposition that a laryngeal may precede a pulmonary tuberculosis. Recent facts have proved the truth of this hypothesis. Fauces and Pharynx. — A nidus may be formed in this region by absorption of the contaminated fluids of pulmonary, laryngeal, and oral secretion, and the bacilli be conveyed through the general system. In the case of a primary faucial tuberculosis there is probably a previous breach of continuity. Clinical evidence would show that there is a possibility of a primary faucial tuberculosis, but the fact has not yet been verified by post-mortem evidence. To7isils. — While faucial and pharyngeal tuberculosis are acutely painful, the tonsils may be attacked without symptoms, provided the other portions are free from ulceration. Treatment. — Considerations under this heading are limited to cases in which the disease, though well established, is not advanced. 1. The first indication is, by climate^ hygiene and general measures, to place the patient in the most favorable position for resisting the baneful influence of the bacilli and rendering their life impossible ; preference is given in early cases to sea voyages and mountain air over hot or moist climates. 2. Inhalations containing oxygenating elements, peroxide of hydrogen and administered by oro-nasal inhalers are preferable to those of steam. 3. Medicines include, fir.^t, atropine as a probable alkaloidal antidote to symptoms of the septicaemic process indicating a ptomaine toxaemia ; secondly, kephaline, of which that of calcium is preferred as most favorable to rapid (calcareous) degenera- tion of the tubercle ; thirdly, glycerite of ozone, which it is sug- gested may act as a specific in the tuberculous disease, though not to the same extent as other drugs. 4. Germicides are of two classes : (a) those which may power- fully affect the general system ; (U) those of a more purely local character. Of the first maybe mentioned peroxide of hydrogen. The use of sulphuretted hydrogen and carbonic-acid gas per BACTERICIDES. ,04r rectum is a method of treatment which is still on its trial, and so far as can be judged, it is more favorable in cases of chronic bronchitis than in tuberculosis. The microbicidal effect of the gas is very feeble. Conclusion. — That, while throat symptoms may be greatly relieved even in cases of advanced pulmonary disease, there is seldom any true cure, but that each year there is a greater hope of such a happy result. There can be no doubt that ulcers in the regions under con- sideration can be healed, and success in this direction is in pro- portion to the accessibility of their site. Treatment. — In its early stages the treatment of phthisis laryngea ought not to be of an active and meddlesome charac- ter ; and general advice as to avoiding changes of temperature, damp and cold atmosphere, hot and irritating food and drink, and tobacco smoking, combined with tonics and drugs by inhala- tion, etc., to relieve the cough, is of more importance than any local throat treatment. When, however, ulceration of tubercular deposits has taken place, and there is much pain on taking food, along with hoarseness and irritating cough, then we must adopt systematic local treatment in the shape of spraying or brushing the affected parts with solutions of cocaine in glycerine in borax. 5 to TO per cent; cocaine pastiles ; insufflations of iodoform or iodol ; lactic acid carefully applied with the brush, and varying in strength from 20 to 60 or even 80 per cent; gradually increas- ing the concentration as the parts become tolerant of it. Solutions of menthol in olive oil to allay pain, and insufflations of morphia and bismuth for the same purpose, are good. All these measures must be combined with the usual cough mixtures, tonics, tar syrup, glycerite of ozone, which are used in cases of pulmonary phthisis. The question of climate is most important if the patient can afford it. Mountainous locations in Pennsylvania are excellent. When the system is heavil}r The Tubercular Bacillus loaded with the microbe tuber- in the culae, if some irritation exists in Stomach and Bowels. the stomach, it will infiltrate its walls, and in some cases, if not arrested by building up the constitutional powers and killing the germ with bactericides, the germ-tubercular colony often as- sumes an immense size. At first an active germ mass, by-and- by caseous, and latterly calcareous. There may be simply one nodule, or several. 1 042 DISEASE GERMS. In any stage, it may either slowly or suddenly break down and pass bythebowels, leaving an ulcer behind, or it may cause perforation of the stomach and death. In the walls of the intestines the same course is pursued, aa irritation, an exudation of plasma from the germ-laden blood, in which the microbe is present, its deposit in or on the walls of the bowel, either in one or several colonies. The very same degenerative changes are liable to occur in the bowels, as in the stomach, congestion, caseous consolidation, calcareous degeneration, either ulceration or perforation of the bowels. Throughout the ileum, but especially, as in typhoid fever, in the solitary and Peyer's glands and those structures at the lower part of the small intestine and in the caecum, there are large patches of ulceration at variable intervals, commencing as small, round, discrete ulcers at the upper part of the canal, and becom- ing confluent below into irregular patches, which extend through- out the entire circumference of the canal. Each ulcer is of an irregularly circular form, and bounded by a thick, raised, round, and inflammatory bo'rder. Internally, the margin is irregular and continuous, with coarse granulations, between which are scattered little yellow masses of tuberculous matter, firmly adherent to the base of the ulcer. Some of the ulcers may extend to the peritoneal coat, and their existence may be known, before the intestines are opened, by an irregular thickening and a corresponding irregularity of the peritonaeum. The points of difference between the tubercular ulcer and the typhoid ulcer are the following : The ulceration in the tubercu- lar ulcer extends transversely round the whole surface of the intestine ; the edges and base of the ulcer are thickened and in- durated. This form of ulcer very rarely heals, and perforation is also very rare. Some contraction and narrowing of the gut fre- quently occur. The presence of the tubercular microbe in either the stomach or bowels, is usually recognized by the gastritis or enteritis present, diarrhea, or constipation ; the presence of the tubercular bacilli in stools, some, but very little pain ; in the later stages, the caseous and calcareous masses can be readily felt through the abdominal walls, the emaciation is usually immense. The same constitutional, hygienic, and medicinal treatment as for tuberculosis, build up the vital force by every possible means ; destroy the bacillus with the most powerful bactericides. Special treatment for the germ in stomach, administer dioxide of hydrogen ; fl. ext stone crop ; kephaline and quinine ; Hy- drastis and avena sativa. BACTERICIDES. 1043 Diarrhea occurring during the progress of the tubercular bacilla in any part of the body, would be strongly presumptive that the bacillus would emerge on or in the coats of the bowel, and if the microbe could be detected in the stools, the diagnosis would be perfect. In this event, bactericides must at once be applied to the en- tire abdomen, as concentrated ozone, with chloroform ; ozonized iodine with chloroform ; or aromatic pinol, over and above all, a flannel roller. Kli^^^'l'%P^' Internally, glycerite of ozone, alternated ^^^S^^W with ozonized stone crop. ^^R^^^ftSf But if there are any evidence of ulceration ^^S^P^Mf by the presence of the streptococcus pyo- fi^^^^j^!|p genes in the stools, then in addition to those I^K^^Sffil remedies, intestinal disinfectants, as naph- iifpf-^^f^^B thaline, salol, salicylate soda, creolin. f^iP?^ >^!i I- " " With rep-ard to intestinal disinfectants, we Tubercular ukers of the <^ ileum must carefully consider the effects those will produce on the organism. When the contents of the stomach and bowels are undergoing decomposition, either from yeast, sarcinae, bacteria, or tubercle, we may get good results by the use of creosote, or salol, or naphthaline, because these substances come directly into contact with the microbes in the stomach, and a quantity of them which is too small to be injurious to the patient, will be suf^cient to act as a disinfectant. If the intestine is to be disinfected, these drugs will not produce this effect so readily, because they will be partly absorbed in the stomach, and one has to look either for some remedy, which, on account of its sparing solubility, will pass through the stomach into the intestine without being absorbed, or else one which will not have much poisonous action. Such we have in the stone crop ; an invaluable drug in all states of ulceration, it tends to promote a renewal of life in that structure. Of all parts of the intestinal tract, the microbe seems to have a special affinity to the posterior part of the rectum ; here the tubercular bacilli deposits itself in nodules upon the surface of the bowel, hard to the feel, smooth and round. If the germ is permitted to establish itself, and undergo caseous, calcareous de- generation, it gives rise to ulceration, and a germ-eaten rectum ; often with fistulous openings, or crescentic thickening. If such a state of things exist, germicide treatment must be pushed, and locally to the rectum, microbicides, as rectal bougies of either resorcin, or thallin, or papoid, or creolin, or naphthal- line, or iodol. I044 DISEASE GERMS. Encmata of boroglyceride, ozonized pine tree, witch hazel, etc., will do much to effect a cure. Tubercle bacilli in liver. The tubercular bacillus sometimes migrates into the liver, creates considerable irritation, and often jaundice. In such cases, small doses of the peroxide of hydrogen, alter- nated with the phosphate of soda, speedily remove the symp- toms. The Tubercular Bacilli in the Peritoneal Membrane. ( Tubercular Peritonitis). Depression of the perito- neal membrane offers a favor- able location for the localiz- ing of the bacilli ; it may ex- ist alone, or be complicated with the microbe in the lung. Tubercular deposit on the peritonaeum is accompanied with some fever, acute pain in the abdomen, increased by pressure, loss of flesh and strength, thirst, loss of appetite, and continuous diarrhea, or diarrhea alternating with constipation. The diseases with which we are most apt to confound acute tubercular peritonitis are typhoid fever and acute non-tubercu- lar peritonitis, and in some instances the resemblance is so close that it is only by great care and watchfulness that we can avoid falling into error. As a general rule tubercular peritonitis of this kind begins suddenly, whilst typhoid is usually preceded by a period in which the patient has been weak, feeble, and feverish, In the former, pain in the abdomen is more marked, and there is BACTERICIDES. 1045 tenderness over different parts ; whilst pain in the latter is rarely- severe, and any tenderness that may be present is confined to the iliac region. In tubercular peritonitis the temperature rises at once, and not regularly, as in enteric fever, and the pulse is usu- ally more rapid. As the case proceeds the temperature varies more in peritonitis, spots are rarely observed, and the stools have not generally the typical appearance of those passed in typhoid ; whilst at a later period the persistence or frequent returns of ab- dotninal pain and tenderness, and of vomiting, the variations of the tem.perature, the alterations of constipation with diarrhea, and the increasing prostration, will in most instances, enable you to distinguish between these diseases. In addition to these differ- ences, you will in many cases be able to render your diagnosis more certain by the discovery of fluid in the peritonaeum, or by the detection of a tumor in the abdomen; or you may find the signs of effusion in the pleura, or of a consolidation in the apex of one or both lungs. Still more difficult is it to distinguish be- tween acute tubercular peritonitis and ordinary peritonitis when the former does not assume from the first the typhoid form. In many cases I believe it is impossible to arrive at a certain con- clusion in the early stage, for both may attack persons previously healthy, both may be ushered in by similar abdominal symptoms, and it is only by watching the progress of the disease that you can form an accurate opinion. As a general rule the pain, ten- derness, and vomiting are less distressing in the tubercular form, the temperature is lower, and there is more usually diarrhea than constipation. As the disease progresses the abdominal symp- toms recur from time to time, instead of slowly subsiding the temperature remains high, emaciation becomes more marked, the effusion into the peritonaeum is very slowly absorbed, and you may discover signs indicating effusion into the pleurae or pulmo- nary consolidation. A child under two years of Tubercular Bacilli in age with either an hereditary or Mesentery. acquired tubercular constitution, (Tabes Mesenterica, or may be subjected to some irrita- Marasmus) tion of the bowels, either from worms, diarrhea, cholera infan- tum, which necessarily weakens the mesentery, into which the bacillus of tubercle enters, and lodges in its meshes or net-work, breeds, grows with great rapidity, destroys its proper function as a blood-raising gland ; obstructs the passage of chyle through the convoluted lacteals, which traverse the mesentery in all direc- 1046 DISEASE GERMS. tions, and give rise to anaemia and leucocythemia, and as a result all the tissues of the body starve and waste away. „^_I^ The spongy net-work of the mesentery becomes enormously engorged with the bacilli. Prior to, or more generally associated with it, there is either diarrhea or cholera infantum. About the earliest premonitory is, the abdomen becomes hot and tender, bloats, more or less con- stant pain in the bowels, sometimes so severe as to cause the lit- tle sufferer to instinctively draw up its knees towards the ab- domen ; deep red color of lips ; angles of mouth covered with small ulcers, or lips fissured ; passages from the bowels resemble chopped spinach, and very acid. Later on, they are very fetid, more frequent, and distressing ; abdomen rapidly grows large, child more pale and anaemic, the emaciation greater, until he gets down to skin and bone; even the marrow in bones wastes; skin white and wrinkled; intense debihty, with rapid, increasing weakness. The abdomen, al- though intensely swollen, soon be- comes irregular to the feel, lumpy in masses like large eggs at first ; when tubercle is active and growing, soft ; then a cheesy feel, and latterly, cal- careous ; there may be a tubercular condition of lungs, bronchi, or mem- branes of brain. Its duration is un- certain, depending on the condition of The tubercle bacilli in the omentum vital forcc and season of the year. in tabes mesenterica. jf -^ ^pp^^^ ^^^j^ -^ Juue, thc little sufferer, unless taken to the seashore or country, stands a poor chance of recovery before September ; whereas, if it appears in August, there is usually little difficulty in tiding the patient into the cool weather. It may occur at any season, but much more common when the vital forces of the child are depressed by solar heat and city life — a season when cholera infantum is prevalent. In the treatment of these cases, the first thing to do is to disin- fect the intestinal tract and kill the microbes of cholera infantum, and those of the green diarrhea ; this can be effected either by the administration of naphthaline, or resorcin, or calomel. The diet should either consist of mother's milk, or sterilized malted milk, or beef juice ; the entire body should be bathed morning and night with castile soap and cold water, followed by a salt water bath ; kept in a quiet, cool place, with abun- dance of fresh air. To the entire abdomen, some bactericide, such as con.'^ozone BACTERICIDES. IO47 to erythema, followed with ozone ointment ; or if con. ozone is not procurable, apply spices ; say a mixture of pulverized cloves, allspice, cinnamon, and cinchona, equal parts of each, saturated with vinegar or acetic acid ; spread between folds of book muslin, and apply all over, then above a roller ; when it cakes it can be crumbled up, moistened, and re-applied ; or, the peroxide itself could be applied. The germicide principle of either penetrates by endosmosis to the tubercular bacilli in the mesentery, either kills or sterilizes them ; it also decapitates the comma-bacillus in the bowels. At all events, the nausea, the vomiting, diarrhea, cease; microbes disappear from the stools. Whatever germicide remedy is used, it must be powerful enough to kill, or at least sterilize the various microbes present ; general principles must guide. But in all cases the general treatment for the destruction of the tubercular bacilli must be enforced. Individuals with a strong tuber- The Tubercular Bacilli cular cachexia, are liable, if any on the part of the body be weakened, to "Walls of the Bladder, have the bacillus deposited on the {Tubercular Cystitis.) devitalized part. When the bladder becomes af- fected, deposits of tubercle occur in its mucous lining, especially about the trigone ; these, after a rime, softening and breaking down, are succeeded by distinct ulcerations with punched-out edges, which, when they remain separate from one another, are usually of small size and often very numerous ; in other cases they run together, and, becoming confluent, form ulcers of con- siderable dimensions, e.g.^ as large as the palm of the hand. The muscular coat subsequently becomes thickened from inflam- mation, and at the same time contracts, so that the capacity of the bladder is often considerably diminished ; occasionally per- foration of its walls ensues, and under these circumstances, sec- ondary abscesses may form in its vicinity. Tubercular cystitis may manifest itself in three different ways. In the most common form, the testicle is the part primarily at- tacked by tubercle ; this is frequently followed by suppuration, and after a while the prostate and vesiculae seminales become similarly affected ; eventually the disease spreads further onward, involving next the bladder, and then the kidneys. Under these circumstances, the affection is very slow in its course, often con- tinuing for as long as ten or fifteen years. In the second form, the bladder is first involved ; the prostate and kidneys may after- 1048 DISEASE GERMS. ward become affected, but the testicles usually escape. In the third form, the implication of the genito-urinary organs is sec- ondary to the development of tubercle in the lungs. One of the earliest evidences of tubercular cystitis is slight haimaturia, the blood coming from the mucous lining of the bladder, and in many cases this continues for a considerable pe- riod, sometimes for several years, before the more severe symp- toms manifest themselves. Sooner or later, severe pain is usu- ally felt, but it differs from that met with in cases of cystitis due to calculus, inasmuch as it is almost constantly present, not being relieved by rest or sleep. Micturition is increased in frequency, and accompanied by tenesmus and a burning sensation, owing to the fact that the trigone is the part of the bladder which is usually the chief seat of ulceration ; the urine contains pus, and the deposit is more floc- culent and less of a gelatinous character than is usually met with in cases of chronic cystitis due to other causes. The position of the patient is often characteristic. He fre- quently lies crouched up in bed, so as to relax the abdominal muscles, for in this way, by taking all pressure off the bladder, slight relief is often obtained. The prognosis is always very unfavorable, most cases eventu- ally terminating fatally, either from the local affection, or occa- sionally, if the kidneys become affected, from the supervention of uraemia. Unfortunately, very little cfan be done in the way of treatment. Washing out the bladder with some germicide ano- dyne solution, suppositories, fomentations, etc., sometimes afford slight relief; but in most instances the severe pain, which is doubtless due to the constant irritation of the urine as it flows over the ulcerated surfaces, continues unabated, and it is the very intractable nature of this symptom which in many cases of pain- ful cystitis is of assistance in helping us to recognize the tubercu- lar origin of the affection. General treatment for tuberculosis, including glycerite ot ozone, ozonized stone crop, uric acid solvent, often retards the disease and prolongs life. Tlie tubercular bacilli in the kidneys. In all diseases due to the presence of a microbe in the blood, we almost invariably find the germs blocking up and breeding in the organs of excretion. This is specially so in the rectum and kidneys of young persons, who are the host of the germ. Males are more prone to this affection than females. The right kidney more seriously implicated than the left. When the germ is thus deposited, they are usually most abundant in the cortex, in the arterioles, and other parts. The BACTERICIDES. 049 tubercle undergoes its various stages of growth and degenera- tion. The symptoms are those of tuberculosis, pulmonary or intesti- nal hectic, night sweats, etc., pain in the loins, irritable bladder, scalding urine, with casts of the bacilli ; invariably tubercle in lungs, prostate, lymphatics. General treatment for the diathesis. The Tubercular Bacilli in the Rectum, ly^ ( Tubercular Ulceration}^ We have seen that simple in- flammation and ulceration of the rectal mucous membrane and deeper tissues are more fre- quently present than what is generally supposed, and is often treated for disease of th"e liver and dyspepsia. Tubercular ulceration is generally in the posterior portion of the bowel, a weakened patch in which the tubercular bacilli have localized and where they are in an active state of growth, the walls of the rectum pre- senting a worm-eaten appear- ance. The annexed cut is a form of rectal ulcer, almost inva- riably present in the last stages of pulmonary tuber- culosis ; the posterior portion of the rectum is germ eaten ; in that riddled structure the tubercular bacilli are seen in their albuminoid, cheesy and \ calcareous stages. This ulcer, with its per- forating fistula is always amenable to a cure by the local appli- cation of resorcin or naphthaline ; with glycerite of ozone in- ternally. The symptoms are nearly identical with the simple form : diar- rhea, followed by constipation ; severe pain in the coccyx, radiat- ing through the hip and down the thighs, passing of mucous and bloody matter during stool ; burning, itching, great uneasiness in the bowel from the presence of the microbes ; inclination to strain at stool, and after movement a burning sensation after stool, but usually pain is slight, neither is there much local disturbance, but the reflex symptoms are vertigo or giddiness ; loss of memory, Rectal ulcer. 1050 DISEASE GERMS. pain in the back of the head, indigestion, bloating of the abdomen, with order of the bladder and kidneys. The great prevalence of tubercular ulceration of the rectum may be gathered from the fact that 90 per cent, of all cases of pulmonary tuberculosis have a worm-eaten rectum. A species of ulceration of the rectum, very nearly analogous to the above, is met with among the insane. In our large, over-crowded cities, among prostitutes, with broken-down constitutions, aggravated by poor or insufficient food, alcoholic drinks, insanitary surroundings, we meet with gangrenous, or phagedenic ulceration of the rectum ; skin adjacent to the sphincter, often extending to the nates, the germ present being the oidium albicans, the evidence of squalor and rot. For the destruction of this we require oup most powerful antiseptics and germicides, with the best of internal nourishment and tonics, to reconstruct the shattered vital force. Gonorrhea of the rectum, venereal warts, condylomata or mucous patches near the verge of the anus must be treated on general principles. This frequently follows gonorrhoea. Tubercular Bacilli in In the early stages the symptoms, be- the Prostate. ing those of catarrh, escape notice, and the tubercle in the prostate can- not be detected by the finger until it has become considerably de- veloped. The catarrhal condition of the prostate, with slight ir- ritation of the bladder, lasts an indefinite time ; eventually atten- tion is directed to the prostate by the occurrence of other symp- toms, such as frequent seminal emissions, or by weight in the perineum and pain in the sacrum. In other cases the patient notices increased frequency of call to micturate, but a slov/ness in starting the stream of urine ; then he feels a burning or cutting pain during the flow. As soon as the shape and consistence of the prostate are altered, the finger in the rectum finds the pros- tate irregular, perhaps larger than natural, tender, particularly at the posterior part near the trigone. The disposition of these irregular thickenings is variable. When cystitis is developed, copious viscid pus, mixed with shreds and blood-clot, form the urinary sediment, and the urine contains albumen in considerable quantity. The further progress of the case is accompanied by gradual participation of the ureters and kidneys in the septic in- flammation, and the patient is gradually exhausted. Acute gen- eral tuberculosis may terminate his sufferings. The ages of the patients usually range between nineteen and forty years. Numerous BACTERICIDES. ^ IO51 and highly instructive cases of advanced disease have been de- tected by the cystoscope, in which the surface was irregular, with pits at the uvula vesicae or neighboring part of the floor of the blad- der, partly filled with shreds of tissue, muco-pus, and blood-clot, though in those cases cystitis, ulceration, burrowing abscess in the floor and walls of the bladder are usually superadded before death. The differential diagnosis of tubercle in the prostate. In early cases the presence of tubercle elsewhere may be wanting, as the prostate is often affected before other organs. The disease most commonly suspected when tubercle is irritating the prostate is stone in the bladder. The urine is at first only moderately tur- bid in both. In prostatic tubercle there is often a gleet or history of such having continued since an attack of gonorrhea; a little shreddy mucus may be washed out with the first portion of urine voided, the remainder being only slightly turbid. In stone, on the other hand, a drop of blood often comes at the end of the stream, instead of pus at the beginning. When blood comes from the prostate, it is usually washed out first as coagula mixed with curdy pus. If the patient be sounded, and stone be there, it can be generally detected. Sounding does not always discover any alteration in the shape of the prostate or trigone, unless the tuberculous disease be far advanced. The distinction of vesicle tumor from prostatic tubercle is so great that confusion is not likely to occur. Tuberculous pyelo-nephritis creates symptoms which often suggest disease of the neck of the bladder. In these cases the absence of change in the condition of the prostate and the presence of tenderness in the renal regions indicate the real seat of the disease. The treatment of tuberculous prostatitis. — In the early stages the catarrh must be cured, and the general treatment for tubercle ap- plied. In the later stages, the ragged cavities must be carefully washed out. A good antiseptic solution is two grains to the ounce of sulphate of quinine, two ounces being injected and left in the bladder after the pus and urine are well cleared out by re- peated small injections of boric-acid solution. Still more anti- septic is an emulsion of iodoform. In cases of chronic cystitis, if the bladder is well washed out, and a couple of drachms of this emulsion injected, the most fetid ammoniacal urine is replaced by acid urine ; fetor disappears, and the pus rapidly diminishes. Again, in cases of cystitis caused by neglect of prostatic reten- tion, the urine in ten days becomes quite free from deposit, and even when calculus, or tumor, or malignant ulceration coexists, the improvement is enormous. Tubercular deposits, nodules, ulcers, on the floor of the bladder are readily made out by the use of the cystoscope. I052 DISEASE GERMS. Cases might be cited, in which the various coats were literally- eaten with the bacilli. These were cured by washing out the blad- der, and then injecting iodoform emulsion, so that in a fortnight the patient — a man with advancing pulmonary tubercle- — was cured of his bladder trouble. When the pain of washing the bladder is severe, cocaine previously injected often renders the operation bearable. When things are too far gone for this, ether should be given. while the bladder is thoroughly washed with a large silver catheter, and Clover's extracting bottle, then a drachm of iodoform emulsion is injected and left in. The subsequent washings may then be carried out with very little suffering. The formula for the emulsion is— iodoform, two parts ; mucilage, four parts ; glycerine, two parts ; water, twenty parts. The microbe of tubercle when The Bacillus Tubercle in the blood has a great affinity to in the Testes. deposit itself in weakened parts and there breed, but of all structures in the body the parotid gland and testes are decidedly favorable loeations. Masturbation, sexual excesses, gonorrhea, stricture, sexual in- compatibility, are common causes, which damage the testes, and afford a location for the germ to run in ; once there, the tendency is to cause a general infection before suppuration takes place. A resection of the tubercular deposit in the epididymitis at the earliest possible moment is advised, but this is really unnecessary in the face of such valuable remedies as we now possess for the destruction of tubercle. The tubercular microbe, when The Tubercular Bacillus the blood is over-crowded with in the Eye and Ear. the germ, often appears in the eye, in and upon the conjunctiva and cornea. (See Tubercular Ophthalmia}) The microbe can be isolated from the serous discharge from the eye. The ear is still more obnoxious to inflammation of a tuber- cular kind than the eye. It is very doubtful if we can isolate any- one case of otitis media or otorrhea without the germ of pus and tubercle. In otitis, from the micrococci of scarlatina, running up the eustachian tube to the inner ear, this germ is present ; in per- foration of the membrana tympani, and in all forms of dis- charges from the outer ear, this microbe is present. Such cases even existing for years, should be placed upon the usual bactericide treatment of tuberculosis. BACTERICIDES. 1055 The Tubercular Bacilli in the Skin and Mucous Membrane. The microbe of tubercle in ter- ribly broken-down cases, often appears upon the skin as well as the mucous membrane of the mouth. Almost every variety of cutaneous disease appears with the germ, but the pathogenic bacillus in some mysterious manner has the ascendancy and runs them into round or crescentic forms, even erythemia, roseola, lichen, lepra ; psoriasis all appear in circles, and may be called any name corresponding to the nomenclature of skin disease. The bacilli can be isolated by scraping off the surface of the ulcer. The bacilli are short, straight, or curved rods, with irregular, undulating and slightly notched contours, of a deep blue color, and contain from two to four spores. They are never free, but are invariably included in wandering cells, in groups of from two to nine. The cells themselves are rarely found at the centre of the infiltration, but exist in pretty large numbers at its edges, and in the adjacent apparently healthy tissues. Lustgarten has also demonstrated the presence of these bacilli in the spinous cells of the rete Maipighi in papular eruptions, through which he explains the clinical fact that moist papules become contagious when they are deprived of their epithelial investment. The Bacilli of Tubercle in the Skin. — Individuals possessing * the tubercular diathesis are lia- ble at all times, if any weakness be induced (either by a mechan- ical or chemical irritant) in any part of the skin, to have the bacilli effused from the blood in the devitalized part. A dam- aged part is a vulnerable one for germ deposit, spore breeding. The annexed diagram is a photograph of a tubercular infil- tration following a burn on the elbow, which h^ealed kindly un- der ordinary remedies, but a few months later became a tu- bercular colony of great growth. The germs are seen in indolent, circular or oval superficial patches, having caused some loss of substance, which is covered by crusts of tubercle. Here and there throughout its centre could be seen dissemin- ated miliary nodules, transparent or of a light yellow color. '"^m^ f^¥'fi The tubercular bacilli acti the cutaneous surface ; the elbow. vely breeding on bove and below 054 DISEASE GERMS. Such an incrustation is not common, but when met with can only be cured by the destruction of the bacilH of tubercle. So far the glycerite of ozone is the only remedy that will kill the germ and prevent its reproduction by a fresh degradation of living matter. It is our best germicide in tuberculosis, and superior to all known remedies, except the glycerite of kepha- line or tincture of oats in constructing a dilapidated brain. The very fact that it contains a very large percentage of com- pound hypophosphite of lime, soda, iron in a fine state of subdivision, ready for assimilation, renders it* invaluable as a constructor of shattered nerve force. Ozone tablets might also be adminis- tered so as to cause the dead germs to The bacillus of tubercle mag- nified 950 diameters, from the above arm. exfoliate rapidly. Locally to the germ colony on the arm, a lotion of the per- oxide of hydrogen should be applied over night, and the oil of boroglyceride during the day. Other remedies, as thymol, ichthyol, ozone ointment, ozonized sulphur water are of utility. The general management of a case of tuberculosis should be enforced. The nails also may suffer onychia maligna^ the matrix of a single nail may be infiltrated by the bacillus, or several, or all, and the severity of the case will depend upon the amount of germs present; in every case there is. inflammation, which begins under the free edge of the nail ; the pain increases so that sleep is disturbed ; the part is red and the nail-bed swollen ; an ulcer develops that creeps along the side of the nail till it reaches the lunula or root, and at last the nail falls off. The ulcer is usually covered with bloody pus, and resembles a diphtheritic ulcer without its phagedenic character. The ulcer remains stationary for an indefinite time in spite of in- ternal and external treatment ; it may be for three or more years ; without attacking the periosteum and bone, or spreading beyond the ungual phalanx. The treatment should be active, glycerite of jozone and saxi- fraga ; locally bactericides, solutions of boroglyceride, creolin, sozoidol ; build up the constitution of the patient by every possi- ble means. In the mouth, the bacillus tubercular appears in round, scooped out ulcers {tubercular aphthcc), in deep ragged, eating ulcers (tubercular stomatitis). Such cases are pre-eminently contagious and infectious, each BACTERICIDES. 1055 ulcer, however small, contains millions of cocci, oidium albicans and the bacillus tubercular. These are readily seen by micro- scopes of low power, indeed the bacillus can be seen in the centre, in the form of cheesy flakes. In the treatment of such cases every possible means must be taken to improve the general health of the patient, the most liberal diet, fresh air of the country, salt-water bathing and mouth bactericides. The gums, cheek, tongue, throat must be washed out or gargled with lotions of boroglyceride three times a day, and also before eating, and then pickled down in either resorcin or thymol, or naphthaline, or creolin jelly. The microbe of tuberculosis lodges Tubercular Bacilli frequently in the bones and produces in the Bone. great havoc, ulceration (necrosis or caries). In these circumstances, the medulla contained in the cancellous tissue of the bone undergoes fatty degeneration, and, as in other parts of the body, this de- generated tissue disintegrates, and so cavities are formed in the head of the femur, containing a quantity of oily matter and bone-earth. It is this bone-earth or grit that sets up, not only a rarefying ostitis, but also the formation of the florid granulations characteristic of caries. The same changes occur as a conse- quence of tuberculosis of the medulla. On making a microscopic examination of a bone affected with tuberculosis in its early stages, we find nodules composed of an aggregation of round cells (among which are usually one or more giant-cells), which compress and so occlude the vessels in the affected area ; but the blood-channels surrounding the nodule and the spaces through which the round cells escape are choked with corpuscles. With the exception of increased cell-growth from the brood-cells, the surrounding tissues appear healthy. I have already referred to the changes which occur in the tubercles, the caseous degeneration of which, in the greater number of cases, ends in destruction, not only of the osseous tissue, but also of the joints, and the soft parts in their proximit}^ Symptoms. — There can be no question as. to the fact that tuber- culosis of bone is in its early stages easy of cure, but most diffi- cult to recognize; in the course of time, however, there is no difficulty as to our diagnosis ; but the cure of the disease is almost impossible without extensive damage to the affected tissues. It requires no stretch of imagination to understand that the pro- duction of cell growth in a structure like the medulla, only sparingly supplied with nerves, may progress to a considerable 1056 DISEASE GERMS. extent without causing pain. There is one symptom, however, referable to nerve-irritation, almost always present in cases of this kind ; and that is a certain amount of stiffness in the mus- cles surrounding the diseased bone. This is especially the case in tuberculosis of the bodies of the vertebrae and of the hip-joint. The stiff back or neck, and the occasional days of stumbling in the early stages of morbus coxarius are well known, but too often disregarded symptoms of diseased bone. From the com- mencement of tubercular disease of the medulla, however, imme- diate and forcible pressure on the bone generally causes marked pain; otherwise, the pain is often felt at the distribution of one of the nerves connected with the diseased bone or joint. Subse- quently, the pain becomes more marked, and is greatly increased if the diseased part be moved or jarred ; suppuration occurs, and sinuses form leading to dead bone, with all the long-continued and well-known consequences. Treatment. — We must bear in mind the fact that, supposing the exciting cause of tubercle be a bacillus, it is certain that an hereditary predisposition, and other recognized circumstances, prepare the soil in which any such influence can take root and grow. Pure air, sunlight, and plenty of wholesome food, are essential to the building up, or fortifying tissues against the action of any causes which provoke the growth of tubercles. If tuber- cles have formed in the bone, means tending to invigorate the patient's health must be enforced, and at the same time the dis- eased tissue should be protected from concussion or injury. Rest to the diseased bone is useful, and it should be employed so as to relieve pain caused by the pressure of the extremities of tender parts against one another. But, in my opinion, it is a mis- take to suppose that rest or confinement to a couch or bed for weeks and months, particularly in young children, is a judicious method of treating cases of this kind, especially in the early' stages of the disease. I am convinced that the actual cautery, applied judiciously, near the seat of the disease, and repeated if necessary, is of great service in many of these cases. In more advanced instances, good hygienic conditions, great patience on the part of the patient, his friends, and the medical attendant,* and the removal of diseased bone, together with free drainage, will bring about results more favorable than could otherwise be attained. Superiosteal excision of the diseased extremities of the bones is sometimes attended with most favorable results. Internally, comp. saxifraga and phytolacca should be adminis- tered alternately; the small but active quantity of iodide of pot- ass, which they contain, rouses up the vital energies which throw off the microbe, while at the same time, kephaline, avena sativa, aid in the reconstruction of osseous tissue. BACTERICIDES. 1057^ Tubercular bacilli in the various Tubercular Bacilli in bones of the body, or, as it is termed, Bone. rickets, is one of the most common (Rickets) diseases of children, and it is an affec- tion, with regard to its etiology, na- ture, and treatment, of which we know too little. The manifes- tations which attract attention are the intense tubercular habit, the malformation of bones, due to the bacillus eating up their os- teogenetic tissue, and deposition of lime salts — the presence of the bacillus in the blood being the cause of the osseous lesion. Rickets may be defined as a chronic tubercular disease in chil- dren, which deprives growing bones of their nutrition, accompa- nied by functional disturbances of various organs, more especially the nervous, respiratory, and digestive organs. The age at which rickets commences during the first three years of life varies considerably, but almost all statistics place the age whei the greatest number of cases come under notice as from twelve to eighteen months, and the next most frequent 'as from six to twelve months ; or taken in years about forty-seven per cent. coTie under observation during the first year of life, and forty-two per cent, during the second year, after which the numbers rapidly decrease. There seems also good reason to believe that rickets may run its course during foetal life, the dis- ease having ceased when the children are born (foetal rickets), while the existence of congenital rickets, i. e., of children born suffering from the disease, is generally admitted. In all large cities, with adulterated food and insanitary condi- tions, it is generally admitted that about ten per cent, of all the children are affected. The bacillus of tubercle strikes at the nutrition of bone ; it may affect different organs, although not always to the same ex- tent. There is invariably an increase in the number of the white corpuscles of the blood. Excessive sweating of the head is a typical symptom of tuber- culosis, due to an irritation of the nerves by the ptomaines of the bacillus ; the febrile exacerbations, the general irritability, the restlessness at night, together with the skin eruptions, all indi- cate an irritation of the central nervous system by either the microbe or its ptomaine. It is this same irritation which gives rise to the occurrence of laryngismus stridulus, which is gener- ally associated with rickets, and more especially with cranio- tabes. Other causes will produce this laryngeal spasm, (i) Pres- sure on the brain through the soft cranial bones ; (2) reflex from the digestive tract ; (3) anaemia of the brain in rickety children ;. 67 058 DISEASE GERMS. (4) the presence of noxious substances in the circulating blood, ir- ritating the vagus centre. All tubercular children suffer from disturbances of the digestive apparatus. These vary in severity from slight dyspepsia to severe gastro-intestinal catarrh, anomalies of dentition. The frequency with which the various parts of the skeleton are affected varies with the age of the patient, in children below six months the bones of the skull being most frequently attacked, while in the following six months the thorax is the chief seat of the disease, the rule apparently being that the bones in which growth is most rapid (these varying with the age of the patient) are most readily and markedly affected. As regards the anoma- lies in dentition, dentition is delayed, the teeth erupt irregularly, and not in groups, as is normally the case, and they are not so good as in healthy children. The presence of the tubercular bacilli in the blood is the pri- mary cause of rickets, derangements of the digestive organs ; erroneous feeding, excess of farinaceous food, and other lowering conditions tend to increase it. No doubt, imperfect aeration of the blood, due to living in badly ventilated apartments, has much to do with it. In support of this view we would remark that this disease is extremely rare in warm climates, and chiefly occurs where, owing to the cold climate, there is much in-door life, or in crowded cities where the general hygienic conditions are bad. That it is not merely a question of bad feeding or poverty is also shown by the fact that it is very rare in gypsy children. Further, the number of cases of rickets is much greater in spring, after a winter spent in-doors, than in autumn, after a summer spent out of doors. Result of imperfect aeration of the blood — carbonic acid and water accumulate in it and in the juices of the body gen- erally. Further, as the result of the imperfect oxidation, numer- ous by-products accumulate in the blood, and it is these pro- ducts and the excess of carbonic acid that lead to the irritation of the central nervous system, with the consequent symptoms. A similar irritation is also exerted on the ossifying bone, leading to increase in the amount of new material, while by these products the alkalinity of the blood is diminished, and thus the lime in it enters into combination, and its deposit in the bone is prevented. Rickets is a bone disease, dependent upon the presence of the tubercular bacillus in the blood. Either the microbe or its pto- maine, or some unknown irritant acting on the bone, leads to in- complete deposit of lime salts in place of true ossification ; to the formation of an incomplete form of bone, devoid of lime, and to increased absorption of already existing bone. BACTERICIDES. IO59 The real essence of rickets consists in a tubercular diathesis, the germ giving rise to inflammatory hyperaemia, and increased new formation of vessels in the osteogenitic tissue, the ptomaine of the germ, a chemical irritant ending in the softening. Rickets, then, is a name applied to the presence of the tubercle bacilli in bone. The disease may appear at birth ; most generally the impair- ment begins between the fourth and twelfth month. Most commonly the rickety condition is not noticed until the child begins to walk, or is affected by his first teething. Of 343 collected cases 98 appeared in the first year. «< " 176 " second year. " ** 35 *' third year. « "19 " fourth year, " «' 10 *' fifth year. «< ** 5 " sixth year. Of these 147 were males and 196 were females. At first the most ordinary symptoms are those which indicate irritation of the intestinal canal ; there may be diarrhea alternately with con- stipation, enlargement of the abdomen and more or less emacia- tion. The child is dull and languid, peevish and fretful ; the appetite is bad, and the sleep disturbed at night. If it tries to walk it is *' taken off its legs ; '^ it is thirsty and will drink plenty of water ; it has pain in the bones ; a pale face and flabby skin ; the hair on the head is thin, and blue veins marble the surface by their prominence; the fontanelle remains open. In the next stage there are three symptoms to be chiefly noticed, (i) A profuse perspiration of the head, neck, and upper part of chest. This sweating is worse at night, beads of sweat may be noticed on the head, while the lower part of the body is dry and hot. (2) There is a desire to kick the clothes off on the part of the child, as if with a wish to be cool ; so that the little patient lies with its naked legs on the counterpane. (3) There is general tenderness, so that the child cries when it is moved about. The urine is thick, and deposits a pale sediment of phosphates on cooling. The next set of phenomena are those connected with the deformity of the skeleton. With the increasing paleness and flabbiness of the skin, the wrists and ankles enlarge, and the ends of the ribs are knuckled. The long bones of the extremi- ties, and chiefly those of the legs, begin to yield, not being strong enough to bear the weight of the child. The deformity is very great in some cases, and such children are called knock- kneed or bow-legged. The spine is curved forwards ; the head falls backwards, and the face looks upwards ; lateral curvature of the spine is not so common, and with this curvature there is generally the deformity known as pigeon-breast. Io5o DISEASE GERMS. The back is flattened, there is a hollow under the arm-pit, the ribs are pressed in and the breast-bone or sternum is more prominent than usual. At each inspiration the softened ribs are sucked in, and the space for the lungs and heart is much en- croached upon. In this way also the bones of the arms become distorted, and the more so if the child tries to support itself by its arms and hands. The forehead is square and projecting. The head is generally unusually large and the top flattened. The process of teething is generally delayed, and those that are through, decay and soon fall out. The bones forming the pel- vis are sometimes distorted, and add to the general mischief. Such children are generally of an inferior intellect, although sometimes thou^^ht by their mothers to be very precocious ; this seems due to the fact that such patients are more in the society of their elders, and have an old-fashioned way about them, be- cause they cannot play with other children. After this the child may gradually get worse ; the emaciation goes on, the abdomen is more tumid, the softening of the bones, and the deformity in- creases, and generally disease of the liver, kidneys, or spleen comes on. Death may occur from bronchitis or congestion of the lungs, or from diarrhea, or from waxy degeneration of differ- ent internal organs, or from general dropsy. Children affected with rickets are liable to attacks of spasmodic croup, convulsions, and chronic hydrocephalus. So death may end a life, which to the unfortunate child has been one of unabated misery. Yet many cases do recover and grow up to adult life, but the de- formity remains, and they are never so healthy as other people. The favorable symptoms will be, an increase in weight, an ani- mated expression, and less pain in the limb; the pulse is less frequent, and the stools not so pale ; the urine will return to its natural color, and the appetite is more natural. The growth of the limbs then goes on with great rapidity, and the muscles ac- quire a powerful development. Many of the dwarfs are examples of recovery from rickets ; they may possess plenty of strength in spite of their deformity ; they are generally irritable and sulky, keeping aloof from their fellow- creatures, in consequence of their misfortune, being the subject of derision and mockery by their more fortunate brethren. The sooner the disease comes on after birth, the more likely is it to be fatal ; as a rule, if the disease be not far advanced, and if the deformity have not much affected the spine and chest, a favorable result may be looked for. Treatment. — Improvement of the general health is the first thing to be sought after. The child should be placed in a warm and dry atmosphere, with due ventilation and pure air. The greatest possible attention paid to bathing. These twice a day BACTERICIDES. IO61 baths should consist of bactericides ; iodine, glucozone, p'ne, etc. ; clothing- flannel. The very best of diet, including malted milk sterilized. General treatment for the annihilation,, and preventing the evolution of the bacillus. The conclusions arrived at by the most profound bacteriolo- gists in the United States, are that in the glycerite of kephaline and ozone ; in the tincture of oats, and glucozone, in the treat- ment of rachitis, we find remedies giving the most brilliant re- sults. Not only afford amelioration, but are curative and pre- ventive. Whenever the tubercular bacilli Tubercle Bacilli exists in the blood of children, all in the the tissues, glands, bones of the body Vertebral Column, are weak, deficient in their natural ele- ments. This is especially true of the vertebrae which possess this inherent weakness in a high degree, rendering it soft and flexible. A child possessing this tubercular organization, placed in some avocation which causes the muscles on one side to become unduly developed and powerful, such as the habitual use of the right arm in a dressmaker or black- smith; constant assumption of an unnatural attitude, or in hitching one shoulder in wearing a low-necked dress; nurses or mothers carrying childi^n always on one arm^ ; repeated standing on right leg, left knee bent ; a tubercular diathesis, in which the the muscles are weak, relaxed, flabby, or where there is a predis- position to rickets, or a deficiency of earthy salts in the bones, so that there results a loss of equilibrium between the resistance of spinal column and weight of upper part of the body where the vertebrae are soft, spongy; rickety diathesis strong, even amount- ing to inflammation, ulceration, or caries of the vertebrae or their inter-vertebral spaces. There are three varieties : Lateral curvature, the convexity being to one side, usually the right. Posterior curvature, or excurvation. Anterior curvature, or incurvation. I. Lateral Curvature. — This is the most common form. Ap- pears chiefly in young girls from four to eighteen years of age, of a weak, tubercular habit, whose bones and muscles are defi- cient in vital elements ; who have been nursed and pampered, not supplied with the proper kind of food, nor had abundance of 1062 DISEASE GERMS. sunlight, or sufficient amount of exercise in open air; and where there has been an inattention to a natural position in standing or walking, or in wearing low-necked dresses, or high-heeled gaiters, corsets and tight-lacing. Its recurrence is much favored by myopia, which is so prolific in our large school-houses from over-crowding and forced strains of the eyes, which leads to a constrained position in writing, walking or in ordinary duties. Symptoms. — One shoulder is observed to be higher than the other, with a growing-out of the scapula. While one shoulder is high, the other is unduly depressed. So one hip projects, while the opposite curves inwards. On an examination, the ver- tebral column is found to be curved ; in double lateral curvature it is twisted like the letter S. As the thoracic and abdominal cavities are more or less depressed, the movement of the lungs and heart are interfered with, and the play or peristaltic action of bowels, liver, uterus are impeded. The general health suffers greatly ; difficulty of breathing, dyspeptic and other indications of derangement ; pain in side from pressure exerted on the nerves. If it is dependent directly on a rickety diathesis, there are the usual cachexia and distortion of the limbs. In the treatment we must bear in mind that the bones which form it are made almost entirely of the spongy or cancellous tissue, and for that reason are specially liable to disease, which sometimes burrows a good distance into the bone before any one, not even the owner of the spine, guesses what is going on. Another trouble to which the spine is liable is curvature, which usually appears first between the ages of twelve and eighteen, just when delicate girls are grow- ing very fast, and probably out-growing their strength. It is very unfortunate that in these cases the spine does not keep pace with the other parts of the body; the head and chest grow, the shoulders broaden, but the strength of the spine does not increase fast enough to bear this extra weight, and so it bends. It is as if you were to try and balance a heavy stone on the end of a thin stick ; the stick would bend, and the spine does just the same and for the same reason. There is no real disease, simply the bacillus, which gives rise to weakness, and this trouble is usually laid upon girls ; about nine cases of it in girls to one in boys. And another thing is, it is usually due to the occupations followed by girls, as distinct from that followed by boys, and besides, a boy will go and join some healthy game after his work is over. That there need be little, if any, difference between most men and women, in the matter of muscular strength, is proved by what goes on amongst some barbarous tribes, where the men BACTERICIDES. 1063 lead idle lives, and the women do all the work and carry the heavy weights, and their muscles grow very strong ; and you certainly will not find spinal curvature amongst them ; that is a trouble of civilized life. You must clearly understand that curvature of the spine is due to tubercle, and is entirely the fault of a child's up-bringing, and her friends do her a grievous harm if they do not take measures in time to correct it, for in time it crushes the other organs in the body, and may shorten life. What ought to be attempted is: (i) to feed the child better ; (2) to give her as much fresh air as you can possibly get for her ; (3) not to let her sit up at a table or any work for many hours together without support to her back, but place her in a chair with a back, and prop her up well with pillows, so that the poor weak back does not get over-tired and yield; (4) if you can possibly avoid it, do not choose for a delicate over-grown girl work at which she must sit bolt upright, or in a stooping position ; (5) whenever she can do so let her lie on a couch ; (6) if she is short-sighted take her to the eye department and get her spectacles. A child with spinal mischief will have a sharp pain in the back if it jumps off ever so little a height, and if this happens once he will not be in a hurry to do it again but you will notice that he moves about carefully, and will not hurry himself, and have the sprightliness of a healthy child. The position which a child will choose as the most comfortable in spinal disease should also warn an experienced eye: he will lean forward, and often grasp the thighs very firmly — a position very much like that which boys assume when playing leap-frog. Gf course the child finds this position the least painful because, to some extent, it takes the weight of the body off the diseased spinal bones and throws it on the upper part of the legs. Another point to remember is that a child will often, when the disease has attacked the upper part of the spinal bones, complain of pain at the back of the head. Of course this may be merely a headache, but if it is repeated often this warning must not be overlooked. Again, if the disease is in the upper part of the spine, the child's neck may be stiff, so that when he wants to turn his head he will turn all his body round, and to look up- wards he will bend the lower part of his back, and also a child will often make a habit of resting his chin on the top of the breast-bone, or of supporting it on the hand. Children with dis- ease of the spine will lose flesh. The diet therefore should be generous, consisting of animal food, milk, eggs, boiled white-fish, oatmeal, corn cake. The remedies used internally should consist of glycerite of ozone to annihilate the tubercular germ ; glycerite of kephaline 1064 • DISEASE GERMS. and tincture of oats ; comp. tincture matricaria to stimulate an appetite. When not exercising for the benefit of her health, the recum- bent posture, with head low. Once, twice, or even thrice daily, -Strengthen the muscles of the back with vitalized massage ; follow with either a stimulating liniment or faradization. Clothing should be light but warm, so that there be as little weight on vertebrae as possible. Unless the case is bad, can be better treated more successfully without than with an apparatus. Posterior curvature prevails among the same class of children, and chiefly affects the cervical and dorsal regions. It is caused in infancy by the frequent practice of mothers and nurses, in raising the child, by placing their hands under the arm pits, and so compressing the ribs, and forcing back the sternum and spine. Under this common custom, the muscles and ligaments, which keep the vertebrae erect, become weakened and relaxed. In other cases it may depend on rickets. Anterior curvature, the tubercular bacilli are literally swarming in the blood, the nervous system is bankrupt, and the bacilli are being evolved in myriads ; all the bones of the body are soft, spongy, devoid of vital stamina, tubercular deposit, evolution of spores, germs, inflammation, destructive ulceration, caries of the bodies of the vertebrae ; the intervertrebral spaces tumble in, owing to interstitial softening, and absorption of calcareous ele- ment of bony tissue. As the bodies are destroyed or absorbed, the spine projects backward, forming an angle. In bad cases, where the tuberculosis is very aggravated, as many as five or six vertebrae may be implicated, with their intervertebral spaces. It is most frequently met with at the middle of the dorsal vertebrae. Symptoms. — Intense tubercular diathesis ; weakness ; coldness ; numbness of legs, with twitching and spasm. Subsequently, paraplegia, with paralysis of bladder and rectum ; tenderness, or dull, aching pain in back ; tightness of chest, with more or less •difficulty of breathing ; rigors ; formation of abscess in back, the pus of which finds its way along the course of the psoas muscle in the groin ; exhaustion, sweats, hectic. Under favorable treat- ment, the disease gets arrested ; bones collapse ; anchylosis occurs ; patient recovering with incurable deformity. Sometimes sudden death, owing to diseased bodies of the vertebrae giving way and crushing the spinal cord, or from discoloration, with ulceration and destruction of its ligaments. In the treatment push the bactericide treatment of tuberculosis as far as practical. Perfect rest in the recumbent position is in- dispensably requisite ; the use of a reclining couch, so shaped as BACTERICIDES. 1065 ;to keep the trunk perfectly quiet ; a stiff bandage of paraftine, .extending from the occiput to hips, to insure rest ; no attempt to be made to rectify the deformity ; pain to be reheved. As soon as the streptococcus pyogenes appears, the abscess should be aspirated and a few drops of peroxide of hydrogen in- jected. For mechanical support, the best application in all cases is a parafifine jacket, made after the manner of the plaster of Paris bandage. To make this jacket, take a large sheet of cotton- wool, long enough to reach from the nape of neck to beyond ;the buttocks. The thickness of the sheet is sufficient, but if the .physician desires to have it thicker, he can double it or use two. It is then to be submerged in the liquid paraffine for five minutes. Have the patient in a nude condition, in the precise position in which it is desired to be retained ; then turn out the .cotton, saturated with the parafifine, on a piece of oil-cloth, or any smooth body, oiled to prevent it adhering ; spread it out to its original size ; and after it has cooled sufficient so that you can place the back of the hand on it without inconvenience, it is ready for applying to the back. This cooling process will occupy three or four minutes. The sheet of cotton, so saturated, is applied to the back, from neck to hips, and well round the body. Its adaptability is perfect, filling every curve or crease. Then apply a bandage over all, pressing the cotton firmly. This pressure causes a cohesion of the cotton and paraffine. Then have a piece of ice handy, which will cause the paraffine to be- ■come as hard as a block of marble. If it is desirable to prevent the hardening, refrain from applying the ice ; the paraffine in that case will take at least twenty minutes to cool. Spina bifida, or cleft spine, is also due to the presence of the tubercular bacilli in the vertebrae during foetal life, which gives rise to an arrest of development or growth of the posterior arches of one or more vertebral bones : the membranes which loosely envelop the spinal cord become distended with fluid, and are bulged out through the tissues in the walls of the canal, and form under the skin a soft and rounded tumor. When the mal- formation affects several of the vertebral bones the base of this tumor is broad, but when only one or two of the arches are defi- cient, or merely fissured, there is more or less of a pedicle or stalk. The size, conformation, and appearance of the tumor, and the symptoms caused by the malformation, differ very much in different cases. The state of things is usually as follows : in the lumbar region, just above the sacrum, and in the middle Hne of the back, is a large fluctuating and rounded tumor, evidently containing fluid, and the surface of which is covered by thin and I066 DISEASE GERMS. distended skin. At the base of this tumor a fissure, or large hole, can generally be felt in the posterior part of the spinal col- umn. When the child is placed upon its belly the tumor shrinks to a slight extent, and the skin becomes flaccid ; in the erect position of the child the tumor swells and the skin becomes stretched and smooth. As the child grows, serious nervous symptoms, such as convulsions and palsy of the lower extremi- ties, make their appearance. In most cases. spina bifida termi- nates fatally, and the patient dies in convulsions, which in some instances are immediately preceded by giving way of the walls of the tumor. The affection, however, does not always cause death ; several cases have been recorded in which the patient at- tained an advanced age without suffering any ill effects from the tumor, which continued to grow, though not out of proportion to the rest of the body. A more favorable and occasional termi- nation of cases of this kind is a closure, through adhesive inflam- mation, of the walls of the orifice between the spinal canal and the tumor. A closed and comparatively harmless cyst is thus formed, which is called a false spina bifida. The walls of the tumor formed in cases of spina bifida are composed of the skin and extended membranes of the cord, and sometimes a portion of the cord itself spreads out into a thin membrane. The con- tents of the tumor are a thin clear fluid, a portion of the cord and some of the spinal nerves. In consequence of the close connection between the tumor in spina bifida and the contents of the spinal canal, all surgical at- tempts at a radical cure of this affection are extremely hazardous. The too frequent result of such interference is acute inflamma- tion of the cord and its membranes, causing convulsions, palsy, and finally death. Symptoms. — A tumor, varying in size from a walnut to a child's head. There is fluctuation, swelling, most tense whert the child is in erect posture. The tumor may be transparent, or the skin may be unaffected, or it may be congested, purple, or blue. If only one or more lumbar vertebrae are affected, spinal cord does not deviate from its course, and only the pos- terior spinal nerves have any connection with the sac. If the tumor occupy part of the lumbar and part of the sacral region, the cord itself, and all its nerves will almost always be found in close contact with the sac. Not necessarily fatal, but likely to be if there is hydrocephalus, or paralysis of the bladder or rec- turn and lower extremities, or if the tumor bursts. The general treatment for tuberculosis should be pushed with care and energy. The glycerite of kephaline, tincture of oats, salt water and iodine baths; most nutritious diet, avoiding EACTERICIDES IO67 Starch. Every means which the nature of the case will admit of for to overcome the tubercular condition. To prevent further protrusion, a compress of some kind might be applied with great care. The collection of cerebro-spinal fluid is first due to the want of the normal support of the vertebrae ; its increase due to the irritation and unravelling of the serous fibres, causing exudation. The collection is termed hydrorachitis. Irritation, shocks to the cartilagi- Tubercular Bacilli nous extremities of the ends of bones, in the from falls, jumping, or other mechani- Hip-Joint. cal irritation, depreciate the nerve i^Coxalgia.) centres, liable, if the tubercular condi- tion does not exist, to create it. The knee, hip, and wrist, are most obnoxious to the ingress of that bacillus. The greater tendency for the germ to appear in those three joints, is accounted for by the presence of pink mar- row in the concellous structure, which dischrages the function of ordinary lymphatic gland, namely the elevation of the blood discs ; so that when weakened in any way, they become invaded with myriads of the bacilli. Most common among children between the ages of seven and fourteen ; met with up to thirty years age ; boys, from their stir- ring habits, are its victims. The first symptom which is observed in the child, is the dragging of the affected limb after the sound one, a flattening of the nates ; pain at first confined to the knee, and in standing, the patient advances the foot a little, slightly everting the toes, and does not rest his weight upon it. After a while pain comes on in the hip-joint itself, and generally conntinues chronic for sev- eral months. At length the symptoms may disappear, and be- come far more serious ; thus the affected limb becomes shorter than the sound one, the motion in the joint being impaired or destroyed, and permanent dislocation taking place. To assist in making an early diagnosis, a careful study should be made in a difficult and doubtful case of those limitations in th^ motions of the joint which become apparent only when the extremes of normal motion are approached. This may be done in various ways. I have found two methods easy in practice and certain in revelations. The first method applies to rotation, which is a direction in which limitation of motion first takes place. Let the patient lie supine with the feet slightly apart. With the hand placed lightly on the knee of the unsuspected 1068 DISEASE GERMS. limb, a rocking or oscillating motion is given to the whole limb, outward and inward rotation following each other, while the toe sweeps through an arc of nearly i8o°, the inner border of the foot striking the table, and the outer border nearly reaching that level. This occurs in the sound limb. A similar manipulation of the suspected limb may reveal a slight limitation of rotation, the result of hip disease. The other simple procedure relates to flexion. Let the patient, still on the table, sit up and kiss the knee. By flexing the neck and back, and drawing the limb up with the hands, this can be easily done with the unaffected limb, while an attempt to do it with the suspected limb may reveal a slight limitation of flexion indicative of incipient hip disease. Another diagnostic sign, too little thought of, perhaps, but of importance in the very early stage, a brawny thickening about the joint in front of the capsule or behind the trochanter. There will in some cases be found a condensation of the soft tissues, due apparently to the vicinity of osteitis, not visible perhaps, but recognizable by palpation or pinching with the thumb and finger, and then often not detected except by comparing the two sides. It will be found that a smaller pinch of the skin and un- derlying tissues can be made on the sound than on the affected side. These tests are to be used, of course, in connection with other diagnostic helps, and with due regard to other conditions which have the power to produce similar phenomena. Properly used they may betray the presence of hip disease in a patient entirely free from pain and lameness at the time of the examina- tion. Later on, the bacillus destroys the cartilage lining, the ace- tabulum, and covering the head of the femur ; the microbe of pus puts in appearance, and forms large masses in the cavity of the joint, ptomaines are excreted by both germs, hectic appears, and if nature or art does not effect an opening into the joint, the pa- tient may die or recover with anchylosed joint and a wasted use- less limb. The treatment in the earliest stage consists in maintaining the limb at perfect rest (the patient in the recumbent posture), in a straight position, which is best effected by putting on the limb a counter extension apparatus, and placing two sand bags, one on each side of the limb, the external one reaching as high as the arm-pit. Local stimulation over the germ-infiltrated tissues, with powerful bactericides, the irritating plaster ; if sinuses form, run them in one, and use injections of peroxide of hydrogen, somewhat diluted, into and around the joint cavity ; otherwise general treatment for tuberculosis. Aspiration of the joint, and injecting eight vol. peroxide has been tried with success. BACTERICIDES. 1069 Tubercular Bacilli in the Knee-joint. ( White Sivelling.) great number of strong The knee-joint is the largest in the body, and is composed of three bones ; the thigh-bone (femur) ; shin- bone (tibia), and knee-cap (patella). These bones are held together by a igaments, and the movements of the joint are controlled by numerous muscles. Like all movable joints, the articular surfaces are covered over with cartilage, and a large and complex synovial membrane is insinuated between the structures forming the joint. A remarkable feature about the articulation, it has in common with one or two more in the body, viz., the inter-articular fibro-cartilages, or as they are here called semilunar ; their office is to defend the joint from severe and sudden concussions, and their mechanism is so adjusted, they are always between the ends of the bones when, and at the point at which the greatest pressure is experienced. From the complex nature of this joint, their size, and exposed situation, it is obvious that it must come in for a large share of injury, and it is peculiarly subject to disease. The natural movements of which this joint is capable are flexion, extension, and partial rotation outwards and inwards. The tubercular diathesis is intense, the joint and all its struc- tures badly damaged, before the bacillus can enter. More common among children than adults. It commences with slight lameness, sweUing of the joint, and from the pain or stiffness of the articulation, the muscles are not brought into play, and so waste and atrophy. The gtneral train of symptoms is as follows: Tubercular habit, some exciting irritation ; occasional pains in the joint, be- comin^j^ g^radually worse ; swelling so slight at first that it is scarcely recognizable, gradually becomes a globular enlargement, owing to infiltration of the synovia with the bacilli, and latterly in and around the joint If the disease proceeds unchecked the bacillus dies, and undergoes cheesy and calcareous degeneration, anchylosis, disor- ganization of the joint ensues. The same rule holds good with reference to the knee, as the hip ; the same pathology and germicide treatment. This illustration is a microscopical appearance from a lymphatic in the groin of a patient, aged seventeen years, who 0/ ©0 The bacilli of tu'^ercle infiltrating one of tke lymphatics of the groin. IQjO DISEASE GERMS. had suffered for eight months with tubercular synovitis of the knee joint. The patient was much emaciated, terribly anaemic and broken up in all the essentials of Hfe. He was placed upon the glycerite of ozone in alternation with the concentrated tinc- ture of kurchicine in half teaspoonful doses, thrice daily. Improvement was perceptible the second day of treatment, which continued on for three months, when he was perfectly cured. The tubercular effusion in and around the joint was somewhat troublesome ; ozonized clay effected most excellent results, but after using it about ten days lost its effect altogether; liquid ozone operated well; this was followed by iodol, which also did good work ; hot fomentation of wormwood, one ounce resorcin to the pint were efficient, iodized oil was most effective. The effusion of tubercle into the synovial fluid of the knee joint must not be confounded with enlargement of the bursa mucosa, situated in front of the patella, and of the tendon imme- diately below it. It is frequently noticed in those who have much kneeling, as household servants, carpenters, plumbers, carpet-layers, etc. Enlarged bursse of the patella are frequently attacked by inflammation and suppuration, and usually there is extensive inflammation of the surrounding cellular tissue. Some- times troublesome burrowing ulcers remain after these abscesses, which are singularly obstinate, attended with fungus growths, the surrounding skin being dark and unhealthy, with deep burrow- ings under the integuments of the knee, and a foul offensive dis- charge. In severe instances the bone (patella) may become ne- crosed. The treatment consists in the first place of complete rest, and a well-fitting splint must be applied, and all motion of the joint prevented. If a recent enlargement, a stimulating lotion of acetic acid and hydrochlorate of ammonia, or a small blister, will often cause it to subside. If there is considerable thicken- ing, as there always is if the tumor has been of long duration, evacuation of the sac and subsequent counter-irritants will often effect a cure. Some surgeons use a seton, which is composed of a ^Qvj threads of silk passed through the cyst, and by setting up suppuration and the consequent contraction and granulation the cavity becomes obliterated. When the tumor has become a solid, gristly mass there is no other treatment than dissecting it completely out. ' the cases most commonly brought under observation, rest, ^v,. :hing, hot fomentations, and purgatives, and failins: these a free incision, usually effect a cure. Efforts have been made, by various remedies, to cause a disin- tegration of the calcareous mass in and around the joint, either by the ozonized clay or dioxide of hydrogen, with electricity, but with no satisfactory results. BACTERICIDES. JO/I Next in order to the knee and hip- Tubercular Bacilli in joint comes the wrist, here the same the Wrist-Joint. microbes often lurk, and here the amount of lymph glands are numer- ous, pink marrow abundant, consequently the anaemia is great. Treatment same as in the other joints ; locally, try the ozonized clay, if suppuration has not taken place ; or better still the gal- vanic cautery, followed with concentrated ozone ; if suppuration has taken place remove matter by aspiration, and inject eight- vol. solution of peroxide to destroy the microbe. Curative treatment has chiefly been attempted by stomach medication, and by the local application of bactericides. Local destruction of the bacillus tubercle by inspiring bacteri- cides, has been effectual and is worthy of a trial, breathing the germicide it often strikes the germ. There are various forms in which remedies employed for inha- lation can be administered, and several methods by which their direct application can be accomplished. All inhalations may be divided into two principal groups — the moist and the dry. In the first group, or moist inhalations, we have — 1. Warm vapors arising from water heated to various degrees of temperature, and charged with medicinal substances properly prepa'*ed for vaporization. 2. Medicated spray, produced by mechanical force. In the second group, or dry inhalations, we have — (^.) Gases or vapors produced by heat or chemical action, and mingled with the air. (/;.) Minutely divided solid substances, or impalpable powders. Each of these forms requires special apparatus for their pro- duction and administration, such as the inhaler, the atomizer, the evaporating dish, properly contrived syringes. For inhalation, important gases, as oxygen, chlorine, and nitrous oxide are oif great utility. The use of oxygen is of utility — a valuable remedy, in those cases of lung diseases which arise from imperfect decarboniza- tion of the blood. In some forms of asthma it is also exceed- ingly beneficial, relieving the difficulty of breathing and restoring the patient to a healthy condition. It must, of course, be used with caution and only under proper professional advice. Chlorine also has been highly spoken of by many writers on con- sumption, and has been even supposed by some to cure every stage of this affection. Numerous physicians have mentioned several severe cases of consumption that were perfectly cured by I072 DISEASE GERMS. this gas, and I am fully convinced that there are certain advanced stages of this disease in^which its inhalation is extremely benefi- cial. In chronic catarrh, and those affections of the lungs and air-passages in which direct stimulation of the mucous membrane is advisable, this gas, properly diluted with atmospheric air, may be applied with the greatest advantage. Like all other forms of remedial agents it must be used with caution and judgment, and when it is so administered it is perfectly free from danger, un- pleasant sensation or inconvenience. This gas may be easily obtained by placing a teaspoonful of peroxide of manganese in an earthenware saucer, floating in a basin of boiling water, and pouring upon it about fifty drops of hydrochloric acid. This will disengage a sufficient quantity of the gas to medicate a room of moderate size. The fumes which arise will rapidly diffuse themselves through the atmosphere, and be inhaled in the natural act of respiration. It will be necessary to keep the doors and windows of the apartment closed during its use, and indeed, if possible, it is better to appropriate a small room for the purpose, into which the patient may go for a few minutes several times a day, otherwise it will be necessary to pre- pare the vapor freshly as required. Nitrous gas has also been found very effective in many forms of lung disease, its action upon the system doubtless depending in a great measure upon the amount of oxygen which it contains. This gas may be obtained by pouring about half an ounce of sulphuric acid into a saucer, and adding to it, at short intervals, small quantities of pure nitrate of potash. By this means the air of an apartment will be quickly charged with the gas. When judiciously applied it speedily relieves violent parox- ysms of coughing, soothes the irritation of the mucous mem- brane, and promotes expectoration. In ashma and chronic bronchitis also it is very efficacious in overcoming the sense of oppression ot the chest and difficulty of breathing which always accompany these distressing complaints. The vapor of creosote may be obtained by mixing ten drops of this substance with half an ounce of water, and allowing it to evaporate in the fumigator and slowly diffuse itself through the atmosphere of the apartment. This quantity will be sufficient to medicate the air of an ordinary-sized room. This vapor has been found very useful in the advanced or ulcerative stages of consumptive disease. It should not be admin- istered whilst any inflammatory action is present, but when used with due caution it is attended with the best results. In the early stage of tuberculosis, before the bacillus has made much of an inroad, the microbe can often be sterilized, and a complete restoration of general health effected by inhalations. BACTERICIDES. 10/3 When the g-erm has effcicted an entrance and become localized in the lun;^, sofcening of the tubercle and its expulsion by expec- toration is much aided by inhaled vapors. When the greater portion of the lung is microbe-eaten, an ulcerous cavity formed, the possibility of a cure depends a great deal on the energy of the treatment. If the microbe, on the contrary, involves the whole of one lung, the prospects of recovery are greatl}^ diminished ; but still cure is possible so long as the other lung retains its integrity and is unobstructed in its functions. Life may be preserved even after the destruction of one lung. A person in this condition cannot have the same power of endurance in pursuit of his ordinary occupations, but he may still live and enjoy comparative freedom from suffering for many years. In such cases, which have hitherto been considered hopeless, a properly conducted course of inhala- tion has produced the following marked effects : the cough and expectoration have been controlled, and the constitutional dis- turbances greatly modified. In this condition the patient may remain stationary as regards flesh, although this will be, of course,, below the former standard. When both lungs are involved in extensive disease, cure is im- possible, and it is folly ever to hope for so great an improvement in the healing art as to embrace these cases among the list of curable. The most that can be accomplished is to afford relief by cleansing the lungs from mucus and pus which obstruct the bronchial tubes ; to soothe the cough and allay the irritation of the lung, so as to promote sleep, and make the patient com- paratively comfortable. But, in defiance of any skill within the power of man, the duration of life is a question of weeks or months. This, however, is no reason why some well-directed effort should not be made to procure the greatest amount of relief possible, and this can be more confidently looked for from the aid of inhalation than, from any other mode of treatment From the above remarks it will be seen how necessary it is for those who are predisposed to pulmonary disease to keep a close watch over the earliest perceptible signs of its approach. All authorities agree that in its first stage consumption is as amena- ble to treatment and as curable as any other form of disease. It cannot be known too soon who are the subjects of it, and it is impossible to ascertain this but by a most thorough, careful and frequent examination into the constitutional and local symptoms of the disease. Every one ought to be examined regularly at stated periods during the year, and there are no seasons better suited for this than the autumn and spring. If the lungs are hea'thy, an examination cannot produce the complaint, and if 68 I074 DISEASE GERMS. any evidence of the malady be detected, the sooner the patient comes under treatment the better chance there will be of his deriving benefit, and the greater probability of an ultimate cure being effected. The treatment should in any case be persevered in so long as the least vestige of the disease remains. To kill bacteria is one thing, to kill germs is quite another. It has been proved that they can stand a short boiling, that they can be floated in air-bubbles through strong vitriol, that they can be washed with a carbolic solution of any strength short of five- per-cent. without being killed, or losing their power of self-multi- plication. Is it likely, then, that) any vapor which could possi- bly be inhaled would be capable of destroying organisms which are so retentive of their vitality ? I think it is quite obvious that all evidence shows that it is impossible, either to keep germs out of the body, or by antiseptics to kill them. What else, then, can inhalations do ? vSimply ameliorate. While Prof McFall was performing experiments on the living matter in the atmosphere, it became necessary very frequently to prepare sterile solutions, and he was much troubled by the pro- longed boiling which was necessary to destroy with any certainty their contained vitality. But he found that if, instead of giving his solutions one long boil, he heated them several times for quite a short period, leaving them at the ordinary temperature in the intervals, he could quite readily devitalize them. This method he described as sterilization by discontinuous heating. He dis- covered, in fact, that however hard and resisting the germ may be, there is, in the life-history of every bacterium, a period when it is very soft, tender and easily destroyed ; and that, although he could not touch the germs themselves, he could let them hatch, and, by repeated slight heatings, kill their offspring as they came out, while they were too young to produce a fresh generation ; and thus he was able, without ever reaching the point of ebulli- tion, completely to devitalize the fluids which he had found most resisting, even to very prolonged boiling. The recognition of this difference between germs and bacteria, as regards the action of destructive agents, explains many things otherwise difficult of comprehension, and enables one to understand how organic sub- stances can often be protected from decomposition by the addi- tion of very minute quantities of antiseptics, in proportions quite too small to be in any way considered germicidal. The modus operandi is probably in all cases the same : the germ is allowed to hatch, the young is killed by an antiseptic far too weak to touch its parent, and thus the race dies out. Now, it seems to me that this is the explanation of antiseptic inhala- tions. The materials which have been found most useful are not BACTERICIDES. 10/5 mere gases which intermingle with the inspired air and then pass out again with it, but are vapors, gaseous forms of soluble bodies which are deposited wherever their penetrating vapor comes in contact with water. On every moist bronchial tube, on the walls of every cavity, and even in every congested spot in the lung, the inhaled carbolic vapor condenses and carbolizes the tissues ; and we are, I think, forced to believe that the benefits derived from the use of antiseptic inhalations are due to this infiltration of the lungs with this antiseptic material rather than to any action upon the floating germs. It must, however, be granted at once that this impregnation of the tissues never goes to any great extent, and the question arises whether so mild a dose can have any effect in preventing bacterial growth. There is plenty of evidence to show that antiseptic inhalations diminish the irritating qualities of the expectoration, and lessen the number of bacteria in it; but there is no proof at all that it can be rendered entirely free from bacteria by any amount of antiseptic vapor ; in fact, all evidence goes the other way. Now, it has often been assumed that, if we cannot stop the growth of micro-organism in fluids lying in the tubes and cavities, we certainly must not expect to check the development when embedded in the substance of the lung. But the cases are dif- ferent ; the one is a question of dead matter, the other of living tissue. Decomposition of expectoration obeys the same laws as experiments in test tubes ; but the growth of bacilli in the living substance of the lung is resisted by the vitality of the tissues themselves. Life is the great antiseptic. There are few points in which the difference between things living and things dead is more markedly shown than in the power live bodies possess of resisting, by virtue of their own vitality, the growth within them- selves of those lower organic forms which, in dead tissue, readily take root and grow, and by their development, rapidly reduce the lifeless elements to their lowest chemical affinities. For scores of years man's body resists decay, and then, when life departs, he rapidly swarms with myriads of bacteria ; not that there is any chemical change making his body more suitable food for them, but because they are able at last to take possession, now that the resisting power of vitality has departed. As it is with the germs of decomposition, so it is with those of tuberculosis. When they attack the lung, they do not usually at first affect those parts which are most actively performing their functions ; the very parts into which they are most freely carried by the air are least susceptible to their attacks ; their active vitality is their protection; but, in the apices and parts injured by pre- vious inflammations, they settle and breed disease. And, even 1076 DISEASE GERMS. when phthisis is well established, and when the air in the chest mu>t be crowded with its germs, large portions of the lung remain for long untouched ; showing on the one hand, how great is the resistance to the disease inherent in the tissues themselves, and, on the other, giving a rough measure of the amount of help required from treatment. For, if the difference between a soil fit and one unfit for bacterial growth is to be measured, for example, by the difference between the functional activity and resulting vital resistance of an» upper and lower lobe of the lung, surely it is not unreasonable to hope that, by impregnating the pulmonary tissues with antiseptic material, which, we know, renders them less fitted for the cultivation of bacilli, we maybe able to make up the lacking resistance, and so prevent the access of disease. The inhalation of bactericides certainly has a tendency to steri- lize the bacillus, and thus aid in at least arresting the disease. First, the material used ought to be capable of absorption by moist surfaces ; it should be a vapor, not a gas ; and a dry vapor, not an atomized solution. Second, as no attempt to filter or steri- lize the air is required, all complex forms of respirator may be discarded. The freest possible access of air should be allowed, the vapor being breathed with* it as constantly as possible ; so that the simplest and most open respirator is always the best, the mere diffusion of the vapor in the room sometimes being suf- ficient. Thirdly, we must combine with the treatment by inhala- tion, all medicinal, dietetic, and hygienic measures which tend to improve the general condition of the patient, and thus increase his vital resistance. It is worth bearing in mind that the view of the matter, which I have so imperfectly brought before your notice, shows the har- mony and unity of purpose which exist among the various means which we make use of in the treatment of consumption. If we accept the germ-theory of the origin of tuberculosis, all treatment, both local and general alike, must aim at preventing the growth of certain bacteria in the body ; the struggle is be- tween one great life and- myriads of small ones; and while all general treatment tries, by providing healthy work, good food, and pure air, and by ai-tention to all the details of a bactericide treatment, the treatment by inhalants should consist in a selection of a few of our best germicides, as eucalyptus, menthol, creosote, iodine, ozonized sulphur water, comp. oxygen. There is really no cessation of attempts to attack the microbe by inhaling or through the stomach. The baneful parasite brood of bacilli are hard to kill, and it requires tact, and good remedies to drench the germs, and cause their departure from the pulmonary cells. BACTERICIDES. 1077 Ozonized sulphur water or ozonized iodine, are most obnoxious to the tubercular bacilli ; their anti- parasite and disinfectant properties are great, and their use is of real benefit in pulmonary- phthisis, in thoroughly rooting out the germ. More recently, inhalation of hydrofluoric has met with success. Where a special inhaling chamber can be contrived, the vapor may be driven into it by means of atmospheric air forced through a mixture of the acid and water in various degrees of dilution. Simpler portable contrivances have been employed, consisting of a bottle containing the mixture of acid and water, through which the air may be drawn by means of an india-rubber tube, and in- haled direct ; or of a bag containing a definite quantity of air, which is connected by tubing with the acid bottle, two wash-bot- tles being interposed between the acid bottle and the inhaler. A definite volume of air is thus drawn through the whole appa- ratus until the air-bag is exhausted. The strength of the acid solution varies from fifteen to twenty or thirty per cent. An eminent physician contributes a note on the action of hydro- fluoric acid in the treatment of phthisis, in which after a full recognition of preceding work, he advocates the careful trial of the remedy as one which is, at any rate, simple and innocuous, and may greatly contribute to the recovery of early cases. He points out, that in this, as in every other form of inhalant, the strength must be so graduated, that long-continued inhalations can be practiced without discomfort. Inhalations that are pain- ful, or in any way distressing to the patient, are of very little value in practice, as they can never be long continued. Hence no positive standard can be laid down for the strength of the acid to be used in each case. The first sensations on inhaling the vapor are always somewhat irritating to the nose and fauces, but toleration is quickly established, and patients are soon able to inhale the vapor continuously. The remedy has been most successful in the early cases, and the first notable improvement is always in the appetite. He also notes that night-sweating is diminished, but that the fever is not always reduced in propor- tion to the improvement in other directions, nor do the number of bacilli diminish to any material extent. The same may be said of the local physical signs. Cough is not very much af- fected, but the sputa, as a rule, becomes less profuse. Diarrhea and laryngitis are not much affected, being generally met with in the case of advanced disease. The inhalation, after the first few moments, is attended with pleasant sensations, and patients al- ways express themselves as being better for it at the time. The hygienic management of all cases of tuberculosis is im- portant, it includes proper directions as to ventilation, diet, cloth- ing, exercise, bathing, etc. 1078 DISEASE GERMS. Ventilation is most important, as a very large proportion of microbial diseases are due to germ-laden atmospheric areas; thus it is bad in quality, often charged with noxious vapors, or irritating impurities, variable in temperature, liable to transitions in electrical conditions ; all these sources affect health. In some the effect is a direct, and in others an indirect, cause of disease. The changes in the temperature of the air are less serious than those in its purity. The former produces active inflammation ; the latter is the parent of low fevers and consumption. The former is the most speedy in its influence on the health, the lat- ter the most fatal in its effects. The influence of pure air is seen in those who live active lives in the open air; riding, walking, or working. The effects of im- pure air, on the contrary, are seen in the pallid visage of the in- door mechanic, in the fragile form and hectic-tinted cheek of the seamstress, everywhere, in fact, when great numbers of human beings are crowded together without the means of sufficient ventilation. Germ-laden air is most depressing to the one affected. Air must be considered in the light of food, the amount of supply, the mode or manner in which it is introduced, as well as the equality of its distribution, are essential considerations in every well ventilated-apartment. With respect to the purity of the air as a preventive or curative agent, there are some curious facts which appeal to our judg- ments in rather a circuitous, but yet cogent way, and which would seem to militate against many of our proconceived notions, and make us reverse much of what we have hitherto enforced in practice. Some physicians have held the view that an excess of fibrine (hyperinosis) in the system predisposed to, if not favored, the development of tubercle. In pregnant women, the disease, if already present, is held in abeyance during the period of gesta- tion, owing to the fact that the arterial blood assumes, in a large measure, the venous character, from the excess of carbonic acid in the system in general, but in the circulating fluid in particu- lar ; and as venous blood contains a less proportion of fibrin (hypinosis) than does the arterial, the arrest, or prevention, of the development of phthisis in the gravid state is thus rationally and physiologically explained. The bright carnation or vermilion hue of the skin of consumptive patients furnishes additional proof of the excess of oxygen over carbonic acid in such cases, and would seem to indicate the most rational remedy for the prophylaxis or cure of the disease, which, under the circum- stances, would necessarily be the very opposite of that recom- mended by so many writes and authorities on consumption. BACTERICIDES. IO79 The solvent action of venous blood on fibrin prevents materially the deposition and development of tubercle, and goes far to strengthen the significance of the foregoing views, so that we are; forced to infer that air contaminated to a certain extent by car- bonic acid is not after all, so deleterious to phthisical patients as we have been led to suppose. The well-known anesthetic action of carbonic acid upon the terminal branches of the sensory nerves in general may not only allay " formative irritability," which, according to Virchow, plays such an important part in the genesis of tubercle and other morbid growths of tubercle, but also effectually calm the incessant, hacking cough which accom- panies phthisis in all its stages, and thus become a potent pre- ventive, as well as a curative agent, in the disease. The effect of climate upon the tubercular bacilli is remarkable, some climates rich in ozone will often completely sterilize the germ, whereas others bring it into amazing activity. It is difficult to suggest a climate adapted to all constitutions, and in recommending special localities a fearful risk is incurred, as the whole matter is involved in uncertainty. To parties who have ample means there are to be found locali- ties suitable everywhere for their special case. Within the limits of our native land there are differences of climate which can be made available according to season. In winter there are shel- tered nooks on our southern and Pacific coasts; in the heat of summer there are the cool and bracing places of the north. Even in our homes it is practicable to secure a temperate yet in- vigorating air, with all the personal comforts to which we have been habituated, in which we can enjoy the charms of a con- genial and social intercourse with friends, and in which the domestic ties are preserved intact to the latest moment of exist- ence. The diet of those suffering from the tubercular bacilli in their bodies should be of the best, and liberal to the utmost degree, as the condition of the patient will permit. Clothing, summer and winter, should be woolen, light as con- sistent with sufficient warmth. Exercise, moderate, is invaluable. In our day too little atten- tion is given to this subject, and the most erroneous notions pre- vail among the people; some of the evil results are forcibly illus- trated in the case of the invalid. Do we not daily see those who are able to walk without any considerable fatigue shut up in close over-heated rooms, lest a breath of pure air should reach them ; whilst others, reduced to the last extremity of emaciation by dis- organization of the lungs, are made to undergo long and tedious journeys on their way to a warm climate? Io8o DISEASE GERMS. Proper exercise is that physical exertion which calls into use the greatest number of muscles, and should be carried to that amount which the patient can bear without fatigue. A walk of a quarter of a m.ile in disease may be equal to thirty miles in health. Every invalid should take regular exercise daily, which must be apportioned in quantity and in kind to the nature of the disease and the strength of the patient, and should always be determined by the physician, in accordance with the condition of the invalid. This particularly applies to cases of consumption, and also to other diseases afl'ecting the breath, as asthma and those of the heart. In addition to these outdoor exercises there are many kinds of passive exercise, such as swinging, rocking, inflating the chest, and the use ot dumb-bells, which may be resorted to indoors when the state of the weather prevents the patient from going out. Much misapprehension exists in regard to the influence of the weather, and, as a consequence, few invalids take half the exer- tion they should and can take with perfect safety in the open air. Rain is an insuperable objection ; and a raw, damp, windy day should never be braved under any circumstances. Snow, on the contrary, when unaccompanied by wind or sleet, offers no obsta- cle to exercise in a covered carriage. The influence of a dull, cloudy day is felt almost as much in the house as in the open air, and the necessity for exercise is quite as imperative as on a fine clear day. With a clear sky overhead — though there may have been recent rain — the invalid may drive out with entire safety. During the autumn and winter, dry cold days are the best for outdoor exercise, and with the protection of a respirator, invalids may go out in the coldest weather, not only with safety, but with comfort to their feelings and benefit to their health. Bathing is an essential element in the treatment of all suffer- ing from the presence of the microbe in any part ; its tempera- ture, period of use become a matter of regulation by the attend- ing physician. There are, however, certain general maxims which ought to be clearly understood : I. The use of cold water should be particularly avoided by those suffering from the bacillus tuberculosis. The quantity of blood circulating in the superficial blood-vessels at the surface of the body is very considerable, and the action of cold water ap- plied to the skin is certain to disturb the equilibrium of the circulation, and to drive back a large proportion of the blood on the internal organs, especially when these are already the seat of disease, thus producing a liability to congestion. BACTERrCIDES. . IO81 2. The use of hot water should be avoided, as being very de- pressing in its effects upon the system, and, from the increased circulation which it causes on the surface of the body, rendering the patient more susceptible to change of temperature and conse- quent risk of "taking cold." 3. Plunge-baths and shower-baths are also to be avoided by consumptives, as necessarily exposing the whole surface at once to the action of the atmosphere, and the sudden shock to the nervous system is equally prejudicial, being a frequent cause of disturbance to the proper action of the heart. In all cases where the bacillus of tubercle is present I recom- mend, as most beneficial, the use of water as nearly as possible the temperature of the blood (98° Fahr.). I also give the prefer- ence to sponging over every other form of bathing, recommending as a precautionary measure to uncover only a portion of the body at a time, and to regulate the temperature of the room by pre- venting draughts of air, and by having it sufficiently heated. As the perspiration is apt to be acid, and charged with oily secretion, the use of a small quantity of an alkaline substance in the water, such as carbonate of soda, will assist the cleansing of the skin more thoroughly and removal of dead microbes. In the more acute forms of disease gentle frictions of the skin after the bath will be beneficial, but in chronic complaints this will not be so essen- tial. Great care should be taken not to expose the person to the open air immediately after bathing, but to allow the equilibrium of the circulation to be fully re-established before venturing forth, for it will be found that with every precaution an amount of con- stitutional excitement will always be produced. It will readily be seen that I attach great importance to the act of bathing; not that I regard it as a specific or directly curative agency, but simply as forming a portion of the general hygienic management which cannot be too rigidly enforced by the physi- cian, or too faithfully put in practice by all who seek relief from pulmonary tuberculosis. As our readers would naturally like to hear what the most illus- trious, leading and learned members of the medical profession in the United States think and say regarding the " tubercular ba- cilli^' we hereby append extracts from their published essays on the subject. A very prominent, highly scientific, and most suc- cessful practitioner, H. S. Lane, M. D., Philadelphia, Jefferson Co., New York, says: ** Tubercle, the degraded bioplasm or living matter of our own bodies, caused by conditions adverse to vitality, and when once present the bacilli being always abundant, whether there be formations or not, renders this diathesis pre-eminently conta- I082 • DISEASE GERMS. gious and infectious. If vital force be low, germs very active in the deposits in the periphery of the nodules, isolated or grouped, and the bacilli or young swarms are found in the sputum, sweaty saliva, stool. Spores producing bacilli are found in every tissue, but breeding is carried on actively in parts that are weak and feeble. Indeed their mode of evolution is the same as other germs — a weakened part, a station suited to the growth of germs ; incubation follows, the seed undergoes changes, same as a grain of oats in the soil. That particular germ may die, but in dying multiplies itself indefinitely ; new germs are let loose into the cir- culation and another colony is formed in another part or soil,, during the incubation of which there is a pause, a febrile excite- ment, a growth. The disease germ in the blood may multiply, but the chances are that if the individual has high vital force and normal physi- ological activity that growth will be retarded until there is a weak, vulnerable point, a locality, a zone where germs can grow. The transmissibility of the micrococci of tubercle may take place from man to man in apparent health ; from husband to wife, or vice versa ; or from tubercular disease or from domestic animals, especially from the milk of tubercular cows, but there is,, properly speaking, no fructification unless vital force is shat- tered. The diversity of disease-germs, aside from tuberculse, is easily explained, and harmonizes with physiological laws ; the germ is originally an elementary element of nutrition of some special tissue, and in that condition it is degraded by mechanical violence,, ill health, depressing causes, as poor food, insanitary states, which accounts for their difference when the condition of de- pressed vital force exists ; still there must be a receptivity of soil as an essential requisite to reproduction — a vulnerable point for their deposit or reception and fructification. These facts teach us that consumptives should in all cases be placed in an invigor- ating residence, with ozone-generating atmosphere, where no dis- ease-germ can live, for where ozone is, tuberculae cannot exist ; a diet rich in blood elements, surroundings free from all insani- tary states, body properly protected with flannel, and daily in- vigorated with bathing and massage. It must be born in mind that the lung at some point has suf- fered a partial death ; it is devitalized, passive, there is a stagna- tion, a lowness, a want of contractile power ; the nerve power, the tone of the blood vessels is lowered, circulalion is feeble, all is delicate, and the working capacity of the lymphatics and pink marrow is greatly impaired.'^ BACTERICIDES. 1083 E. S. Pixley, M, D., Pittsfield, Massachusetts, a most experi- enced and highly scientific practitioner, who has added much to the dissemination of the germ theory of disease, in a recent printed essay on chronic disease, says : " Tuberculosis originates in one or other of two ways, the microbe is either the changed, altered, degraded bioplasm of our own bodies, by living under conditions inimical to vitality ; or it is the product of others. Whether it is acquired, or the product of an invasion, the recovery or destruction of the patient depends upon the relative vital power of the microbe and the integrity or strength of his own vital force. In the struggle it is the object of remedies to weaken the one and strengthen the other. This can only be effected by selecting and administering such germi- cides as are innocuous to the human body, whilst they are as inimical as possible to the microbe. If the microbe is not anni- hilated in the blood and tissues it will excrete ptomaines, a chemi- cal substance disastrous to living matter. Numerous attempts have been made to destroy the bacillus in the lung, blood and other tissues by means of germicides, either inhaled through the bronchial mucous membrane ; or by the stomach, or by endosmosis through the skin or rectum; to destroy the bacillus without interfering with the delicate structure of an organ. The principle is a good one ; the glycerite of ozone is the remedy, which, when taken into the stomach eliminates ozone ; this, the great scavenger of nature, enters the blood, in which it either sterilizes or annihilates all microbial life. By the persistent administration of half a teaspoonful thrice daily, well diluted in water, the tubercular bacilli is constantly exposed to its action. The remedy is volatile ; permeates all the areas of living matter, circulates in the blood ; vitalizes that fluid ; has a specific power to destroy tubercle without injuring any tissue, even deli- cate lung structure. From its first dose, the microbes are para- lyzed, they fail to excrete ptomaines; hence hectic, diarrhea, fever, states in which ptomaines play an important part, are wiped out orally or otherwise. Over the germ colony, or desposit or infiltration, an active bactericide should be applied either constantly or at suitable in- tervals. Such a germicide as ozonized turpentine, if the tubercle is localized on the peritoneal coat ; if in the lung, the concentrated ozone with chloroform ; if in the knee-joint, glucozone ; such local applications are found to destroy tubercle when kept in close contact. Indeed the tubercle bacillus speedily disappears." The observations of Prof. W. V. Rutledge, M. D., of St. Louis, Mo., who is one of the foremost workers in the field of bacteri- ology, has developed the significant fact that the bacillus of tuber- 1084 DISEASE GERMS. cle may co-exist with numerous other microbes, as those of lepra, syphilis, rheumatism ; that the evolution of the microbe can be prevented by a high standard of health. " The tubercular germ is undoubtedly the most common, one to which the human race owes more mortality during the working period of life, between fifteen and fifty-five, than any other, and it is the duty of the individual, as well as the government, that a systematic attempt should be made to diminish, and when possi- ble, remove the preventable cause of this scourge. The evolution of the microbe can be prevented by a rigid ob- servance of sanitary science, by abundance of the best of food, good clothing, a high moral atmosphere, and everything which tends to ennoble man. The reception of the germ from other bodies is more difficult to control. Amongst the various modes by which the infecting bacillus has been shown to enter the body, there are two which are of special importance in connection with the subject of this paper. Com- munication by means of the mucous membrane of the alimentary canal is of interest because of the prevalence of tuberculosis in cattle, and from the experimental proof of the infectiveness of the milk of tuberculous cows. As animals which are crowded together in sheds with deficient ventilation, etc., are most liable to tubercu- losis, an efficient inspection of cattle kept for dairy purposes is necessary. Although the injurious properties of the milk of diseased animals may be destroyed by boiling, precautions are required as to the selling of milk for food; and even though the bacilli are rarely found in the muscles, it has been suggested that tuberculosis should be included amongst the contagious and infectious diseases of animals. Infection through the respiratory system is, however, the most frequent starting point of phthisis ; and as the risk is intensified by close contact and by the crowd- ing together of sick and healthy, the necessity for ventilation and the prevention of overcrowding is apparent, and becomes more marked when the predisposing causes are considered. Wherever tuberculous persons or animals are congregated, the air must contain larg;e numbers of the tubercle bacilli, which must be taken in with the inspired air by many individuals, of whom only a proportion become phthisical. It is probable that even if the bacilli escape expulsion by the expiratory effort, the healthy tissues do not afford them a suitable habitat ; but a lowered vitality of the tissues, whether local or general, places them in a more favorable condition for the development of the micro-organism, and thus constitutes in the individual a predis- position to tubercular disease. Speaking generally, a suscepti- BACTERICIDES. 1085 bility to tubercle ma5^ be produced by diseases of the respiratory- system, or by constitutional enfeeblement. Amongst the predisposing causes, some of the most important result from the aggregation of persons in a crowded population, or from the industries which mark an advancing civilization. Indoor and sedentary occupations, as well as those in which dust is inhaled, influence largely the prevalence of phthisis; and much of this disease amongst those who follow these occupations is preventable. Here, again, the basis of all preventive measures is to be found in efficient ventilation of mines and work-places. Printers, tailors, and dressmakers afford sufficient example of the effect of employment in crowded and ill-ventilated rooms, and the prevalence of phthisis amongst these classes is shown to be very considerable. The home-workers are more difficult to deal with than those who are working in large establishments, but the provision of public work-rooms, in which conveniences for various occupations could be found, might lessen the evils of the present state of things. With regard to climate, its influence in the causation of phthisis is probably infinitesimal as compared with the effects of density of population. The dampness of the soil has been shown to have some influence on the prevalence of the disease, and this can be remedied by drainage. Damp in houses may be pre- vented by concrete foundations and the insertion of a damp- proof course in the brickwork above the level of the ground. Overcrowding is of two kinds — the aggregation of buildings on a confined area, with insufficient open space around and be- tween houses ; and the crowding together of the inmates within the house. Both arc unfortunately too common, and are potent factors in the development and spread of tubercular disease. By-laws should be enforced regulating the width of streets, the amount of open space around house*^, the minimum height of rooms and size of windows ; and efficient inspection of new houses should be carried out before they are allowed to be occu- pied. Tenement houses should be licensed to hold a certain number of inmates, and be liable to inspection. In considering the number of inmates to be allowed to a house, attention should be paid to the means of veitilation as well as to the num- ber and size of the rooms. As many diseases which produce a general debility thereby predispose to tuberculosis, sanitary and hygienic measures, framed for the control of these, tend to di- minish the amount of phthisis in a community: and seeing that insufficiency of food, of fresh air, and of exercise, continued anx- iety and mental depression, and dissipation must be reckoned amongst the predisposing causes, the philanthropist may assist I086 DISEASE GERMS. the sanitarian in the fight against this widespread disease. How many cases of consumption will result from the present epi- demic of measles in this city, which might have been checked by the timely closing of schools ! The fundamental principles which must form the basis of any successful attempt to diminish the prevalence of phthisis are : (i) to provide a sufficiency of fresh air in and around dwellings, and work-places and (2) to endeavor to improve the resisting power of the individual by all possible means, as physical training dur- ing the period of growth and development, by exercise and recreation, and good food. As the effects of the tubercular microbe in the individual are not confined to his generation, but handed down from parent to child, any causes that tend to increase tubercular disease among a people must be regarded as tending to produce progressive vital deterioration of race. We owe it, therefore, to humanity, to succeeding generations, to allow no time to be lost in com- mencing a systematic attack upon everything productive of this germ." Tuberculosis is a most contagious and infectious disease. We copy the following which is part of a report made to the Health Board by the eminent R. H. Randolph, M. D., Portland, on the prophylaxis of tuberculosis: " That the terrible mortality due to tuberculosis must not be reckoned only from the cases of phthisis, but that a large num- ber of examples of bronchitis, pleurisy, meningitis, peritonitis, enteritis, diseases of bones and their articulations, indolent abscess and others, are due to the same fatal and protean source. Tuberculosis is an infectious, parasitic malady, caused by a microbe, but can only be conveyed to healthy individuals under special circumstances. Besides its transmission by descent, the microbes can gain entrance aerially by the organs of respiration, by the stomach mixed with food, by the mucous membranes, and by the skin through wounds, scratches, or punctures. The most common and active source of contagion is to be found in the sputum of consumptives. In its liquid state, this has little activity, and can only very rarely do mischief; it is when dried and reduced to powder by attrition that it is most dangerous. When expectorated on the ground, the floor, or the surface of walls, on one's clothes, carpets, bed coverings and cur- tains, even in handkerchiefs or napkins, it may readily be re- duced to this pulverulent form, and then be distributed by the air, to be absorbed by the lungs, settle on one's skin, on mucous surfaces, or become mixed with food. In the faeces, also, of the phthisical, the microbe exists, and may be disseminated by simi- BACTERICIDES. 1087 lar means. Therefore the utmost care should be taken in the reception and disposal of the sputa ; the spittoon should always contain water or some antiseptic liquid ; never sand, sawdust, or ashes. The contents [should be thrown daily into the fire, and the vessel well washed with boiling water. It should never be emptied into drains, on dunghills, or on the soil of gardens. Handkerchiefs should never be allowed to become dry before washing, but be put into water as soon as possible after use. But the best plan is to use some cheap material and burn it. A healthy person should not sleep in the same bed as a con- sumptive, nor, if it can be avoided, in the same room. In hotels and establishments devoted to the use of consump- tives, the furniture should be of the simplest kind, and readily washed ; and all textile fabrics should be disinfected* before a change of occupancy by heating in steam under pressure. Besides the chances of human contamination, there is the ever-present danger of infection by tuberculous animals. The fatal microbe may be found in the milk, the flesh, and the blood of those used for the food of man ; in beef, in cows^, goats', and asses' milk, the flesh of rabbits and fowls. Cows' milk is most frequently infected, that ot the goat and ass much more rarely. But it is safer to boil them all before used as infants' food. The carcasses of all animals slaughtered for food should be jealously examined before the meat is per- mitted to be sold. There is a horrible practice, common in France, of people frequenting the abattoirs for the sake of drink- ing the warm blood ; one is glad to hear that it is exceedingly dangerous ; and meat should not be cooked in large joints, since the bacillus can stand a high temperature with impunity. The children of tubercular parents are most inimical to the disease, and this is obviously true, apart from the possibility of congeni- tal infection." The presence of the tubercular bacilli in Tubercle Bacilli the sputa, or in any other discharge of a in Sputum. patient is a sure proof of the tubercular in- fection of the individual. It might thus appear very easy to discover the tubercular taint in a person. Such really is the case, but the naked truth remains that it is occasionally exceedingly difficult to prove the presence of tubercle bacilli, especially because of their close resemblance to the bacilli of lupus and lepra. Prof, McFall, M. D., oi Dallas, Texas, however, seems to have discovered a procedure which promises the long-desired aid. This procedure is as follows : I088 DISEASE GERMS. " After the sputum or the pus has been treated in the usual man- ner on the watch-glass, it is allowed to dry thoroughly in the at- mosphere, and the glass then drawn in the well-known way through an alcohol flame. The glass is then taken hold of by brass pincers, or, still better, glass pincers, and dipped quite slozvly into the strongest undiluted nitric acid, i. c, the acidum nitricum fumens of 145 to 150 specific gravity; it is then taken out just as slowly, and at once dipped into a vessel containing pure water, and there rinsed. The thus prepared material is then dried and afterward placed into the coloring fluids according to the usual method, and in this the floating glass is permitted to remain for twenty-four hours, when the color is removed with diluted nitric acid. For the first coloring process fuchsin, for the second a solution of malachit, is employed by him. The fuming nitric acid used must each time be a fresh preparation, as it at once attracts the water from the atmosphere, and by giving off nitrous vapor changes to common nitric acid, which no longer retains the property of the fuming acid. Tubercle bacilli thus treated perfectly retain their form, shape and color ; only their contents have undergone an alteration ; their interior appears as little nodules attached to each other like a chain of pearls. The bacilli, therefore, seem to consist of a hyaline wall and coagulable contents. Neither the bacilli of lupus nor those of lepra show the same changes. This " chain-of-pearls " appearance, being characteristic of tubercle bacilli alone, may well serve, therefore, for the differ- ential diagnosis of the three kinds of micro-organisms mentioned, while the method will permit us, henceforth, at once to establish the presence of tubercle bacilli without having to await the results of inoculation or of pure culture. The present methods of detection often fail, he says, on ac- count of the frequent scarcity of the bacillus in any given speci- men, and the tenacious character of the latter renders it difficult to get the film on the cover-glass sufficiently thin and uniform. We advise that the whole sputa for the twenty-four hours should be placed in a conical vessel, very like a urine deposit glass, and that it should be subjected for another twenty-four hours to a uniform heat of 36-39° 0.(95-103° Fahr.). This temperature he considers to fairly represent the temperature existing in the lung — the habitat, for the time being, of the parasite. At the end of the above time the thicker portions of the sputa will have settled to the bottom of the glass, and will have lost much of their tenacity. The supernatant fluid can be easily decanted, or a drop of the thickened portion can be spread upon the cover-glass with uniformity, and, of course, is much more BACTERICIDES. 1089 liable to show bacilli, if present, than a drop of sputum before concentration. They are often five times as abundant. C. L. Sender, M. D., Burrows, Indiana, has made a specialty of the treatment and cure of tuberculosis. His high scientific at- tainments, together with his profound erudition, have made him a standard authority on the subject. In a recent essay on the subject we read : " The bacilli of tubercle, a degradation of the living matter of the patient's own body, which ^akes place under unfavorable condition to existence, or is received by weakened bodies in the form of contagion or infection — whichever, it colonizes in devi- talized parts, on or in the bronchial or pulmonary tissue, and is usually accompanied with great emaciation and debility, because the pink marrow and other lymph canals are germ-laden, blocked up ; difficulty of breathing after exercise, and a cough, which is always troublesome, and annoying expectoration, hectic fever, diarrhea. Under states or conditions prejudicial to a high state of life, the bacilli of tubercle may appear at any age, but poverty, hardships, colds, catarrh, pneumonia, and many other states of vital deteriora- tion bring it on', as certain deleterious trades, confinement, mo- notony, insanitary states, alcohol, excesses. Of all diseases, probably the presence of the malarial germ in our bodies has much to do with the greater prevalence of the disease in our country, but a very large per cent, of all cases are due to the sudden changes in our climate, to insanitary states in- cidental to modern sewage, and heating of dwelling ; to deleteri- ous food and perverted habits. Like all germ diseases, it is essen- tially contagious and infectious — a damaged part is its seat of deposit. It is there it breeds ; if lung substance is weak from any cause, it imbeds itself there ; if the lining membrane of the bronchi is impaired, there. It is always dangerous from the growth and development of tubercles. A vital organ smitten — a deposit on the bronchi is much more dangerous than when in the substance of the lung — the danger is in proportion to the amount of germs present, and their activity, which depends wholly on the amount of vital depression. The only cure for tuberculosis is the destruction of the bacilli tuberculas in the blood, and in the part where they have colo- nized, and the maintaining and building up of vital force. If there is cough, emaciation, haemoptysis, hectic fever, night sweats, etc., administer the glycerite of ozone, the only remedy so far discovered that will positively destroy the germ, the factor of disease. Under its persistent use, there will be strength, greatly diminished cough ; he will gain flesh,; every dose will 69 iogo DISEASE GERMS, reduce 'pulse, respirations, and abolish hectic, it will arrest night sweats and bleeding from the lungs. If there are great prostration, great and grave lesions in lung structure, or on bronchia ; if the patient, and even physician, is hopeless of a cure, we say giveil ; administer it persistently when the bacilli are active in an albuminoid state, for it will annihilate the germs : give it when the germ is merging from a caseous to a calcareous mass ; an inorganic body ; give, for it will then cause a chemical dissolution." /. F. Bcckner, M. D., Kentland, Ind., may also be regarded as standard authority on the tubercle bacillus. In his recent scien- tific and brilliant essay on the subject, he says : " The discovery of the tubercle-bacillus is a scientific fact ; all, with the same facilities, may see what others have seen. It is the one thing tangible, describable, known by its peculiarities among entities as readily as one individual is known from another. To doubt its existence in tuberculosis is to doubt the utility of scientific medical research, and to abandon further progress to the unstable dreams of theorists. The sputa of the phthisical contain these germs ; the air they exhale is loaded with them or their spores, and their introduction into the system of animals will always produce tuberculosis, while notliing else zvilL These are not speculations, but demonstrable facts ! Further- more, clinical observations go to prove conclusively that healthy individuals, living in an atmosphere contaminated by the phthisi- cal, will contract this disease, and not any other which might be due to a lowered vitality, from being in close quarters and breath- ing a vitiated air. On the general question, as to how far it is possible to con- tract tubercular disease by contagion, we certainly have at the present time no sufficient evidence to warrant us m arriving at any satisfactory conclusion. All that is certain, or even probable, is that when a large number of human beings are herded together in a small space one of the diseases which make themselves most commonly felt is tuberculosis, whilst in the presence of abun- dance of fresh air it can almost with certainty be banished. It is equally certain that under such favorable conditions that poison may be communicated from one individual to another, a fact which is abundantly demonstrated, both by general clinical evi- dence and likewise by experimentation of animals allied to man. We have before drawn attention to the disadvantages that arise from the intimate association of healthy and tubercular individu- als, but it by no means follows from these facts that any real danger exists of contagion from one person to another, provided that the most ordinary precautions are taken. We have yet to BACTERICIDES. IqqI appreciate and to understand what it is that makes an individual more prone at one period of his existence than at another to be- come infected with the poison of disease, and until it can be shown that infection from one individual to another takes place on a far larger scale than anything that has hitherto been demon- strated, it is certainly premature to conjure up dangers in the mind of the public which are purely hypothetical. With a rea- sonable supply of fresh air, and with our meat and milk thor- oughly cooked, there is but slight fear, if any at all, of tuber- cular infection, and certainly to attempt to lead people to believe that it is dangerous to inhabit any room which has been occu- pied by a consumptive person, unless it is furnished and uphol- stered in such a manner that disinfection can be easily and com- pletely carried out after the departure of each patient, by means of washing and sulphuring the rooms, is to frighten people un- necessarily, and to conjure up ideas in their minds which have no real basis for their existence." Oscar N. Snow, M. D., St. Albans, South Carolina, another eminent specialist on pulmonary phthisis, and who has achieved brilliant results with bactericides, in its treatment 'and cure. He says : " The gaseous treatment of pulmonary tuberculosis is a total, nay, a glaring failure. Eminent savans are now pushing forward an old but valuable remedy, lime water and phosphate of lime, not with the view of killing the microbe, but in the hope, in the far future, of creating calcification and fibroid changes in the neo- plasm — thus retrogressing or sterilizing the bacilli. The action of the phosphate of lime and lime water, or infu- sion of burned oyster-shells, is too well-known to need recapitu- lation at this late day, of their value in dentition, in small-pox, and even carcinoma no one can doubt, but in tuberculosis their use is powerless to arrest germ evolution. The glycerite of ozone is prepared chiefly from the hypophos- phite of lime and soda added to C. P. glycerine, ozone being added until it is thoroughly charged. This very fine chemical preparation of lime is easily and quickly assimilated, and has a much more rapid action in build- iug up vital force — in aiding a renewal of life, than the crude phosphate. The only chance of ever checking, or arresting, or curing, pulmonary tuberculosis, is by germicides, by building up vital force, by the administration of a microbe destroyer, like the gly- cerite ol ozone, a remedy that enters the blood — coming in con- tact with the germ annihilates it. The microbicidal effect of the glycerite of ozone is thoroughly established, as is illustrated by IQg2 DISEASE GERMS. over six thousand physicians, who- prescribe it daily and in their remarkable success in the management of the most hopeless cases of the malady." The leading scientific savan, and undoubtedly the most distin- guished and successful physician in Tennessee, her only bacteri- ologist, Pr^. W. J. Heacker, M. D., Beon's Station, Tennessee, says : '' PLilmoiiayy tubsrcitlosh miy b^ defined t:) be the deposit or presence of the tubercular bacilli, either in the substance of the lung or the mucous membrane of the bronchi ; the localization of the germ, its growth, its multiplication, its tendency to degen- eration, excavation of the parts in which it is situated, with wasting of the body, and other evidences of germ evolution. The bacilli must exist in the blood. The lung must be smitten, or damaged, or weakened, and the contractility of its blood vessels impaired so as to permit of the exosmosis of the bacilli from the germ- laden blood. The onward progress of the microbe depends altogether on the state of vital force, and how great the state of partial death in a portion of-the lung. Degeneration and destruction mark the different stages of growth. The progress of all cases varies according to the state of vital force and the nature of the lung lesion. The more of neurasthenia, the greater the amount of germs in the blood ; lung congestion ; capillary infiltration ; the progress of the germ is irresistibly rapid ; uninterrupted, harassing cough ; opaque, cheesy, clotty expectoration ; increasing shortness of breath, profuse sweats, frequent chills, rapid loss of flesh and strength ; gei-m-eaten rectum, aphthous alimentary canal. If vital force is not so depressed the degradation is less marked and the germs in the lung less abundant ; slower in its metamorphosis ; fewer tubercles, little cough, less fever and wasting. The bacilli of tubercle may deposit themselves either on the mucous membrane of the larynx and bronchi, or in the substance of the lung, the selection invariably being a weakened part or tis- sue for growth and reproduction. The localization of tubercle in the apex of the left lung is the most common ; here it may re- main latent for many years ; the lower lobe of the right lun^:^, if congested or damaged by repeated attacks of cold, offers another favorable location for the lodgment of these micro- To effect a renewal of life in the germ-smitten lung and destroy the germ in the affected part, and in the blood, is the most efficacious method of treatment. The administration of BACTERICIDES. 1093 that positive therapeutic, glycerite of ozone, annihilates the germs, checks the tissue waste, while it increases the quality and number of the red corpuscles of the blood. It thus lowers tem- perature, decreases the heart's action, alleviates cough, checks night sweats, and aids in the maintenance of the appetite better than all the bitter tonics, and is a more effective arrester of meta- morphosis than brandy. Tumors, or new growths, are divided by patholo- Tumors. gists into two main groups ; one of innocent or benign growths, the other of malignant growths. The latter are distinguished by the following common characters : rapidity of growth, tendency to infiltrate and to replace the tissues of the affected part, tendency to recur after removal by operation, tendency to multiply locally and to infect other and remote parts of the body ; a tendency to destructive and progressive ulcera- tion, inducing fatal exhaustion through pain, continuous dis- charges and occasional loss of blood. To any tumor presenting these so-called characters of malignancy, the term cancer was applied by pathologists of a past generation, but at the present time, in consequence of the extensive use of the microscope in pathological research, there is a tendency to classify tumors with regard more to minute structure than to clinical characters. The tumors constituting the maglignant differ much inconsistency, and in minute structure, but the great majority of them have been referred to one of the following two great divisions : that in which the growth is composed of some form of connective tissues, and that in which it is made up in great part of cells re- sembling in character those found in the epidermis, on mucous membranes, and in the ultimate lobules of secreting glands. To the former division belong tumors that are called sarcomata or fleshy growths, to the latter belong the true cancers or carcino"- mata. Structurally the two are distinct ; with regard to clinical characters and malignancy, their resemblance is very close, the chief distinction in these respects being the facts that cancer almost invariably, and sarcoma seldom, affects secondarily the lymphatic glands, and that the latter usually appears at an earlier period of life. Innocent or benign tumors may occur in almost any part of the body, and they may vary in character from so simple a growth as a wart up to formations which may endanger life or require some serious surgical operation for their removal. It would be useless to attempt in a work like this any useful classification of tumors, as any properly devised system would be unintelligible to I094 DISEASE GERMS. the ordinary reader. The question with most people who find a tumor is forming is as to its being of a cancerous nature or not, and this can only be answered by obtaining the advice of a medi- cal man. Much harm is done by the reckless way in which patients, to get rid of their malady, fall into the hands of those who pretend to cure them, while too often they only hasten on the fatal termination. The great majority of small tumors are harmless in character, and often cause inconvenience rather than any other distress, but in ail cases proper surgical advice must be taken before recourse is had to removal. Tumors then are swellings, prominences of greater or less size, developed by irritation, from either normal or adventitious matter upon any part of the body. The following division is a most excellent one, the best which can be devised under our present light of science : They are classified as follows : 1. Type of fully-developed Connective Tissues — Fibroma Type of fibrous tissue. Myxoma " macous Lipoma " adipose Chondroma " cartilage Osteoma " bone Lymphoma | ■ . , lyr^phoid Lymphangioma/ ^ ^ 2. Type of Efnh}yonic Connective Tissue. Sarcoma its different varieties. 3. Type of higher Tis sites. Myoma Type of muscle. Neuroma " nerve. Angioma " blood-vessels. 4. Type of Epithelial VYssues. Papilloma Papilliie of skin or mucous membrane. ^^^^^^^ ]. Glands. Carcmoma / K. Mixed Tumors, or I'eratomata. Fibrous tumors are growths of Tumors. mature connective tissue. Both the {hibrorna — Fibrous Tissue) cell and intercellular substance are in a state uf complete development, and they resemble normal connective tissue. There is usually a constitutional predisposition, an excess of over nutrition of these elements in the system ; prolonged irritation operates as an exciting BACTERICIDES. IOqc cause, still a simple hypera^mia is often sufficient when lymph channels are gorged or blocked. Three varieties are met with, the solid, soft, and cavernous. These tumors may originate from connective tissue in any situation, at first consisting of embryonic tissue, cells being abun- dant and intercellular substances scanty. As they develop the number of cells de- creases, and the intercellular substances in- creases enormously, fibrillated and hardened. The cells are smal' and spindle-shaped, and hidden amongst the fibres which run irrep"- . Ill- • in r 1 Connective tissue is of the ularly m all directions; the fibres lorm the most embryonic type- greater portion of the growths, being closely —"y a vigorous grower. interlaced and often concentrically arranged around the blood vessels. The growth of these tumors are slow, gradual, central, they are always encapsulated. They are liable to inflammation, hemorrhage, mucoid, fatty and calcareous degeneration. They vary in consistence from being very dense to that of succulent, areolar tissue, and vary in size from that of a pea to a massive growth. Innocuous, painless, usually single, unless originating from the skin, sheaths of nerves; and harmless, unless their size interferes with the func- tions of parts. Usually they are non-recurrent after removal. Found in all parts of the body. Some contain more blood vessels than others, and are pinkish in color, but the majority of them are destitute of vessels. This class of tumors is found in the womb, breast, bone. They are firm to the feel, free from ten- derness, smooth, oval, or lobulated ; of slow growth, lasting an indefinite number of yeajs. It often degenerates into a stony mass, or earthy salts. When no larger than an orange, the application of the ozonized clay should be tried, keeping it steadily applied if no erythema is produced, and administering comp. saxifraga and phytolacca in- ternally. That failing, extirpation is the only remedy. Besides the above, there are often found, (i) a subcutaneous tumor about the size of a pea, composed of fibrous tissue, which affects women, and gives rise to neuralgic pains ; (2) a fibro- cellular tumor, made up of bands of firm, white, fibrous tissue, infiltrated with serum' ; (3) fibro-plastic tumor, made up of fibrous tissue and lymph ; (4) fibrous tumor, composed of filaments of fibrous tissue, with naked nuclei. Fibrous tissue in the female breast is usually effused in a nodule, or mass, in the breast, constituting a tumor of irregular shape, hard, dense and fibrous ; it may become large. No pain or lymphatic enlargement General health good. ' In some cases 1096 DISPIASE GERMS. they assume a cartilaginous or bony consistency. They, as well as the fatty, depend, the one upon an excess of adipose tissue, and the other upon a superabundance of fibrous tissue in the blood, owing to some constitutional defect. Treatment. — If not very dense or hard, the same treatment as for the fatty ; but here alteratives as compound phytolacca, Fibroid tumor, where the tubules have undergone some proliferation into cysts. e^>-i^~^.,>^x->- tf ^^,' Fibroid tumor of the breast. iodide of potass, glycerite of ozone, play a most important part in procuring their absorption. So those remedies should be persevered with, and the clay kept on, alternately with bella- donna, iodide of potass and muriate of ammonia. Even in cases Fibroid in the female breast. Fibroma of the cerebellum. as dense as bone, they can often be absorped with the above remedies. Never tamper with electricity, unless under the care of a scientific pnysician. Fibrous tissue is often effused in the brain and cerebellum, more especially the latter. The annexed diagram is taken from the cerebellum of K. Jones, who died in Beverly, N. J, 1878, whose case puzzled the entire medical profession of the Uaited States as no symptom existed during life upon which to base a diagnosis, but intense po^t- cervical pain, which by its agonizing vibrations literally caused the death of the patient. BACTERICIDES. [O97 Fibrous tiesue is often found in nodules on the spinal cord, first lymph which becomes organized. Irritation of all kinds, falls, blows, strains, lifts, anything we can imagine that would weaken any portion of the cord or its membranes, may permit of effusion of lymph which produces thickening, or if the 'blood of the patient is highly loaded with the germs of the tubercle, cancer, syphilis, rabies, they may form a nidus or seat of deposit, and grow and multiply, giving rise. to a nodule of tubercle,, an exostosis of syphilis, a cancerous infiltration, and may thus, by causing pressure or producing atrophy, cause paralysis. Symptoms come on slowly but progressively. Paralysis of motion precedes that of sensation, often not very decided till growth or infiltration is some size. Apt to be pain over seat of iuduration, cramps and convulsive movements of the extremities. Nature of tumor or thickening is to be inferred from the history of case and diathesis of patient. Treatment. — General health to be well cared for; nutritious brain diet ; bathing with frictions and inunctions of oil into paralyzed limbs ; attention to secretions. Persistent use of altera- tives and tonics, iodide potassa, tincture iodine, iodide of starch and lime, with vegetable alteratives, as phytolacca compound, and such tonics, as quinine, mineral acids, occasionally ergot; bitter tonics, as kurchicine, gentian, and above all things the unremitting applicatign of a two-inch-wide strip irritating plas- ter on both sides of the spine, changed every morning ; keeping up a free, copious discharge of pus. Firm, determined perse- verance will often get rid of the difficulty. These tumors consist of mucous tis- Tumors. sue, the intercellular substance of which {Myxoma — Mucous is homogeneous, translucent, and jelly- Tissue) like, containing much fluid, and yielding mucia. Pathologically mucous tumors contain one or two distinct nuclei. The cells are oval, stillated, fusiform, or spherical, and distributed scantily, in which case the growth is translucent, but if the cells are very abundant, and packed closely, a whitish, brain-like opacity is imparted to the growths. The growth as a whole is gelatinous, soft, trembling, of a grayish white or pinkish color. The cut surface yields a muci- laginous, tenacious liquid, in which the cellular elements may be seen. These tumors arc usually encapsulated, and are met with in 1098 DISEASE GERMS. the later periods of life, being most common in sub-serous and sub-cutaneous fat, inter-muscular, and sub-serous tissue. A pure myxoma is rare, met with usually mixed or combined with lipoma. This class of tumors are liable, when they arrive at some size, to rupture of their capilla- ries and hemorrhages, or the growth may be- come inflamed, ulcerated or necrosed. The myxomata are mostly benign tumors, but they often attain an enormous size. They never reproduce themselves after complete re- moval. Often associated with sarcoma in the female breast. Mucous cysts consist of dilated and expanded gland ducts filled with mucus and epithelium. There may be one, or several cysts, in one or both breasts. They seldom grow larger than a Hyaline Myxoma. (Mucous tumor.) Inter-cvstic giowth, suirounded with fatty molecules. Cystic tumor of the breast. Cystic tumors of the breast. hazel-nut. Most common after change of life. They give rise to no pain or inconvenience, but when detected should be re- moved by a simple incision. If allowed to remain they simply become the seat of cancerous deposits. Under the head are classed cystic tumors, which consist of a .^^ac containing solid or liquid substances. They may arise by the formation of definite cavities in the meshes of the areolar tissue ; by the dilatation and growth of obstructed gland-duct or folli- cles ; by the erratic development of nu- cleated cells, which become exaggerated into cysts. Some contain serum ; others a jelly-looking substance, some blood, others solid matter. M^ens, or encysted tumors, are most common on the head, face, and shoulders, and consist of ob.structed sebaceous glands, Cystic tumor on neck. BACTERICIDES. 1099 or else of erratically formed cutaneous cysts. In examining" them with a small glass, the orifice, or mouth of the gland, can be seen in the centre in the form of a black spot or crust. They are all lined internally with a serous membrane, which secretes water, epidermis, scales, hairs, nails, oil-globules, and crystals of cholesterine, which cause the contents of the sac to resemble gruel or suet. The cyst is liable to accidents, which give rise to distension, suppuration, ulceration. Treatment. — The cause that engenders them is irritation ; so they never should be irritated or tampered with, and, as a rule, not interfered with if patient is out of health. In all cases they should be removed by the knife only by making an incision through their centre, and carefully dissecting out their sac, for if the smallest portion be permitted to remain, it will give rise to a sinus and weeping. Such tumors are common in the breast, prostate, parotid, and thyroid glands. As a rule, they are pain- less, not tender, moderately soft, elastic, and lobulated. ExMr- pation is the only cure. The liver is often the seat of myxoma. Encyi-ted, knotty tumors, containing a cheese-like substance are found in the glandular substance, varying in size from a pea to that of a hen's egg. They arise from irritation and inflammation of the hepatic ducts ; steatomatous contents composed of irregular granules, free oil globules, and occasionally plates of cholesterine. Simple serous cysts, with clear watery contents, are sometiiTies found scattered over the liver, usually about the size of a small bean. Sacculated cysts, contdAnmg a glairy fluid, are also met with. In some cases they resemble a honey-comb. The liver in some cases is crowded with such cavities. Ovarian tumors are very generally of this class. Those are an invariable result of chronic inflammation of the ovary when that condition is not seen to promptly, and managed properly. Irritation is the cause of those growths. This irrita- tion may spend itself upon the serous membrane and give rise to dropsy of the ovary, or on the fibrous tissue, or upon the seba- ceous glands, or other tissues of the ovary, thus giving rise to different kinds of effusions or tumors. Ovarian dropsy is the most common of cystic disease of the ovary. There are three forms met with : the simple cyst or bladder, filled with a fluid ; then there are the proliferous cysts, in which there are a number ; and the dermoid cysts, the lining membrane of which is capable of secreting hair, nails, teeth, sebaceous matter, or any substance of the body. Causes. — It is unnecessary to recapitulate the causes, suffice it IIOO DISEASE GERMS. to say that they are to be embraced under all those of chronic inflammation of the womb and ovaries, acute and chronic — which see — and placed under one term, irritation. Symptoms. — Most cases, if carefully scrutinized, will exhibit well-marked symptoms of chronic inflammation of ovary; still the irritation seems to be even a little less, so the uneasiness or An ovarian dermoid nearly natural size, with two nipple-like projections. An ovarian dermoid, containing a fold of skin resembling a shrunken ntamma. pain of that condition is often not well marked, and may, if the patient is of a cheerful, sanguine temperament, escape detection until the abdomen begins to enlarge. In other cases, the pain in the ovary is well marked, and when the ovary fills up, it gives rise not only to an appreciable tumor in the affected side, but o;ives rise to some irritation of the bladder and rectum ; a sense An ovarian dermoid with a spurious mamma and a nipple growing from its wall. Pedunculated dermoid tumors from the rectum — removed or rather exfoliated entire by the introduction of a je- quirity capsule. of weight and oppression in the abdomen ; pain and numbness down the thigh of the affected side. Besides, there is the usual lassitude, weariness, backache, constipation, irritable bladder. Menstruation at first may be regular, but scanty or abundant. After tumor has attained some considerable size, the symp- toms become aggravated ; there is greater pain and tenderness, as well as distension of the abdomen. Menstruation now is in- terfered with greatly, usually it is disordered, frequent or sup- BACTERICIDES. I lOi pressed. There is loss of appetite, indigestion, constipation, loss of flesh ; frequent micturition ; urine scanty, often suppressed. Strength diminishes ; emaciation becomes greater ; hectic spells ; no sleep, sense of smothering, cannot go to bed, sits up. Mean- time the abdomen increases in size, becomes enormously en- A lock of hair, twenty inches long, from an Ovarian Dermoid. larged. The swelling is one-sided, it may lay over to the other side in the recumbent posture ; the pain is only in front, if it is simple, but if it contains cancer germs, the pain will radiate from the front to the back ; if it contains a fluid, a sense of fluctuation can be detected even if the cysts are like a honey-comb, whereas, if it contains any solid constituent of the body, hair, nails, bone, teeth, or cheesy matter, it is solid, dull on percussion. As the tumor grows it fills up the abdomen, and may cause dropsy of the abdomen by ijnravelling its peritoneal fibres ; oedema of the legs and thighs. As it progresses, patient's movements become impeded from the bulk of the tumor, suflermg is augmented, all the symptom's grow worse, the nights are wretched, the difficulty of breathing is very great; the swelling or dropsy becomes con- siderable, often suppression of urine and f^ces ; uraemic poison- ing or fatal prostration is very apt to take place. Treatment. — When tumor is smaller than the two closed fists of the patient, an effort at absorption is" to be tried, which, \Aith our new remedies, is often successful ; and if it fails, it will be no barrier to ovariotomy. Every point must be well guarded and seen to, as the best of food ; regular evacuations ; good, com- fortable sleep ; flannel clothing ; a perfect alleviation of all pain, and the best of hopes encouraged for a cure. Then selecting a tonic and alterative from the list for a week, then change, and so on for another week. Among our best alteratives are comp. saxifraga and Phyto- lacca, alternated with wine of aleteris farinosa, comp. syrup partridge berry, and elixir of apiol. In addition, pastilcs of cocaine and boroglyceride, might with advantage be inserted far up the vagina several times a day. Locally, the ozonized clay over the entire tumor, bound on with a firm roller and T bandage. If the clay causes no redness, it can be put on fresh every morning ; but if there is the least redness, it can be taken off and broken up fine, and water added JI02 DISEASE GERMS. to it and reapplied for four or five days. The action of this clay on this class of growths is most extraordinary ; causes their thorough, positive dissolution and disintegration. As this pro- cess goes, on, the bowels must be kept open with cascara, and kidneys stimulated with cream of tartar lemonade. Cover entire tumor with the clay, and no more, and as this process goes on, push diet, alteratives, and tonics. All other methods of treatment are simply a loss of valuable time, such as tapping, aspirating. If the absorption plan with the clay, and other drugs fail, then there is only one thing left, and that is ovariotomy. In larger tumors than those mentioned, the clay will reduce their bulk, and in some rare cases cause their disappearance ; but in very large ones we cannot speak with the same precision as we do of those of a smaller class. In ovariotomy, that is in making an abdominal section in the median line of the abdomen, ligating the pedicle of the tumor, then dividing it, removing tumor and returning the ligated stump into the abdomen, stitching up abdomen, etc., and treat- ing for peritonitis, do not wait too long, until there is no recup- erative power left in the patient. Fatty tumors are growths of adipose Tumors. tissue; a general and diffused infiltration of [Lip jma— Adipose fat is obesity; a fatty tumor or lipoma is a Tissue)) localized and circumscribed formation. Lipomata originate wherever fat exists normally, being produced by fatty infiltration of existing tissues. Their growth is central, encapsulated and lobulated, and at first it increases slowly. The cells of a lipoma are larger, and the fat they contain is more fluid than normal adipose tissue. Fatty tumors are liable to glide out from the deepest structures and show themselves under the skin. They are all sizes and forms. They generally grow in the cutaneous tissue, between the skin and the muscles. They are most frequently met with below the collar-bone, back, neck, inside of the thighs and some- times in or among the muscles. In number there is generally one ; it grows slowly, may attain an immense bulk, seldom degenerates, is free from pain and is easily recognized by its soft, lobulated, doughy feel, which never can be mistaken for anything else. If the tumor is not large, in some cases (not always), the ap- plication of the ozonized clay has a most marvellous effect in causing a dissolution. It is worthy of a trial. It may be kept BACTERICIDES. I 103 constantly applied, if it induces no redness of the skin ; if it causes any redness, off and on at proper intervals. Internally, fucus vesiculosus ozonized might be tried, that is the fluid extract combined with peroxide of hydrogen, alternated with ten or fifteen drops of liquor potassa, as they are the only remedies which disorganize the fatty cells. Adipose tissue or masses of fat may be freely and evenly dis- tributed throughout the entire connective tissue of the gland, or in nodules, or aggregation at different points. Its doughy, ine- lastic feel and perfect freedom from pain will be good points by which to recognize it. They grow slowly, give rise to immense bulk and considerable inconvenience. Treatment. — Ozonized clay is the only known remedy that will cause a dissolution of those growths. Kept on the breast or tumor constantly, if no redness of skin is produced ; if redness is caused, to be removed, and lotions of peroxide of hydrogen, and then the clay reapplied again and again. Internally, altera- tives, as in lacteal tumor. Tumors. ( Chondroma — Cartilaginous Tissue^ cells embedded in fibrillated basic sub stance (fibro-cartilage) ; [c) as cells emb- edded in a mucoid basic substance (gela- tinoid or mucoid cartilage). To these may be added an osteoid form. The growth in nearly all cases leading to ossification. To be found most among near joints and on white fibrous tissue. Cartilaginous tumors are common in the neighborhood of joints. Cartilaginous growths or tu- mors are often met with and exist in three forms {a) as cells embedded in a hyaline basic sub- stance (hyaline cartilage) ; (b) as Calcified cartilage, showing the calcification of the intercel- lular substance, x 300. Bony tumors consist of connective tissue in which the bone corpuscle or cell pre- dominates. Bone is originally from car- tilaginous or fibrous membrane, and event- ually from periosteum. Osteomata are produced by mechanical or microbial irritation of the periosteum or medulla of bone. They are usually divided Tumors. ( Osteoma — Bony Tissue.) I IQ. DISEASE GERMS. into two classes, viz., an exostosis and osteophytes \ the former, from proceeding from the bone or periosteum ; the latter, more or less remote from the bone. A covc\y^2.QX osteoma, which grows from the surface of the bone or its periosteum, usually exhibits a line of demarcation, although covered by the ordinary periosteum. Osteophytes, found in the common connective tissue, tendons, cartilage in the interstitial connective tissue of muscles, glands and organs, any part subject to chronic irritation ; tumors formed by the irregular hypertrophy of bone. Such tumors are hard, pain- less and globular, and mostly situated on the long bones. Their structure is that of ordinary bone, but usually more dense and compact. In some cases they are porous, in others of an ivory consistence. They cause no pain unless they press on nerves. On the inside of the sIcuU they press upon the brain, and give rise to epilepsy ; in the orbit they cause the eye to protrude. Their cause is irritation, and effusion of lymph, which becomes organized into bone. Treatment. — If not too dense, they can often be got rid of by absorption, by alteratives and by iodide of potassa, with the local application of ozonized clay ; when hard, of the consistence of ivory, they can be cut down upon and chiselled off. These tumors are growths of lym- Tumors. phatic or adenoid tissue, and are [Lymplwma — Lymphatic divided into soft lymphomata, in Tissue}) which there is a preponderance of lymph corpuscles and indurated, lymphomata, with preponderance of stroma and microbes. The causes of lymphomata are numerous and varied; irrita- tion, the microbes of syphilis, tubercle, cancer and other disease germs. These tumors are to the physician a sort of barometer or index of the state of the blood of the patient; enlarged lymphatics, soft or indurated, indicate feeble vital force, and excessive micro- bial growth. Soft lymphomata begins with a proliferation of the lymph cor- puscles, and a migration of the disease germ with the white cor- puscles. The growth is pultaceous and soft, resembling brain substance in color and consistency. The growth of soft lympho- ma is rapid; becomes very large, often breaks through structures in which it is infiltrated. The indurated lymphomata are characterized by an entirely op- posite condition of things — being marked by induration with a tendency to calcareous degeneration. BACTERICIDES. 1 105 In what is termed Hodgkin's Disease, there is a progressive en- largement of all the lymphatic glands of the body — gradual painless enlargement. Glands of neck, axilla, groin symmetrically enlarged, not in- flamed or fused together ; thoracic and abdominal glands also affected. Patient has all the symptoms of ansemia and leucocy- thaemia; is very weak, loses flesh and sniffers from great exhaus- tion on the slightest exertion. The white corpuscles in blood are greatly increased; tightness or constriction of chest and abdomen ; progressive increasing debility. The spleen is enlarged, filled with spores of tubercular bacilli. The glands, when cut into, are uniform in structure, translucent arid filled with various microbes, the contents appearing to the naked eye as albuminous or lardaceous matter, and precisely the same in the spleen, mesentery and pink marrow. It is this blocking up of those blood-raising glands that gives us the ex- treme anaemia, dropsy, exhaustion and death. In all cases, tuber- cle is present, whether the syphilitic or cancer germ is present or not. Sarcomatous, or fleshy tu- mors consist of embryonic con- nective tissue, and retain their embryonic type throughout the whole period of their growth. They are classified, and thus named : fibro-plastic, fibro-nucleated, re current- fibroid, and myeloid tumors. Many growths, which Turhors. {Sarcoma — Fleshy or Embry- onic Connective Tissue^ . thin section of lymphomata. Another section of the same growth Round-celled sarcoma in its incipient stage. W Round-celled sarcoma more advanced. were formerly described as cancerous, are now to be classified under this head. Cells constitute nearly the entire bulk of the growth, and pre- sent great variety of shape, form, and color. They are round^ fusiform, myeloid, and pigmented. All the sarcoma present an intercellular substance, small in amount, but their blood vessels are numerous. Sarcoma may be found in the brain, spinal cord, in or among 70 iio6 DISEASE GERMS. all the muscles of the body ; in the orbit, parotid, luflgs, liver, kidney, spleen, and in all parts of the body. Sarcoma. — The term sarcoma, a fleshy tumor characterized by the appearance of one of several, usually at first isolated ; pea to nut sized and even larger ; smooth, spherical, irregular, as lobu- lated, cutaneous or subcutaneous neoplasms, as tumors, pig- Sections of sarcoma. Sarcoma ; splndle-cells visible in sections of a cutaneous nodule removed from one of the author's patients. About x 300. mented and non-pigmented, having a marked inaptitude for ul- ceration, but malignant in character, recurring speedily after re- moval, and usually terminating fatally by involvement of the viscera. These tumors may be free, movable, but eventually they become adherent, both above and below. Their characteristics are their white color, rapid growth and _^^_ development, with systemic tainting of the entire blood. Their predisposing cause, a hybrid microbe produced by the mingling of the proto- plasmic elements of the cancer germ, and the bacilli of tuber- cle in the lymph spaces of the blood. Once these hybrid germs are effused from the blood by some irritation in the skin, cellular tissue, or elsewhere, the weakened patch, the lesion becomes swollen, infiltrated, painful, germ proliferation active, enormous, skin reddens, ulcerates, often attains an enormous size. In a short time, weeks not years, if there are .several nodules, they aggregate together, the nodules or neoplasms coalesce, degenerations by ulceration, and participates in the process of destructive metamorphosis going on. Death speedily results, exhausting fever, with sarcomatous involvement of the viscera. section of a sarcomatous nodule wirh the spindle cancer germ interspersed throughout its sub- stance, magnified 300 diameters. BACTERICIDES. I 107 This germ deposit may take place in any weakened parts of the body. All tumors of this class are abundantly supplied with blood vessels, lymph canals, and the germ with mottled tubercles inter- spersed through it, exhibits a net-work of spindle-shaped, spher- oidal, branched, with one or more nuclei, with connective tissue and basement membrane. Its correct diagnosis rests upon the microscopical examina- tion of the growth. Up until a very recent period, the treatment was very unsatisfactory, even its surgical ablation, is followed by a speedy return of the tumor, so far as germicide remedies are concerned. The Chian turpentine mistura has effected most wonderful re- sults in the cure of this form of growth. This preparation differs from all others in the molecules of the turpentine, being in a fine state of subdivision, being dissolved by the ethereal peroxide of hydrogen, resorctn, thallin, and other germicides being added. In some cases ihe glycerite of ozone, or the comp. saxifraga, or the glycerite of sulphur, were used in alternation. Sarcoma found in the bladder. Sarcoma in the liver. The general symptoms of sarcoma of the bladder are very similar to those met with in other varieties of vesical growths, consisting of haematuria with signs of irritability of the bladder, viz., pain and increased frequency in micturition ; in most cases evidences of obstruction to the escape of urine are sooner or later produced, micturition becoming difficult and attended by straining efforts. In addition, attacks of retention and inconti- nence of urine are sometimes present in the later stages, and in some instances distinct evidences of the existence of the growth can be detected upon a physical examination of the bladder. Haematuria is usually a prominent and often an early symp- tom. It frequently precedes the signs of irritability of the blad- der, so that in this respect sarcoma resembles papilloma — a pain- iio8 DISEASE GERMS. less hemorrhage often continuing for a considerable period, sometimes for several years, without any other symptoms, is generally characteristic of the latter affection. As in papilloma, the bleeding at first occurs in attacks separated by intervals of varying duration, during which the urine is quite clear. As the disease progresses the attacks last longer and become more fre- quent, until, after a certain time, there are frequent, excessive attacks, which speedily undermine the vital forces of the sufferer. Numerous cases of different forms of sarcoma have been diag- nosed cystoscopically during the last year. Embryonic connec- tive tissue, or sarcoma, is also met with in the liver. The Chian turpentine mistura is really the only remedy of value in sarcoma of the bladder ; it certainly, by its microbicide action, has a decided effect in arresting germ evolution. The pipssisewa is a drug of intrinsic value, has a specific influ- ence upon the walls of the bladder; it not only checks the ravages of the microbe of sarcoma, but prevents the ingress of the cancer germ. Muscular tumors, consisting of non-striated muscular fibres, always arise from muscular tissue, espe- cially from the walls of the uterus. In this organ as they enlarge, they push aside the normal tissue and protrude into the cavity of the perinaeum or uterus. Tumors. {Myoma — Muscle Tissue.) View of tumor, showing the adventitious tissue, muscular, glandular, from walls of the uterns. Myoma ot the walls of the uterus. Becoming pedunculated in the latter organ form fibroid poly- pus of the uterus. They are often found in the prostate, oesoph- agus, stomach, intestines. Their growth is slow, central, often multiple or compound. The myoma form the great bulk of all uterine growths, very liable to become calcified, forming in the uterus a hard, stony lump, the so-called womb stone. BACTERICIDES. IIO9 As a general rule, the myoma are elastic, pear-shaped and spheroidal. Their firmness depends upon the age and amount of connective tissue present. Their color varies from muscular redness to pinkish or grayish white. Their presence gives rise to exhaustive hemorrhages. Mucoid degeneration often takes place leading to a cyst-like formation in the growth. As a rule, these tumors are innocent. General Treatment. — Improve general health by every possible means — tonics, alteratives, as comp. saxifraga and phytolacca, alternated with distillation of aleteris farinosa, and comp. syrup partridge berry. Where the myoma involve the walls of the uterus, the use of the ozonized clay is often of great utility. The best local treatment is by electricity, mild uninterrupted currents, so as to stimulate absorption, not growth. This must be performed by one having the highest scientific attainments, and who thoroughly appreciates the subject.* These tumors are growths of Tumors* nerve tissue, very rare outside of {Neuroma. — Nerve Tisstie.) stumps. Their substance re- sembles the cerebro-spinal nerves. With the nerve fibres there is usually associated a certain amount of connective tissue. Their growth is slow, seldom become of large size, usually exist in single nodules, they are quite innocent, although very painful. They always spring from a cut or lacerated nerve. Solid or cystic. The solid growths have a deal of fibrous tissue inter- spersed through them, making them, dense and plastic, implicat- ing the neurilemma of the nerve. Occasionally nerve fibres merely spread over tumor without being involued in its texture. A nerve, when divided, if its two ends are placed in apposition, will unite like bone, and sensibility and motion be restored. If not placed in apposition, their ex- tremities will become bulbous, or may aid in the formation of these growths : so they are common after lacerations, wounds, *In 1870, Prof. John J. Siggins, M. D., of Philadelphia, Pa., introduced a chemico- clectrical method of exciting absorption, and thus curing a large percentage of these tumors. Indeed it was a brilliant success. This same modus operandi in all its varied details and with numerous improvements, is carried out by the following scientific physicians: A Park, M. D., 517 W. Twenty-third street, N. Y. ; F. L. Tuttle, M. D., 233 Main street, Springfield, Mass. ; J. J. Jones, M. D., Philadelphia, Pa. ; S. H. Plati, M. D., Waterbury, Conn., and numerous others. It consists essentially in keep- ing one electrode over the tumor moist with specially prepared peroxide of hydrogen. II IQ DISEASE GERMS. injuries, amputations. There may be one or several, and vary in size from a grain of barley to a melon. Symptoms. — These growths are found in the course of a nerve ; grow slowly but steadily ; of an oval or oblong form ; long axis in the course of the nerve ; darting, lancinating pains in paroxysms. Treatment. — Excision is the only hope of cure ; tumor to be carefully dissected out, and, if possible, the ends of the divided nerve to be brought into appo- sition, and an effort at least, made to keep up continuity, so that the function of the nerve be, if possible, restored. We meet with- tumors of nerve tissue on both brain and cerebellum, also on the cord, which give rise to grave or- ganic lesions. This diagram represents a true neuroma of the skin, cov- ering the shoulder and arm. Cases similar to this, have been recently cured by the application of the ozonized je- quirity powder made into a paste with butter of coca, and glycerine ; a perfect exfoliation was effected. Neuroma in the skin. Tumors. Angioma — Made up of Blood ■ Vesse/s.) The angiomata are a class of tumors or growths, consisting of blood vessels held together by a small amount of connec- tive tissue. Under this heading are included nsevi, aneurism by anasto- mosi^s. They are usually divided into two varieties. The simple, or capillary angiomata, and the cavernous, or venous. All the angiomata originate from blood vessels, and occur chiefly on the skin and mucous membrane. Their growth is slow, rarely large, very liable to ulceration. Usually they are of a bluish hue, pulsate. Occur in skin, sub- cutaneous tissue, and are found in the orbit, muscles, liver, spleen, kidneys, and are usually what is termed mother's mark. Where abnormal conditions, such as naevi, or angiomata, exist, which are of large dimensions or lie in situations that are not BACTERICIDE^ I I I I readily within reach of the knife, there can be little doubt that few p'ans afford us such an effective mode of treatment as a gal- vanic battery. To work such a plan successfully the operator must thoroughly understand the construction of his instrument, so as to able in a minute to rectify any temporary stoppage of the current. Almost equally essential is the need for a galvano- meter, without which it is difficult to detect the variations in in- tensity of the current, and sometimes quite impossible to' ascer- tain whether the current is passing or not. A neglect of these two precautions is almost certain sooner or later to result in a disastrous failure, which is ascribed to a fault in the pi'ocess, and not to its true source, the neglect of proper precautions by the op- erator. Without a galvanometer, it is perfectly true that an ex- perienced operator will form a shrewd guess what is going on in his patient, by the visible signs of the procedure, viz , the bub- Dilated capillaries filled with red corpuscles at umhilicus, known as capillary angioma of umbilicus. Capillary iorna at the umbilicus, a few leucocyte^. bles of gas and fluid that emanate from the growth. In a similar manner an experienced physician will predict the course of a disease from the symptoms that he can observe without the aid of a thermometer, but with instriiments of exactitude at hand, the treatment proceeds with greater ease and a readier precision. Most galvanometers which are to be employed in such operations are graduated in milleamperes, so as to determine exactly the strength of the current to be employed. With some simple battery at hand, the patient is placed under an anesthetic, for the process is often a prolonged one, and by no means devoid of pain. If the naevus is a large one, and placed in a situation where the presence of a scar is of no importance, as for example, in the middle of the back, half a dozen needles from each pole are introduced at various points of the growth, care being taken that they do not touch one another, and in determin- ing that no contact arises during the procedure, a galvanometer is of the greatest value, for if they do touch the current at once chooses the easiest route through the needles, and no longer subjected to the resisting action of the tissues of the body. I 1 1 2 DISEASE GERMS. causes a rapid deflection of the galvanometer needle. If the gal- vanometer is doing its work satisfactorily, the naevus soon com- mences to swell up, and gas exudes from the small punctures made by the needles, while no perceplible rise in temperature takes place in the part. The gas issuing from the negative pole is hydrogen, and that from the positive oxygen. By these mani- festations of chemical decomposition it is rendered abundantly clear that the process in question is a true electrolysis, and not of the nature of burning as it has been often wrongly termed. It the process of destruction is carried far enough, the tissues are so far destroyed and undermined that death of the part ensues, and a true slough separates a few days later, quite as extensive in character as if the galvano- cautery had been employed, and quite indistinguishable from a slough so produced. It is, however, quite possible, and by the aid of the galvano- meter very easy, to modify and restrict the process of tissue-de- struction with so much nicety and exactitude that no more tis- sue need be destroyed than is absolutely necessary to effect a cure ; but if this result is to be obtained a weaker current and a shorter sitting must be employed, and the process of destruction can be still further minimized by using only negative needles in the nerves, and placing the positive pole on a distant portion of the body. The novice will very soon determine how far it is de- sirable to go on making his first attempt with diffidence, and by gradually increasing the length of his sitting, will at length suc- ceed in removing the growth without leaving more than a slight discoloration of the skin, where before lay an unsightly and ex- tending mass of veins and capillaries. There are other plans by which the scarring is reduced almost absolutely to a vanishing- point ; the needles should be insulated to within an eighth of an inch of their point with gutta-percha, and they can be introduced, say, a quarter of an inch into the growth to be destroyed, so that the skin at the seat of puncture is protected from the action of the current, and the electrolytic process is limited to the subcutane- ous tissues. When the first operation is over due time must elapse before a second is attempted, in order to insure that full contraction of the cicatrix has taken place; five or six weeks, or two months, when it can be given, is not too long a time to allow. On a subse- quent occasion, should it be advisable to produce a small slough in any portion of the growth, the positive pole, with a stronger current, can be employed, and all the needles concentrated in the one situation. Such methods as these are capable of almost in- definite application, whilst they can be employed in situations where no other plan of treatment is possible, and with results which cannot be equalled for precision by any other method. BACTERICIDES. III3 Tumors. {Papilloma — made up of Papillce of Skin and Mucous Membrane }j Papilloma, tumors resembling or- dinary papillae. Irritation may cause existing papillae to sprout out, from either the mucous, serous, or cuta- neous surface. The simple papillae are usually small and conical. Papillary growths are not infrequent in the bladder, uterus, urethra and intestines. Under this head are to be classed all warts and horny growths. A simple papilloma may become an epithelioma. A large number of growths are developed from the walls of the bladder ; warty, or polypoid fibrous bodies ; villous, or vascular growths, and cancerous deposits. Whatever the nature of the growths, they give rise to symp- toms that resemble calculi — frequent micturition, a painful sense of inability to empty the bladder ; ^^^^^.^s-^^^l^ urine may be bloody, or purulent, or ammoniacal, or loaded with mucus. Cancerous deposits are the most numerous; medullary, epithelium, more common than scirrhus ; suffer- ing great ; easily recognized by the pain anterior and posterior, the cachexia, and germs in urine. Papilloma in the urethra is often mistaken for stricture. Tumors or growths resembling in their struc- ture ordinary papilla, springing from the ordinary papilla of the mucous, serous, or cutaneous surface. They may also arise from the sub-epi- thelial connective tissue, as that of the stomach and larynx. Even in its simplest form there is present the bacterium porri, a pathogenic microbe, in and around the vessels of the connec- tive tissue — most numerous where the vessel turns, or ascends to the apices, or turns to form a plexus. These papilloma owe their origin to irritation, and gradually, as the bacterium become active, give rise to ulceration and hemorrhage. Papillary growths upon the skin include horny growths and warts. Larger and more vascular papillary growths are formed A bladder fungus ; present in chronic catarrh of the bladder, and in condi- tions where the micrococci urinarii are found, also in papilloma of the bladder. H DISEASE GERMS. when the bacterium porri unite or mingle with other microbes, as the venereal, in the formation of venereal warts. CHnically, the papillomata, accompanied with their pathogenic microbe bacterium porri, are innocent growths, but often prove fatal by ulceration and hemorrhage. Papilloma of the bladder presents nothing special at the outset, unless it be a little undue frequency of micturition, which is probably the only sign which excites suspicion. But early in the progress of'the papilloma, or all villous growths, there in an im- portant sign, characteristic of it, throughout its entire course, and common to most other tumors at a later period, namely, the appearance of blood in the urine. Hemorrhage occurs after exer- cise, much more abundant than what would come from the pres- ence of a calculus, and it is unaccompanied with pain and irrita- Papilloma as seen by the endoscope on the walls of the bladder, cured by per- oxide of. hydrogen and salicylate soda. Papilloma as seen by the endoscope on the walls of the bladder, radically cured by injections of thuja and peroxide of hydrogen, alternately — very weak injections. Papilloma as seen by the endosf-ope on the walls of the bladder, radically cured by injections of peroxide of hydrogen twice a week, and daily inserting a thallin gela- tinized bougie into the bladder and retaining it one hour. tion of the bladder. As the papilloma increases in size, hemor- rhage becomes more profuse; still pain is absent. A microscopic examination of the urine will reveal the characteristic appearance of papillomatous structure and the presence of a fungus. The bladder should, in all cases, be washed out with a tepid solution of boroglyceride ; an examination made with a sound, which reveals a soft, flimsy tissue, springing from a thick base. On those outgrowths, papoid or trypsin has a well-defined action as solvents, and much better adapted to the location than either lactic or acetic acid. Oil of thuja answers well, both locally and internally, and probably is our best drug. As an injection into the bladder it is of great efficacy, diluted half an ounce to four of tepid water. Probably thuja internally to sterilize the blood, and papoid as a digestive agent for injecting the bladder. BACTERICIDES. III5 Tumors. (^Adenoma — made up or Glaudidar Tissue^ Adenomata are tumors or growths of gland tissue, and they usually re- semble tubular or racemose glands m consisting of saccules or acini, lined by epithelial cells. The adenoma proper is an innocent tumor, its favorite seat is the female breast and lung, in pulmonary phthisis. Adenoma of the Bi'east. — Irritation of various kinds, as corset- bones, dress ; mechanical violence, as blows, contusions, etc.,. The female breast, dissected back to show adeno-fibroma of the nipple, showing the racemose arrangement of the acini or saccules lined with epithelial cells. often cause a sort of glandular growth in the interstitial structure of the breast. In one variety of partial hypertrophy of gland structure, we find the tumor dense, compact, lobulated, and pro- vided with a fibrous capsule ; with ducts and sinuses developed. In another class, there are cysts with growths attached to their walls and floating in a fluid ; while, in still another class, dilated ducts are converted into cysts, with growth of gland springing from their sides. These glandular tumors, made up of the substance or out- growths of the breasts, occur in healthy women, between puberty and the thirtieth year of age; and single women are much more liable to them than the married. Their growth is slow, pro- iii6 DISEASE GERMS. gressive, and an enormous size may be attained. In some cases they grow considerable, then cease, and often disappear; in Section of an adenoma of the breast, magnified 750 diameters. Other cases, after growing to a certain size, they remain station- ary and breasts disappear. There is never pain nor lymphatic enlargement. Symptoms. — The tumor begins as a small, movable growth ; seems to be isolated from gland tissue ; never painful ; nor does Adenoma of the brea?t. Gummy growth in the kidney, with an adenoid formation. it involve the skin nor cause enlargement of the lymphatics of the axillary space. As it grows, breast may atrophy. Rate of growth depends on irritation. If it becomes very large the coverings might ulcerate, and the tumor protrude through. Treatment. — The application of the ozonized clay during the day, and the belladonna ointment during the night, with a general vegetable alterativ^e and tonic course, is the best treat- ment. If the case is stubborn and resists these remedies, then apply a complete casing or covering of iodol in gelatine and gly- cerine, and internally administer ozonized iodine. BACTERICIDES I I 17 During its activity, that is, Tumors. secreting milk, the female breast {Mixed Cancer Germs and is most obnoxious to what is other Microbes}) termed a milk or lacteal tumor, generally due to violence or blows, which cause a rupture of a lacteal tube, which permits of the escape of the milk into the surrounding connective tissue ; or it may take place from an occlusion of the orifice of a milk- duct, by inflammation of the nipple, and various other mechani- cal conditions. It occurs only during the activity of gland in lactation. Symptoms. — A round, oval, or cystic swelling, varying in size from a walnut to that of a large orange or pear, can be felt, which, when recent, is elastic and fluctuating, but as its watery portion becomes absorbed, it becomes firm and solid. There is an absence of pain, and the general health is unaffected. So very little annoyance does it give rise to, that the patient may not discern the enlargement for quite a while, or by accident, and when she does so, becomes greatly alarmed, fearing cancer. If the patient is tubercular, the coagulated caseine in the lobule, or in connective tissue, sometimes become a concretion, like chalk. Treatment. — If infant is old enough, or not near the approach, or during the summer heat, wean the child ; arrest secretion of milk by belladonna ; administer saline purgatives ; and subse- quently apply ozonized clay to the breast, and place patient upon an active course of alteratives, as compound phytolacca ozonized, iodide in stillingia compound, glycerite of ozone. If there is suppuration, incision and same treatment as for abscess. As a rule, there should be no interference with the coagulation until gland-tissue becomes inactive. Mixed class of tumors are found in the antrum. They consist of bony matter, exostosis, and fibro-plastic tumors of the con- sistence and form of brain or liver; often the color of the latter, and difficult to recognize from cancer. Others have the color and consistence of kidney. We meet with fibrous tumors, very dense and encysted tumors, and other deformities, that may be mistaken for enlarged antrum. With all diseases of the teeth and nose, the antrum has much to do. The incessant tinkering about old stumps ; filling with amalgam loaded with mercury, sets up irritation and effusion. The ignorant extraction of teeth has also much to do with it. Catarrh, and its diseased germ, amoeba, often block up the nasal opening. The trouble seems to be that when its lining mem- brane becomes irritated, that it will secrete an endless variety of substances, which, when liquid, semi-liquid, and glandular, are iii8 DISEASE GERMS. easily got rid of by an opening, stirring up the contents, and washing out the' antrum daily with a stimulating wash. The kidney or liver deposits are often mistaken for cancer by the great pain they occasion. In all cases, besides the removal of contents, an alterative and tonic course. From the number of Adenona-fibroma. Adeno-fibro-sarcoma. ignorant men entering the dental profession, it is highly prob- able the diseases of the antrum will be much increased. We respectfully direct attention to the fact that the tissues, which are the seat of malignant neoplasms (cancers, sarcomas, epitheliomas, etc.), may, at a given moment, be invaded by divers microbes, the origin, species and nature of which, it has, so far, been impossible to determine. This invasion, the causes and mechanism of which are alike unknown, may remain latent for an indefinite period, but in certain cases, in the evolution and nutrition of the tumor, it may lead to several modifications, such as the rapid enlargement, the softening, or the ulceration of the part affected. Microbes are not to be found in all neoplasms, or even in all neoplasms of the same kind, nor yet in every portion Adeno-fibroma, where the secretions from the glandular tubules have collected in them and given rise to numerous small cysts. Adeno-fibroma, having a dense fibrous stroma, which includes newly-formed glandular or ad- enomatous matter, with increased prolifera- tion. of the neoplasm invaded. They are not to be found, for instance, in lipomas or in pure fibromas ; they cannot be found in the early stages of sarcoma or cancer, in which the progress is slow, and tJACTERICIDES. 2 1 lo the growth is covered by healthy skin ; on the other hand they are nearly always to be found in softened and ulcerated tumors. These microbes, besides their irritant, phlogogenic and pyrogenic action, which they exercise locally even on the diseased tissue possess other pathogenic properties, which may affect the whole system. Thus so far as an* opinion can be found, they may give rise to a more or less intense and irregular febrile condition, whilst they are pent up in a tumor about to grow rapidly or to soften. Moreover, during the removal of a tumor, they may im- pregnate the fluids contained in the softened parts, infect the operative wound, and so inoculate it as to develop septicaemia, which may lead even to death. The knowledge of this last fact pleads strongly in favor of the removal of malignant neoplasms, so desirable from every point of view, and suggests forcibly to surgeons the necessity of adopting preventive measures, both during and after operations, for the extirpation of tumors infected with microbes. Any form of tuinor may have black pigment matter in its in- terstitial tissue to which the term melanosis has been indiscrimin- ately applied to all tumors or deposits containing black pigment matter. Pigment is of frequent occurrence in the human body, and consists in a deposit in jthe form of the minutest sepia-colored granules, of a dark-brown or black appearance. These granules may be free, or collected into masses, with a cell membrane around them, or they maybe added to any morbid growth whatever. The chemical composition is not accurately settled, but nearly all forms contain from eighty to ninety per cent, of pure carbon. The division into true and false is a good one — the true being an animal matter, the spurious, carbonaceous matter from without that has found its way into the body, or the action of chemicals on the l5lood, or the stagnation of blood. (^.) True melanosis is a diathesis or cachexia, in which large quantities of pigment may be deposited or infiltrated through many organs in the same individual, either alone or in conjunc- tion with other elements. The primary growth is likely to arise from some pigmentary tissue, as the choroid, or a cutaneous mole. The secondary desposits are mostly found disseminated in the connective and adipose tissue, in muscles, tendons, mu- cous membrane and bone. The bones of the cranium, ribs and sternum, most frequently affected. The organs which it generally affects are the spleen, liver, lungs, pancreas, lymphatics, brain, eye, kidneys, testicles, uterus, ovaries, rectum, mammae. It may be associated with cancer. When melanotic tumors, or nodules, are on the surface there is no difficulty in their recognition. When deposited on or in 1 1 20 DISEASE GERMS. internal organs, symptoms are obscure. In all cases there is great languor and sinking of vital power. The cachectic appear- ance is a dusky, or ash-colored countenance; emaciation, dropsy, night-sweats, exhaustion. Treatment. — Same as for tuberculosis. {B) Spurious forms : inhalation^ of coal dust in miners, in bronchi and lungs. From the action of chemical agents on the blood, and also from the stagnation of that fluid. It may not appear for twenty-four hours, or several days. Ecchymosis may, besides being due to injuries, be a symptom of purpura, scurvy, fevers, or of gangrene in inflammation. Treatment. — The object in treatment is to check extravasation of blood, prevent inflammation and procure absorption of the effused blood. For this purpose the bruised part should be placed in a raised position, and if about the eye, a few leeches might be applied, and then a poultice of Solomon seal. If it occurs on other parts of the body, tincture of arnica or mari- gold should be used. Arnica or marigold has the property of astringing and contracting the walls of the capillaries, and also promoting the absorption of the effused blood. The ordinary garden marigold is an unexcelled agent. This should be taken when in full-bloom, flowers, leaves and stem, and put to steep in common whiskey for a month, pressed well down with whiskey ^ enough to cover. It is much superior to arnica. Either of the two may be administered internally, but their effects are very doubtful in that way. Pigmented or black cancer, usually begins as hempseed, to pea-sized, single or numerous, soft or dense nodules, which develop in time to tumors of considerable size, and are stain- ed in various shades of color. Black pigment matter as found in a rare frnm a crrai/iQli Krown c\r a claf^ form of epithelioma on the Up. irom a grayisn orown, or a siare color to a dead black ; the pig- ment being occasionally displayed irregularly in streaks or bands, over the suiface of the growth. They occur anywhere, the eye, skin, etc., starting as moles, marks, naevi. The pigment is deposited in the protoplasm of the cancer mi- crobe in the epithelium, and connective tissue frame work of the cancer. All melanotic cancers are remarkable for their speedy growth, malignant career and noteworthy tendency to degenerate into BACTERICIDES. Ij2i ulcers. Often such verrucous masses are surrounded by grayish or blackish papules or by diffuse cancerous infiltration of the in- tegument, exhibiting irregular pigmentation of the surface. The local application of lactic acid about twice a week and the internal administration of the Chian turpentine mistura are our best remedies. Breaches of continuity of the surface are either Ulcers. the result of inflammation or some unrepaired {^Cutaneous}) injury. Ulceration consists in the gradual disin tegration and separation of tissues, the healthy nutrition of which has been disturbed by local inflammatory changes, by impoverishment or poisoning of the blood, or by an injury to one or more of the nerves of the affected region. In this process the destroyed tissues break down into minute parti- cles, or undergo liquefaction ; in gangrene, to which ulceration is closely connected, the open sore is formed by the separation of the dead tissues in sloughs or large and visible masses. Ulcera- tion may attack any organ or tissue ; it is often met with in bone, and sometimes in teeth ; the tissues most disposed to it are the skin, mucous membrane, and connective or areolar tissue. Nerves and blood vessels resist longer than other tissues the ulcerative process, and may, m cases of rapidly-increasing and sloughing ulcers, be seen isolated in the midst of discharge and slough. The cornea is a frequent seat of ulceration, which too often causes blindness or serious impairment of vision, by resulting in opacity or perforation of the membrane. Within the body ulceration very frequently occurs in some part of the alimentary canal. Ulcer of the stomach, ulcer of the duodenum, after severe burn, typhoid and tubercular ulceration of the small intestine, syphilitic and dysenteric ulceration of the colon and rectum, and fissure or painful ulcer of the rectum are all well-known affections. The pathological process of ulceration occurs in many different diseases of the skin, but for the presence of special microbes and application of remedies, it is best to keep them apart from all other cutaneous diseases. In ulceration there is always a loss of substance, a molecular death, disintegration and discharge of tissue. As a rule, ulcers heal slowly, for in all breaches of continuity, there are disease germs present, and the molecular destruction hinder the formation of granulations. The nomenclature of ulcers is exceptionally bad ; we have the healthy or simple ulcer, the fungous ul:er, the weak ulcer, the inflammatory ulcer, the irritable ulcer, the varicose ulcer, the ec- 71 ^ 12:2 DISEASE GERMS. zetnatous u!cer, and many others. These names are little better than jargon, but are nevertheless in common use, and are likely to remain so. Such names as varicose ulcer, eczematous ulcer, and gouty ulcer may be regarded as a kind of conventional short- hand writing, and may possibly be justified on that ground. Etiology and Pathology. — Simple ulcers of the leg always 'arise from some previous inflammation of the skin ; they are, as it were, a pathological accident of the inflammatory process. There are many causes which may give rise to them, but three only re- quire especial mention : (i) varicose veins ; (2) chronic eczema ; (3) blows or other injuries to the skin. Ulcers of the leg are sel- dom met with in the young ; they are most common in middle and advanced life, and their production is much favored by any occupation that involves much standing. With regard to heal- ing chronic ulcers of the leg, a prejudice exists among the pub- ' lie, and even amongst some members of the profession, against stopping a discharge, on the supposition that the ulcer gets rid of some morbid material out of the system, and that if the ulcer ceases to discharge, this will be retained, and the patient's health suffer in consequence. But the pathological changes which sometimes occur in other parts of the body coincidently with the healing of a chronic ulcer of the leg, cannot possibly be ex- plained in this way ; the morbid discharge from the ulcer is cer- tainly not drawn as such from the body generally, but is simply morbid in connection with the ulcer itself; its morbidity is en- tirely local. All ulcers, or breaches of continuity, are germ depots, and must be treated with microbicides. All cases, no matter the cause, should be placed upon a general alterative and tonic course of remedies, with the best of diet, and regulated secretions. With a breach of continuity existing, no matter whether it be superficial or deep-seated, it invariably creates a neurosis of the nerv^gus systmi at large; consequently an essential point in the treatment of all u'crrs is sedation, a tranquillized nervous sys- tem ; nothing aids a local treatment so much as the regular ad- ministration of opiates in all cases. This is not incompatible with any form of treatment. The local treatment of ulcer must depend on the amount of ir- ritation present in the surrounding tissues ; when this is great, the parts must be kept as quiet as possible, and lotions of boroglycer- ide or creolin applied on lint, changed often, covered with oiled silk, never permitted to become dry. As soon as the inflamma- tion has subsided, a bandage, if the parts admit of it, should be applied from the extremity upwards. Taken off every night and re-applied in the morning; this is always of utility. Strapping BACTERICIDES. II23 with salicylate rubber adhesive plaster above and below the ulcer, sometimes strips over it, so as partly to cover it, drawing the edges toward each other, allowing open spaces for pus to dis- charge ; over and above this a bandage. Those most liable to ulceration are the debilitated, the intem- perate, mercurialized, or those whose blood is loaded with the ba- cillus of tubercle and syphilis. Healthy Ulcer. — In constitutions, or parts predisposed to it, the slightest irritation may be sufficient to excite ulceration. In the vigorous it requires more irritation ; but when produced, it may be what is termed a healthy ulcer, and present a sore free from pain with a fine granulating surface, with smooth, white, milky edges, and its pus thick and creamy. A healthy sore is smooth, covered with a transparent pellicle, or scum, which is lost on the margins of the granulations. . Treatinent. — In all ulcers or breaches of continuity we must recognize a degradation of healthy, living matter, or diseased germs. In a healthy sore we find nothing but the bacteria, and streptococcus pyogenes, and those in very small numbers, so that it is important that all dressings exclude air completely, be somewhat stimulating, and invariably antiseptic. Ozone oint- ment, or black salve, should therefore be kept constantly applied, Bacteria as seen in simple ulceration. Living mass of working germs in irritable ulcer. spread on fine old linen or lint, about one-sixteenth of an inch thick, a little larger than the sore, changed twice or thrice daily. The dressing on each occasion to be fresh. Before any dressing is applied, the limb should be bandaged from the extremity up, leaving a space for the application of the ointment, and over and above that a few turns of the bandage. The limb should, if possible, be kept at rest, and in an ele- vated position. The constitutional treatment required here is tonics, cinchona, and a liberal, generous, blood-forming food. Irritable Ulcer. — This term is applied to an ulcer when it is hot, tender, very red and painful ; bleeds easily, and the discharge is thin, irritating ; in some cases foul and copious, and heavily loaded with bacteria. The cause of this is some malassimilation, perverted nutrition, or derangement of the general health. The treatment should consist in opening the bowels, correcting 1 1 24 DISEASE GERMS. the malnutrition with tonics, as comp. tincture of matricaria; plain, unstimulating food. After a free action of the bowels, the irritability of the sore should be removed by applying a saturated solution of boroglyceride covered over with oiled silk, this will speedily exhaust the irritability and reduce it to the condition of a simple ulcer. If not, the ulcer might be sprinkled over with ozonized jequirity pulv. which will cause a complete exfoliation to take place, and stimulate it into a healthy condition. Then it might be healed up with ozone ointment. In the case of irritable ulcer it is indispensable that anodynes be administered freely, tonics and alteratives pushed. Indolent Ulcers. — Old ulcers of ten or twenty years' standing have generally a smooth, uneven surface, of a pale ashy color, like a mucous membrane. In some cases it may display a crop of weak fungus granulations. The edges are raised, thick, white insensible, either inverted or everted ; discharge scanty and thin and contains a few bacteria. Those ulcers may remain stationary for years, or take on at attack of irritability, and become in- flamed ; or may heal, and then suddenly give way. An irritation Bacteria in indo- Tubercular ulcer. Another form of tubercle lent ulcer. bacilli in an ulcer. in the body existing for years gives rise to a cachexia which is essentially tubercular. Treatment. — Before interfering at all with the ulcer, the patient should be placed upon a very active alterative and tonic treat- ment, with a varied diet, rich in blood elements, for a month or two. If the patient is feeble, the stramonium ointment and iodide of potass should be applied to the ulcer to soften and absorb the granulations and indurated edges. If he is in average health, the powdered or distillation jequirity might be applied to cause an exfoliation of its surface. Ointments made either of hydrastin, lycopodium, or pinol, or naphthaline, or aromatic sulphuric acid, or resorcin. Tubercular Ulcer. — The microbe of tubercle often blocks up the lymphatics in the neck, axilla, groin. Usually the bacilli crowd into the chain of lymphatics, two, three, or more ; they aggregate together in nests, first in an albuminous form, then as they die in the lymphatics, they become milky, cheesy, and lastly calcareous ; generally inflammation is excited at several BACTERICIDES. IJ25 points in the lymph canals, cellular tissue, skin, giving rise to numerous openings, through which the curdy or cheesy matter exudes. These perforations communicate with each other in the cellular tissue, forming ugly puckered cicatrices on the neck or elsewhere, where they discharge and heal up. In all cases, the general treatment for tuberculosis should be enforced : glycerite of ozone, iodized oil, or ozonized iodine, sul- phur water, avena sativa. Locally to the sores, ozone ointment, sozoiodol, iodol, per- oxide of hydrogen, benzoin ointment. Varicose Ulcer. — An ulcer dependent upon a varicose condi- tion of the veins of the limb. The consequent venous conges- tion weakens the already debilitated parts, and renders them prone to ulceration. The ulcers are generally three or four in number, situated above the ankle. Oval in shape, indolent in their progress, neither extensive nor deep, but attended with considerable pain of an aching character. Treatme?it. — Get the general health into good order by tonics and alteratives, with abundance of good food and fresh air. Keep bowels regular, and attend to the skin by daily sponging. The internal and local exhibition of the witch hazel to tone up the veins ; an infusion answers the purpuse. The patient should wear an elastic stocking or bandage during the day. Before it is applied in the morning, limb to be bathed first with soap and water ; then either tincture or infusion, or ozonized distillation of witch hazel applied ; sore dressed with either black salve, vaseline or ozone ointment ; over the dressing a piece of oiled silk ; then an ordinary stocking, and, above all, the elastic stock- ing. The same should be repeated in the evening, but the elastic stocking need aot be kept on during night, unless case is very bad one. Infusion of oak bark, alcohol, and salt, and other remedies are of no importance when we have the witch hazel. A cerate of calendula, or pinus, or of hazeline, are most effectual. Fistulous Ulcer. — Consists of a tube or narrow channel, lined by a false membrane, which is a secreting membrane, and which may, or may not, lead to a suppurating cavity. In old cases, the walls of the tube are dense and semi-cartilaginous. Fistula may be produced by a deep-seated abscess, not healed from the bottom, or by caries, or necrosis of bone ; or by the perforation of tissue by a mechanical irritant or obstruction, as a foreign body perforating through the walls of the rectum to the external parts. If there are several openings, or fistulae communicating with dead bone, it is folly to try to heal them. If the parts permit, they should be run into one opening, so as to give nature as little I I 26 DISEASE GERMS. work as possible in throwing off the dead bone ; or if due to the imperfect healing of an abscess, it should be slit up from the bottom and injected with peroxide of hydrogen. (See Fistula in A?io.) Phagedenic Ulcer. — This term is used to express a variety of ulceration which destroys the tissues more rapidly and to a greater extent than ordinary forms of ulcer. The subjects of this local affection are usually individuals who have been debih- tated by some severe febrile disorder of a typhoid character, or who have been subjected to the influence of cold and wet, foul air, bad and insufficient food, fatigue, and excessive indulgence in spirits. It is generally preceded by some sore or wound, and its local causes a^'e irritation of the open surface, and gross neg- lect of cleanliness. A vx;ry superficial sore, such as that formed by the application of a blister, may under the above-mentioned constitutional and local influences, rapidly become phagedenic and produce much destruction of the soft parts. It has been most frequently met with in connection with venereal ulcers, especially in those cases in which the parents have been submit- ted to a prolonged and excessive use of mercury. Phagedena varies in intensity in different cases ; it is somes so mild as to be scarcely distinguishable from ordinary ulceration, and in other instances it spreads with so much rapidity and destroys so great an extent of the surface of the body, that there seems to be very little difference between it and the affection ■{.:f^-:m^ known as hospital gangrene. This latter form tfi^^Pl^j^A oi phacredena is met with in noma, can- ^K|^^^ crum oris, and the sloughing throat of scar- ^^^P^ latina. It is believed by some surgeons that ^^gre°ife^and'^''ta"edeni''"' phagedenic ulccration is caused by poison- in^ of the blood, in consequence of the ab- sorption of putrid matter. In phagedena there is a large and rapidly spreading ulcer, the edges of which are formed of sharply-cut, indented and undermined skin. The surface of this ulcer is uneven and of grayish color, and is covered by a dark-colored, thin and very fetid discharge, which is often marked by streaks of blood. The integument surrounding the ulcer is swollen, and of a dusky-red color. The ulcerative process is attended with severe gnawing pain. In the treatment of this affection it is necessary that the patient be supplied with good nourishment, and that alcoholic stimulants be given freely, but at regular intervals. Opium is generally ad- ministered for the purpose of relieving the severe pain, and of allaying nervous irritation. The patient should kept in bed in a BACTERICIDES. 1127 large and well-ventilated room. The bowels should be kept open by mild purgatives, but great care must be taken to avoid diar- rhea, as the subjects of phagedena may rapidly sink under any excessive drain upon the system. The local treatment consists in cleansing the surface of the ulcer by frequently syringing it with some disinfectant lotion, as a solution of carbolic acid, of per- manganate of potass, boroglyceride, or peroxide of hydrogen, and in relieving the pain by the application of poultices or poppy fomentations. In severe cases, where the ulceration, in spite of this treatment, is spreading with rapidity and attacking important parts of the body, the surgeon often finds it necessary to apply the actual cautery, or some strong caustic. Of caustic applica- tions, fuming nitric acid seems to be the most in favor. Bed-sores are large unhealthy ulcers formed over the hips, but- tocks and the lower part of the back of bedridden persons. They are due to long- continued pressure on these parts, to a vitiated state of blood, and to general debility, and are met with in the subjects of fever, paralysis, broken back and in very old people who have been in bed for a long time. In cases of paraplegia, bed-sores are very large and deep and spread with rapidity. A bed-sore commences as a dusky-red patch on the skin, which be- comes excoriated. After the separation of the cuticle the sur- rounding soft parts become swollen, and the inflamed integu- ment is converted into a gray or black slough, from the under surface of which there is a discharge of thin matter, and the mi- crobe of phagedena. This sloughing process extends both su- perficially and deeply until a large cavity is formed, which, in some instances, exposes bone. In old or very debilitated sub- jects death is frequently the result of this affection. Except in cases of palsy and broken back the existence of a bed-sore bears witness to the incompetence or carelessness of the nurse. In cases of long continued illness and confinement to bed injurious pressure on the back and hips may be prevented by the use of soft pillows and air and water cushions, and by a constant atten- tion to cleanliness. Same treatment as phagedena. Gangrenous Ulcer — Hospital Gangrcjic. — Gangrenous and ul- cerative processes which attack wounds and stumps after ampu- tation, when the patients are collected together in .great numbers and are placed under faulty hygienic conditions. Hospital gan- grene in all its forms is both contagious and infectious, and seems in some instances to be due to epidemic influences. It is very prevalent among armies during military operations, and when large numbers of wounded soldiers are collected together in buildings unsuitable in size and internal arrangements for hos- 1121 DISEASE GERMS. pital purposes. The disease has often made its appearance with- out any known cause in one or more American hospitals. It at- tacks small as well as large wounds, and even blisters and leech- bites, but is never met with in perfectly sound individuals. In the most severe form of hospital gangrene a small livid spot or bleb makes its appearance on a stump, or near the margins of a wound, which had previously been closing favorably. This bleb increases rapidly in size, and converts the extremity of the stump or the whole of the wound, with the surrounding healthy skin, into a black and swollen gangrenous mass. The disease spreads rapidly, and is associated with. constitutional symptoms of a low typhoid character. At other times a stump swells and becomes hard and very pale, and its surface is marked by large blue veins. This form is also attended with severe general symptoms and much pain. Like the preceding one, it is generally fatal. In the less severe forms the surface of a wound is covered by a thick, yellow, and adherent crust, which increases rapidly both in depth and superficial extent. This disease has been met with chiefly in Europe, and is there known by the name of diphtheria of wounds. The constitutional symptoms are not so severe as those of the strictly gangrenous forms, and the fever, if it be present, is gen- erally high and of an inflammatory kind. The general treatment should consist in supporting the strength of the patient by tonics, stimulants, germicides and nourishing diet. In the diphtheritic form, however, the diet should be moderate, so long as there is high fever, and alcoholic drinks should not be given freely. The local treatment is generally directed towards arresting the spread of the gangrene by the application of bactericides of great power, charcoal, yeast, resorcin, chlorinated soda, boroglyceride. Syphilitic Ulcer. — A breach of continuity in which the venereal bacillus appears. When not due to a specific inoculation, they The venereal bacillus eating the dorsum of the hand — forming a duplicating ulcer— which healed kindly under resorcin and ozone ointment. Pus from syphilitic ulcer with the venereal bacillus and streptococ- cus pyogenes, magnified 1250 diameters. are usually met with on the legs, occasionally on the thighs and arms. The annexed diagram was photographed from a living subject, made a rapid cure under saxifraga and resorcin oint- ment. BACTERICIDES. 1 1 29 Malignant Pustule (Anthrax). — Becoming very common, from importation of foreign wool, hides ; and the operatives in such are often fatally affected. It begins as a little -rx \ dark red spot, with stinging or pricking pain, ^' A '^ "^ , on which a vesicle and then a pustule, seated ' W j(y^^ on a hard, inflamed base. When this is opened v V^ \ "^f^ it is found to contain a slough as black as gpores of the badiius charcoal, which is a mass of giant bacteria. amhrax from a pustule —,, 1-11,1 .1 1 , on the hand of a wool- rhere are likely to be more than one, and to sorter, magnified 750 spread with great rapidity, and the system diameters. becomes affected ; or there may be systemic poisoning first, from the workers breathing in air loaded with the diseased germs. Butchers are often affected. The stomach, from its important functions, con- Ulcer, trolling the whole system of nutrition, merits {Gastric}) greater consideration than it \s, apt to receive at the hands of many. Any disease of such an organ implies so much interference with all other functions as to pre- clude, in great measure, their proper fulfilment. Even the func- tions of the brain are intimately dependent on those of this organ. Common acute inflammation, such as often affects other organs, is rare in the stomach, except when excited by some powerful ir- ritant swallowed. On the other hand, the slighter form of irrita- tion, commonly called gastric catarrh, is much more common than is supposed, and is, indeed, the ordinary form in which the stomach resents ill-treatment; ordinarily, this form of malady is reckoned as indigestion merely. Dyspepsia, as well as inflammation, is productive of ulcer. The two most important maladies of the stomach are simple and malignant ulceration, the latter commonly going by the name of cancer. Cancer of the stomach — a painful and intract- able malady — commonly affects one or other of the orifices of that organ, and of the two, by far the most frequently that next the bowel called the pylorus. Disease in this region interferes sadly with nutrition, prevents the half-digested food from passing on- wards in the digastric tract, and so starves the patient. As a consequence of this obstruction, too, the organ commonly be- comes dilated, the food, only half digested, collects and putrefies, and so vegetable organisms form in it. After being retained in the stomach for a time, giving off foul-smelling gases, the whole contents are ejected — a foul-smelling, black-looking mass, often resembling coffee grounds. The pain at these times is severe, but not at others, the great want felt being really a want of I 130 DISEASE GERMS. food. In the simple ulcer of the stomach there is also, as a rule, vomiting, but the part most frequently affected being the poste- rior wall at some distance from either orifice, there is not that regularity in its occurrence there is in cancer. In simple ulcera- tion of the stomach there is one serious danger always possible, that arises from bleeding. The shape of the gastric ulcer is mostly round ; if several make their appearance and coalesce, it is irregular, and occasion- ally belt-shaped. The shape at first is nearly always round ; after existing for a time the ulcer becomes elliptic or gets small notches, and thereby becomes irregular. The ulcer spreads mostly in an oblique direction, there- by occasionally encircling the whole stomach like a belt. Perforating ulcer of the jf ^hc ulccratcd proccss p;oes ou Until stomach. ^ o the ulcer reaches the deeper and larger blood vessels of this organ, it is quite possible for one of these to give way before it is closed at either extremity, and so the blood is poured out from it so rapidly that life is endan- gered. Most frequently under such circumstances the blood is vomited, and this vomiting of blood may be the first symp- tom ot" danger. At the same time, however, the blood will in part pass into the bowels, and being there partly altered and blackened, is so discharged. This constitutes melaena, vomiting being termed hsematemesis. Often it is not easy to diagnose between the simple and malignant variety of ulceration, though this is important, the simple form being tolerably amenable to sound treatment, the malignant not at all so. When bleeding does occur it constitutes a danger so serious as to demand instant attention, for if the bleeding does not stop the patient will die. Frequently, too, it will be found that the bleeding recurs again and again, tasking the resources of the physician and the strength of the patient to the uttermost. Here are the rules to be adopted. The patient must be kept at absolute rest, and ice given freely. Let the patient crush the ice roughly with the teeth, and swallow it in lumps. Let ice be placed outside the body over the stomach. The best thing to give is dry cham- pagne, in small quantities, well iced ; if that is not to be had, iced brandy and soda, only the smallest quantity of brandy. The best medicine is gallic acid, made into a paste with water, twenty or thirty grains for a dose, with perhaps ten or twenty drops of dilute sulphuric acid. There are a score of other remedies, but these are the best, and as a rule will succeed if any will. But as regards food — there is the real difficulty. Well, it is best to face BACTERICIDES. 1131 it from the beginning, and give no food by the mouth, but only nutrient encmata. If the case is severe, that is the best plan ; \\ sHght cases a Httle milk, iced, is best to be q-iven. But in ail cases of real difficulty, there is nothing like nutrient enemata — strong beef tea. The bowels ought, however, to be well washed out with soap and water before administering the injection. Disease germs are productive of ulceration of the stomach, and it is quite certain that by lavage of the stomach thev can either be discharged or washed out. This is a valuable aid to medical treatment. It is well to bear in mind that the symptoms of gastric ulcer in middle-aged persons, differ very considerably from those which have occurred early in life, though the symptoms consist chiefly of pain, tenderness, vomiting, and haematemesis. The individuals are no longer simply anaemic, but are often cachect'c and wasted. The pain is often much less acute, and the sickness much more frequent and distressing. There is generally great tenderness over the region of the stomach, and the matter which is brought up is intensely acid, and contains quantities of blood, sometimes in the form of clots, but more often presenting the coffee-grounds form. In such cases there is often great difficulty in distinguishing between gastric ulcer and malignant tumor of the stomach, and indeed the diagnosis can only be arrived at with certainty after the case has been for some time under treat- ment, and the absence of a tumor has afforded further indications of the non-malignant character of the disease. At the prcst^nt time it is rare to find death occurring from perforation in cases of gastric ulcer, and yet it has been estimated that the propor- tions of death by perforation is something like fifteen per cent. Largely, this result is due to improved methods of treatment, and to early recognition of the disease, but it may be doubted, even at the present day, whether as much is done in the shape of treatment, as might possibly be accomplished. One of the most important points to be borne in mind is to insist on the importance of simple physical rest. A physician is very com- monly called upon to deal with two very distinct classes of in- dividuals ; those occupying a bed in hospitals, and those who either go to his out-patient room, or consult him at his own house. The greatest rapidity of recovery is always to be found amongst those who are kept quietly in their own beds. It is extremely difficult to convince people that this is really an advantage. So long as individuals can move about at all, and more especially if they can move about with any ease and comfort to themselves, they are extremely loath to lie quietly in bed. It is only a very few who will place such complete reli- II32 DISEASE GERMS. ance on the instructions of their physician, as to allow him to carry out to his heart's content, treatment by rest. It is ex- tremely difficult to lay down what particular forms of food should be taken or rejected, but most experience shows, though of course many instances to the contrary might be quoted, that all forms of uncooked food, meat, stimulants, and things generally known to be indigestible, must be prohibited. Some can take milk, some eggs, some farinaceous foods, whilst some seem to be specially irritated by them. As far as possible, it is desir- able to insist on rectal alimentation. The value of the treatment of drugs depends largely upon the amount of an accompanying gastric catarrh. It is very much the fashion at the present day to give alkalies, usually in the form of carbonate of soda, com- bined with a little iodide of potassium, and possibly some opium. __ If symptoms of hemorrhage supervene, it ~ ' "^ ^ is obvious that all the more need exists for care in treatment ; but the subject of treatment is so large a one that we must briefly epitomize it. First, as to the alimentary canal. In their abnormal conditions, the digestive organs present a nidus peculiarly favor- able to the development of the lower or- ganisms, and I believe that many, if not most, of the annoying phenomena of in- Ducts and acini similar to the digcstion depend on fermentation and pyloric glands and the fine, putrefaction of their coutents. An in- richlv cellular connective tis- ,. . . . ,, . , sues formino the inter-tubular digestion Originally dependent either on stroma in microbes. . ,.^. r ,^ some passmg condition of the primae viae, or on some solitary indiscretion in diet, is often indefi- nitely prolonged by the development of torulae, sarcinae, and other (microphytes. The acids and gases evolved by their baneful activity confirm a condition that otherwise would be evanescent. The delayed digestion of the so-called atonic dyspepsia, I am convinced, is often due to the excessive acid- ity of the stomach contents, which, in its turn, is due to the growth and activity of torulae and sarcinae. By the destruction of these microphytes, or even by the temporary inhibition of their activity, we greatly relieve, if we do not cure, the dyspeptic ; and certainly in those cases not dependent on incurable organic lesions, we make a long stride towards cure. But how destroy these microphytes, or inhibit their activity ? Chiefly by the internal use of germicides. Those best adapted to this purpose are, so far as my observation extends, peroxide of hydrogen in the fluid ext. of hydrastis or columbo, or liquor ceni. BACTERICIDES. 1133 Of these, the liquor cerii is probably the most suitable in the majority of cases. It is efficient. It is a digestive as well as a general tonic. By its gradual solution, its action is prolonged, and even extended into the intestine. It is easy of administra- tion. Thus we see that it answers a number of indications most admirably. It should be administered in about thirty-drop doses, three times a day, and always after meals. Hand in hand with this, of course, should go the proper se- lection of foods, their thorough mastication, and the use of di- gestive and general tonics, such as pepsin, the vegetable bitters, and especially moderate quantities of alcoholic stimulants. In dilatation of the stomach, the administration of the appro- priate germicide should be preceded by a thorough washing-out of that viscus. Authorities recommend the use, before meals, of the mineral acids in cases of excessive acidity, and of the alkalies, in deficient acidity, of the stomach contents. This advice, as they say, is based on the physiological fact that alkalies increase the secre- tion of the stomach acids, while, on the contrary, acids diminish it. This explanation has always seemed to me a little strained, and especially so, since the demonstration of the germicidal power of the mineral acids. Were it the true one, excessive acidity should be its own remedy. The excessive presence of the normal aeid, I believe, is very rarely a cause of acid indiges- tion ; on the contrary, the acid of acid indigestion is the acid ot fermentation. With this view, the explanation of the efficacy of the mineral acids before meals, and of their failure after, is very simple. Administered on an empty stomach, their degree of concentration is sufficient to be germicidal, while on a full stom- ach, it is insufficient, and so the would-be remedy aggravates the trouble by adding its own acidity to that already existing. The value of the mineral acids in this condition is not solely dependent on their germicidal powers; muriatic acid and nitric acid in a less degree assist in the digestion of the albuminoids, and by their astringency give tone to the debilitated mucous membranes. Muriatic acid before meals, therefore, is one of our most valu- able resources in the treatment of acid dyspepsia. The bisulphite of sodium in full doses or in divided doses, re- peated as necessary, is especially adapted to the treatment of those cases of acute septic indigestion, otherwise known as bilious attacks. It occurs to me that perhaps in these very cases it was, that calomel, as an unsuspected germicide, acquired its false reputation as a cholagogue. If administered in the very outset, both experience and observation assure me that bisulphite I 134 DISEASE GERMS. of sodium will often abort these distressing attacks. Here it is best given in drachm doses, dissolved in mint-water to mask its abominable taste. It must be fresh so as to contain an excess of sulphurous acid, wliich is liberated in the stomach, and on which its efficiency depends. Lavage is an important element in the treatment of gastric ulcer. Lavage is thus performed. An oesophageal tube, with a blunt double-e)'ed extremity, made of flexible-rubber, 28 inches in length, and from a ^ to ^ an inch in diameter, is attached to a small section of glass tubing, which is also attached to a yard of soft rubber tubing, into the free extremity of which, a glass funnel capable of holding ei^ht ounces should be inserted. This oesophageal tube well- warmed and oil, should be passed down the oesophagus in the usual manner, the patient aiding all he can by attempts at deglutition. When the stomach has been reached the funnel is raised above the patient's head, and from a pint to a quart of the lavage solution is slowly poured in, ob- struction or regurgitation being noticed by the glass tube joining the two tubes. When sufficient of the lavage solution has been introduced, the funnel is lowered and inverted over a basin. While making this change compress the tube ; when the change is made, relax it ; freed from the pressure, the tube becomes a syphon, and the contents of the stomach is rapidly removed. If there be irritability to the passage of the tube, smear its edges with cocaine ointment, and if patient be very nervous, ex- tract of musk-root to be given. With regard to the solutions used ; as simple lavements, infu- sion of slippery elm and resorcin ; boroglyceride ; creosote, one- per-cent. ; carbon bisulphide ; charcoal ; creolin ; naphthaline. The strength of the various solutions must be carefully regu- lated. In some cases, as with slippery elm, or wild indigo infusion, they may be permitted to remain. Any irritability must be over- come by painting the fauces and throat with cocaine. The different forms of ulcer of the larynx Ulcers of the may be embraced under the following heads : Larynx. Catarrhal; follicular; diphtheric; tubercular; syphilitic, and other forms due to the micro- organisms of the eruptive fevers. The tubercular and syphilitic are the most common. Catarrhal ulcers are not infrequently associated with nasal ca- BACTERLCIDES. II35 tarrh, and are usually superficial, as they are round, then oval, and gradually, as the germs burrow (amaeba), become more exten- sive in size, and more numerous ; often coalesce, become large with irregular outline. The folliciilar tilcer as a rule, is superficial with a limited area of extension. The tubercular ulcers are either superficial or deep ; most com- monly met with at the inter-arytenoid commissure, generally associated with laryngeal tuberculosis. The deficient vascularity of the pale and thickened arytenoids favors the occurrence of those ulcers. They have their inception in a neurosis, a general bankrupt state of the nervous system, the evolution of the bacil- lus tuberculi which causes deep destruction, calcification and ne- crcsis of the laryngeal structures, which is usually aggravated by discharges from the bronchi or lung, independent of degenera- tive changes and tubercular nodules. Syphilitic ulcers of the larynx depend greatly on the general health, if vital energies are greatly exhausted, the mucous mem- d^m^i mi^ K^^^ Syphilitic microbe as found in the scooped-out coppfr-coiored ul- cers on the larynx. © .^m r-.^Sffi: ■ :s more distinct. Renal tube casts are almost always associated with albumi- nuria, or Bright's disease, although they often appear when no albumen can be detected in the urine. They are, as their name implies, casts of the renal tubules, in the majority of cases of the convoluted tubules of the cortex. The chief forms of tube casts are the follow- 1 . Epithelial Casts. — In these the fibrin- ous cylinder has become covered over with epithelial cells, which have been de- tached or exfoliated from the lining mem- brane of the tubule. These cells ma}- b^,- more or less cloudy and swollen. Such tube casts are peculiar to Bright's disease. 2. Pits Casts. — Casts containing in them pus corpuscles, are diagnostic of glomerulo-nephritis. 3. Fatty Casts. — Very frequently in fatty degeneration of the kidneys, do we find oil globules studded in the casts. ^^ Fatty c.ists. \ 25c. Grai.ular casts. y4, large granular casts; ^, small finely granular casf;. 4. Granular Casts. — Dark opaque granular casts are also the result of epithelial degeneration in the renal tubules. 5. Blood Ozj/j.— Many consist wholly or partially of blood; the corpuscles being closely adheient to one another, or fibrinous casts may be seen containing one or two blood corpuscles im- bedded in them; such casts point to capillary rupture, as in acute nepritis. 6. Hyaline Casts, are structureless, transparent cylinders, having a tendency to fracture transversely, and are derived from BACTERICIDES. I 16^ the fibrinous exudation which has passed through the degene- rated walls of the renal vessels and coagulated in the tubules ot Blood cabts. A, collecting tube blood casts ; j9, mu- cous casts. Hyaline casts. ^,delicat<: hyaline casts; B, ccvkt so-called waxy cast<. »^°-?S O O the kidneys. Small hyaline casts are present in the incipient degenerative stage of Bright's disease, whereas, the larger ca^^ts are to be seen in the chronic form. Occasionally hyaline casts may be found, which exhibit the amyloid reaction, becoming reddish brown on the addition of iodine, and dirty violet on the further addition of sulphuric acid ; and giving a beautiful violet, with methyl green. Waxy and amyloid casts are more strongly refractive than the ordinary hyaline varitty, and being less flexible, they ex- hibit deep fissures where they have been torn asunder in passing through the straight tubules. Blood. — Blood may be found in the urine as such (haematuria) or blood corpuscles, or blood pigment may be present (haemoglobinuria), and these two conditions are readily distinguished by the fact that in the former case blood cor- puscles are found on microscopical examination, while in the latter they are absent. A very small quantity of blood in the urine gives it a peculiar smoky appearance. When blood is present in a larger quantity the urine becomes bright red or dark brown. Small quantities of blood are best detected by the microscope, but when no corpuscles or crystals ofhsematin are present, recourse should be had to the spec- troscope. In cases of haematuria it is important to ascertain from A\hat point in the urinary tract the blood comes, and this is not usually difficult. The hemorrhage may come : I. From the urethra. — The blood is mixed with the first por- tion of the urine voided — often being expelled as a long clot, and it continues to flow in the intervals of micturition. o o < 00 o Blood. y4,S\voll-:n red corpuscles seen in urine of low specific gravity; B. Crena- ted corpuscles from dense urine, x -z-o. I 1 64 DISEASE GERMS. 2. From the neck of the bladder, or prostatic portion of the urethra. In this case, the blood usually appears at the very end of micturition, when the sphincter vesicae begins to contract. 3. From the bladder. — The blood is usually coagulated, and is passed in clots as large as the calibre of the urethra will allow to escape. 4. From the ureters. — In this case, the blood often appears in the form of long worm-like clots, which are casts of the ureters. 5. From the kidneys. — When the blood comes from the kid- neys, it is generally equally diffused through the urine, very rarely in large quantities ; when the urinary sediment is exam- ined, there are found tube casts, usually containing blood-corpus- cles. Hemoglobinuria appears in the urine in such diseases as pur- pura, scurvy, pyaemia, typhus, small-pox, etc. Results from a breaking down of the red corpuscles in the bloodstream, and the consequent liberation of the hemoglobin they contain, when it escapes into the urine. In malarial germ-laden blood it is often periodic, its appearance ushered in with a chill. Micro-organisms. — Living matter, degraded bioplasm, disease germs, or microbes, lower class of organism are found in the urine; passed in the urine as it leaves the body. In all diseases due to the presence of a micro-organism, as measles, scarlatina, variola, cancer, tuberculosis, syphilis, typhoid and other fevers, etc., the urine has a peculiar condition, termed bacilluria, in which it is opalescent when passed, from the enormous number of bacilli present. The reaction is acid, and when the urine has stood for some time, the microbes sink to the bottom of the glass, leaving the supernatant fluid clear. Very rarely do we find the embryonic form of parasites which infest the blood present in tiie urine. Fully-developed hydatids and echino- coccus, or only portions of these, may appear in the urine, having been devel- oped at some portion of the genito- urinary tract. The microbe of malaria, the sarcinae and yeast plant of gastric catarrh, the former in the ha^maturia of malaria, the latter in fungous sugar urine. Spermatozoa are occasionally found in urine. They preserve their normal ^^ appearance for a long time. If the urine Spermatozoa. , ^ 1 1 1 • ,1 1 be very alkalme, they may even be seen in active motion, but those movements are soon lost. Urine which contains spermatozoa becomes alkaline very rapidly. BACTERICIDES. 165 Urticaria may be defined as an acute non- Urticaria, contagious affection of the skin, characterized (NettlcrasJi}) by the development of wheals, and accompanied by sensations of stinging, itching and burning, like those produced by the stinging of a nettle. In the wheals 'of the eruption can be detected a bacterium, re- markable for its easy culture in acidulated beef-tea ; so far it has not been proved to be pathogenic. Nettlerash is remarkable for its variable and fugitive character, and for the great variety of circumstances and conditions under which it is developed. In all cases, however, the presence of wheals or some equivalent eruption is pathognomonic of the disease. The size, form and general appearance of the wheals vary greatly ; sometimes they are no larger than a split pea, while at other times they may occupy a considerable extent of surface and cause much swelling of the skin. In typical ex- amples they are round, raised and circumscribed spots, with a white centre and a reddish border, closely resembling the erup- tion produced by a nettle sting. In other cases they may take the form of streaks, ovals, or irregularly shaped patches ; some- times the only eruption consists of a diffuse erythematous-looking bright red blush ; but whatever be its form, it is very evanescent and liable to appear and disappear almost suddenly, leaving no trace behind. In all cases the subjective phenomena are nearly the same, and consist in excessive itching, tingling, stinging, and burning sensations ; sometimes the itching preponderates ; at other times perhaps the stinging or burning sensations are the most marked, for like the eruption itself, they are subject to constant changes. The rash often appears with a sudden burst all over the body, while at other times it is developed more slow- ly and appears successively on different parts. The subjective sensations invariably cause the sufferer to scratch and rub the skin ; this greatly aggravates the symptoms, and brings out fresh wheals wherever the finger-nails are applied, and in severe cases small excoriations and little spots of coagulated blood may be seen scattered about the skin as the result of scratching. The eruption is roughly symmetrical and may appear on any part of the body, but is most common on the trunk, face and upper ex- tremity. An ordinary attack of urticaria may last from a few hours to several days, but always with partial remissions and ex- acerbations ; it is usually associated with very slight febrile dis- turbance. It must not be forgotten that the mucous membrane sometimes participates in the changes which occur in the skin ; this is especially the case about the fauces and throat, which become suddenly swollen, so as even to threaten suffocation. I 1 66 DISEASE GERMS. The circumstances under which urticaria is most Hkely to oc- cur require a brief notice, as having some bearing on diagnosis, (r) It is extremely apt to complicate other irritable affections of the skin, such as scabies, phthiriasis, prurigo, and eczema; this is especially the case in children, who are more liable than adults to this affection ; the production of nettlerash under these circumstances is due to a reflex nervous action set up by scratch- ing. (2) Urticaria produced by the irritation of some part of the mucous tract is not uncommon, and belongs also to the group of reflex nervous actions. We often meet with examples of this kind dependent on uterine irritation from pregnancy and other causes ; also in children who suffer from worms. (3) The bites and stings of poisonous insects and the hairs of stinging plants will produce in some people pretty severe local attacks of urti- caria, so that the face or arms become much swollen and very painful. (4) Certain kinds of food are apt to produce nettlerash ; amongst these may be specially mentioned shell fish, mushrooms and many kinds of fruit ; but in these cases much depends on the idiosyncrasy of the individual. (5) There is a nervous form which occurs in individuals whose nervous systems are utterly broken down. (6) Certain drugs give rise to it as copaiba, cap- sicuni, turpentine, cubebs. In its diagnosis great care must be exercised so as to assign it its proper type — a great variety of forms, as urticaria papulosa, lichen urticatus, purpura urticans, urticaria vesiculosus. Uricaria may take the form of simple, roundish, red patches, or it may be white, or a buff copper color. Urticuria is undoubtedly associated with a weak digestion and mal-assimilation of food ; in its treatment therefore, our attention should be specially directed to a suitable diet. As a rule, fruit, vegetables, pastry and sugar should be avoided, together with any other food that seems to produce indigestion ; the sufferer should, in fact, adopt the simplest form of a plain and nutritious diet, such as milk, meat (once cooked), toast or bread, light pud- dings and cocoa. Wine, beer, coffee and most other stimulants should be avoided, but in some cases a little weak brand}' and water may be required, and is the form of stimulant which is generally the most suitable. No rules as to diet can be laid down which are applicable to all cases ; it is only possible to in- dicate the general plan of dietetic treatment ; the idiosyncrasy of the individual must, of course, be studied. F'or example, with some people milk always disagrees, and it would be the height of folly under these circumstances to insist on a milk diet with a view to improve a weak digestion. The conditions of the teeth and the proper mastication of food, regular and suitable exercise BACrii:RlClDES. ,i5 and a sufficient amount of rest, are all points that demand atten- tion. With regard to medicines, those are most useful that pro- mote the processes of digestion, correct an excessive secretion of acid, and prevent an unhealthy decomposition of the food. By far the most generally useful is a mixture containing bismuth, carbonate of magnesia, bicarbonate of soda, and small doses of nux vomica taken before each meal. Sometimes small doses of Fowler's solution with alkalies do great good, chiefly by im- proving the powers of digestion. Nux vomica and carbolic acid pills are occasionally useful. A large proportion of the cases of urticaria are distinctly of neurotic origin, indicated by other disturbances of the nervous system. This especially applies to that form which recurs at a fixed hour in the day, and which sometimes replaces an attack of neuralgia. Quinine and tonics are both useful in dealing with urticaria of this kind, but thorough change of air is of all re- medies the one which is most certainly beneficial. The malady is, however, often very obstinate. Acute urticaria of the ordinary kind is generally produced by poisoning from shell-fish, fungi, or some other poisonous food. Under these circumstances it is often associated with vomiting and diarrhea, which relieve the most serious symptoms. The best treatment in these cases is free purging and a simple emetic, if the latter can be administered soon enough to remove any of the offending matter from the stomach ; this treatment is particu- larly applicable to children, who usually bear emetics well ; fol- lowed with resorcin, or naphthaline, or with 24-grain doses of salicylate of sodium, every two hours. Acute febrile urticaria is a rare affection, and occurs without any assignable cause except perhaps some severe shock to the nerv^ous system ; it should be treated by rest in bed, a light un- stimulating diet, mild saline purgatives, followed by tonics, espe- cially quinine. As the suffering is very considerable, soothing external treatment must be adopted ; warm alkaline or bran baths, and alkaline and sedative lotions are the most useful. Ver)' severe symptoms sometimes occur in consequence of the sudden swelling of the mucous membrane of the throat ; when thi-s happens, a sharp quickly acting purgative is always indi- cated. Lichen urticatus, which is a form of urticaria almost confined to children, is a most troublesome affection to deal with. In many cases it does not in any way yield to treatment ; the af- fection, however, usually dies out in a few years. The most generally useful medicine, I find, is carbonate of magnesia and soda with a little bromide of potassium ; the bowels should be I 1 68 DISEASE GERMS. kept open and the diet carefully regulated ; soothing lotions should be applied to the skin, and amongst the many that have been tried, one containing bicarbonate of soda and hydrocyanic acid dilute is excellent. Among the myriad of remedies for those troublesome af- fections, we have no other which affords such complete and in- stantaneous relief as a solution of menthol. Not only is the itching relieved for a time, but a cure seems to be effected. In pruritus and in eczema, moistening the parts with menthol solu- tion causes an immediate cessation of the pain. The solution should contain from two to ten grains of menthol to the ounce of water. Vaginal alimentation has been thoroughly Vaginal tested, and the absorbing powers of that canal Medication, have been proven to equal that of the rectum. Suppositories containing various animal and vegetable foods have been used, capsules containing peptonized foods have been introduced into the vagina at regular intervals, and it is asserted by the experimenters that the results were bet- ter than when the same foods were introduced into the rectum. Moreover, the vagina has many advantages over the rectum. The necessity of an alvine evacuation every day, a tight sphincter ani, the presence of hemorrhoids, an irritable rectum, render the vagina less objectionable as a receptacle for food or medicine than the rectum. The absorbents of the vagina are much nearer the uterus, ovaries, and other tissues connected with the genital apparatus than the stomach. Physiologically, all medicinal substances ought to act more promptly on the pelvic organs when placed in the vagina. In my gynecological practice for nearly twenty-five years, I have practiced applying to the uterus and vagina the remedy indicated by the symptoms and condition of the organs affected. Whenever I could induce the patient to allow the proper appli- cation of such remedies, or apply them herself, I have found the curative process to proceed much more rapidly then when medi- cines were given by the stomach. Some medicines when applied in the vagina to the os and cervix, will act as quickly as when given hypodermically. To those not accustomed to observe the action of medicines applied per vagina, I will say that I have repeatedly observed the general temperature to fall 2° in as many hours after the appli- cation to the OS uteri of a tampon wet with aconite 2x dil. I BACTERICIDES. I 169 have seen severe uterine pain relieved quickly by the local use of belladonna 3X dil., and uterine spasm by the use of cannabis indica, ergotin, hamamelis and *sabina. Cinnamonum will ar- rest chronic hemorrhage as soon or sooner when topically applied. I have arrested the violent vomiting of pregnancy with tampons moistened \vith ipecac, cocaine, bromide of soda and ozonized iodine, when they had failed otherwise. Every gynecologist has observed when applying iodine, carbolic acid, iodoform, argentum nitrate and mercurial agents to the os and cervix, that the woman has complained or observed the taste of these agents immediately. I have known the mouth and tongue to become dry and the pupils dilate in one minute after the application of a too strong lotion of belladonna or atropia to the cervix. Innumerable instances could be mentioned proving the rapid absorption of medicinal agents into the general system, when placed in the vagina. By this method we can sooner get the tonic and haematic effects of iron, manganese, aurum, argentum, hydrastin, cinchona and quinine as well as cod liver oil, cocoa and other nutrients. This consists in dilatation and a convoluted state Varix. of the veins, due in most instances to an obstruction of the current of blood towards the heart. It occurs very often in the lower part of the rectum, where it constitutes haemorrhoids ; and in the affliction known as varicocele, the veins of the testicle are thus affected. The most frequent seats of varix, however, are the lower extremities, a condition being there established which is commonly termed that of " varicose veins." In a well-marked case of " varicose veins " the inner surface of of the lower limb, from foot to groin, is studded with a number of soft, bluish swellings, varying in size and shape, and which are formed by a tortuous and dilated condition of the large saphena vein, which extends along the Avhole length of the limb. These swellings become more prominent when the patient stands up, or after constriction of the knee or thigh. The skin covering the tumors is generally thin and distended. This condition gives rise to stiffness and aching pain in the affected limbs, and even slight exercise is soon followed by a sense of fatigue. The skin about the ankles is puffy and is marked by purple patches of small veins, arranged in an arborescent form, etc. The feet are generally cold, and the toes of a- bluish color. The skin of the leg is generally dry and itches very much ; it is very often red and inflamed, and the seat of an eczematous eruption. In old people, and in cases where the varicose condition is of long stand- 74 1^0 DISEASE GERMS. ing, large ulcers may form on the lower third of the tilting the so-called varicose ulcers. An occasional serious result of varix is thinning and giving way of the skin over a distended vein and hemorrhage, which, so long as the patient remains in the erect position or allows the leg to hang down, continues, and may speedily become fatal, but which may be readily arrested by placing the patient on his back, elevating the limb, and ap- plying slight pressure with a pad of lint and a bandage over the bleeding point. The predisposing causes of varix are an inherited tendency and debility, due to old age, over-work, or long illness. It is believed by some that the distension of the veins is occasionally preceded by a gouty condition of the blood. The chief exciting cause is obstruction to the venous circulation applied either directly to the lower limb, as in the case of w^earing tight garters, or indi- rectly, as in disease of the heart, congestion of the liver, or con- stipation, with overloading and distension of the large intestine. Varix may be caused by the pressure upon the veins of the pelvis of tumors, or of the pregnant uterus. Pursuits necessitating much standing or walking very often give rise to the affection. It has been stated that cooks and soldiers are the people most especially prone to the formation of varicose veins. In all cases of varicose veins, an effort should be made to strengthen the whole body ; tonics, best of diet, rest. The patient should avoid as far as possible the standing posture. When the veins of the limbs are affected, they should be bathed every night, well rubbed and then the ozonized extract of witch hazel rubbed well in and permitted to dry. In the morning the same proceeding is gone through, and before the affected individual is permitted to get up, either the limb should be bandaged from the toe to the groin, or else an elastic stocking should be applied. If this does not cure it will at least prevent such complications, as eczema, ulceration. The essential elements of all sound treatment are to strengthen the various tissues of the body by every possible means ; the most generous diet, massage, electricity, change. The internal as well as the local exhibition of hamamelis is of great utility. Indeed the witch hazel in alternation with cinchona and avena sativa form about all the reliable remedies for varix, and they should be perseveringly given. Many operations have been recommended for the purpose of producing permanent obliteration ot the distended v^eins. Of these none of them can be recommended as safe or reliable. Neither ligation nor sutures are of any real permanent benefit. BACTERICIDES. I 171 External appearance of the parts in vai icocele. A condition of \'arico.sity of the veins of Varicocele, the spermatic cord, usually of congenital origin, resulting in or associated with deficient development, or functional imperfection of the corresponding testes in the majority of cases. The varicose condition is al- ways well marked, and is altogether,, from that temporar)^ ful- ness which may from to time occur in the spermatic veins of any healthy individual from intro-abdomi- nal pressure. In the large majorit}^ of cases the affec- tion is only on the right side ; in a certain- number of cases both sides are affected. When limited to the left side, the disease may be the only evidence of varicosity in the body, when it occurs on both sides, there is usually more or less varicosity of the veins of both lower extremities. The causes then of varico^cele ma}' be inherent weakness of organization, direct or from maternal impressions during intra- uterine life, or masturbation pr-or to and subsequent to puber- ty, or for indiscretion of the newly married, or men ad- vanced in years who push their failing powers too far. The sexual appetite — the faculty to perpetuate the species is impaired by work, by suffering, confinement, sedentar}' habits, worry and care — anything that tends to wipe out the typical fissures of thought — as alco- hol, tobacco, opium and chlo- ral ; any element of partial death will give us varicocele, with undeveloped or wasted or mis-shapen parts, as twist- ing or cur\ing, with a per- fect avalanche of nervous symptoms. Varicocele, a dilated, tortuous, relaxed, knotty, hard condition of the veins of the cord, feeling like a bag of worms, dilate on couf^hing, diminishes or disappears when the afflicted individual lies down, gives rise to burning, aching in and along the cord and testicle, great dragging in the back with partial or total im- potency, great nerve prostration. Natural testicle. Section of healthy- testicle. 72 DISEASE GERMS. The habit of masturbation is very damaging, of most dis- astrous effect upon mind and body, producing a mental and physical wreck, must be discarded before any treatment can be effective or a debilitated organ restored to its integrity. Varicocele invariably gives rise to seminal weakness, nervous exhaustion, shattered mind and body, wasting of testes, and latent spermatorrhoea, as weeping, draining of life (without erection or pleasure) in the urine. This very loss, this abnormal waste causes the organs to waste still further, until perfect atrophy qn- sues. One testicle, generally the left, at first becomes soft and flabby, and both become similarly affected. A tes- ticular waste or atrophy soon becomes identical with castration, but more disastrous to th^^ mind. The reflex state of dwarf- age of the genital or- gans gives rise to greater despondency, deeper de- spair, more profound gloom and mental dis- order. In the cure of varico- cele, the irritable condi- tion of the seminal vesi- cles, and seminal losses, must be got rid of, sexual vigor restored, and a speedy positive cure es- tablished. There must be a general appreciation of the true physiology of the reproductive organs. The entire profession keenly appreciate the tincture of the green root of gelsemium and the ozonized extract of black wil- low in the cure of varicocele — the former a genital sedative of the highest order; the latter, one of the most profound sedatives and astringents to the spermatic ducts and veins of the cord, it contracts, soothes. For varix within the range urinary organs the black willow operates w^ell. All members of the profession are agreed on the utility of well-regulated secretions, local baths, local application of witch- Varicocele, the result of mas- turbation after puberty. Varicocele, the result of masturbation be- fore puberty. of the genito- tJACTERICIDES. II73 hazel, and mechanical support with a suspensory bandage, bath- ing with the ozonized extract of witch-hazel, and a general al- terative and tonic course of remedies. No remedy ever presented has been so favorably received by all members of the profession for the cure of all weaknesses of the generative organs as the saw palmetto — the sales of this drug have been immense, and the most satisfactory, unprecedent- ed success has attended its exhibition. It has been thoroughly tested and extensively used, and as an exciter of glandular p^rowth found to be unexcelled. Nearly all cases of varicocele are associated with seminal weak- ness, emissions or leakages, due to irritation of the prostatic por- tion of the urethra and an inflamed or relaxed state of the ejaculatory ducts ; these must be checked, blotted out by use of the cocaine suppository or a urethral bougie. Physiological rest should be obtained, so as to allow the parts to regain their tone and normal strength, and all unnatural losses of leakages arrested before a cure can be effected. As soon as this is accomplished, the patient, dilapidated and a wreck, should be placed upon those great brain essences or fertilizers kephaline and phosphated tincture of oats ; then the dilated and sagging veins become emptied, the testes begin to grow larger, the parts regain their tone, strength, contractility. Relief is prompt with such remedies. Vascular Excrescences and Erectile Tumors of the Female Urethra. — These are mostly composed of bunches of capillaries, distended and varicose, covered with a highly sensitive mucous membrane, are essentially warts. They are generally met with at the orifice of the urethra, and extend back a little distance. They grow in size, extend in numbers, become exquisitely sensi- tive, cause great untold agony to many ladies, so much so that the reflex effect of it breaks down and shatters their nervous system. Severe, often acute and prolonged pain accompanies micturi- tion ; the suffering is often protracted after the act. Pains pass back into the rectum, cause straining and bearing down, so that hemorrhoids soon appear. The uterus suffers ; there is often a constant congestion of the organ, owing to reflex irritation. The bladder symptoms are apt to overtop all others. The irritation extends up from the urethra, causing bladder tenesmus, sometimes retention, then frequent desire to p^ss urine, of whith but a few drops are passed. The pain attending the act is often fearful. Treatment. — The first thing to be done is to quiet the irrita- bility of the urethra and anesthetize the mucous membrane and 1 174 DISEASE GERMS. the growths. This is best accomplished by applying a lO or 20 per cent, solution .of hydrochlorate of cocaine, then apply the thuja occidentalis. Give the same remedy internally. This is superior to all known agents as a local and .internal remedy to those painful erectile tumors at the orifice of the urethra. Whenever sexual intercourse is loose and varied, Venereal few women among many men, there takes place a Disease, change, an alteration or degradation of the living elements concerned in the nutrition of the genital organs of both sexes into a diseased germ. This change in the embryonic cell or primary elements of nutrition is the direct result of a violation of natural -and divine law. This degrada- tion of biophasm may result in the evolution of an immature or perfect germ. This naturally leads to the description of the venereal disease under two distinct divisions — the immature^ im*- perfectly developed germ, which, when applied or deposited on any mucous membrane, especially that of the urethra or vagina, will give rise to a specific form of inflammation, with a profuse muco-purulent discharge, or if applied to a crack, or fissure, or abrasion, will cause follicular inflammation, or soft, non-infecting chancre or sore ; whereas the mature germ, the perfectly formed microbe, may localize, by aggregation, in the urethra, or vagina, and give rise to a very slight inflammation with a scanty muco- purulent discharge, or if there be a crack or a fissure on the external parts, and the germ-laden pus applied to it, will produce a sore or chancre, with a hardened base, from which focus, the point of induration, a germ-breeding colony, the germs will enter the blood, causing a disastrous destruction of the red corpuscles, the life of that fluid, and grow there with less or more vigor according to the degree of vital force. The immature germ is a microbe of low potency, and although capable of exciting violent inflammation in the urethra or vagina, and causing a non-infecting chancre, which, in conditions of filth and insanitary states, may assume a phagedenic state ; still, the germ never enters the blood, even if the individual has it a hun- dred times. The germ is so immature that it will not grow in an alkaline fluid like the human blood ; and if it is not interfered with, will die out in a few weeks ; whereas the mature germ, the microbe of syphilis, the perfectly developed germ, whether it finds access to the urethra, and there gives rise to a pock, or a crack, fissure or abrasion anywhere on the skin, invariably enters the blood. The growth of the true syphilitic germ in the blood depends BACTERICIDES. /3 altogether on the degree of vital force he possesses ; if vital force is good, its fecundation and growth may be retarded — that is, it will remain latent ; but if vital force be slightly deteriorated, it will grow ; and if vigor be low, it will grow with rapidity. No- thing can be more disastrous than the contraction of the disease from an opposite and distinct race of men or w^omen. As the venereal disease has been described and spoken of under the terms primary, secondary and tertiary stages, these terms must now be discarded, for the discovery and elucidation of the disease, as being due to a living microbe, renders the use of such terms absurd and meaningless under the science of modern medicine. The living syphilitic germ can enter the body in many ways, as by towels, drinking vessels, breath, sweat, saliva, kissing, close contact, as in sleeping ; through air, water, milk, clothing, cushions, articles handled in ordinary use, from parent to child, neither primary nor secondary states existing. Just let the germ enter the blood in any way, so it reaches the true skin, and it will grow and multiply in weakened tissues or gland with a slowness or rapidity according to the status of vitality of the individual. GonorrJica. — This is essentially a specific form of inflammation of the mucus membrane of the urethra of the male, or vagina The Micrococcus of Gonorrhea, la hours after sexual congress with a woman afflicted with gonorrhea, magni- fied 750 diameters. Microscopical diagram of the gonococcus and the germ sy- philitic in the same patient. The cocci are the gonococcus of a soft chancre ; the rods in section, the embryonic 'germ about to split up in curved microbes, true cryplica syphi- litica. Taken from the dis- charge of an infected female. Magnified 750 diameters. The Micrococcus of simple Gonorrhea, due to the immature germ of a soft chancre, from 24 to 48 hours after coition, magnified 750 diameters. Within may be seen seve- ral forms of fission cf their nuclei, and micrococci moving in the protoplasm, (magnified 600 diam.) of the female, caused by the gonococcus, or immature germ. It usually makes its appearance in from forty-eight to seventy-two hours, sooner or later, after a suspicious connection or exposure to the germ-laden virus. As men and women have numerous other discharges, the mi- croscope should be brought to bear upon all doubtful cases. The above beautiful microscopic diagrams of the gono- coccus in different stages of microbial existence are worthy of Ii;r6 DISEASE GERMS. serious attention. Interspersed through those germs we have the streptococcus pyogenes, pus germ, which has been completely isolated and removed. The gonococcus, cocci, singly, in pairs, groups. They are found in great abundance in the muco-purulent discharge from the urethra, in the pus of a soft chancre and buboes. The mi- crobe bears cultivation well in nutrient broth, and the patho- genic character of the cocci is established beyond all doubt by inoculation. Symptoms. — The presence of the gonococcus in a healthy urethra or vagina gives rise to the following : The first manifes- tation which attracts attention is a tickling, burning or smarting sensation at the orifice or at about three-quarters of an inch within, upon its under surface. On ex:amination, the meatus is found to be of a pinkish color, slightly swollen, and between its lips may be seen a drop or two of mucus, as the germs multiply rapidly. Pain and smarting in urinating become decided, dis- charges increase in quantity, become thicker, muco-purulent, change to milky hue, then yellowish or greenish, often streaked with blood. The pain in urinating increases, the meatus becomes highly inflamed, swollen, contracted in calibre, the glans penis, and the whole extremity of the organ becomes reddened and enlarged. The prepuce may become affected, swollen, puffed up by infiltration of the products of inflammation into its cellular tissue, that it may be impossible to cover the glans, or it may be swollen over the head and it may be impossible to retract it. Pain is experienced all along the urethra, sensitive to pressure. An increased desire to urinate is felt at all times, and the act is accompanied with difficulty and extreme suffering owing to the swelling of the urethra. The act of micturition is described as if molten lead was passing. P^xtremely likely to be attended Avith chordee, a bent or crooked condition of the penis during an erection ; painful erections along the urethral canal ; pain in the back, groin, perinaeum, fever, aching in the testicles. In four or five weeks, without treatment, there is a gradual subsidence of the acute symptoms. In order to constitute a gonorrhea, the characteristic microbe must be present and detected in or on the mucous membrane, in the discharge. In the male this is never difficult, but in woman there are numerous bacilli and cocci which are satellites of that micro-organism which render a diagnosis more obscure. There is, so to speak, a conglomeration of germs usually present in the female vagina when the gonococcus 'is present. Indeed, the female genital tube is a true, natural incubator, favor- able to the most luxuriant growth of germs. A bacterioscopic BACTERICIDES. II77 -examination is imperative in both sexes, so as to detect the mi- crobe. Such a proceeding aids diagnosis, prognosis and treat- ment. Although the gonococcus is an immature germ, — never enters the blood, — still its presence either in the acute or chronic form operates disastrously upon the genitals of both sexes, giving rise to impotency and sterility. The formidable prevalence of the gonococcus demands the strictest surveillance over prostitution. Diagnosis of a gonorrhea in a woman, the gonococcus must be present, and there must be pelvic trouble, her general health suffering to an extent not explainable b}^ the slight changes ob- served in the sexual organs. She has a purulent discharge, not depending upon the presence of an existing erosion, sarcoma, or carcinoma ; or there may be a scanty glairy discharge from the bright red, eroded cervix. There is a catarrh of the ducts of the vulvo-vaginal glands. Small acuminated condylomata are seen around the vaginal outlet; there may be a ring of them just above the anal orifice. Granular vaginitis is present. Evidences of peri-salpingitis, or ovaritis, the latter being of the glandular variety. It is essentially important, that several or all of these symptoms should be combined ; a single one has no diag- nostic value whatever. * Of all forms of venereal disease, oricrinatina; in sexual inter- course, the above is the most common. In the other form of gonorrhea, the infecting form, that due to the microbe of syphilis, the mature genu, there are few of the above symptoms present, — usually a slight muco-purulent dis- charge in the morning. The entire uretha is not affected, simply a small area, in the lower aspect of the canal— an ulcer or chancre at the neck. In this form there are few complications, except chordee. The great trouble with this form is s}'philitic germ disease of the entire blood. Treatment of Gonorrhea. — Since the recent discover}' of the germ origin of gonorrhea, the treatment has been somewhat modified. If a case is seen early before the discharge has become muco-purulent, an effort should be made to abort the germ evolution in the urethra. For this purpose the patient should be instructed, after every urination, to inject the urethra with the ozonized distillation of the eucalyptus, in the proportion of one ounce to four of water. This might be repeated for twenty-four hours after every micturition, and at night before retiring, a solu- ble gelatinized. germicidal bougie, composed of either thallin, or three grains of ic)dol to each bougie inserted. If this is performed early enough, the gonococcus is killed; even if it is the true syphilitic germ it is likely to be sterilized. 1 178 DISEASE GERMS. The aborting or stamping out of a gonorrhea may be effected as follows : It consists in irrigating the urethra with large quantities of a tepid solution of boroglyceride or creolin, and repeating the procedure three times a day. It is best effected by a fountain syringe ; patient seated upon the edge of a chair ; syringe elevated four feet above the pelvis, rubber tube same size as number six catheter, passed to the deep urethra, and let current flow, it passes out outside of the catheter, causes no irritation whatever. In nearly every case in which this is tried, the microscope has shown no micrococci to be present, but it is best to continue the irrigation, as the germ is often imbedded in the lymph spaces of the mucous membrane. In some cases it is worthy of a trial. If this abortive treatment is not successful, in arresting the entire germ colony in the urethra or vagina, then a regular sys- tematic course must be resorted to and persistently pursued. In beginning this treatment, the patient must be carefully in- structed to have his bowels opened every morning with some saline, such as the following mixture ; sulphate of magnesia, one ounce ; bitartrate potassa, two ounces ; nitrate potassa, one drachm ; water, six ounces. Mix. A tablespoonful or more added to a glass of water first in the morning. This will keep the urine alkaline, obviate the presence of an overloaded rectum, overcome the local congestion, lessen the pain in urinating. He should also be cautioned to avoid all active exercise, such as prolonged walking or riding on horse- back, dancing, etc., and as much as possible to sit or lie down. No doubt the best position is the bed, in the recumbent posture, as the erect posture favors congestion of the parts. This may be impossible, but a partial compliance may be effected. All sexual excitement while suffering from the disease must be avoided. The diet should consist of articles, that will not en-, gender acidity ; salads, hot dressing, mustard, pepper, asparagus, gross food like pork, together with all alcoholic and malt liquors, must be positively forbidden. Frequent ablutions, are an important part in the management. The patient should be directed to bath the parts morning and night, or more frequently, in hot water, and to immerse the penis and testicles in it for five or ten minutes at a time. If the parts are much swollen and painful, the patient should be instructed to wear a T bandage, and by means of that and a handkerchief keep the organs properly supported, so that they do not hang loosely. Various methods of treatment are resorted to and pushed with less or more activity, all having but one object .in view the de- struction of the germ. BACTERICIDES. 179 This being so, all remedies used, internal or local, should in the highest degree be of the most germicidal character, and the in- ternal ones of utility are those not used up in the process of diges- tion, such as kava kava, copaiba, oil of sandal wood, resorcin, petroleum ; these exert an antiseptic action on the mucous mem- brane of the urethra, in the urine in form of infinitesimal molecules come in contact with the germ, unite with it and destroy it. Formulae for killing the gonococcus in gonorrhea. Comp. syrup stillingia, four ounces ; tincture of kalmia, one ounce ; balsam capaiba, one ounce ; oil of sandal Avood, two drachms ; oil of peppermint, thirty drops. Mix. Shake well be- fore taking. Dose, one teaspoonful every four hours. Balsam copaiba ; sweet spirits of nitre, of each one ounce ; mucilage of acacia, two ounces; tincture of opium; tincture of iodine and tincture of lavender comp., of each two drachms. Mix. Dose as above. Mucilage acacia, four ounces ; oil of cubebs ; oil of sandal wood, of each one ounce. Mix. Dose as above. Comp. syr. of tolu, four ounces ; oil of sandal wood, one ounce ; spts. nit. ether dulc. Mix, Dose as above. Kava kava paste or pill. Comp. syr. tolu, fl. ext. kava, oil of sandal wood, equal parts. Mix. Dose as above. One of the above should be selected, the one which the physi- cian deems best suited to destroy the germ ; have the best healing and modifying action upon the irritated or ulcerated mucous mem- brane. The use of some such remedy in all stages of the disease is attended W'ith advantage. They are useful remedies, and should not be omitted. The use of the gelatinized urethral bougies, highly ozonized, is to be recommended in all cases. They are prepared from various ingredients all of a powerful antiseptic character, capable of killing the gonococcus and healing the abraded mucous mem- brane. They are prepared from hydrastis canadensis, iodol, resorcin, thallin, and numerous other agents, incorporated in a plant of glycerine and gelatine. When a bougie made of any of the above ingredients is inserted into a germ-laden urethra, it imme- diately commences to dissolve, and the medicating ingredient with ks peroxide of hydrogen causes the microbe to die, and heals the abraded surface. As time — from twenty minutes to three- quarters of an hour — is required for the complete solution of the bougie, a gradual prolonged and continuous action of the remedy is maintained, and during that time it does its work well. It causes no pain in its introduction, it separates and distends the walls of the urethra, penetrates into every sinus, every follicle or IlSo DISEASE GERMS. fold. As the germicidal properties of the bougie penetrate in all and every direction, killing the germs as fast as evolved, and healing. The advantages of these bougies, are, they are thorough in their action, prompt in their effect, affording a speedy cure in all cases. They prevent the formation of stricture, relieve chordee, and will effect a cure without any other treatment, in all stages of the disease. Gleet. — In this we have great debility of the mucous mem- brane of the urethra, either from long-continued inflammation or inherent weakness, with a glairy, weakening discharge, like the white^ of an ^^^, or it may be milky or watery, without any symptoms of inflammation. The discharge may be quite little, a drop or two, or even very profuse. It is most important in all cases of so-called gleet to be sure that there be no stricture, no prostatorrhcea. Then pursue a tonic course of treatment, either administer in- ternally compound tincture matricaria alternated with ozonized iodine, or iron and quinine alternated with salix nigra. Urethral bougies of iodol, hydrastis, have an excellent effect. Urethral Catan^li. — Patients will sometimes return after a sub- .sidence of all tne symptoms, when the are apparently well, com- plaining that the discharge has returned, probably owing to some indiscretion, as prematurely, having sexual congress, or causing their urine to become acid by the use of malt liquors, etc. On examination of these cases there is found a slight watery discharge, probably most in the morning, or merely a drop or two, once or twice a day ; no pain in urinating, simply due to de- bility, a sort of lack of tone in the capillaries of the mucous membrane of the urethra. General tonic and alterative course ; compound saxifraga and Phytolacca, compound tincture matricaria, avena sativa. Stricture. — When the case is permitted to run along for several weeks or months there is very apt to be deep-seated damage done by the inflammation or by the remedy administered ; lymph is often effused from localized patches of inflammation that may exist ; this lymph is generally effused on the inferior aspect of the urethra ; it is thrown out either in a flattened piece, or in membranous bands across the canal, and if not promptly re- moved will form an impediment to micturition, cause the stream of urine to be twisted like a cork-screw, or forked, or like a thread or in drops. This continued obstruction gives rise to a leak- age or discharge; if they are old, ulceration is liable to take place behind them ; they invariably produce congestion of the prostate and prostatorrhcea, with functional impotence, invariably some leakage. BACTERICIDES. Il3j The correct treatment — gradual dilatation and absorption. Chordee. — This is perhaps the most common comph'cation of a gonorrhea, when it is permitted to run its course ; the gono- coccus eats through the tissue, usually the inferior aspect. When the patient becomes warm at night in bed, owing to the existing inflammation, a great determination of blood takes place in the organ, powerful, painful erections; when these erections take place the penis becomes crooked or bent, in the form of a bow or arch. The complication gives rise to great suffering. The best remedy for the purpose of paralyzing the erectile fibres of the penis is the green root tincture of gelsemium in the following mixture : Camphor water, four ounces ; bromide of potassa, half an ounce ; nitrate potassa, two drachms ; green root tincture of gelse- mium, one ounce. Mix. This mixture should be given in the afternoon, after supper and before retiring, in teaspoonful-doses, added to a little water. The rectum should be washed out with ozone distillation of hamamelis, followed by a cocaine suppository. Sleep on hard mattress, in a cool room, avoiding all sexual thoughts. Chronic Gonorrhea. — As a rule, the gonoccocus dies in from .five to six weeks in an acute attack of gonorrhea without treat- ment ; with treatment, of a germicidal kind, a few days, or at least from a week to ten days, should be ample time to kill the germ and cure the patient. True, there are cases in which the germ may hold on, the discharge quite a good deal, re-aggravated by the slightest provocation. Even indigestion, the slightest sexual excess, or ungratified sexual desire, the use of alcohol, cold, wet, over-exertion, will re- surrect the gonoccocus, give rise to more or less pain in urinat- ing, with a rather profuse creamy discharge and other inflam- matory symptoms. The patient should be placed upon a general alterative and tonic course of remedies, embracing compound saxifraga and sandal wood, kava-kava paste. The most common lesions occurring in chronic gonorrhea are these: i. A catarrhal inflammation locahzed in deeper parts of the urethra. 2. Papillary granulations resulting from hyper- plasia of the mucous membrane. 3. Granular vegetations, or peculiar bloodless (or rather vesselless) protrusions, the degener- ation ending in atrophy of the tissues. Every one of the three forms is accompanied by a mucoid or muco-purulent discharge, and may lead in course of time to the formation of strictures of varying size. The stenoses of extreme degrees are usually recog- 1 1 82 DISEASE GERMS. nized fairly easily. It is otherwise in cases of milder strictures, which frequently do not give rise to any marked symptoms beyond the so-called goiitte militaire — that is, a morning drop of discharge arising from inflammation caused by stagnation of the urine behind a narrowed spot. Without a careful examination, such slight strictures may be easily overlooked, and our treat- ment accordingly prove a failure, since such means as routinary injections are powerless to remove the lesions of this kind. In view of the facts, Dr. Hobensack recommends the examination of every patient suffering from urethral discharge by means of a large- sized catheter. If the latter failed to pass into the bladder, a stricture is present. If the instrument passes with some diffi- culty, one of the three lesions mentioned above must be sus- pected. The best means for establishing a differential diagnosis between the forms is undoubtedly afforded by an endoscopic ex- amination. The latter, however, requires a considerable skill and experience. In the absence of the conditions, the endoscope may be, to a certain extent, substituted by a bulbous catheter. In such cases, where the introduction of the instrument causes a strictly localized pain, and is followed by a few drops of blood, either the i form or the 2 must be thought of In the absence of the pain, and bleeding, the cause of the urethral discharge is constituted, probably, in granular vegetations (the form 3). The treatment varies according to the nature of the cases. In those mentioned under i and 2, excellent results may be obtained from injections of ozonized distillation of eucalyptus. In cases of granular vegetations, soluble bougies of papoid. Strictures are best treated by a systematic dilatation of the urethra with metallic bougies. Besides the two forms of gonorrhea, men are liable to have numerous other discharges, all due to micro-organisms ; sexual congress with females who suffer from intra-uterine catarrh, in which both the yeast plant amoeba and sarcinae are present, will contract a discharge in which these germs appear. Congress with ladies during their menstrual flow, or with those affected with ulceration, will be likely to give rise to a dis- charge in which the bacteria, the factors of the irritation, are present, so with cancer, the bacilli of tubercle, etc. Both forms of gonorrhea are liable to have a train of compli- cations or sequelae in their acute and chronic stages ; they ex- hibit features and characteristics of inflammation of mucous membrane, whatever germ be present. The germs travel back gradually, extending by continuity of surface, to the deep urethra, bladder, ureters, kidneys. BACTERICIDES. II83 The venereal disease consists of The Venereal Bacillus, two distinct germs, one immature, {The Pathogeyiic Microbe the other a full-fledged microbe. of Syphilis}) The immature germ gives rise to a gonorrhea, and a soft, non-infecting chancre, but is too feeble to enter the blood and produce any havoc there. The immature germ gives rise to specific suppurative inflammation on both mucous membrane and skin ; on the latter a well defined pock or pustule, with scooped-out edges, and an abundant secretion, and when you take it between your finger and thumb, it is soft to the* feel. In the treatment of this form of sore, since the introduction of so many germicides, caustics are avoided, and instead, this class of sores are promptly destroyed and healed • by sprinkling on them iodol, or applying a wash of lime water and tincture of iodine, or any other good antiseptic, like the peroxide of hydrogen lotion. Whichever of these be used, they should be applied fresh every morning and night, until the sore is healed. When this immature germ is inoculated on the prepuce or glans of an individual of a tubercular diathesis, the sore in which the germs are breeding take on a serpiginous or horseshoe ap- pearance, owing to the tubercular bacilli and the venereal germ mingling, which gives us a true hybrid ; one which cannot pro- create, but is nevertheless most intractable to get rid of The iodine salts are the best remedies, painting the sore with a mixture of tincture of iodine and iodide of potass, in the pro- portion of half an ounce of the former to three drachms of the latter, about once a week ; keeping iodol applied in the interim. Keeping the patient upon the comp. saxifraga, internally. The non- infecting sores have a great tendency to suffer ad- ditional degradation if exposed to, or in close proximity to, insanitary states, such as overcrowding, filth, meagre, or un- healthy food, mercury, imperfect drainage, absence of sunlight, etc., the oiJium albicans, evidence of the human rot, mingles with the immature, and gives us phagedena, eating, sloughing condition. Such cases call for prompt attention : apartments should be disinfected by the fumes of burning sulphur, greater cleanliness observed, removal of all nuisances, germicidal applications, as lotions of peroxide of hydrogen, boroglyceride, sulphur-water, fresh air, nourishing food, thorough hygiene. The bacillus of syphilis consists of rods, very minute. Two or more ovoid points are visible in the course of the rod, which are spores. They are best observed from the secretion or dis- charge of the indurated chancre, or from the ulcers in the mouth. ii84 DISEASE GERMS. When the blood is searched for them, they are, when present, found in the interior of the nucleated cells. The microbe is pathogenic of systemic syphilis. Bears culture well ; reproduces itself in all red-blooded animals when injected subcutaneously. The ptomaines excreted by the syphilitic germ are peculiarly toxical to skin, mucous membrane, bone, brain, lungs, etc. When the atmospheric electrical influences are low, germ breeds most actively. Thence the nocturnal pains in bones, etc. The bacillus in syphilis as seen in the blood ; the full-fledged microbe. The mature, full-fledged germ, the true syphilitic microbe^ wherever it reaches the true skin, a true secreting membrane, through a breach of mucous tissue, or cuticle, finds ingress to the human blood, its genuine pasture field, where it remains latent or breeds according to the degree of vital force present in the individual. There are numerous other channels of ingress into the blood for this germ, besides cracks, fissures, abrasions on the genital organs of either sex. It may come into our bodies from the germ-laden tissue of the affected by close contact, breath, kissing, clothes, bathing dresses ; through food, espe- cially milk and raw beef, and we might cite the case of profes- sional tattooers, who often contaminate thousands of persons by their saHva. In ordinary everyday life, the spread of this germ, either in the urethra, vagina, male genital organs, is generally through a scratch, or abrasion, or fissure of the cuticle or mucous mem- BACTERICIDES. I185 brane ; in this crack, or fissure, the microbe breeds, forms a nest, or reservoir, from which the veins carry the germ to the nearest lymphatics, or blood-forming glands ; so fast, so energetically does the microbe breed, that the veins are unable to carry off the germs, so entire colonies remain at the point of inoculation, forming a ridge, or eminence, or induration of the sore. It is simply a mass of germs, an aggregation which feeds the blood. When those microbes enter the blood they are safe, their living particles find protection and nutrition there. If vital force be maintained at a high standard, it will resist or retard germ evolution, and the microbe can be held dormant, although the individual can at all times be trans- mitting the disease to others, especially to his offspring. Let vitality be low, depressed by any cause, then growth, ac- tive multiplication of the germ takes place ; the rate of germ growth and destructive metamor- phosis being in propor- tion to the deviation from the standard of health ; and if there be any localized weakness in any part of the body, the microbes will congregate there and grow, giving rise, through the germ-laden blood, and reflex irritation, to ob- scure chronic disease of vital organs, as the brain, heart, lungs, bones, mucous membrane, skin. From the moment that the germ enters the body, till its death or destruction in the body, for it must die there, systemic syphilis is a contagious and infectious disease, whether it be latent or active. Suppose, then, that vital force is depreciated and the germ merges into activity and growth. Simultaneously with the entrance of the germ into the body, if vital force is feeble, or six months later, if somewhat stronger, or even years, subsequently, an indescribable train of symptoms make their appearance in no definite order. There may be languor, lassi- tude, debility, even fever. If the skin is feeble, the germ may appear there in some form or grade corresponding to the con- dition of vital force ; if mucous membrane be feeble, colonies of germs will settle there, giving us various forms of ulceration, but it has now blended with it the oidium albicans of aphthae ; but on skin and mucous membrane it is easily recognizable in 75 Indurated chancre on the lip, the result of a kiss. II 86 DISEASE GERMS. the Caucasian by its copper-colored appearance and lack of sen- sibility ; if the bones are feeble, the germs will lodge there, giv- ing us periostitis with nodes ; ostitis with necrosis and caries ; they often find their way into the most delicate parts ; one even can estimate or approximate their growth and their destructive action on the blood, by the degree of nocturnal pain in the bones, the tenderness of the sternum and enlargement of the post-cervical glands of the neck ; they are never-failing cri- terions ; the matrix of hair suffers an invasion, and the hair drops out. Tuberculae are created, mucous tubercles or patches be- come common at points where skin and mucous membrane meet, lips, vulva, anus ; often iritis, if vital force is greatly shattered, with deafness, and brain affections ; in some cases, the onyx of nails are copper-colored, and often rot or crumble ; ulceration of tongue, hard and soft palate, perforating ulcers, larynx, trachea ; elevations and gummy deposits ; caries and necrosis of the cartilage and bones of the nose, and in a large per cent, of cases the germ invades various vital organs, as the brain, spinal cord, lungs, heart, liver, kidneys, never appearing on skin or mucous membrane at all. Treatment. — The first and most important consideration in the management of these cases is the care of the general health. The bathing of the entire body daily is a matter of great importance. Cold or tepid baths, either by sponging or immersion, followed by shampooing or massage, are of great utility. The clothing should be woolen, adapted to the season of the year, so as to give warmth. The diet should be generous, consisting of the most easily digested and nutritious articles possible. The mouth, gums, and teeth should be well cleansed before and after meals, with a solution of boroglyceride, or comp. tinc- ture cinchona, tincture of myrrh, or resorcin, added to water. To- bacco in all its forms must be rigidly forbidden, as it is decidedly injurious. The patient should sleep in a well-ventilated apart- ment, and alone, as his disease is pre-eminently contagious and capable of transmission to sound persons by close contact or by drinking vessels. Gentle exercise in the open air, selecting healthy locations, elevating amusements, the regular routine of business, unless it proves too exhausting, then change of scene. The mind should be kept cheerful, free from needless worry or anxiety, and all thoughts of their disease as much as possible avoided. Malt . and alcoholic drinks should be employed solely under the explicit directions of a physician. Infection. — The question of the possibility of several attacks of syphilis has long been settled. It admits of no discussion. An BACTERICIDES. iiSy Venereal Microbe in the breast, caused by nursing a syphilitic ch'ld. individual may have attack after attack ; his blood never becomes sterilized to the ingress of brood after brood ; there is no im- munity ; re-infection after re-infection is the rule. A man or woman may each have an indurated chancre ninety-nine times, and each time it is a fresh syphilitic re- infection. The germs are there until they are absolutely annihilated. Turning to the use of remedies em- ployed in systeniic syphilis, we may re- mark that there is no routine plan of treatment, no specific which can be advantageously used in every case. The remedies which are to be employed must be powerful germicides, and on the part of the physician, he must have experience, fine discrimination, good judgment, unusual professional skill to manage those cases. The success in curing venereal cases, that is, destroying the microbe in the blood, does not depend on the largest amount or varied assortment of drugs, but in the tact and skill in their ap- plication in combating a most most formidable disease. Prepa- rations of mercury, iodide of potass, nitric acid, iron, quinine, are the great remedial agents for the destruction of the syphilitic microbe ; these may be used to no purpose by one physician, whereas another, with greater tact, achieves the most bril- liant results with them. The vegetable prepara- tions, stillingia, saxifraga, Phytolacca, kalmia, dul- camara, iris versicolor, tt*.^ are slower effective as but the fully as mineral agents. But a microscopical inspection of the blood in syphilis is the best for diagnosis. This is posi- tive, and demonstrates clearly to us that the germ is there, and how numerous or how scanty they are. During a course of treatment under saxifraga, phytolacca, and other germicides, it emphatically The microbe of syphilis as seen in the inter-corpuscular spaces, from the blood of an affected individual, 1200 diameters. 1X88 DISEASE GERMS. tells us how fast the disappearance of the germ takes place. The preceding diagram exhibits the syphilitic germs in the bloody active with life, hurrying hither and whither with the ceaseless motions of protoplasmic life. They appear as copper-colored bacilli in the blood. Before proceeding to lay down a course of treatment for the destruction of the microbe syphilitica with remedies of acknowl- edged value, it must be borne in mind that no two cases are alike ; that there is the widest range between the most benignant forms of private practice to the most malignant type as seen in hospitals. Mercury as a germicide stands to-day unrivalled as a remedy for the destruction of the syphilitic germ. Administered with skill, in a properly graded dose, immense advantage is often gained by its use, provided the patient gains in health, strength, and vigor ; but if salivation, stomatitis, fetor of the breath, spongy state of the gums, with inappetence, gastro-intestinal disturbance, be produced, more harm than good may be produced. The least hurtful, and a form of great energy is the protochlo- ride in the following : Comp. saxifraga, four ounces . tincture of kalmia, one ounce ; iodide potass, two drachms ; bichloride of mercury, two grains. Mix. Dose, one teaspoonful every three hours. The hypodermic injection of mercury is very popular and effec- tive. The following is the formula in general use. Hydrarg. bichloride, eighteen grains ; chloride of ammonia,^ eighteen grains ; chloride of sodium, one drachm ; distilled water, four ounces. Dissolve and filter, and add the white of one Our professional brothers should test the action of the com- pound saxifraga or the compound phytolacca, ozonized, or either combined, or as follows : Compound saxifraga, ozonized, four ouiaces ; tincture of kal- mia, one ounce ; iodide potassium, three drachms ; resorcin, one- half ounce. Mix. Dose, a teaspoonful thrice daily. Watch the blood changes on the syphilitic germ, and later on the total disappearance of the germ from the blood, under this germicide. Since the discovery of the venereal bacillus, there has been inaugurated a change from the older methods of treatment to one essentially of a bactericide character ; the change has been gradual and progressive, and to-day it is as simple and sensible as formerly it was complicated and senseless. The very moment it is detected, treatment should be begun, and continued for some time after all symptoms have disappeared* BACTERICIDES. 189 In this way it can be cured. It is not necessary to have an ini- tial, as the microbe can enter the body in many ways without, as by close contact, breath, saliva, sweat. If there is a sore, or pock, excision is regarded with favor by a few syphilographers as capable of preventing general infection. Others regard the initial lesion as a sign of general infection. The former position is hard to establish, as it is open to two ob- jections : first, that it is impossible for the diagnosis of the initial lesion to be certain until later manifestations appear ; and second, that it is impossible to be sure that the disease may not manifest itself after the usual period of observation. This part of the treat- ment of syphilis cannot, therefore, be considered as yet accepted. Again, as to the proper time to begin treatment, we say at once, Treatment early diminishes the intensity of the disease. There must be no inaction where this germ exists, as we have abundant means for combating it. The bacillus of syphilis frequent- The Venereal Bacillus, ly localizes itself in the eye and {The Pathogenic Syphilitic on the lids. On the lids the mi- Microbe in the Eye.) crobe appears in three forms, pri- mary lesion from a towel, or a finger, with the virus, initial sclerosis, exanthem, and gumma. Ophthal- mia due to the mature germ is very rare. Still occasionally we meet with ulcers on the cornea, following corneal abscesses in which spores of the syphillic germ can be isolated. Iritis is undoubtedly the most common of all eye affections. In broken down states of the body associated with poor or meagre food and insanitary conditions. In such cases, general treatment must be energetically pushed, with stimulation to the nape of the neck, quinine internally, never neglecting atropia in the eye. The tendency to corneal ulceration often lies in a diminished vitality of the cornea, which debilitates it for the battle against the ever present pyogenic microbes. One essential portion of the treatment must, therefore, ever be the fortification of the gen- eral system and improvement of its condition. In many cases in which ulceration of the cornea is found to frequently recur, it will be found that there is a chronic condition of trachoma, or a neg- lected inflammation of the lachrymal sac, or obstruction of the duct, causing the cornea to be constantly bathed in stagnant tears. These collateral relations should ev^er be borne in mind, for no treatment can be successful which does not include a rational at- tention to the general physical, as well as the local health of the cornea and its adjoining tissues. 1190 DISEASE GERMS. Civilization with its varied im- The Venereal Bacillus, provements is unfavorable to brain {Phrenal Syphilis. longevity, much more so than the The Pathogenic Microbe in intellectual torpor of a semi-civilized the Brain^i condition. Modern thought with its neurasthenia of the cerebrum, renders the brain proper a favorite site for the location and evo- lution of the germ syphilitica. But over and above the well-recognized forms of nervous and mental disease, there are certain groups of symptoms which may fairly be regarded as indicative of specific infection, although the proof may not be greater than that to which the lawyers give the name of" prima facie ^' — /. e., proof amounting to a presumption, which may, however, be rebutted by adequate testimony to the contrary. These symptom-groups, if I may be allowed to formu- late from my own experience, are as follows : (i) Quasi-periodical cephalalgia of a peculiar kind. (Nocturnal.) (2) Hemiplegia under forty years of age, with or without preced- ing cephalalgia of the aforesaid type. (3) Cephalalgia followed by hemiplegia, which bear a singular relationship to one another in that the cephalalgia ceases immediately upon the supervention of the hemiplegia, and does not recur. (4) Convulsions in the adult, which have not been preceded by convulsions in infancy, and are not of traumatic or nephritic origin, or due to pregnancy, or in an individual subject to migraine. (5) Symptoms indicative of a lesion at the base of the brain. (6) A comatose condition ex- tending over days or weeks, not traumatic, meningitic, diabetic, nephritic, or from typhoid fever. (7) Tabes dorsalis. (8) Gen- eral paresis. (9) Spinal lesions in a subject who has had intra- cranial syphilis. I have very pronounced ideas with regard to treatment. I have no faith whatsoever in mercury. I am quite prepared to say, that unless the iodides with their proper adjuvants — of which I shall speak in a moment — can cure a case of nervous syphilis, it cannot be cured at all. But the dose of the iodides which is administered by the Germans and French will often be entirely inadequate. I give the iodides until the symptoms yield, or until iodism is produced. Should iodism ensue before the symptoms yield, I pursue one of two methods. I first increase the dose of the iodide by about one-third, and rapidly increase each succeeding day. Singular to say, in some cases this increased dosage will cause the iodism to disappear, and the larger doses will be borne very well. Should, however, these larger doses still more increase the iodism, I decrease to one-half of the dose at which the iodism had begun, and continue BACTERICIDES. 91 this decreased dose until the iodism diminishes or disappears, when I again rapidly increase the dose, and am usually able to go on without further trouble. In some few individuals, however, no amount of care will cause more than a certain amount of the iodide to be borne, and such cases, as I have said, are usually of unfavorable prognosis. In some cases, too — fortunately they are '^ rare — even small doses of the iodide will produce a cardiac dis- turbance that prohibits its administration. I am perfectly well aware that the medical chemist will object that these large doses of the iodide pass through the body and are quickly excreted by the urine ; but I am equally well aware, in the face of this fact, that these large doses of the iodide will cause symptoms to yield that cannot be made to yield by lesser doses. I have given as much as several hundred grains of the iodide of potash in the twenty-four hours, and have seen symptoms disappear with these enormous doses that would not yield to minor ones. I admin- ister the iodide after meals, and either in a full tumbler of ice- Cerebral softening. Small blood-ves- sel from a focus of yellow soften- ing in phrenal syphillis. o. Softening of the cerebral pulp in phrenal syphilis. Sclerosis of the brain. Cerebral sclerosis • in chronic intersti- tial inflammation from the presence cf the syphilitic germ. water, or in a glass of Vichy, or in a glass of Bohemian spring water, the Giesshiibler. But he who expects to cure his patients with the iodides alone, unless the case be so grave as to call for immediate relief, will be disappointed. The human organism must be put in the best possible condition. A generous diet should be employed. Free- dom from care and worry, where possible, should be enjoined, and all strenuous exertion of body or mind avoided. The germ syphilitica frequently localizes itself on the circum- ference and base of the brain, in the form of an exosmosis from the blood vessels, and appears in the form of thickenings, adhe- sions, contractions, puckerings, with a germ-eaten state of the blood vessels. 1 192 DISEASE GERMS. Microscopically throughout the effused lymph, there appears soft jelly like masses, irregular in form, blended intimately with brain structure, the pathogenic micrococci appear as spindle and stellated cells imbedded in an alveolar frame work. It is needless to emphasize the fact that cerebral syphilis is very common — true the brain resists with tenacity the localization of the germ — but epileptic seizures, paralysis, as hemiplegia, or eye neurotis, aphasia, etc., occurring in middle life, are most significant, especially if there are symptoms of nocturnal headaches, numb- ness, formication, heats and colds, etc. If those exist look for syphilis, because tumors, abscesses, organic lesion are rare at that time of life. By placing the patient on specific treatment for syphilis, when in doubt, is the safest. The repeated application of tv/o small fly blisters to the nape of the neck for six hours at a time, twice weekly, often diverts the germ to other pasture fields. It is safe, salutary. The internal administration of comp. saxifraga ozon- ized is a treatment calculated to be invariably beneficial ; its use for months is the only probable means of cure. The origination and use of this remedy is the outcome of a national necessity, an agent that never fails to give satisfactory results. Good authority says, the profession must depart from their usual course in the treatment of syphilis — the initial lesion affects the whole system — disseminates the germs through every tissue. Our people, more than any other nation, suffer from phrenal syphilis. Syphilitic growths, gummata, will, if formed on the brain, disappear as speedily as any other lesion ; and when their mi- crobial growth gives rise to pressure, the resulting damage to the nerve structure is recovered from in the most complete degree. When there is reason to suspect inflammation of the cranial nerves — syphilitic neuritis — the prognosis is chiefly influenced by the duration of the morbid process. If the inflammatory pro- ducts are in such a stage that they can be removed, the progno- sis is good if the damaged nerve fibres will recover conducting power. If, however, there is reason to suspect cicatricial trans- formation of the new formation into fibroid tissue, it is improbable that the degree of improvement will be sufficient to permit severe symptoms to pass away entirely. The same general prognosis is true also of infiltrating growths. In true acute inflammation that is treated early and arrested early, the prognosis is the same as in similar inflammations that are not specific. The recovery or persistence of the symptoms depends on the recover}^ or per- sistence of the changes in the nerve elenients which are pro- duced by an intense inflammation, and effusion of germs. BACTERICIDES. j Iq^ The clinical history of the neurotic form of syphilide has an individuality of its own. In the \'ery earl\' months of the di- athesis, either in the stationary period of an early syphilide or at its decline, generally preceded or accompanied by severe neural- gic symptoms involving the facial or cranial, intercostal, anterior •crural, or, in fact, in any cutaneous nerve, by severe cephalalgia, continuous or nocturnal ; by rheumatoid pains in muscles or joints, and by general malaise and debility, this eruption makes its appearance with more or less promptitude and dev^elops quite rapidly. In some instances the invasion is very acute, so that at the end of a week, we may find fully developed tumors an inch or two long, in others and in the majority of instances the de- velopment is slower and nearly two weeks elapse. Besides the general neuralgic symptoms, local pains on the site of the lesions or in the whole territory on which they are de\^eloped are ex- perienced. These may be continuous or intermittent, and in some cases are excruciating as in severe herpes zoster. There are two points in the treatment of syphilitic diseases of the nervous system on which I think a word of caution is ur- gently needed. The first is regarding the prolonged adminis- ' tration of anti-syphilitic drugs, especially of iodide of potassium. By " prolonged " I mean exceeding from six to ten weeks. I believe that full doses in this time will effect all it can achieve in the removal of the syphilitic process. Here, as I have just said, we want facts that are visible, numerous, and carefully observed, to guide us in our conclusion. I do not say that the symptoms will have disappeared. It cannot be too firmly remembered that symptoms are due to changes that are not syphilitic, changes in the nerve elements secondary to the syphilitic disease, but so far independent in course that they may persist long after the speci- fic lesion is at an end. Hence the fact that the symptoms have not yet ceased is no indication that the specific lesion is not en- tirely removed. If iodide be continued, as it often is, during many months (and much more, as it sometimes is, during years), there is a danger that the normal tissues of the patient may be- come so accustomed to its presence that the drug may no longer hold in check the syphilitic processes. Probably we may still influence the lesions by increasing the dose, but this process must have limits in practice, if not in theory. Such prolonged and augmented treatment may. do definite injury to the patient's health, and even then fail to effect the desired object. If the poison is in an organized virus we might a priori expect this re- sult. By long-continued, gradual alteration in the conditions, low organisms, as has been shown in remarkable experiments, •can be made to endure influences that would at first be fatal to 11(^4 DISEASE GERMS. them. By slowly raising the temperature they will not only live but flourish at a degree of heat which, had it not been for their acclimatization, would have killed them in a few minutes. But the question is not one in which we can be guided by theory, far less by analogy, possibly 'remote. There is, moreover, a positive danger in this method. It is also great in the practice to which I referred, that of repeated courses of energetic treat- ment to remove residuary symptoms .that cannot be thus re- moved, because they do not depend on any residual specific process. A very eminent authority says : Inherent weakness of certain parts or structures of the brain permits of the deposit and locali- zation of the syphilitic germ if present in the blood. The mi- crobe is here found in the form of gummatous tumors, composed of small, round, oval and pyriform cells, with basement sub- stance. These masses may undergo a variety of changes and degenerations, and often migrate from bone to brain and vice versa. The history of the case, persistent localized nocturnal head- ache, impaired intellect, dull, stupid, apathetic ; impairment of the senses, often facial paralysis, and, if energetic treatment is not pursued, unconsciousness, stertorous breathing, dilated pupils and death. The diagnosis rests chiefly on the presence of the syphilitic germ in the blood. The treatment consists in the use of the most energetic remedies to kill the germ, with persistent repeated blisters to the nape of the neck to attract the germ away from this vital organ. The venereal disease, both con- The Venereal Bacillus, tagious and infectious, is to a great [Pathogenic Microbe extent a preventable disease, if Syp/iilitica) licensed and put under restraint by the State. The microbe, when once in the body, is generally carried to every nook and corner of the tissues. The ingress of the germ is silent — effected without a sore, coming in by the breath or contact, or through the translucent lymph of vaccine pustule. Of all forms of venereal infection, lung syphilis is the most potent and effective. The microbe is generally scattered through- out the entire body of the blood vessels and lymph canals. It is to be freely found in all the secretions and excretions — in the S}'novia, bone, periosteum, brain, skin, etc., but in no form is the infection so great and pungent as in pulmonary syphilis. BACTERICIDES. II95 So, it is well in all cases, especially those with a cough and expectoration, to resort to rigid antiseptic precautions. The room in which a lung syphilitic affected individual sleeps or lives in should be disinfected at least every two weeks, thoroughly fumigated with burning sul- phur ; that his sputum, faeces, urine, should be destroyed ; that the individual should be isolated from his fellows. He should not be permitted to sleep with or come in contact with healthy persons. All workshops in which venereal pa- tients congregate should be frequently dis- infected. It must ever be remembered that both in tuberculosis and syphilis, that domestic animals play an important part in carry- ing these germs from one individual to another. Syphilitic germ in the kidney^ found forty-eight hours after death actively evolving spores ; ihey were detected in the urine several months before death took place. The Venereal Bacillus. (The Pathogenic Microbe of SypJiilis passing from Parents to their Offspring}) The microbe passing" either in the spermatozoa of the male or ovum of the female, or both, is a frequent cause of either blighting the foetus, caus- ing its death, or, if the uterus is healthy, it often repels the germ- smitten foetus, and miscarriage results. The child may be born with unmistakable signs of the disease, or may be born apparently healthy and in a few weeks the symptoms develop. Emaciation or great sleeplessness may sug- gest the taint. The symptoms resemble the secondaries in the adult, and appear about the same time as the acquired after inoculation. When markedly present the child has a peculiar " old man " look, a prematurely old appearance, is very ema- ciated, simply skin and bone, these children being frequently premature. The cry is shrill and hoarse, compared to the sound of a penny trumpet, and the child has a hard cough, often sick- ness and diarrhea, coryza, and snuffling due to inflammation and ulceration of the mucous membrane of the hose causing it to become blocked, the child therefore refusing the breast on account of it only being able to breathe properly by the mouth. The skin is hard, dry, dirty looking and wrinkled ; soon, acquires patches of a light brown color, and the nails are often cracked. The skin and mucous membranes are the first to show the symp- toms, gummata being met with later in the skin, mucous mem- 1 196 DISEASE GERMS. branes, periosteum, bone and lymphatic glands. The usual history helps in the diagnosis, as rash, throat, bones, miscar- riages, or children dying soon after birth, etc. The eyes seem weak, the eyelids sore. The parts about the mouth, nostrils, buttocks, anus, flexures of joints get copper-colored, fissured and excoriated. A dermatitis about the pelvic region is not always specific, and may be due to wet napkins, etc., although if reaching beyond the limits enclosed by the napkin, i. c, down the legs and up on the abdomen, it is syphilitic. A detachment of the epidermis from the palms and soles is an almost certain sign of the disease. In the various systems the following lesions are met with : Skin. — Dermatitis and detachment of the epidermis as stated. Deep red or copper-colored blotches on palms, soles and pelvic region (gluteal folds and genitals). Mucous tubercles about the anus and flexure of the groin, condylomata about scrotum, and on neck, thigh and arms. Mucous Membranes. — Condylomata and mucous tubercles about the mouth and anus, bucco-pharyngeal mucous membrane, and in larynx. A chronic inflammation and ulceration of the mucous membrane of nose causing " snufiles." At the angles of the mouth we get ulcers leaving cicatrices (specific stomatitis). Bones. — Periostitis leading to formation of nodes ; Diffuse ostitis, causing hypertrophy and sclerosis. Ulceration, causing caries and necrosis (in the case of the nose causing the bridge to fall in). Cranio-tabes from atrophy (often not specific as is rickets). Cranial bosses (often not specific as is rickets). Separation of the epiphyses. Stoppage of ossification. Eye. — Acute iritis, interstitial keratitis. Ear. — Otitis. The disease in question is the most common cause of double deafness in children. Voice. — Lary n giti s . Teeth. — Notched (the permanent ones). Visceral. — Congestion and fibroid enlargement of liver and spleen. Peri-hepatitis is one cause of infantile jaundice and ascites. Chronic inflammation of cerebral arteries. Meningitis, hydrocephalus, pulmonary affections, etc. With regard to infantile syphilis, this is either hereditar}' or acquired. If the former, it is transmitted from one or both parents, and the infected foetus may be expelled with a clean skin and the characteristic rash not displayed for six weeks after birth ; if the latter, the immediate contagion may be from the nipple of the nurse, or from kissintr, or from some article of dress. BACTERICIDES. I 197 The presence of the syphilitic germ in an infant gives rise to a shrivelled or emaciated appearance. Some cutaneous manifesta- tion appears near the sixth week. Defective nutrition, in the form of emaciation or marasmus. Emaciation progresses rapidly ; the skin seems to stretch unnaturally over the facial bones ; the expression is one of distress ; the cry becomes a fretful moan ; the skin loses its natural hue, and acquires a sallow or muddy tint ; and very peculiar wrinkles or puckered lines radiate from the angles of the lips. The faces of those germ-eaten creatures have the appearance of age. In the recognition of the disease, the history of the case, the copper-colored appearance of the rash, together with syphilitic coryza, give a clew to the presence of the germ. The discharge from the nose, at first serous, later purulent, desiccating suffi- ciently to obstruct the nasal passage. Crusts form about the nose and angles of the mouth, giving rise to the snuffles, obstruct respiration. The mouth, larynx, vulva, anus are often the seat of mucous patches or condylomata. The liver in our country is The Venereal Bacillus. naturally weak, being exposed to (The Pathogenic Microbe of the malarial germ, the irritating Syphilis in the Liver. action of carbonaceous food and Syphilitic Hepatitis}) drink, and to this organ the bacil- lus often migrates. Let the germ enter the body- of a person with a weak or devitalized liver, the first thing we often observe is syphilitic hepatitis. As a rule, Fatty liver, interspersed with Microbe of syphilis in the liver, the syphilitic germ. the syphilitic germ does not manifest any special preference for the liver, like the skin or mucous membrane ; it does not seem to be a pleasant or congenial pasture field. When it takes that organ for its abode, it colonizes in three forms : (i) germs gen- erally diffused through interstitial structure ; (2) a large congre- gation of germs, colonies varying in size from a linseed to a bean ; (3) in large irregular patches. 1 198 DISEASE GERMS. Symptoms. — Sometimes there are all the indications of chronic inflammation of the liver ; in other cases, there are few, if any, symptoms present but jaundice, a coppered-colored appearance of mucous membrane, with other marks of syphilitic cachexia, enlargement of spleen and albuminuria. When the microbe migrates to the liver, there is usually all the symptoms of jaundice present ; nausea, vomiting, brown-coated tongue, yellow skin and conjunctiva, itching in the skin, cla}'-col- Syphilitic microbe in the liver. Another form of syphilitic microbe in the liver- ored stools. The usual treatment for the destruction of the syphilitic germ must be persevered with, to wit, saxifraga, Phyto- lacca, comp. dioxide of hydrogen, etc. In addition, local stimulants over the liver, as either the irri- tating plaster, or take iodoform, one ounce ; ether sulphuric, suf- ficient quantity to dissolve it. Mix. Paint freely over the region of the liver twice daily ; or ozonized iodine. Internally, such remedies as phosphate of soda, nitro-muriatic acid, fringe tree, with chloride of ammonia. These remedies exercise a most salutary action on the liver. In all cases, it is most important to attend to this germ migra- tion and at the same time take care of the mother germ and its brood of spores in the blood. All individuals who have the The Venereal Bacillus, pathogenic microbe in their blood, {TJic Microbe in the Liings}j if their lungs be weakened in any way or from any cause, are liable to have a migration of that bacillus to that weakened point, when it passes by the name of syphilitic phthisis. There can be no question, that in the majority of instances in which phthisis has been produced through acquired syphilis — and syphilitic phthisis is more prevalent than is generally be- lieved — the symptoms, physical signs, and course of the disease are peculiar and characteristic, and distinguish it somewhat from other forms of phthisis. There is no doubt, too, that many cases which are regarded as examples of ordinary phthisis possess a BACTERICIDES. ngg congenital element of syphilis, and that this disturbs the normal course of the disease. Just to what extent this factor is opera- tive we are not prepared to say, but it is very certain that some cases of ordinary phthisis are more readily influenced by micro- bicides than others. Although syphilitic phthisis is a well-reorganized disease, so far as its pathology goes, I am convinced that clinically it is not understood as well as it should be ; and in order to aid as much as I possibly can in determining it from other diseases, I shall endeavor to lay before you the salient points of the disease as they occur in its clinical course. The characteristic signs and symptoms which distinguish the syphilitic from the non-syphilitic form of the disease are chiefly an absence of well-defined physical features in its earlier stages, frequently the only evidence of the presence or the disease being a wavy respiration, or an impaired respiratory sound. However, when crepitation appears it commences suddenly, and is usually The sputum in syphilitic Micrococci in the sputum in Mould of bronchial twigs phthisis. syphilitic bronchitis. expectorated m a case of syphilitic bronchitis, ■of a loud, moist character, and may diffuse itself very rapidly over the whole side of the chest. Haemoptysis is generally a prominent factor ; there are no persistent, well-defined fever and night-sweats ; the expectoration is frequently tough, white, stringy, and abundant ; the patient, as a rule, is anaemic, subject to diarrhea and vomiting ; the marked anorexia and wasting do not appear early ; and every change which occurs in the course of the disease, either toward recovery or death, is generally more marked and sudden than in the ordinary form. The absence of fever, or the tendency of the fever to assume an irregular or abnormal course, I regard as • one of the most valuable symptoms in differentiating this form of phthisis. When- ever I meet with a constant low temperature in such cases, my suspicion of infection is always aroused, in spite of the absence of other satisfactory evidence. The presence of fever is deter- mined, I think, in a great degree by the rapidity of the destruc- tive process. If this assumes a gangrenous form, as it does oc- casionally, the fever, as a rule, runs high. In addition, there may be aching pains in the sternal region, over the crest of the tibia, as well as in some of the articulations. The venereal bacillus in lung structure, found forty-e.ght hours after death in a case of syphilitic phthisk BACTERICIDES. 201 Also enlargement of the post-cervical glands, with nocturnal pains in the bones. There is a great difference between the behavior of microbe of syphilis and the tubercle bacilli in the lung, an interstitial as well as an anatomical difference. The anatomical changes in the lung chargeable to syphilis are cicatrices, connective-tissue growth, gummata, and chronic in- duration of the pulmonary tissue in the form of peri-bronchial growths, nodular formations, and diffuse lobular condensation, which generally start from the bronchus of the part (diffuse syphilitic infiltration). The diagnosis of these changes during life may be made with a certain degree of probability at times, but can never be made with certainty. The shortness of breath, cough, scanty and sometimes bloody expectoration, and other signs, rational as well as physical, are so wanting in characteristic peculiarities that the syphilitic nature of the affection cannot be made out from them. The diagnosis is to be based rather on the history of the case, the presence of well-known symptoms of general syphilitic infec- tion, and laryngoscopic examination, which will reveal in nearly all cases of pulmonary syphilis old lesions of the upper air-pas- sages. The tubercular and syphilitic bacilli may co-exist in the same lung, and both can be detected and isolated in the sputum. Syphilitic brrnch'tis with myriads of Transverse fertion of bronchial wall m" 'perms at work forty e yht h urs after syphilitic bronchitis with the venereal death. Magiiilied 50 diameters. bacillus hard at work i'orty-eichi hours after death. The most common form in which the syphilitic germ appears in the lung is the gummata. These vary in size from a pea to an eg?, and are either single or in groups, appearing in the lun^s as well-defined rounded tumors, surrounded by a fibrous capsule and usually deep seated. The microbe in its eating operations on the lung has fibrous tissue thrown out with it. The presence of the gummata in the lung causes it to be more weighty, larger, more dense. White, dry specks are seen on a section of it. There is also thickening of the alveolar walls, and minute bronchi, thick- ening and obliteration of pulmonary areas. 76 1202 DISEASE GERMS. Any irritation in the lungs of a syphilitic patient may cause gummata to form, and abscesses are quite common. There may be masses, nests of the tubercle bacilli, right alongside of the gummata in the same lung. There is also in syphilitic cases a deposit of the germ on the bronchial mucous membrane, which gives rise to the syphililic asthma or bronchitis, or both. In some cases there is great ulceration, with copious expectoration, with the microbe in sputum. Lung and bronchial syphilis resemble in their symptoms tuber- cular affections of the same organs. Lung syphilis more generally follows inhalation of the germ by sleeping with an individual affected, or by berthing in a Pull- man with germ-saturated persons, or by kissing, or from the use of drinking vessels, than when the germ enters through a pock on the genital organs. Still, if the lungs are weak, we may have bronchial and lung syphilis before the germ appears in any other location. The weaker the aff^jcted individual or organ, the more virulent and active the germ. There are no sta^-es — microbial infection calls for none. There is no protection from one or a dozen attacks ; every time the germ enters, a fresh attack. At whatever point the syph- The Venereal Bacillus. ilitic microbe enters the body, ( The Pathogenic Syphilitic whether it be by a hard chan- Microbe in the Lynipliatics— ere on the penis, or on the Syphilitic Bilbo) lip, or on the nipple, or through the endosmosis of a kiss, or contact by a drinking vessel or a towel, the lymphatics in the vicinity convey the microbe into the blood; in this process they themselves become contaminated by the deadly microbe, and suffer a partial death in the presence of the germ ; inflam- mation of the lymphatics takes place ; they become clogged up with germs and products of inflammation, and form what is termed buboes. The seat and virulence of the sore determines in a great measure the kind or quality of the bubo. All the muscles of the The Venereal Bacillus. body may become the seat (The Svphi/ific Germ of the syphilitic germ. The Enterino; Muscular Structure — muscle most frequently af- Myositis Syphilitica) fected is the sphincter ani. The localizing of the germ on this muscle gives rise to great pain, tenesmus before and after BACTERICIDES 1203 defecation, which often lasts for hours. The pain is aggravated by pressure from without. Women are more subject to it than men. The whole muscle is not affected ; sound bundles of fibres may be found among the diseased ones. Both the blood vessels of the perimysium and the nuclei of the sarcolemma are involved in the inflammatory process. As the affection of the sphincter may last long after the other symp- toms of syphilis have disappeared, we may have to treat the con- traction of the muscle and the consequent pain by sphincter- otomy. The Venereal Bacillus. ( The Pathogenic Microb^of Syp] Litis in the Male Urethra; or the Female Vagina^ Hard, indurated in- fecting chancres are met with in both locations, and require tact and good judgment, with re- liable remedies, to effect their destruction. In the male, gelatinized bougies of iodol can be introduced, and the germ colony gradually killed off. In the female, the task is much easier, as the capacity of the vagina will admit of copious vaginal injections of either boroglyceride or resorcin, or creolin, or even packing the vagina with borogly- ceride, are usually successful in wiping out the sore, together with bactericides internally. Another form of location, but much less frequent, is the ap- pearance in the form of papillomata, or warts, or condylomata. In ihe male urethra .,-^.— ^.-^^t,-^— ^- - these are not mfre- quently mistaken for organic strictures, and very foolishly dilated, curetted, even burned out with electrolysis with no result what- fQ ever but a return of the affection. In the C^ vagina of the female, ^ they also appear as papilloma, warts, con- dylomata, and unless a very careful examination is made, the leucorrheal discharge is often mistaken for some other affection. In all cases of supposed stricture of the urethra, the endoscope should be used for the purpose of making a diagnosis. If warts are present they are readily seen in the form of gelatinous Vegetating condylomata of the vulva. 1204 DISEASE GERMS. growths of various sizes, studded over the canal. In the female the Fame procedure should be adopted, although here they can be readily felt. In the form of papilloma, either in the male urethra or the fe- male vagina, the introduction of the oil of thuja speedily steri- lizes the germs and causes them in all cases to peel off — effects a cure. Frequently around the corona glandis, on the penis, or on the vulva, orifice of the urethra, or on the internal labia, these papil- loma make their appearance, and are most annoying. It is well to bear in mind that cleansing off by a lotion of per- oxide of hydrogen, and subsequently applying oil of thuja sev- eral times, they readily disappear. Chancres in and around the The Venereal Bacillus, nose are rare. The slightest ab- {^TIlc Pathogenic Syphilitic rasion at the entrance of the nos- Microbe in the Nasal trils and the application of the Cavity') microbe by an infected towel, in- strument, etc., may be the exciting cause. Later on, especially if mercury or debilitating treatment be used, the region of the nasal fossa is often the abode of the germ. Symptoms vary according to the period of germ growth and number of spores and germs present ; ulcers surrounded by a bor- der of inflammatory tissue are seen on the anterior portion of the septum and inferior turbinated bone, while posteriorly they are localized behind the uvula and soft palate. The symptoms com- plained of by patients vary with the position of the lesions. Thus, if the latter be situated anteriorly there will be a sensation of heat and discomfort, with slight muco-purulent discharge ; if posteriorly, the disturbances will affect swallowing and hearing, and impart a nasal twang to the voice. Examination reveals the characteristic patches on the mucous membrane, with, later on, ulcerations. Along with these appearances there will be the usual constitutional manifestations in other parts of the body. Syphilitic condylomata occasionally make their appearance on the border between the skin and nasal mucous membrane. It is, however, in the later or tertiary stages that the ravages of nasal syphilis are most clearly manifest, The most wide- spread destruction of the nose, externally and internally, is by no means uncommon. Ulceration of the integuments may spread from without inwards, or from within outwards, destroying the tissues and forming ashy colored open sores, with the character- BACTERICIDES. 1 205 istic indented edges and indurations. These ulcerations spread in depth and width and, unless arrested, permanently destroy the shape of the nose. Flattening and collapse of the bridge, and partial disappearance of the whole organ, are not unfrequently met with. The internal lesions are, however, the more common. The earliest symptom is a gummatous infiltration of the mucous membrane, which is at first apparently harmless, and may readi- ly be mistaken for chronic rhinitis. Obstruction of the nose, disturbances of smell, increased mucous discharge and a change in the timbre of the voice are at first the only diagnostic symptoms. Gradually, however, the discharge becomes thicker and more purulent, but not fetid. About this period examination will reveal ulcers on the septum and turbinated bones, The next stage is the presence of fetid discharge, sinking of the bridge of the nose, perforation of the septum, and caries and necrosis of the turbinated bones. The diseased bones can be seen as dark masses projecting into the nasal cavities and emitting a sickening stench (syphilitic ozaena). In these cases the discharge from the nose is generally abundant, and no amount of syringing with disinfectants can remove its foetor. If the vomer be attacked the bridge of the nose will fall in and become characteristically flattened ; on the contrary, if the cartilage of the septum only is destroyed the tip of the nose will collapse. The ravages of the disease do not, however, in the worst cases stop here, for they may extend to the lachrymal canal, or the ethmoid and sphenoid bones, and large pieces of these may be thrown off. Even the brain has been occasionally laid bare, and this has been followed by meningeal inflammation and death. The odor from syphilitic ozsena is peculiarly repulsive and dis- gusting, and cannot be removed by disinfectants. In its char- acter and obstinacy in this respect it differs very distinctly from true ozaena, and should not be confounded with it. The diagnosis of nasal syphilis during the early stage of gum- matous rhinitis, may be difficult ; later on the collateral symp- toms will be a good guide. The prognosis, provided bactericides are pursued with vigor, is good. General remedies. — Nose must be cleaned out with lotions of creolin, resorcin, permanganate potass, which are of a stimulating, detergent, deodorizing character. Stimulating, antiseptic inhalation of distillation of the pine, eucalyptus, jequirity, are of great value. Push general treatment, which will consist of iodide of potass in comp. saxifraga and phytolacca. I2o6 DISEASE GERMS. The venereal bacillus is The Venereal Bacilius. dualistic, consisting of two {The Pathogenic Microbe on the microbes, one immature, Skin — D em iqto- Syphilis.) the other full-fledged. The imniatnre gives rise to soft, non-infecting sores (soft chancres), and a gonorrhea, but the germ is too feeble to enter the blood, hence there are no blood or tissue lesions ; the mature germ, if inoculated on any part of the body, ogives us an indurated chancre, in which resides the true syphilitic germ, which enters the blood and produces the gravest form of blood changes. This, the true syphilitic germ, may appear in the urethra or vagina and give rise to some dis- charge. It is not at all necessary for this microbe to have an inoculation, a breeding place, a focus from which the blood can be saturated, hence the entire body, for it can be communicated from individual to individual by breath, by close contact, by kissing, drinking cups, towels, seats, cars, etc. This is the pathogenic germ of syphilis ; the immature germ of a soft chancre can do no more harm than excite local inflam- mation ; it has not advanced in the scale of microbial existence to enter the blood. The true microbe syphilitica, once in the blood, seeks the weakest part, and there either grows, or if vital force is moder- ately good, may remain latent. Suppose a depreciation has occurred and the cutaneous surface weakened, then the microbe will make his appearance in any or all of the numerous forms of skin affections. The diagnosis of these are important, that is, the difference between simple skin eruptions and those that contain the patho- genic microbe of syphilis. In making this, the history of the case is fallacious, as the germ can effect an entrance without a pock or primary sore ; the history of the case has no bearing in diagnosis, neither have such terms as primary, secondary or ter- tiary ; the germ will, if present, show itself microscopically and the appearance of the syphilitic eruption must be taken as it exists ; without a history of the case. The appearance of the complexion of a microbe-syphilitic patient is remarkable. More prevalent in a chronic case than in one which the microbe has recently effected an entrance ; also influenced by the number of germs present in the blood and the constitution of the individual. We must not, for example, expect to meet with it at the begin- ning of an outbreak of secondary specific roseola; but if the dis- ease has lasted for some months, we shall almost surely find that it has produced a peculiar change in complexion, which is best BACTERICIDES. I 20)^ described as a pale and dirty opaque appearance. This change in color is due to two causes. (1) The paleness is the result of general anaemia from an impoverished condition of the blood, which may often be demonstrated by placing a little blood under The venereal bacillus on the skin in the i'jxvn. of a lichenous msh, assiciaied \v; greatly modified by the aciioM ( ' microbe. ^^:Z:S^lX shades of color, from the pale dirty brown ac.ion of the pathogenic ^q ^hc typical coppcr-coIorcd blotch, and from this again to the deep purplish-brown, or almost black pigment stain, which is sometimes left after a syphilitic sore has healed. Indeed there is no other disease of the skin which leads to more remarkable changes in the rete Malpighii. Of all the characters which distinguish dermato-syphilis, per> haps polynioryhisni, or the appearance of sev^eral forms of erup- tion at the same time, is most important, because in no simple disease is this peculiarity developed to anything like the same extent or with equal frequency. It is, in fact, the exception to find a syphilitic eruption assuming a uniform appearance in dif- ferent parts of the body. For example, we may find maculae in one part, and mucous tubercles in another, or ulcers in one part, and nodes in another ; or we may even find four or five diffc;rent forms of eruption on one and the same individual. Hence the great importance of examining every part of the eruption in doubtful cases. A red patch on the chest may present none of the characters of syphilis, but if we find also a typical ulcer on the arm. there will be no difficulty in arriving at a diagnosis. Locality^ as a means of diagnosis, is sometimes of value. BACTERICIDES. £209 Secondary eruptions which ' follow closely on the sore, are com- monly syinnicti'ical ; but remote eruptions are, on the contrary, generally nnsyini/ictrical, tJiongJi frequently both-sided. The rea- son of this diffjrence is, that recent eruptions occur while the microbe is still in the blood, while remote eruptions occur after the perm has migrated everywhere, when all the tissues of the body have probably undergone some obscure change, which is manifest by the development of syphilitic growths. Ulcers often appear en the arm, abdomen, without any apparent cause. Certain forms of alopeci I, seborrhcei, appear on the scalp, and sometimes on the pabis ; syphilitica roseo'a, maculae, pemphigus, on the palms of the hands and soles of the feet. In all forms there is a per- fect lack of sensibility and copper-colored appearance of the emotion. If the affjcted individual be tubercular, or acquire that condi- tion during the progress of syphilitic germ life, all forms of the eruptions will be either round, crescentic, or serpiginous, but copper-colored, with lack of sensibility. Irritation, pain, itching, are at a minimum in all syphiHtic eruptions. The microbe can be found in the crusts of the sores, hence thev are typical syphilitic. The fre4uent development of tubercles in the skin, in conjunc- tion with other changes, is extremely characteristic, as those are never found in any other skin affection. Gummata and tubercles never can be confounded with any other affection. The occurrence of ulcers of a round, serpiginou=;, crescentic, or horseshoe shape, with sharply cut edges, and of the character- istic copper-color, or ash-gray, is an important sign of the pres- ence of the microbe. The presence of white, flattish scars on different parts of the body is sometimes an aid to diagnosis. It will generally be possible to obtain a history of these scars, and if they have been produced by sores which occurred without any such apparent ^cause as bu'-n=;, injuries, or bed-sores, there will be presumptive evidence of a former attack of syphilis, and this will be all the stronger if they are pretty numerous, and found on the trunk, thighs, arms, or scalp. We must be very careful, however, in drawing conclusions with regard to a single scar found on the face or shin. The chronic indurated enlargement of the lymphatic glands in different parts of the body, without any apparent local cause, is a dia'Tfnostic sign of syphilis of the first importance. The foregoing remarks apply more or less to dermato-syphilis generally. It will now be necessary to enumerate in detail the 12IO DISEASE GERMS. principal forms assumed by syphilitic eruptions, and also to point out briefly the peculiarities that disting^uish each variety. The common recent secondary eruption are the following: (i) Roseola, or rose rash. (2) Maculae. (3) Papular eruptions (syphilitic lichen, so called). (4) Mucous tubercles and patches, \ve also meet with alopecia, pustules and ulcers, but of these the The venereal bacillus. Aiuist syphililic eczema ot the lace, l^a niebs, copper colored. The venen al bacillus Dry syphilitic ecaema. Devoid of p.iin, and copper colored. two latter are less common on the skin as recent secondary forms, and usually occur only in severe cases. There is no well- defined line of demarcation between the recent and the remote secondary eruptions, of which latter the following are the most The venereal bacillus. Syphilitic Lepra. Scattered sp.jrstly over the fore-arms. Painless, copper colored. The venereal bacillus. Lepra syphi- litica, with paral\sis of the extensor muscles of thu fingers. common: (5) Pu.stules, particularly ecthymatous and acne- form. (6) Seborrhoea and alopecia. (7) Squamous patches. (8) Tubercles. (9) Ulcers. (jo) Rupia. (n) Onychia. There are many other varieties of syphilitic eruptions, but they hardly require any special description. Congenital syphilides correspond very closely with secondary eruptions, but coppery blotches and mucous tubercles are the prevailing forms. Bullae, though rare, are more common in con- genital syphilis than in the acquired disease. Rose rash or roseola syphilitica, when it first appears, may be very easily mistaken for other red rashes if we trust alone to its BACTERICIDES. 12 appearance, which is often identical with simple erythema. It is in this form of the disease that the history of a primary sore and other symptoms are of the greatest value for the purposes of dif- ferential diagnosis. Syphilitic roseola always follows closely on the primary disease (inoculation) ; indeed it often develops be- fore that has disappeared. It is frequently accompanied by the characteristic sore-throat, and other well-known symptoms, and at the outset of the eruption, these .general symptoms are our chief means of diagnosis. A little later on, when pigmentation occurs, the dia:^nosis is easy. Syphilitic roseola may, in the first instance, be readily distinguished from measles and German measles, by the febrile and catarrhal symptoms of those mala- dies. Pigmented syphilitis rose-spots become more defined by exposure to cold ; the reverse is the case with the simple red rashes. Again, the subjective sen- sations are more marked in the latter than in the former. Syphilitic macules are among the commonest manifestations of the disease. They may be red, livid, copper-colored, dirty brown, purple, or almost black, the tint of color being produced by the varying combinations of local hyperaemia and abnormal pig- mentation. They may occur as recent or remote secondary erup- tions ; in the former, the hy- peraemia usually preponderates over the pigmentation, and therefore the red or bright copper- colored maculae ajre the most common. The yellowish syphilitic pigment spots, especially about the forehead, may be easily mis- taken for chloasma or freckles. The pigmentary syphilide which is sometimes met with on the back of the neck in women, is generally a remote secondary eruption. Papular dertnato- syphilis for the most part follows quickly on roseola ; mucous tubercles, and patches, are the most character- istic evidence of the germ. Pustular-dermato-syphilis may assume many forms. It may closely resemble acne, variola, ecthyma. Pustular-syphilitic rash on face, back and body, very common in broken-down subjects. Syphilitic alopecia very common. It takes the form of a thinning of the hair of the whole of the head, and is not at all confined to the parts usually affected with bald- ness. It commonly occurs as a secondary affection, and is often Syp^iilitic microTie attacking the tiiberoFities of vari m-; honis. The nodules if germs on ihe elbows and knees were thick y set. 212 DISEASE GERMS. associated with scboii^Jiosa. The head becomes covered with dirty yellow scales, and the hair harsh and brittle, so that it breaks off and also combs out easily. Sometimes alopecia is associated with a distinct active syphilitic inflammation of the Syphilitic papulae, with germ laden blood, 'i he gemimi syphil lie inicr. I'C :ippcar. ing ill ilic turin of coppei-coloitil paj u se on the face. 'I'h' re vv.is no ori^;iiial p -ck — ihe sysiem was s:itiirattd wiih the niicrnbe ihioiijih vsashing the clothes of ail uifccted brother. : p- on IMS, cnverinjj ;ht-st all haci-c I tie dead vtiieieai bacillus could lie isolated Imni the scales; spore could bear culiivuiiou. scalp resembling eczema, and producing a discharge which forms dirty unhealthy-looking crusts ; as these are removed the hairs come out. It may be distinguished from simple eczema by the absence of itching and irritation, by the character of the crusts, the rapid loss of hair, and by the peculiar and very disagreeable smell and the presence of specific symptoms in other parts of the body. Squamous sypJiilidcs are either diffuse or circumscribed. The former are usually a later stage of some papular, mascular or rose ash, and as such are not difficult to recognize; the scales are thin, there is on itching, and the skin is more or less abnormally pigmented, which gives it the peculiar dirty look to which I have so often referred. In short, scaly affections of this kind are little more than a chronic desquamative stage of previous eruptions. Syphilitic Rupiaand Ichthyosis. BACTERICIDES 1213 The circumscribed forms of scaly dermato-syphilis are more important, and may be easily confounded with dry eczema or psoriasis vulgaris, particularly the latter, which often leaves be- hind brown pigment-spots. The syphilitic scaly eruptions, how- ever, do not especially attack the point of the elbow and the skin below the knee-pan, though they may oc- casionally appear there as elsewhere. The scales are thinner and dirtier than those of psoriasis and more diffi- cult to remove, and the corium does not blend readily on their re- moval, as is the case in psoriasis ; pigmenta- tion is usually well maik:d and of typical color. Itching is rarely present. Moreover the scalp is often affected, and this is invariably attended with loss of hair, whereas simple psoriasis, when it attacks the scalp, has but little effect on the hair. Listly.^the complexion of those who suffer from the latter disease is clear and fresh, and contrasts remarkably with that of the constitutionally syphilitic patient. Psoriasis palmaris and plantaris, as it is miscalled, is always either of syphiliiic origin or a dry eczema of the palm. It differs in apparance and nature from true psoriasis, which, moreover, never occurs as simply a palmar eruption. It usually shows itself as a small copper-colored spot; this gradually becomes scaly, with a desquamation of epithelium, leaving a somewhat thickened, raised, or di ty ragged edge. The tendency of these patches is '^o spread at the circumference. Scfmetimcs the cuticle becomes thickened, brittle, and fissured. The affection is very chronic, and often very inveterate. It may be confounded with dry cracked abortive eczema of the palm, but the appearance is different, the itching and pain are much less, the history of the commencement is also different, and lastly, eczema rarely occurs on the palm without being, or having been also 'present else- where. Syphilitic g*'in papii'a; (Ik hen), has the diHgnostic character- isiics — «.oppir-coiore(l, lack of sensibility. 214 DISEASE GERMS. Syphilitic squamous patches are not uncommon about the peri- naeum, scrotum, and penis. They usually present a rounded, well-defined border, and from their situation are apt to become red, inflamed, and very chronic. They may be easily mistaken for old patches of psoriasis or eczema ; the latter disease, how- ever, especially in this region, is attended with intolerable itching, and although this form of syphilis is also often irritable, yet the Syphi itic lupia a'most Covering ihe eniire body. Mollusaim cpiihelia, associated with inherited syphilis, showing ihe copper-colored eruption on neck. itching is far less than in simple eczema. The previous general history is here a valuable guide, but it must be admitted that the diagnosis is sometimes difficult. SypJiilitic tubercles. — I have already referred to tubercles, and therefore will only add that the remote ones are "^f two kinds, gummy tubercles and tubercles of the connective tissue. Rupia is a rare eruption, typical of syphilis. It consists of pe- culiar hard, conical, laminated crusts of a limpet-shell shape. The removal of the crust exposes a specific sore. Onychia maligna is also frequently met with, which give rise to a brittle or rotten condition of the nails. The syphilitic germ modifies all cutaneous diseases, by the microbe altering the nutrition of the tissues; the normal re sisting power is weakened, so that the change in the tissues usu- ally produced by syphilis is impressed upon it; it is altered by being made more chronic, there is greater pigmentary deposit, less scaling, more crusting, and more infiltration, especially at the margin of the lesion. In the treatment of all forms of cutaneous syphilis, there should be no deviation from the general line of remedies. Anni- BACTERICIDES. 1215 hilate the microbe and build up the vital forces of the patient. Saxifraga and phytolacca are the remedies. If mercury is deemed advisable, let it be the proto-iodide, in pill form, with one grain of opium. If this is administered, it is a good plan not to exceed one twelfth of a grain, and to follow it up with larger doses of iodide of potass than what is contained in the saxifraga syrup. The special indications for the administration of this salt in dermato-syphilis are (i) the existence of periosteal affections ; (2) a l6w constitutional condition ; (3) the co-existence of albuminu- ria, other than that due to syphilis, in which case mercury is gener- ally contra-indicated. The most important point in connection with Syphilitic microbe in pustules (rupia). The venereal bacillus. The germ syphili- tica in pustule s oi> the hand, with moist gangrene of the fingers. the use of iodide of potassium is the fact that it soon loses its effect unless the dose be from time to time steadily increased. This should be done about once a week, otherwise the result of the treatment will be often disappointing. In those cases in which the constitutional condition is low, iodide of potassium should be given in combination with carbonate of ammonia and cinchona, and the dose gradually increased from five grains up to half a drachm (or more if required) three times a day. Under these circumstances, if there is no indication to the contrary, a I2l6 DISEASE GERMS. dose of opium every night is of the greatest possible value. When there is much aniemia or albuminuiia, tlie iodide of po- tassium should be combined with iron, or with the citrate of iron and quinine. The great use of opium in the treat- ment of all syphilitic sores is too much forgotten. 1 have seen cases in which '^ >^ J **/ y^.- 'i^^ ^^1 remedies seemed to irritate, and had little or no effect until the nervous sys- tem was soothed by the action of opium. The use of sulphur, iodine, and ozone baths is attended with ^ood results in the severest forms of syphilitic eruption. They are especially useful to aid the action of internal remedies, and used about twice a week. Local treatment of syphilitic eruption is not of much utility, but they should be covered with ozone ointment, or sprinkled with iodol or iodide of starch, or the anti-microbe powder. Sozoiodol is the best remedy for indolent ulcers ; the ulcers should , first be washed with a solution of boroglyceiiJe, then Syphilitic Ichthyosis Dry pangtene. rne r f ihefflTectsof the A'cnereal b;., of Esom Hill, Ga., says that it grows extensively in the Southern States, and is collected while flow- ering. A germicide of some power^ especially in sterilizing the urethra, and killing the gonoccocus ; acts as a sedative to the urinary passages. Besides its utility in insomnia, it is of great service in nervous affec- tions. The mode of administration Hemp(c«««a^z>ja//z'a): a, male inflor- should bc Small doscs frequently escence; b, female inflorescence. repeated in watcr, Until the systcm. is thoroughly brought under its influence. The common names are, waxweed, flax Cuphea weed, red pennyroyal. This medicament is Viscasissima. claimed by bacteriologists, to be a very valu- able germicide in the treatment of cholera infantum. A tincture of fresh plant is used, in doses of five to ten drops according to age, every hour until relieved, then so often as need be. There are two classes of cases in which cuphea is specific. First, those arising from acidity of milk or food ; vomiting of undigested food, or curdling milk, with fre- quent green, watery and acid stools, varying in number from five to thirty per day ; child fretful and feverish ; can retain nothing on stomach ; food seems to pass right through the child. Second class, the stools are decidedly dysenteric, small, frequent, bloody,, with tenesmus and great pain ; high fever, restlessness and sleep- lessness. In both the comma-bacillus is completely sterilized. is in our opinion the purest stimulant in the Capsicum Materia Medica. It possesses the properties of ergot and nux vomica combined. It is a pure stimulant to the ganglionic system of nerves, and acts on un- striped muscular tissue. It increases arterial tension by stimulat- ing the vasomotor centre. It is at the same time a sedative and a stimulant to the stomach and intestines, one action is on the mucous membrane, the other on the unstriped muscular tissue,, and the third on the glands of these organs. BACTERICIDES. 1269 Its action is both direct and reflex. Capsicum increases peri- staltic action by stimulating the filaments of the sympathetic and the unstriped muscular fibres of the intestines. In this way it cures chronic constipation. We have cured many severe cases of this trouble, the atonic, with infusion of capsicum. We know of no medicament that can be any more relied on in atonic dys- pepsia caused by catarrh of the stomach and duodenum, than infusion of capsicum. Its action is sure on the catarrhed mucous membrane and glands, on the nerve endings of the mucous membrane, acting on them as a tonic stimulant and thus controlling the secretion of the glands of the organ ; it contracts the arterioles of the mucous membrane in virtue of its action on unstriped mus- cular tissue. In all probability it acts on the local vasomotor mechanism of the parts, stimulates them to a greater functional activity in virtue of which the nutrition of the tissue is enhanced. In some cases of adynamic fever and inflammation, capsicum is the remedy to wake up the latent energies of the ganglionic nervous system and keep the forces of organic life jogging on until the crisis is passed. It slows the heart and firms the pulse and strengthens the respiratory centres, a failure of which is often a slow, yet certain decline to the grave. In delirium tremens, we have seen a very strong tea of cap- sicum steady the shattered nervous system, stop the delirium and restore the appetite. In all cholera and cholera morbus for- mulae, capsicum holds a conspicuous place. These are the words of one of the most brilliant savans in medicine, Prof Jos. Adol- phus, M. D., of Atlanta, Ga.: " It is an excel- lent drug in uterine hemorrhage." Capsicum. Cardamom Seed. The seeds of the arnomum rej^ens or cdLtddimom. are highly germicidal, and a grateful aromatic, less heating and stimulating than others of the same class but more highly germicidal ; it is a most useful adjuvant or corrective to all cordials, tonics and griping pur- Amomum 1270 DISEASE GERMS. gatives. The use of all this class of aromatics increases the bactericide properties of every remedy into which they are in- corporated. Carbolic Acid or Phenic Acid. Is obtained by careful distillation from coal- tar. It is met with in two forms, either in liquid or crystal. Very sparingly soluble in water, but it parts when mixed with water, just sufficient to be of value. It is a powerful bactericide, and as such is extensively used to prevent and destroy microbes in wounds and disease-germs in the alimentary canal. Carbolic acid, twenty grains ; syrup of tolu, four ounces. Mix. From a half to one teaspoonful every three hours. Locally for burns or compound fractures, six ounces of olive oil to one of carbolic acid. Mix and apply. Locally. A ten-per-cent. solution or injection in the centre of a hemorrhoidal tumor or pile immediately causes it to wither and disappear. The following formula is esteemed excellent, and is used in the same manner : Glycerine, two and a half drachms ; phenic acid, twenty drops ; morphia, five grains. Mix. A few drops injected into any pile causes it to painlessly dis- appear. This is quite extensively cultivated for its seeds, Caraway, which contain on an average about four per cent, of a volatile oil, which when fresh is of a limpid brown color, becoming darker by age; it has the odor and chemical proper- ties of thyme — thymol. Without dis- tillation the seeds yield their oil to alcohol, more slowly and less sparingly to water. The seeds distilled with alcohol at forty-five gives us what is known as kemmel, a very favorite bev- erage of some European nations. In all its forms, seeds, oil or essence, it is an invaluable germicide, killing bacteria and the oidium albicans. Its more general use should be encour- aged, especially in food and medi- cine, among people denizens of over- crowded cities. Caraway. BACTERICIDES. I 271 In small quantities has a germicidal Carbonic Acid Gas action, sterilizing bacteria, on the stomach, causing the arrest of vomiting. Carbonic acid is always present in the atmosphere in a small quantity, and it is partly an accumulation of this gas which makes a small, badly-ventilated room smell close and stuffy ; languor and headache then come on, and unless fresh air is admitted in- jurious consequences may supervene. From this cause over- crowding is injurious, and those who work together in a room, as dressmakers, etc., are often liable to headache, anaemia, and general debility. Fresh air is of course the simple remedy for this condition of things, while in serious cases of poisoning by the gas, and when the patient is found insensible, removal of the individual into the open air is the first thing to be done, and then artificial modes of respiration must be resorted to. Carbon- ic acid is a gas, and in its pure state is poisonous when retained in the blood. It is at all times exhaled in the breath, and is one of the chief agents in inducing that languid state experienced in crowded apartments. It is the principal ingredient in the choke- damp, so fatal to miners after an explosion. It causes death by arresting all change in the lungs, so that the whole blood be- comes black and impure. By itself it is not greatly used in medicine, but in the form of soda-water it is often exceedingly useful. It is this agent contained in effervescing liquids which gives them their sparkling character, and which enables them to be retained on the stomach, which would otherwise reject them in fevers, and such like disorders. It is partly due to the car- bonic acid in it that champagne is frequently retained when nothing else is. To manufacture soda-water, the so-called gazo- genes now so plentiful, may be made use of, carbonate of soda and tartaric acid being employed in the process. On the large scale sulphuric acid and chalk or marble are employed, but the gas requires to be carefully washed, otherwise the taste of the soda-water is bad. The gas itself has been employed to relieve the pain of cancerous, especially uterine affections. The extensive use of carbonic acid exhausts the sexual ap- petite, in the base of the brain. The leaves of the Jacarando procera and other Caroba. species are largely used in the United States and in Europe for chancres, buboes, chronic catarrh of the urethra, syphilitic lesions, and pains in the body from misuse of mercury. The fluid extract has proved successful in this country for the treatment of gonorrhoea. It is given in doses of ten to sixty minims according to the virulence of the case. 1272 DISEASE GERMS. A species of sea-weed, which grows on the Carrageen, rocks, along the sea-shores of the greater part of temperate Europe and North America, used to a considerable extent medicinally and as an article of food. The species which constituted the carrageen of commerce is Chondrus crispiis, of which there are numerous varieties. It contains eighty per cent, of active medicinal properties, a vegetable jelly with iodine and ozone, which renders it invaluable in microbial disease of the pulmonary organs. When half an ounce of carrageen is placed to steep for ten minutes in three pints of cold water, and then boiled and strained^ it yields up its therapeutic proper- ties, and with or without spices forms a valuable drink. With a larger proportion of carrageen, a thickish liquid or mucilage is ob- tained, and on further boiling this strong decoction, and cooling, a stiff jelly is procured, which can be ren- dered quite acceptable to the most delicate stomach by the addition of spices and sugar. Now that its true bactericide pro- perties have been made clear, that there is a something more intrin- sicall)' in it than emollient and demulcent, its use should not be overlooked. Milk may be used in its preparation instead of water, and various other germicides can be added, to still further increase its efficacy. The fluid extract prepared from the root Cascara Sagrada. of the cascara-sagrada is a standard remedy for constipation. Various other prepara- tions are in use, but are comparatively worthless, except the cas- cara sagrada ozonized lozenge^ prepared with the purest chocolate. Cascara sagrada is a tonic laxative. It also aids the general processes of digestion, especially promoting those of nutrition and assimilation. Cascara sagrada seems, when given in suffi- ciently large doses, to exercise a soothing influence on the rectal mucous membrane. Originally introduced by ourselves, w^e have paid particular at- tention to the importation of the most carefully selected bark {Rhamnus purshiana), and used the greatest care in the manipu- lation of the various preparations we have from time to time BACTERICIDES. 1273 introduced, and their superiority over the various imitations that are now made has been verified by the profession, after careful and extended trials. In its crude state, cascara has an intensely bitter taste ; and on its first introduction this was found one of the great objections to its use, especially with ladies and children. We have, however, succeeded, after careful experiments, in rendering the different products perfectly tasteless, and the presentation in the form of an elegant and pleasant lozenge renders its administration, espe- cially to children, a matter of the greatest ease. • The lozenges are carefully prepared in our own laboratories with our especially prepared Extract, rendered tasteless by our new process of manipulation, and are combined with the purest eating chocolate, and can be taken as easily as the ordinary bon- bons of the confectioner. Dose : Each lozenge contains two grains of pure tasteless ex- tract cascara.. For adults, one, two, or three may be taken at bedtime ; children may take from half to a whole lozenge for a dose at bedtime. Grows in the marshes and dried-up rivers of Cassia Alata Porto Rico. It is a beautiful shrub, with yel- low flowers, growing to a height of six or eight feet. The entire plant, leaves, flowers, and stem, is highly germicidal ; they owe this property to the large amount of chrysophanic acid they contain. Simmering the fresh leaves, buds, flowers, bark in lard gives us an ointment of rare value in all skin affections. A decoction of the bark, leaves and flowers applied to the skin in chronic eczema, promotes a very rapid healing. An infusion of the flowers and leaves, one ounce to the pint of water, and drank freely during the day, is •of s^reat efficacy in all skin affections. The seeds are a reliable vermifuge administered fasting, are almost certain to bring away any form of tape worm. In overdoses it produces copious, watery evacuations, and is highly esteemed as a remedy in syphilis. Cassia Alata. 1274 DISEASE GERMS. Celona Glabra. The entire herb possesses strong germi- cidal and parasitical properties, acting effi^ ciently on the liver, stomach, and bowels, cleansing all the alimentary- tract of germs and parasites ; hence its utility in dyspepsia, jaundice, mal- assimilation ; especially valuable in all conditions of debility. The best form in which to admin- ister it is in the form of a fluid ex-^ tract. gentian, and Balmony {Chelone Glabra). ^^^^ pOWCr. extract is the best form ; the for- mer applied to old indolent ulcers promptly kills the bacteria in the sore and promotes a healing pro- cess. As an application to all forms of tissue it surpasses many modern drugs, kills the spores of tinea capitis and versicolor, re- moves freckles and all microbial spots and marks upon the skin. Internally, it is a good parasiti- cide, no species of worms can re- sist its action ; most effective in jaundice and torpid liver ; and completely sterilizes the germs of rheumatism. The remedy is best administered in the form of tincture. Beginning with small doses until it acts freely upon the liver ; then decreasing to such doses as will move the bowels once in twenty-four hours. A cerate for parasite skin affections is usually made by simmering the green or dried plant in some ole- aginous body, as petroleum ointment. A parasiticide and Centaury, germicide, having all the tonic properties of an anti-periodic of no A decoction or fluid Erythrea Centauriunu BACTERICIDES. 1 275 Highly bactericidal, destroys the Cerastinum Vulgatum. bacteria on old ulcers, and pro- (Moiise's Eaj^) motes rapid cicatrization ; used alternately with the resorcin ointment and Chian turpentine mixtura in- ternally retards and kills all cancerous tumors ; the green herb cut up fine and bruised and applied to a wound speedily promotes primary union; boil the fv^ plant in vinegar, add sugar to make a syrup, cures bronchitis by sterilizing the germ. As a general remedy in all diseases, it wipes out their micro- ^"^lo^se Ear. organisms. Cerebrin is a soft, light amorphous hygroscopic Cerebrin. powder— isolated from the white substance of the brain. As it is liable to chemical change, it is best administered in the glycerite of kephaline or phosphated tincture of oats. Dose : One to five grains at meals thrice daily. Kephaline, a soluble form of cerebrin, is best adapted for gen- eral prescriptions, being a stable and reliable form. Oxalate of cerium is a white granular powder, Cerium, odorless, tasteless, insoluble in water, alcohol or ether, but dissolves freely in sulphuric acid. It is a valuable sedative in all irritation of the stomach and bowels. Until the introduction of the ozonized liquor cerii it was our best remedy in the reflex vomiting of pregnancy. The oxalate is entirely superseded by the ozonized liquor cerii which is most valuable in the nausea and vomiting of pregnancy, and in similar symptoms associated with dysmenorrhoea, flexion, and other uterine disorders, and with hysteria from anxiety, grief, overwork, and the like. It is also used with good results in pyrosis and in phthisical and atonic dyspepsia, as well as in cases of gastric ulcer. It is serviceable in the violent morning- cough accompanied with dyspnoea on exertion and sickness on the patient getting out of bed. Cerium has also been employed with benefit in epilepsy, when belladonna and bromides had failed to relieve. The liquor cerii, ozonized, is therefore, worthy of trial in obstinate cases of epilepsy and similar complaints. One of the most valuable remedies in the Ma- Cinchona, teria Medica, being an antipyretic, tonic, stimulant^ antiseptic. The alkaloid quinine is the best form for antipyretic purposes. There are two functions which quinine serves. The one is 12/6 DISEASE GERMS. that quinine has the power to lower the temperature in febrile conditions which are not due to malaria ; the other is that quinine has no extraordinary power of arresting the movements of leucocytes, causing them to draw in their pseudopods, and to contract into a sphere. In the case of free cells like the white blood corpuscles we can see that such a contraction as this will considerably lessen the surface of protoplasm exposed to oxida- tion, but one can hardly see how the change of form is likely to interpose any obstacle between the oxygen contained in the serum surrounding the cell and the protoplasm. The case is different, however, if we take such a structure as the pigment cell of the frog. Here the protoplasm does not fill the whole cell equally at all times ; occasionally it stretches itself out into all the ramifications of the branching cell, and then it will not only allow a large surface for oxidation, but will be separated by a comparatively thin layer of paraplasm from the lymph or in- terstitial fluid by which the cell is nourished. When the pro- toplasm contracts it forms a rounded mass in the centre of the cell, and then presents a minimum of surface for oxidation, and at the same time a maximum thickness of paraplasm is inter- posed between it and the cell wall. If we suppose that quinine produces an effect upon the protoplasm of cells composing the tissues of the body similar to what it has upon leucocytes, we can at once see how. it will lessen oxidation in the tissues, and thus act as an antipyretic. Nor is it necessary to assume that it exerts this effect directly upon the tissues themselves. The re- sult will be the same if it stimulates thermal centres in the brain and spinal cord, and causes contraction of the protoplasm through them. Quinine is best administered either dissolved with tartaric acid or aromatic sulphuric acid. The best time to give it : after de- termining at what time during the twenty-four hours the temper- ature is lowest, administer the dose during the fall. We have seen a fall of half a degree the next day follow this course, and the evening temperature would not rise. The constituents of cinnamon are a volatile Cinnamon, oil and resin. The oil is prepared chiefly in Ceylon, by grinding the coarsest pieces of the cinnamon, soaking them in sea- water for a few days, and then dis- tilling. Two oils pass over, one lighter, the other heavier than water. It varies much in color, from yellow to a cherry- red, the yellow variety is the best, and most highly esteemed. BACTERICIDES. 1277 Its medical properties are aroma- tic, carminative, germicide, hemas- tatic. An arrester of uterine hem- orrhage. A remedy of great value in nausea, vomiting, and diarrhea, especially when such states are caused by the presence of micro- organisms in the alimentary tract. Stick cinnamon, boiled in milk, forms a valuable remedy in diar- rhea. Cinnamon; a, end of branch, with leaves and flowers ; b, four-celled anther. Perhaps the Camomile. most highly es- teemed of all do- mestic remedies. It is a bitter aro- matic tonic, yielding its properties readily to water ; it has an excel- lent action upon the stomach as a vitalizer, promoting an ap- petite and assimilation of food, but its use is contra-indicated in all derangements of the brain. A highly aromatic essential oil abounds in the entire plant, which is of a greenish yellow color, and highly germicidal, being most destructive to the vibrios of typhoid fever, to the spirilla and cocci of cholera infantum. The oil is best administered in a high state of trituration, a few drops being added to a drachm of sugar of milk, thoroughly tritu- rated, divided up and adminis- tered as indicated. It is besides a valuable stimulant to the ab- dominal sympathetic. Matricaria, or German camo- mile, is altogether a very differ- ent drug from the above, being one of the most valuable of all tonics, in cases where there is a poverty of nerve force, such as nervous debility, paralysis, a gen- eral failure of brain power, premature decay ; it has a most vital- izing action on the brain, and the most minute periphery of nerves. Besides, it is a germicide of great power, a true ozone Camomile. 1278 DISEASE GERMS. generating drug. The compound tincture is the form in which it is usually administered, and in doses of from five to ten drops in a glass of water before meals. It is perfectly compatible with avena sativa or kephaline ; com- bined or alternated with those, it is a most reliable remedy in functional disturbance of the brain, threatened softening, loco- motor ataxia. The action of matricaria upon all organs supplied with ganglia of the great sympathetic, is most marvellous. The larynx, lungs, heart, stomach, spleen, bowels, left kidney, and reproductive organs, are all rejuvenated by its use. Chelidonium. This is a peculiar germicide, the fresh juice of the plant applied externally to corns, warts, excrescences, stimulates them beyond what their languid vital power can bear, and they exfoliate. Mixed with cream or boroglyceride and applied to the eye, it will re- move opacities of the cornea. A saturated tincture in large doses, is a drastive purgative and poison ; in small doses, it acts beneficially on the entire glandular system, pink marrow, mesentery, lymphatics, and the liver. It is upon the liver that the entire force of the remedy falls, acting upon that gland as efficiently as the mercurials. Under its use the symptoms of torpidity disappear. Common Celandine. Or carbon, occurs in nature, as black lead or Charcoal, plumbago, but is ordinarily made artificially from animal or vegetable substances. Wood charcoal is mostly employed externally, and that most frequently in the form of poultice, combined with linseed meal and bread. This poultice is of very great value when sores are fetid and parts are sloughing away, keeping them moist and warm, whilst prevent- ing smell. The powder may be used with similar intent. It is sometimes given internally, when patients are suffering from or- ganic diseases of the stomach and intestines, accompanied with BACTERICIDES. 12^9 the formation of foul-smelling gases and acrid fluids. It is also recommended as a temporary antidote for certain organic poisons, as aconite and strychnine. In either case a tablespoonful should be given suspended in water. The ozonized chlorate of carbon. — Specially indicated in cancer, syphilis, tuberculse, all fevers, and whenever there are disease germs in the hurrian blood. This remedy has acquired a world- wide reputation in the cure of cancer. Its high repute is well merited. It is introduced into the ozonized saxifraga and Phyto- lacca, to render those invaluable alteratives most extremely effi- cacious as a germicide in the radical cure of all morbid states of the blood. Locally, it can be introduced into all cancer plasters, being compatible with extracts of sheep sorrel and red clover tips, with bichloride of mercury, arsenic, chloride of zinc plasters, and the chloride of chromium, ozonized. Dose, Five grains, added to some alterative syrup or water, every three hours. Pulverized willow charcoal. — Efficient bactericide, whenever we have reason to suspect microbes in the alimentary canal. Ox gall and pulverized charcoal make an efficient pill for gall stones and sluggish liver. The bisulphide of carbon^ although an unpleasant remedy, has immense bactericide properties ; it kills the microbes of typhoid fever, diphtheria, dysentery. A" saturated solution of the bisul- phide in water, mixed with milk, taken half an hour before meals, promptly kills those germs. In the case of dysentery, the tenes- mus is at once relieved, stools lose their offensive odor. Bisulphide of carbon, local use of in neuralgia and headache, used as follows often acts like magic : Take a wide-mouth bottle of convenient size, fill it half up with cotton or a sponge, then pour on two or three drachms of the bisulphide. Apply the open mouth of the bottle over the seat of pain closely, so as to prevent escape of the vapor ; continue the contact four to ten minutes, according to the severity of the pain. In a short while a sensation of tingling, which will shortly be raised to feeling of smarting and burning, then remove the bottle. The pain soon departs. Headache is treated successfully by applying the bottle to the temples or nape of neck. The bisulphide of carbon acts as a solvent for phosphorus, and in itself has a beneficial effect in intestinal catarrh. This oil is one of the most powerful Chaulmogra Oil. germicides in the Materia Medica. It {Gy?iocardia odoj^ata) has a most remarkable affinity for cer- tain germs, as the bacillus of leprosy, j28o DISEASE GERMS. ainylobacta of rheumatism, tubercle, lupus, and obstinate skin- affections. C. B. Stevens, M. D., 21 Hanover Street, Manchester, N. H.,. who may be regarded as an authority on the use of this oil, says: " The kernels of the seed of the fruit of the gynocardia odorata yield a fixed oil, by compression, or boiling with water, which possesses potent germicidal properties, so strong and energetic that when administered in tuberculosis, psoriasis, lepra, elephan- tiasis, rheumatism, or sciatica, prove effective in destroying the germs of the disease. Internally the dose is from five to twenty drops three times daily after meals. Larger doses are apt to nauseate and constipate. Locally, to parasite eruptions, one part of chaulmogra oil to ten parts of olive oil. The active prin- ciple of chaulmograoil is gynocardic acid, which is a most excel- lent form for administration. This acid in doses of half a grain three times daily after meals, in the form of a pill ; the dose can be increased. It has many advantages — definite in composition, positive in action, small dose. Haifa drachm of the acid to one ounce of petroleum ointment is very valuable in leprosy and psoriasis. or better still, antkrarobin, which is an innocu- Chrysarobin, ous succedaneum for chrysarobin, the so-called chrysophanic acid. It is a bactericide of great power. Very favorable results are reported of its action in cu- taneous affections. Prof. D. K. Hitt, M. D., of Prospect, Marion, Ohio, employed with success, in a large number of cases of hemorrhoids, the plan of using chrysarobin. In the cases where the hemorrhoidal tumors are external he uses the following formula : Chrysarobin, 80 centigrammes ; iodoform, 30 centigrammes ; extract belladonna, 60 centigrammes ; vaseline, 25 grammes. Mix. A small quantity of the ointment is placed several times daily upon the hemorrhoids, after previous washing with a 1:50 solution of carbolic acid, or of 1:100 of creoliri. If the hemor- rhoids are internal, suppositories after the following formula may be employed : Chrysarobin, .08 centigrammes ; iodoform, .02 centigrammes; extract of belladonna, .01 centigramme; cacao butter, 2 grammes. Mix. For one suppository. In two or three days the pain caused by the tumors disappears, and after two or three months a complete cure is said to follow. BACTERICIDES. I 28 1 Chian turpentine mistura, highly Chian Turpentine, ozonized, is an emulsion of Chian tur- pentine with ethereal peroxide of hydro- gen, resorcin and thallin ; we have a mixture devoid of all irritat- ing properties, easily absorbed and taken into the blood, and at the same time possessing the highest bactericide properties. Chian turpentine, which we use, is specially collected for us in the Island of Chio, from the Pistacea terrebirithce. This, as we have prepared it, is an energetic ozone producer, an agreeable aromatic, with an odor resembling the pinaceous turpentine. Its special action, when admini:5tered, passed in the blood tissues, is to search out the cancer germ, which it surely finds, and slowly, silently kills it. Under its use pain ceases, the tumor, or aggregation of germs, with it also die. If there is an open breeding, eating surface it becomes covered with a characteristic grayish slough, indicating a perfect annihilation of the cancerous microbe. Tumors also dwindle in atrophy under its use. Dose : One teaspoonful of the Chian turpentine mistura three times a day, which is to be gradually increased to nine teaspoon- ful in the twenty-four hours. r. 5. Dozvney, M. D., Maitland, Mo., and G. W. Moble, M. D., Edon, Ohio, both of whom have had a most extensive practice in the treatment and cure of cancer; both eminent members of our profession, speak in glowing terms of their success with this pre- paration in the management of cases deemed incurable. Chinoline Salicylate Tartrate. — Powerful antiseptic, capa- ble of destroying the malarial germ and the mycelia of hooping- cough. Dose : Two to ten grains every three hours. is a true liver tonic, in the sense that Chionanthus Virginica it innervates the secreting protoplasm of the hepatic cells, and stimulates the local vasomotor centres in the organ. The medicament is de- serving of all the praise which the entire profession have bestowed upon it. It is remarkably curative in the conditions that lead to cirrhosis ; infantile jaundice yields readily to its action. It is undoubtedly a fine cholagogue. It relieves abdominal plethora and quickens the circulation in the hepatic capillaries. No dri5g past or present can excel it in jaundice. 81 ■ 1282 DISEASE GERMS. Dose : Fifteen grains, added to syrup Chloral Hydrate, of orange peel, every hour, or every three hours. Externally, efficacious in pro- ducing sleep in delirium tremens. Combined with bromide of potassa it will control raving mania, puerperal convulsions. Its persistent use creates a habit, and exhausts the ophthalmic tract ; causes amaurosis. Applied locally to the breasts, during lactation, it will arrest the secretion of milk ; it is also an invaluable counter-irritant ; more penetrating than cantharides. Dose : Five grains in syrup Croton Chloral Hydrate, every half hour. Indicated as an anesthetic for deep sleep and relief of pain. Croton chloral contains more hydrogen than chloral hydrate. It is, in fact, butyl chloral. Its practical value is the property of diminishing sensibility before producing narcosis. An excellent hypnotic and germicide, of Chloralamid. great utility in all microbial diseases. Insomnia and restlessness resulting from pain were little, if at all, influenced by chloralamid. In two .cases — one suffering from disease of the ankle with starting of the foot at night, and the other from dysentery with cramp-like pain in the abdomen — doses of 45 grains caused, indeed, sleep, but with an attack of pain readily broke. From these few observa- tions, it would appear that the new hypnotic is not altogether free from some of the disadvantages attending those already in daily use. Doses of 30 and 45 grains have been followed by giddiness, feeling of sickness, dryness of the mouth, and even slight delirium — symptoms which, though not alarming, are cer- tainly disagreeable, but which seem to be inseparable from the action of almost all our sleep-producing agents. A comparison of the action of chloral with that of the amide shows that the latter is not so rapid, sleep coming on half an hour to an hour after its administration ; whereas after chloral it often results in fifteen minutes. This slight disadvantage, however, is more than compensated for by the almost entire absence of action which chloralamid has on the circulation. Dr. Patterson has paid special attention to the dose of this sub- stance, and says : "Usually 30 to 45 grains suffice in the case of a man, while 20 to 30 grains will give satisfactory results in a woman. In experiments carried out by Alt, 60 grains produced in BACTERICIDES. 1283 two strong, healthy women severe giddiness, symptoms of intoxi- cation, with great excitement, and in one great nausea and retching. Chloralamid has no action on the digestive organs, -and the appetite remains unimpaired. That this drug will be a valuable addition to our therapeutical armamentarium is un- doubted." Dose of the wine chloralamid, two fluid ounces ; dose of the elixir, half a fluid ounce ; of the pellets, three. Chlorine water in the treatment of infec- Chlorine Water, tious and contagious diseases should never be lost sight of, and as it is so easily pre- pared every physician should have recourse to it in diphtheria, scarlatina, small-pox and even typhoid fever. To prepare it : Place powdered chlorate of potassium, three drachms, in a quart bottle, then pour on it three drachms of mu- riatic acid. After a moment or two cork the bottle and allow the gas to form and fill up the whole space. Then slowly add cold water, the colder the better, and shake well so as to mix the gas and water and insure the solution of the chlorine ; add more water, shake again, continue in this way till the bottle is full. The water will be nearly saturated with chlorine. Here you have the chlorine water. Order a wine-glass full to be given to the patient every hour or two. This water must be kept in a cool place, and should be prepared fresh every day. Its value in diphtheria and scarlet fever is too positive to be neglected by progressive physicians. An excellent bactericide in measles, scarlatina, variola ; if it does not kill, it at least sterilizes the micrococci. The cancer antidote, for external Chloride of Chromium, use only. The liquid chloride of [Ozonized.) chromium is added to pulverized blood-root, or any other inert powder ; is made into a paste of the consistency of tar, spread on leather the size desired, and applied over the cancer, the adja- -cent parts being carefully protected by plaster. Spread fresh every morning, and apply until the cancer drops out, then discon- tinue. Indicated in all external cancers, whether they be covered by cuticle or open, ulcerating. The moment it is applied, by en- dosmosis, it penetrates the cancer germ, unites with it and kills it. To this germ it has a chemical afiinity, as the mass of cancer germs are, when destroyed, a perfect ozonoid. The destruction 1284 DISEASE GERMS. of the germ is effected without pain, but the surrounding tissues are so blended in and through it that they suffer oxidation, which gives rise to some pain in the separation of the germinal mass from the healthy tissue, but much less than what is caused by any other remedy, except the ozone paste. Both the red and white clover are valuable bacterid Clover, cides. Trifoliiim, red clover. — An extract obtained from the leaves, stem and flowers, by pressure or by boiling and evaporation to the consistency of molasses, spread on leather and applied to any cancer colony or infiltration will gradually kill it and painlessly cause its separation from the sound tissues ; very slow but effi- cient in its action. Infusion of red clover tops, drank ad libitum, destro5^s the can- cer microbe. The compound syrup trifolium is prepared as fol- lows : 32 parts of red clover; 16 stillingia, burdock, Phyto- lacca roots, berberis and prickly ash. Mix. Make like com- pound syrup stillingia. Substantial efficacy ; curative by being a microbe killer in the blood. Meleotus — zvhite or sweet clover. A mother tincture, active, energetic in sterilizing the germ of degraded nerve-bioplasm, vibriones, hence is of great utility in chorea, convulsions and fits generally ; superior to simulo, as it prevents recur- rence. The flower Cloves, buds of the clove tree are its prin- cipal product. When ripe they are gathered, and dried by the smoke of wood fires, or by exposure to the sun. When first gathered they are reddish, but soon become a deep brown color. The medi- cinal properties, which are germicidal, reside in an es- sential oil, which occupies, by weight, one-fifth of the entire quantity of buds. This oil is obtained by repeated distillations with water. While this process is going on two sorts of oil pass A branch of the clove tree, with buds. BACTERICIDES. 1 285 over, the one lighter than water, the other heavier. When pure, this oil has a light yellow color ; a brown red when not so pure. This oil is soluble in ether, alcohol or fixed oils. Cloves are a germicide of the first rank, and should be freely used in every household to kill the floating aerial bacteria of all large cities. They are powerful enough to destroy the ordinary malarial germ. Thus, a very favorite, crude, but extremely effi- cacious formula is the following : Take one ounce of pulverized cloves ; one ounce of Peruvian bark, finely pulverized ; one ounce of cream of tartar, and one drachm of capsicum. Mix thoroughly. Dose : One teaspoonful every three hours. This rarely fails in ordinary cases of malaria. The part used are the leaves, the Coca Erythroxylon. extract from the green leaves, and the wine. The drug is a stimulant, hav- ing a vitalizing action upon the motor cells of both the gray and white matter of the brain and spinal cord. It is an admirable tonic and restorer, and maintains the vital force of the user under most extraordinary efforts of mental and physical tension. The fluid extract^ in teaspoonful doses, thrice daily, imparts to the nervous system a strength, a vigor, or an endurance that en- ables it to resist the severest fatigue. It is the most effective tonic plant in the vegetable kingdom. It possesses the virtues of all tonics. It is a powerful restorer of the vital forces. It strengthens, exhilarates, sustains, and refreshes, aids digestion, imparts new energies to the worn-out or exhausted mind or body, and excites every faculty to healthy action. It invigorates the genital organs, and is a specific for all nervous complaints, such as sick headache, neuralgia, wakefulness, loss of memory, nervous tremorsj loss of appetite, depression of spirits. It vital- izes the blood in all brain workers ; there are elements of strength in it, induces cohesion of, and great accumulation of nerve force. Coca et Celerina, causes a cohesion of all the finer elements of the nervous system, effectually eradicates the opium, whiskey, chloral, and other habits. Wherever there is a poverty of nerve force, as in neurasthenia, in alternation with kephaline, its action is unexcelled. Wine of Coca Erythroxylo7t Ozonized. — This wine is prepared from the finest Florida oranges ; the green coca leaves, and per- oxide of hydrogen. It forms one of the finest and most elegant preparations ever introduced to the medical profession. It is the only wine which possesses in an eminent degree the 1286 DISEASE GERMS. valuable tonic and invigorating properties of the erythroxylon coca, the celebrated Peruvian restorative, an invaluable remedy- to be administered when the nerve forces are shattered, deficient^ Erythroxylon Coca. or exhausted, being thus a powerful tonic for fatigue of mind or body. Taken in small doses, at intervals of three or four hours apart, it is a gentle excitant to the motor cells, giving the consumer great powers of endurance of both mind and body. It acts as a BACTERICIDES. 287 scavenger to diseased blood, cleanses it from all microbes, im- parting a marvellous freshness of vigor to the whole body. It lessens metamorphism, at the same time increases the appetite ; its use in fevers lowers heat, pulse, and respirations. As a voice tonic to preachers, public speakers, singers, it is indispensable, being tenser of the vocal chords, thereby greatly strengthening and increasing the tone and volume of the voice. Indicated: In all deviations from a normal standard of health; in all acute and chronic diseases ; wherever microbes or pto- maines exist, neuralgia, insomnia, malaise, despondency, and a positive cure for all habits. It is a powerful muscular, nerve, and voice tonic, giving un- usual power of endurance in both mental and physical labor ; it is also remarkable in its food-replacing power, persons being able to abstain from food for many hours after a full dose of this wine of coca. A powerful nerve stimulant. Restores the functions of the di- gestive organs, strengthens the mental and physical powers, as- suages thirst, relieves the dulness and drowsiness of nervous debility. Given with benefit in cases of opium and morphia habit. The North Am. Med. Chir. Re- view, March, 1880, has the follow- ing : — ** In large quantities, it is said that this drug produces a general exaltation of the circula- tory and nervous systems; impart- Young plant of Er>'throxylonCoca. ing increased vigor to the muscles, as well as to the intellect, with an indescribable feeling of satisfaction.'^ In small doses it increases appetite and promotes digestion. In cases of sleeplessness from exhaustion and fatigue, it is in- valuable, producing a sound and refreshing sleep without the distressing sensations so common after opiates, bromides, and hydrate of chloral. One wineglassful is equal to one drachm of the leaves. Dose, as a tonic : one wineglassful before or with each meal. Children, half or quarter of a wineglassful. For sleeplessness from nervous exhaustion : place a wineglass- ful at the bedside, and take a sip about every half hour until asleep, or take the whole at one dose, and repeat during the night if wakeful. 1288 DISKASE GERMS. The spermatorrhea pill which has acquired such a celebrity in the cure of seminal weakness, is prepared as follows : Cocaine, one drachm ; jerubelin, fifteen grains ; hypophosphate of lime, thirty grains ; gelsemium, six grains ; extract ignatia, three grains ; leptandra, thirty grains ; glycerin, q. s. Mix, Ft. sixty pills. Millions of pills from the above have been sold for arrest of spermatorrhoea with most gratifying results. Cocaine in that formula being a mere abstracta. The Cocaine Suppository from the divine plant is prepared as follows : Butter of cocoa, six ounces ; cocaine hydrochlorate, two to four grains ; solid ext. hyoscyamus (English), one and one half ounces ; Ft. lOO suppositories. Mix. The addition of either the hyoscyamus or conium, modifies the action of the cocaine. This suppository positively cures spermatorrhoea, impotence and sterility, continence or incontinence of urine, inflammation and enlargement of prostate, piles, stricture of rectum ; also cures coccydynia, dysmenorrhoea, or painful menstruation, cancer of the rectum. is the common name for a berry of a Cocculus Indicus climbing shrub, which grows in Cey- lon. It is used in large quantities by brewers for increasing the bitterness and intoxicating power of malt liquors. It is also used to destroy fish. As a microbicide, its power is immense, but its use demands great care and caution, Picrotoxicon, its alkaloid, a most irritant poison, is used in the form of a cerate to kill parasites on the skin. It has also been used with some success in epilepsy. Best to try it in pill form. The whole herb is Cochlearia Officinalis, officinal. The bac- {Scurvy Grass) tericide properties are most abundant in the green plant. This resides in an oil which is obtained by distillation from both the green and dried plant, most abundant in the former ; this oil is identical in germicide properties with the oil of mustard. The tincture of either the Scurvy (irass. green or dried plant, best made with dilute alcohol. It is, take it all in all, an excellent energetic stimulating alterative and germicide, very useful in dormant liver or spleen ; often suc- cessful in paralysis ; of great utility locally in ulcers, sores in the mouth, and spots upon the skin. BACTERICIDES. 289 Cocoa Theobromo. The fruit of the gods, from tree which is extensively cultivated in the tropical parts of Asia, Africa and Amer- ica. It is a tree which rises with a bare stem to the height of six or seven feet, dividing into many branches, and attaining a height of from sixteen to twenty feet ; oftentimes tw^ce that height. ^^^^{iy////» It attains its full growth in seven ^ M\^I^^^Uiiw<'^^^f/ years. The fruit has the appearance of a cucumber in shape, six or eight inches long, yellow, but red on the side next the sun. The rind is thick and Avarty, the pulp sweetish, not unpleasant, the seeds quite numer- ous, easily compressed, with a thin, pale, reddish brown, fragile skin or shell, covering a dark brown, oily, aromatic bitter kernel, which con- sists mostly of wrinkled cotyledons. These seeds are the beans of com- merce ; the larger seeds decorticated, Ijruised, ground, yield that delicious, nutritious beverage — cocoa. The principle constituent of the bean, aside from this more solid constituent, is the oil or butter of cocoa, which forms fifty per cent, of their weight, a glucoside, t/ieo~ droma, which is identical with caffeine, slightly more nitrogenous. The butter is extracted by com- pression of the seeds, or by de- coction, or by the action of a sol- vent; the method of expression is preferable. The butter is an ex- cellent germicide ; useful for mak- ing bougies, cones, pastiles, sup- positories and ointments. Theobroma Cacao. •Coffee ; a, a branchlet with leaves, flowers and fruit ; b, section of fruit. hilarating and refreshin| The important con- CofFee. stituents of the coffee bean is caffeine, a sub- stance to which it, tea, kola nut, guarana, cocoa nut, owe their ex- The effect of caffeine is not 1290 DISEASE GERMS. identical witli tea or coffee, or the other drugs containing it ;. all possess a germicidal action. Extensive clinical experience have demonstrated caffeine to stimulate the heart and respiratory movements ; increase the peristaltic wave ; excite the brain and spinal cord ; retard tissue change, and augment the flow of urine. It is the remedy which excels all others in the so-called nervous headache, or in that due to fatigue or overwork, or the abuse of intoxicating li- quors. It is used as an antidote to opium poison- ing; as a diuretic in drop- sical effusions due to cardiac disease. Dose : from two to five grains. Of the various salts of caffeine, the citrate and bromide have m.et with most favor, being soluble and not deliques- cent. The caffeine soda salts are the best germicides,, because they are per- fectly soluble in water, and make permanent solutions, and will, if brought in contact with the amceba of catarrh, the bacteria of erysipelas, kill those micro-organisms. American Columbo. The an- American nexed wood Columbo. cut is an il- lustration of the columbo or frasera, which grows so abun- dantly in our Southern States. Frasera is a mild, bitter tonic, of a rather fine order. In many particulars it re- sembles columbo in its medical properties as well as in its appearance, and experience in. BACTERICIDES. I29I its use has given us a high opinion of its virtues. It neither astringes nor stimulates, and is a bitter above all others that is most acceptable to the stomach. It answers admirably as a remedy in simple dyspepsia and in all enfeebled states of the alimentary canal. ' Its very mildness and absence of all irritating properties render it a tonic of great value in the convalescing stages of all acute diseases. Even in inflammation of the stom- ach it will be tolerated when all other remedies will be rejected. The article termed fraserin is simply a solid extract in a state of trituration. Columbo is regarded as next to coUinsonia as a tonic to the stomach and bowels. There are many preparations of it, all of great excellence. The following formula is very efficient : an ounce of columbo, half an ounce of ginger, the same of leptandra, and thirty grains of capsicum, to one pint of boiling water. Dose, a wineglass three times a day. Colchicum, as employed in medicine, is either the bulbous under- ground portion (more cor- rectly termed a corm) or the seeds of the meadow saffron. From the corm are pre- pared an extract and a wine of colchicum, and from the seed a tincture. Colchicum seems to have the effect of increasing the flow of bile, of diminishing the force and rapidity of the heart's action, and if large doses are used, causes vomiting and purg- ing. The specific action of colchicum is, however, on the pain of the gouty par- oxysm, which it relieves in a marvellous manner. Its use is followed by some pros- tration, and a tendency to faintness which is far from agreeable, even though the pain has gone. It is sometimes used in acute rheurhatism, but does not produce the same wonderful effects as in gout. There is, how- ever, one fact which is of vital interest to those who suffer from gout, they may kill the pain with colchicum, but they do not cure the disease, and in all probability this will return sooner or more violently after being chocked off with colchicum, than had it been allowed to exhaust itself, or other remedies, as alkaline purgatives, employed. Of the ordinary extract, about a grain Colchicum. 1292 DISEASE GERMS. should be given for a dose ; of the wine and tincture ten or fifteen drops every four hours. Its bactericide action is exerted chiefly on amylobacta and urate of soda of gout. Indicated where there is a rheumatism of joints, worse by motion. Dysentery of a bloody mucous character, with loathing of food, and nausea. Dose, one-half to one drachm of the wine, or twenty-five to thirty drops of the normal tincture. In small doses it is valuable in pericarditis, gout and rheumatism of the small joints. It may be used in any heart affection connected with rheumatism. In dysentery, with stools like the scrapings of flesh, colchicum is a good remedy. In tympanitis, three drops of the tincture every half hour is a very positive relief And where there is a pain after urinating, twenty drops three times a day gives relief In dropsy after scarlet fever small doses, say three to five drops with thirty to fifty drops of the tincture of asclepias syriaca is apt to be followed by a cure. Colchicum with apocynum androsem, in doses of ten to thirty drops, ac- cording to age, cures dropsy or rheumatism. Commonly known as '' stone CoUinsonia Canadensis, root," or " knob root," is one of the most valuable of indigenous American medicinal plants. It is widely distributed, being found in richly-wooded soils from April to October in all sections of the United States. It possesses a rank aromatic odor, and is hot and somewhat pungent to the taste. Its principal medicinal con- stituent appears to be a volatile oil, which is driven off by boiling or drying. All parts of the plant may be used in medicine ; but the root is the most powerful, and the portion usually employed. As it yields its virtues to water and alcahol, it may be administered in the form of a powder, or as the tincture, the fluid extract, or the infusion. The dose of the powdered root varies from ten to sixty grains, that of the tincture from twenty drops to two drachms ; the fluid extract from fifteen minims to a drachrrt ; the infusion from one to four ounces. The physiological action of collinsonia, very much resembles bayberry and stone crop, intermediate between the two. It is an astringent to mucous surfaces and a bactericide of consider- able power, besides equalizing chaotic nerve centres. It is very highly esteemed in all disordered states of the ali- mentary canal, starves out both gastric and intestinal sarcinae. Its action upon all organs contained in the pelvic region is BACTERICIDES. 1293 good, relaxes the ureters, promotes an increased, flow of urine, facilitates the expulsion of calculi, diminishes the irritability and general sensitiveness of the bladder. Acute cystitis is most effi- ciently treated with collin- sonia in alternation with gel- semium. So is constipation, hemorrhoids, rectal neuralgia. Again in chaotic nervous affections, like chorea, it is equal to cimicifuga in its ac- tion; very valuable in neuroses of the vagina. Its germicidal action is best seen in its sterilizing the mi- crobe of hooping-cough. Upon the urethra, prostate and rectum its action is very similar to the stone crop. It has some peculiar action upon ptomaines, as when it is being used, all odors of the body disappear. CoUinsonia is of great utility in piles, as follows : Tincture hamamelis, tincture collinsonia, tincture euonymus of each equal parts. Teaspoonful in water four times daily. Take the first daily dose early in the morning in a tumbler of water in which ten grains of soda bicarbonate are dissolved, then at night just before retiring; remaining two doses between meals. CoUinsonia. The product of gun-cotton dissolved in ether Collodion, and alcohol, when exposed to the air, the ether speedily evaporates, leaving it in such a state that when painted on it leaves a thin film on the surface to which it is applied. This film is impervious to the air and is very useful for cuts. Steeping gauze in collodion and applying in gaping wounds, supersedes the use of sutures. Tannic acid and collo- dion are useful for sterilizing the microbe of corns. 1294 DISEASE GERMS. A preparation called flexible collodion, made by adding Cana- da balsam and castor oil to ordinary collodion, is however much more useful in many instances than ordinary collodion, as it does not crack on being bent or stretched. To this various germicidal remedies can be introduced and painted over parasite skin affections — creolin, resorcin, ichthyol, creosote, naphthaline, added render it an application of the most powerful germicidal character. The com- Colt's-Foot, mon name of a British plant, known to botanists as tMssilago farfara. It is a com- positous plant, and has had a good reputation as a remedy in diseases of the lungs. Colt's-foot contains an en- ergetic active principle, a glucoside, which is a most valuable germicide. This principle sterilizes the microbe present in asthma, bronchitis, and incipient pulmonary dis- ease. Cigars made of the leaves and smoked afford prompt relief in the violent paroxysms of asthma. Infusion excellent for colds. Coltsfoot. The root of this plant Comfrey. yields to water a peculiar mucilaginous substance, highly antiseptic, which renders it of great value in the treatment of all bronchial affections. It has a sterilizing action on the amoeba of chronic catarrh, and on the conferva of long-standing bronchitis. It yields its properties to hot water ; hence an infusion is the best form for administration. It makes a most admirable tonic for female weakness as follows : Take one ounce each of the fluid extract comfrey, Solomon's seal, uni- corn root ; half an ounce each of fluid extract camomile, compound gentian, sassafras, cardamom ; Common Comfrey. BACTERICIDES. 295 alcohol, four ounces ; sherry wine, one pint and a Dose : A tablespoonful every three hours. half. Mix. Convulvus Panduratus. Common name, Indian Turnip, man of the earth. Its properties are that of a most active bactericide, mild but efficient alterative, without pro- ducing any drastic action either on the bowels or kidneys. The milky juice of the fresh root is so powerful a germicide that it will, if applied to the part freshly bitten by a rabid animal or venomous reptile, kill or antidote the poison. Indian Turnip. One or two drops in a carious Concentrated Ozone, tooth will instantly relieve most vio- lent toothache ; rubbed over a painful nerve the pain of neuralgia ceases ; two to twenty drops in sweet- ened water will afford most refreshing sleep ; cloths saturated with it and applied (covered with oiled silk) over any portion of the body suffering from inflammation, will instantly arrest it and cause a renewal of life ; to the abdomen in cholera and typhoid ; to the throat in diphtheria and scarlatina. Successfully used in parturition to alleviate its pains by rubbing it over the abdomen and lumbar plexus of nerves ; if applied over the mammae when secreting the lactiferous fluid it is a more efficient arrestor of secretion than belladonna. Dose : For internal use five to ten drops ; for local use rub freely over the painful part ; repeat as indicated. has been chemically examined. It con- Condurango Bark tains two or three glucosides and a resin, all of them manifesting the same action. These substances form collectively the condurangin. It coagu- lates when heated in an aqueous solution, even at 40° C. and, like albumen, is precipitated from an aqueous solution by sodium chloride. Its action on the central nervous system is decidedly a poisonous one. In small doses it produces symptoms like those of tabes dorsalis in ataxic change of gait. It also appears to act on the peripheral nerves and muscles, at first increasing and then depressing their electric excitability. Loss of appetite, and in the earlier stages a plentiful flow of saliva, as well as 1296 DISEASE GERMS. ;)'mptoms in mammals. The poisonous dose of condurangin is about 0.02 gramme per kilogramme of the body weight for carnivorous animals, and about three times as much for herbivorous animals. It was brought forward as a remedy calculated to destroy the microbe of cancer, but for this purpose it is utterly useless. An'ozonized extract prepared from the conium Conium. maculatum is one of the most valuable remedies when the blood is germ- laden with the micrococci of cancer. From one to three grains should be given every four hours. It sterilizes the cancer germ, it aids in rectifying the defect in nutrition upon which the degradation of bioplasm takes place so as to give us the germ. So valuable is this remedy that no case of cancer can be successfully treated with- out it. Excellent results are ob- Conium Maculatum. taincd from the administra- tion of conium in the cure of chorea with violent movements. Large doses at first are best, until the system is thoroughly under its influence, when smaller doses, more frequently repeated, will keep up its action. The uncertainty of action of certain preparations necessitates care in its administration. An ointment prepared from the green leaves is an admirable remedy in rectal irritability and fissure. Two glucosides from the Convallamarin — Convallarin. flowers of convallaria maja- lis, or lily of the valley, con- vallamarin and convallarin, whose physiological effects were determined by Marme, in 1 866. Convallamarin is of a persistent bitter taste, readily soluble in water, insoluble in ether and chlo- roform. . Upon boiling it with diluted acids, it is split up into BACTERICIDES. 1297 cofivallamaretin and sugar. According to Marme, it is emetic in small doses, and affects the heart similarly to digitaliu, arrest- ing its action in systole. The commercial pro- ducts vary widely in strength. Merck's con- vallamarin may be ad- ministered hypodermi- cally in doses of .005 to ,02 grammes several times daily. Given by the mouth, .05 to .06 grammes every hour or two up to .1 gramme per diem, produce the full effects of the drug. Lllyofthe Valky. Convallamarin is indicated in weakness of the heart, oedema from myocarditis and other cardiac diseases, as well as in exudative pleurisy and Bright's disease. Convallarin has a scratchy taste, sparingly soluble in water, insoluble in ether, but readily soluble in alcohol. It is also separated into convallamaretin and sugar upon being boiled with diluted acids. In action, it is purgative only. Dose : About one-fiftieth orrain. An alkaloid from the coto bark ; of great utility Cotoin. in diarrhea and cholera. Cotoin is insoluble in the gastric juice of the stomach, and passes unchanged into the intestines, where it is dissolved. It is specially indi- cated in the diarrhea of those affected with ulcer of the bowels, as in the insane, in phthisis, in the diarrhea of detention. It is contra- indicated if there be congestion. Dose : One grain for adults ; half grain for children, in powder or emulsion ; several times a day. A leafless herb, sending up Corallorhiza Odontorhiza. from a coral-like rhizome a {Coral-Root.) simple flower, from si^ to six- teen inches high, furnished with sheaths, instead of leaves, of a light brown or purplish color, and bearing small, greenish-brown flowers in a long: spike. It is a parasite plant, growing from the roots of trees, and 82 1298 DISEASE GERMS. nourished by them. The root is the part used. It is much branched, toothed, of a brown color, and from its resemblance to coral in appearance, has derived its name. Like numerous other parasite plants, it has a peculiar action in morbid states in which micro-organisms play an important part. Administered in doses of thirty grains, every three hours, either in powder or in jelly, it acts precisely like exalgine, lower's heat, respirations, pulse. Corallina. Corn Smut. piles, epistaxis Ustilago, fl. extract, ten to sixty drops in uterine hemorrhage, bleeding aids parturition when uterine contractions are feeble. Useful in enlarged p r o s t a te ; s permator- rhoea, im- potence. The re- Maize, or Indian Corn. \Zea Mays). putation* of stigmata maidis, as a diu retic , demulcent, and anti- septic in all affections of the genito-urinary tract, is well established. In order to obtain a most efficacious preparation, the fluid extract should be prepared from freshly-gathered silk. Cotton Plant. The bark Cotton Root. of the root of this plant is emmenao-ogue, parturient, abortive and diuretic. As it causes a condition^ of .engorgement, in true congestion, it is very apt to BACTERICIDES 1299 be followed by hemorrhage in patients of a sanguine tem- perament. The bark of the green root is the most active, the so-called active principle gossypium, is worthless, perfectly inert. Those desirous of procuring a reliable article of cotton root, must procure it from some one who will dig the root, slice off the bark, and at once put it into alcohol. To imagine that it can be prepared otherwise is absurd. Dried root preparations are all worthless. This is the active volatile constituent of the Coumarin. tonka bean, a germicide of great power, capable when administered in hooping-cough of kiUing the microbe of that disease. This active principle is sometimes found in a crystallizable state, between the two lobes of the kernel, but more commonly it is thus prepared : The beans are coarsely ground, heated for some days with twice their bulk of alcohol. This tincture is poured off, set aside, and the tinctured mass subjected to the same process. After this is completed, the two tinctures are mixed together, the alcohol distilled off until it appears turbid, when twice its bulk of water is added, which precipitates the coumarin and fatty matter. This precipitate is then heated to the boiling point and passed slowly through a wet cloth, which attracts all the fatty matter, and the coumarin passes through. The fluid extract may be used with great advantage. Tonka Bean. is a substance composed of carbon, hydrogen, Creatine, nitrogen, and oxygen, and is found in the juice of the flesh of all animals. A pound of flesh yields upon an average about five grains. The quantity varies in dif- ferent animals. The flesh of fowl yields the largest quantity. The flesh of fish contains it in larger quantities than beef or mut- ton. Creatine is obtained in colorless, transparent crystals, and, dissolved in water, it has a slightly bitter taste. It unites with the various acids forming salts. If creatine is boiled with I^OO DISEASE GERMS. alkalies, a new alkaloid is produced called sarkosine. If boiled with hydrochloric acid, it produces creatinine. This substance also forms salts with the various acids, and is found normally in flesh. These alkaloids are probably the result of the decompo- sition of the flesh of animals. They are found with the extract of meat, but whether they exert any power on the system is not known. B. F. Shepherd, M. D.y Frankford, Ind., in an able and elabo- rate article on creatine, entertains a most favorable action of it and recommends its use in doses of two grains, four times a day,, as a remedy of great value, as an excitant of muscular action in atonic conditions of the general muscular system, especially of the heart. The remedy is placed dry on the tongue, and fol- lowed by a draught of water. A bactericide of the very highest order, pro- Creosote, duced in the destructive distillation of wood for the purpose of obtaining acetic acid. It is a colorless, transparent liquid, with a peculiar odor and burning taste. It is an invaluable drug in medicine, its germicidal action is prompt, decisive. It completely annihilates the bacillus of tubercle, the sarcinae ventriculi of gastric catarrh, the microbe of diarrhea and dysentery. Inhaled through hot spray atomizer, it kills the germs in the bronchial tubes. It is not well to use it in lotions or gargles, as it does not mix with water. It is freely soluble in alcohol and acetic acid. On account of its remarkable property in coagulating albumen, it has acquired quite a reputation in coagulating aneurisms. Externally applied to the germ-laden veins in phlebitis, its power of penetration is so great by endosmosis, that it kills the entire bacterial colony ; of great value in destroying the microbe of dental caries ; com- bined in various proportions with salicylic acid, it is capable of destroying the microbe of lupus, and other forms of skin germs and parasites. Internally, in all affections where the tubercular bacilli are present in the blood, it has the power of sterilizing and partially annihilating that germ. It should be given internally in syrup of tolu or some emulsion in drop doses, and by inhala- tion of various strengths. This well-known germicide has been demonstrated by Pro- fessor Bigger^ M. D., of Atlanta, Ga., to be fatal to micrococci in the strength of i to 200. While he admits that it may not be from its antiseptic or germicidal powers that it benefits, but that BACTERICIDES. 1301 it may be simply from its favorable action upon digestion, still he advises that it be pushed to its utmost limit of toleration, as here is where so many fail in its use. Pushing it to this extent would be unnecessary if its beneficial action was expended only upon the process of digestion and assimilation ; for experience with the drug plainly shows that it is the small doses, and not the large, which assist digestion, and that the large ones which he advises, occasionally irritate the stomach. He says that dis- appDintment arises through timidity. " The more creosote that can be borne the better the effect," is his dictum. He claims to have treated 500 cases during the past nine years, and of those treated by this formula, twenty-seven per cent, recovered. Others were treated by the following formula, which gave the best results : Creosoti, fifteen minims ; tr. gentian, forty-five minims ; spir. vini rect., six and one-half fluid-drachms ; vini xerici, q. s. ad three fluid ounces. Of this, one ounce was taken three times a day. The creosote was gradually increased to thirty grains. He obtained the best results by following treatment for from three months to a year. The most benefit was seen in the young, and in the first stages of the disease, when the symptoms were not well defined. Good results were always secured when tubercular glands were pres- ent. It generally relieved irritation and cough, and secretion and expectoration diminished, so that narcotics could be dis- pensed with. Dr. T, E. Quick, of CarroUton, N. Y., after trying various formulae, settled upon the following as the best : Creosoti purissimi, two parts ; alcoholis, thirty parts ; tr. gen- tianae ; ext. caffeae, aa ten parts; aquae destillatae one hundred parts. M. Sig. — Shake well and take a tablespoonful in half a glass of milk twice daily. From most extensive experience, and merited success, he formulated the following pill : Creosote, one-half minim; iodoform, one-tenth grain; ext. of opium, one-quarter grain ; balsam of tolu, turpentine, of each, one-third minim. Mix. Of these, from three to ten may be taken daily. is a product of the dry distillation of coal, and is an Creolin. oily, dark-brown, fluid, smelling of tar, but differing from carbolic acid in being easily and completely miscible with water, forming a milky solution which tends to become brown. We have tested its action on several I302 DISEASE GERMS. varieties of organisms. A two per thousand mixture of creolin killed the gholera bacillus and the streptococcus of pus and of erysipelas in . two minutes, the bacillus anthracis in five minutes ; but the typhoid bacillus, the staphylococcus pyogenes, was not affected in an hour's treatment. A two-per- cent, mixture, however, killed the staphylococcus and tertragenes in about fifteen minutes. Creolin is a more powerful germicide than carbolic acid ; a three-per-cent. mixture killed the spores of bacillus anthracis in two days, a six-per-cent. in twenty-four hours, whereas a carbolic acid mixture up to eight per cent, did not affect the spores in seven days. Many other experiments con- firmed the superiority of creolin over carbolic acid. Given in large doses to animals, creoHn is not found to be poisonous. It is eliminated by the kidneys, and the urine is not discolored, although tribromophenal may be separated from it by the addition of bromine water and of hydrochloric acid. Creolin has been used therapeutically both for external and internal ad- ministration. Externally, we have used a one-per-cent. mixture in a severe case of puerperal joint affection, in ulcers of the leg, in old operation wounds, and also in recent wounds. Good re- sults were obtained in all these cases ; the growth of granulations was stimulated, and the excessive discharge was stopped. Ulcers may be treated with a gauze-compress soaked in a one-to-two- per-cent. solution and bandaged up for about four days. We strongly recommend the employment of creolin in gauze or as an emulsion in surgical practice, in conditions similar to those indicated above. We have employed it with good results in otitis media. We use an injection of the strength of ten drops to one- half pint of warm water in acute otitis. It relieves the pain, and owing to its innocuousness, it may be used as an injection in leu- corrhoea. As regards its administration, it effects big results in gastric catarrh, in diseases of the stomach and intestines. It was found free from poisonous effect and non-irritant. It may be given in doses of three to fifteen grains-, in gelatine capsules, three times daily, and relieves meteorism and catarrh, and is serviceable in the severer forms of local inflammation of the in- testines, such as typhlitis. In simple dilatation of the stomach, in flatulence and in diarrhea, it is of great service. It is of great utility as an injection in cystitis. • It is always well to be a little cautious of taking too rose-colored a view of the action and effects of a newly-introduced drug. If all that has been stated about creolin be correct, we have in it a drug of great import- ance, a powerful antiseptic with no poisonous qualities. Experi- ence will determine the extent of its utility. The germicidal properties of creolin has been thoroughly in- KACTERiCiDES. 1303 vestigated bv 'enns\'lvania's great bacteriologist, J allies M. Bunii, non-toxic disin- mixing a certani per- culturcs of the organism. M, D., of Altoona, Pa., who pronounces it fectant bactericide. The experiments were performed by centage of the antiseptic with bouillon from which mixture, after a certain time, the presence of living bacteria was tested by a fresh cultivation free from creolin. It was found that a two-per-iooo mixture of creolin killed the cholera bacillus and the streptococcus of pus and of erysipelas within two minutes ; the bacillus of anthrax was killed in five minutes, while the typhoid bacillus and the staphylococcus of pus were still alive after one hour. The last organism, as well as tetragenes, was killed in ten to fifteen minutes by a two-per-cent. mixture. Compared with carbolic acid, it was found that a two- per-cent. mixture of creolin killed the spores of the anthrax bacillus in two days, a six-per-cent. mixture within twenty-four hours, while a carbolic acid mixture up to eight per cent, had no effect on the spores within seven days. A similar comparative result was obtained with the hay bacillus, and the superiority of creolin over acid was further shown by its great power of pre- venting the growth of organism in culture. Creolin is not poison- ous, as it maybe given in large doses to dogs without deleterious effect. Biinn earnestl}' recommends its use in surgery in place of corrosive sublimate, carbolic acid, and iodoform. He has strongly recommended its use. He has applied it in the form of emulsion or a creolin gauze, and found that it stimulates the growth of granulations, and aids in separating sloughs without the pro- duction of any toxic symptoms. The urine does not present the green color of carbolic acid urine, but tri- hromophenol may be separated from it on the addition of hydrochloric acid and bromine water. Curarin Curarin is found in Sulphate, the form of a sul- phate in the arrow poison of the South American In- dians, the so-called curari or woorari which is derived from a number of plants of the strychnos family. Curari was first brought to Eu-rope by the celebrated traveller, Waterton. It has long- been used as a remedy in the treatment of convulsive affections. Woorari Poison. I304 DISEASE GERMS. tetanus, hydrophobia, etc., with more or less success. The dose of the curari is one-tenth grain. Great care must be exercised in its use. The sulphate of curarin is used for the same disease, but as it is more powerful than curari, the dose must be propor- tionately smaller. From one-twentieth to one-sixtieth of a grain has been given. The remedy is worthy of trial in cases of tetanus, when the combination oi lobelia, capsicum and valerian cannot be procured. Cyclamen Europseum ; a, the b, the fruit. ^hole plant; point of until the germ dies. an emetic cathartic spasm gives way ; This is a glu- Cyclamen. coside isolated from cyclamen europseum, a powerful germicide, capable of destroying the microbe of tetanus, producing effects on the animal system analogous to those of curari. This prepara- tion is soluble in water, sparingly so in alcohol. Upon shaking an aqueous solution it assumes a frothy appearance. Besides being destructive to the germ of tetanus, it has the same action on the red corpuscles of the blood. Either orally or hypodermi- cally, its administration must not be prolonged or carried to the , small doses frequently repeated then at longer intervals, until the Turiiera aphrodisiac a, is used in renal and vesi- Damiana. cal diseases, nephritic albuminuria, diabetes, and has proved successful as a nervine tonic in a case of blindness from tobacco amaurosis ; also as a tonic for the genito-urinary tract. The fluid extract when ozonized is indicated in all cases of sexual debility in young or old of both sexes. It is a true sexual invigorator, its merits are sustained by extensive experience, and it is of the greatest efficacy in every case of genital debility. Dose: From ten to thirty drops added to water; every three hours. BACTERICIDES. 1305 Foxglove, a powerful car- Digitalis, diac tonic in small doses in enfeebled heart action, a stim- ulant which gives permanent improvement by increasing the nutrition of the heart. It exerts a contractile or tonic action upon the capillaries, unlocks the absorbents, and sterilizes disease germs. Where the heart is feeble, there is no more direct remedy than digitalis. In all forms of serous effusion, the infu- sion of digitalis is a drug of great efficacy, and can always be relied upon in the gravest cases of dropsy. The tincture is the best form for general administration. In all cases it exercises a special influence on the circulation ; a sedative, calming in- fluence, which can only be explained by its excitant action on the ultimate branches of the sympathetic system. Foxglove or Digitalis- The bark of the Dogwood, cornus Florida forms one of our best ozonized fluid extracts and may be prescribed with great certainty as a tonic, germicide, stimulant. It acts chiefly upon the brain and spinal cord as a stimulant. Some think that it is a good substitute for quinine; in this they are mistaken. It is much inferior to cinchona preparations. Still it is an excellent tonic in dyspeptic cases. Its internal use increases the strength and frequency of the pulse, and elevates normal, while it depresses abnormal tempera- ture. Dose of the bark from thirty to sixty grains. A fluid extract in doses of from a half to one teaspoonful every four hours is a good form in which to administer it. Dogwood. I306 DISEASE GERMS. Sunde patient relief from bronchial This plant is highly Drosera. germicidal and has a wide range of action. Its effects are best exhibited when administered in diseases of the re^ spiratory organs, as in nasal catarrh,, laryngitis, hooping cough, asthma, bronchitis, pulmonary phthisis. It promotes a renewal of vitality, bet- ter innervation of the lungs, at the same time it sterilizes all germs in the air passages. The special action of this drug is upon the great nerve centres, having a special action in getting rid of congestion. Its action is mild, but invariably effective, affording the irritation. Eggs. — In addition to eggs being a nutritious food, they are also of value as a medicine. The albumen, beat up in water and salted, is an excellent remedy in diarrhea, also very useful in. the vomiting of cholera infantum. Or squirting Elaterium. cucumber, in its mature state, is a plant rough all over with stiff hairs, has a trailing branch stem without tendrils ; the leaves are heart-shaped, bevelled and tooth- ed on long stalks ; the flowers axillary, yellow ; the male-flcw- ers in small racemes ; the fruit oblong, about an inch and one- half long, grayish green, covered with soft prickles and finally parting from the stalk and ex- pelling its seeds along with a thick mucus, through the aper- ture, where the stalks are in- serted. This remarkable phenomenon is action within the fruit : a thin membrane Wild Cucumber {Ecbalium agresti'i . ascribed to osmotic separating a. mucus BACTERICIDES. 1307 which immediately surrounds the seeds from a less dense juice, which abounds in the succulent part of the fruit, and the quality of the former being gradually increased at the expense of the latter, till on the perfect ripening of the fruit, the much-distended central cell is open to permit its ejection. It is this mucus surrounding the seeds — a thick green mucus of a very peculiar character which contains the elaterin. To collect this the juice of the ripe fruit is allowed to stand a short time and become turbid, when it deposits a sediment. This sediment, carefully collected and dried, is elaterium, from which the crystalline principle elaterin is prepared, one of the most powerful of all drastic cathartics, but invaluable in certain forms of dropsy. The patient should be, in all cases, suitably prepared for the remedy by drinking rather freely of an infusion of digitalis for a few days, and then the elaterin in one-twelfth of a grain, in a fine state of trituration, should be given every few hours until copi- ous evacuations of serous fluid takes place. Elaterin. — Indicated in all dropsies — the most active agent known to remove large serous accumulations. Its use should be preceded by infusions of digitalis. Dose : one-twelfth to one- twentieth of a grain triturated in sugar of milk, as indicated. A bac- Elecampane. tericide of great pow- er, exercising a peculiar ster- ilizing action on all microbes ; has a most remarkable action on the bacillus of tubercle. It is worthy of further inves- tigation. It is a good remedy, of in- trinsic value in rabies ; it has a powerful germicidal action, faint aromatic odor, a bitter, acrid and a somewhat cam- phor-Uke taste. It is a stimu- lant to the organs of secre tion, promotes expectoration, and is a diuretic and soporific. Elecampane {Inula Helenium). It contains two active principles^ one called inulin, which resembles starch, but is deposited un- changed. An old author speaks of it thus : " Elecampane root, taken with honey made in an electuary, cleanseth the breath, ripeneth the i3o8 DISEASE GERMS. tough phlegm and maketh it easier to be spit forth, and prevaileth mightily against the cough and shortness of the breath, com- forteth the stomach and helpeth digestion." The bark, leaves, shoots, flowers and berries of the Elder, common elder are highly antiseptic, diuretic and slightly narcotic. These properties reside in a vola- tile oil which is present in the entire plant, but most abundant in the flowers. A decoction of the leaves is so strongly antiseptic that if ap- plied to the bacterial blush of erysipelas, it will in a few hours destroy the germs. Elder water is unexcelled as a local antiseptic in skin affec- tions. An ointment prepared by simmering the inner bark, flowers and leaves, in lard, is very highly esteemed by rectal specialists as a local application to rectal ulcers of a tubercular character. The following is their for- mula: Unguentum sambucus, one ounce ; hydrargyrum mur. sub., thirty grains; pulverized opium, solid ex- tract belladonna, of each, seventeen grains. Mix. The bowel is first washed out with castile soap and tepid water, subsequently the ointment is brushed over the ulcer. . This repeated several times at intervals of a week apart until the germ colony is destroyed and the ulcer heals. Elder flower soap excels in therapeutic value all other germi- cidal soaps. The berries make an agreeable sub-acid wine, con- taining much malic and citric acid, sugar and glucose. Flower-stock, leaves, and cluster of berries of com mon elder {Sambucus nigra). Elm Bark. The pulverized bark makes an excellent ger- micide poultice, to which bicarbonate of soda in any given quantity can be added.' An infusion of the bark is one of our best remedies in gastritis and gastric ulcer. BACTERICIDES. 1309 Slippery Elm Bark in the successful treatment of tapeworm is well presented by recent authors. Pulverized slippery elm bark, four ounces ; water, one pint. A tenacious mucilaginous flyid is thus obtained. The following directions for use are given : The patient to fast two days ; the evening of the second day to take a purgative dose of castor oil sufficient to move the bowels the following morning, and while still fasting take one-half the medicine, and in half an hour the remaining half along with the full dose of castor oil. In a case so treated the entire parasite in a mass was expelled in one hour after the last dose of medicine, measuring forty feet in length. Epilobium Angustifolium. {WiU(m) Herb) This indigenous plant has very nearly identical properties with the willow tree, and even yields sali- cine, hence it is germicidal, bracing, se- dative, astringent action. It yields its properties freely to both water and alcohol. It seems to have a special affinity to unite with and destroy the micro-organ- isms of diarrhea and dysentery. Its sphere of action is best exhibited upon all organs in the genitourinary organs, hence it is valuable in catarrh of prostate. The tincture is the for administration. Willow Herb. the vagina, bladder, most eligible form Erigeron Canadensis. The oil is equally effi- cacious as terebene, and as powerful a germicide, also astringent, styptic. Five drops of the oil on sugar repeated as indicated, exerts a well-marked influence over the heart and arteries, and is a most efficient remedy in chronic bronchitis. Re- cent extensive clinical experience with this ancient reputation as an invaluable haema- static to the uterus, bladder and rectum. Its chief sphere of action druor Erigeron. confirms Its I^IO DISEASE GERMS. is upon the genito-urinary organs, it is essentially a uterine styp- tic, stops the flow, lessens the irritability ; it is also of great effi- cacy in haemoptysis. It acts well upon the kidneys, checks haematuria ; greatly lessens the flow of albumen in chronic inter- stitial nephritis, and in chronic cystitis it exerts a good effect in lessening; the mucous exfoliation from the coats ot the bladder. If the oil dropped on sugar and administered excites any heart- burn, administer in mucilage or syrup of tolu. The degradation of the primary elements of nutri- Ergot. tion of certain grasses, cereals, fruits, vegetables, by adverse states, as poverty of soil and absence of nutritive pabulum, into a fungus or microbe, has nothing in com- mon with the normal gland. The principal use of this fungus, up to a lecent period, has been its efficacy in parturition. When administered during labor, it produces a constant, unremit- ting contraction and rigidity of the pregnant uterus. Consequently, un- less the OS uteri and external parts, are sufficiently relaxed, it is apt to prove disastrous to the mother and child. The indiscriminate use of this fun- gus gives rise to thrombosis or em- bolism, hence sudden deaths during its use is the rule from clot and rup- ture of the heart. It is, however, a spinal stimulant of great efficacy, and this, together with its faculty of causing a coagulum to form in the blood, renders its use of rare value in all hemorrhages from or- gans in chest and abdomen.- So are its properties as a spinal stimulant, that hypodermic injections of ergotine, will, in short time, reduce an enlarged prostate, or cause absorption of a uterine fibroid ; so with en- largement of the thyroid. The Glucoside Ergotine. — By stimulating the spinal cord (lum- bar portion) it causes contractions of the uterus ; used in paraly- sis of the sphincters ; enuresis ; incontinence of urine ; impot- enc}^ ; to absorb uterine fibroids ; diminish enlarged prostate. Dose : one-fourth to one grain every four hours. Ergot ©f Rye. great BACTERICIDES. 31 or adder's-tongue. All parts Erythronium Americanum, of this plant are active in the destruction of microbe. The plant in its green state is most ■energetic, its activity is much diminished by drying. The crushed leaves and bulbs, added to diluted alcohol, macerated four weeks, percolated, make an elegant preparation for emetic purposes, as an alterative and germicide; in very small doses it is often of advantage in the cure of chronic eczema and herpes. In the form of a preparation made from the green plant we derive the most efifi- cient results. Cerate is of great utility in nearly all skin affections. Eryngium, This is ive tonic a most effect- valuable active stimulant germicide and restorative. Its special action is upon the genito- urinary organs, being a diuretic and Adder's-Tongue {Ophioglo su»,- 7>ulgatnm\. Sea Holly; {Efyngiiun 7naritimu)ii) ; a, a floret; b, a petal; c, a stamen; d, the pistil. aphrodisiac. In its action it re- sembles apio], allays vesical and urethral irritation from what- ever cause. Some claim that it will destroy the microbe of snake bite, but this is not correct. It acts well in some cases of dropsy, dependent upon conges- tioh* or obstruction of the kidneys with liric acid. Its use in alternation with the saw palmetto, has a most excel- lent effect in atrophy of the testes. It has been used with great success in dropsical effusions. It acts well in all such cases, in alternation with strophanthus. 1 2 12 DISEASE GERMS. This plant has been thoroughly Eschohltzia Californica. investigated, and three distinct products have been isolated : a glucoside, a new alkaloid, resembling codia, and a very small percentage of morphia. Two pounds of the dried plant yielded about six grains of morphia. The tincture, or fluid extract of the entire plant is a most ex- cellent, efficient germicide, and entirely well adapted to combat the various diseases of infancy, especially the green diarrhea of the summer season. From a large number of cases in which the remedy was used in cholera infantum during the heated term of July, August, and September, in crowded-up abodes, devoid of all sanitary precau- tions, and among a class of cases, with great vital disorder, pain, fever, spasm, prostration, it has demonstrated itself to be a rem- edy of vast importance, and one destined to supersede lactic acid, salicylate soda, resorcin, in the treatment of those formidable af- fections. It can be administered with safety to the youngest child in any stage of the disease, and always wjth the most satis- factory results. * In infantile diarrhea, when the common bacillus are liberating ptomaines, as is manifested by the symptoms of utter goneness, pallor, distress, tense abdomen, drawing up of knees, screaming or crying, etc., with green stools, in this stage the action of the ramedy is seen to the best advantage, for when administered right here, a complete change to the better at once takes place, and if persevered with, the green stools, with the bacillus and ptomaines, disappear and recovery is rapid. the name applied to an extensive genus of Eucalyptus, trees of the myrtle family, natives of Australia and Tasmania, all possessing great germicidal properties. The eucalyptus globulus, or blue gum, one of the species, has come into high esteem and deserved repute as a sanitary tree, and has exercised in regions of the warm temper- ate zone, a greater influence, scienic, industrial, hygienic, bacteri- ological, than any other species of arboraceous vegetation, even the pine not excepted. It is a great ozone generator, liberates that agent in great abundance. The planting of this tree in the most pernicious paludal and malarial marsh, where ozone never penetrated, and human life could not exist, rendered them perfectly habitable and healthy. There are numerous preparations made from the selected leaves, such as a fluid extract, which is almost inert, as in the mode of extraction, the essential oil is virtually lost. BACTERICIDES. I o i ^ All the bactericidal properties of the leaves are in this essen- tial oil, which can readily be prepared in the form of a glycerite, and five volumes of hydrogen dioxide added, in this form we have a germicide of great efficiency in sterilizing and annihilat- ing the microbes of croup, diphtheria, catarrh ; and is capable of neutralizing offensive discharges from the vagina, or ulcers. An ozonized distillation from the leaves is the most efficient remedy ever discovered for promptly killing the gonococcus of gonorrhea ; one ounce of the distillation, added to four ounces v/ater, gives us an injection of intrinsic value in gonorrhea, leu- corrhea, ophthalmia. Suppositories prepared from the fresh leaves kill the tuber- culse bacilli of a germ-eaten rectum. A cerate prepared from the oil is valuable in erysipelas. Eucalyptus honey, contains all the ozone-generating properties found in the tree, and to the presence of which are due all its wonderful germicidal properties. This honey plays an important part in the cure of all laryngeal, bronchial, pulmonary diseases, as well as in hooping-cough and influenza. Eucalyptol^ active principle in solution. — -In the administration of this remedy for malarial fever, open the bowels freely. Three hours before the chill, ^°^'^ Eucalyptus, give two tablespoonfuls of the extract undiluted; drink of all kinds to be strictly forbidden ; twenty minutes before the rigor, another half-ounce. In place of the chill, a violent perspiration sets in, which has the peculiar odor of a marshy swamp, which is due to the dead germs on the skin. Dose : from ten to fifteen drops on sugar thrice daily. Utterly insufficient to destroy the tubercular bacilli, but acts powerfully on the bacteria. Eucalyptus Folia. — (A distillation from the fresh leaves, ozon- ized.) In gonorrhea, use as an infection after urinating, or three times a day ; for leucorrhea, use as an injection by fountain syringe morning and night ; for ophthalmia, keep a cloth con- stantly wet with it, loosely applied to the eye. An energetic agent to destroy the germs of gonorrhea and leucorrhea. It not only destroys the germ, the factor of gonorrhea, but its use be- fore a suspicious connection acts as a prophylactic. In the various forms of purulent or gonorrheal ophthalmia, it com- 83 iSH DISEASE GERMS. pletely kills the bacteria or gonococcus present. Dose : add one fluid ounce to four fluid ounces of water. For external use only. This new drug has proved most Euphorbia Pilulifera. successful in cases of asthma, bron- chitis, coughs, influenza, affections of the chest, and is now being tried for hay-fever. Preparations. — As this plant is a poison, great care should be taken not to make too strong a decoction, or ill instead of good results may be expected. The decoction is prepared as follows : Place one ounce of the weed in an enamelled saucepan contain- ing two quarts of cold water, boil, and then allow it to simmer for a couple of hours, or until the quantity of water is reduced to one quart ; strain it, allow it to cool, and bottle for use, adding a teaspoonful of alcohol and chloroform to fortify and prevent fermentation ; also a tincture. Doses : Decoction, two fluid ounces to be taken at night be- fore going to bed, on rising in the morning, and an hour before dinner. Tincture : one-half to one teaspoonful, two or three times a day in water. ^^Most favorable reports reach us from all quarters, of the prompt beneficial results in asthma, promoting easy breathing ;and soothing the irritation of bronchial tubes. It succeeds when all other remedies fail. This decoction has, from Euphrasia, time immemorial been famous {Eye Bright}) as a remedy for dimness of vision. On account of its astringent and antiseptic action, it is invaluable in all forms of ophthal- mia. Add to one pint infusion one ounce of boroglyceride, and we have an eye lotion of great efficacy, one which will purge the visual organ of all microbes, and in granular con- junctivitis act as an absorbent to effused lymph. Besides its utility in eye effections, it is often of great service as a diuretic. The in- fusion to be taken freely. An excellent extract may be prepared by macerating the coarsely ground plant with equal parts of water and glycerine for fourteen days, and then percolating. Euphrasia Officinalis (com mon Eye Bright). BACTERICIDES. I315 The extract may be administered in all acute and painful af- fections of the eyes ; it is even successful in opacity of the cornea, in twitching and paralysis of the lids. Eupatorium Purpureum. Queen of the mead- ows, or gravel root, is a decided tonic to the granular structure of the kidneys ; an infusion of the root is very valuable in alternation with nitro-glycerine in Bright's disease of the kidneys. There are few remedies so beneficial as this one in affording relief wherever there is painful suppression of the urine, either from inflammation or from calcareous accumulations. It is of great benefit in the treatment of almost all affec- tions of the kidneys and bladder. In dropsy, strangury, haematuria, gout and rheumatism, it is a valuable auxiliary agent, and of decided benefit in dropsy, on account of its stimulating influence on the vessels, as well as its diuretic powers. Queen of the Meadows, or Gravel Root. The name (ex, privative, and algos, pain) is sig- Exalgine. nificant of its qualities. The formula is CgHnNO (or C6H5.O2H3O.NCH3), and the substance is one of the three isomeric (para, meta and ortho) methyl derivatives of acetanilid. It occurs either in fine acicular or long tablet-like crystals, accordingly as it is obtained by evaporation from solu- tion, or by fusion thereafter. It is sparingly soluble in cold water, more soluble in hot water, and extremely soluble in very dilute alcohol, or in water slightly alcoholated. Physiologically it acts very much like analgesine, having, however, more effect ^pon the sensory and less upon the thermogenic centres than this substance. Its therapeutic effects are obtained in doses of from four to six grains, administered at once, or from six to twelve grains taken in two doses in the course of twenty-four hours, and are powerfully analgesic, subduing the element of pain in all forms of neuralgia, including visceral. Like all new remedies of this sort, it is at present on trial. It is claimed by 3i6 DISEASE GERMS. eminent authority that it has in their hands up to the present exhibited no evil sequelae, being free from the rash, cyanosis, etc., so frequently observed after the ingestion of antipyrine and ace- tanilid, Exalgine is eliminated by the urine, upon the quantity of which it exercises a marked effect, acting like the antipyretics of the same group, diminishing the quantity of the secretion. In diabetes it also diminishes the quantity of sugar eliminated. Like all of the derivatives of the aromatic series, it is antiseptic and antithermic, as well as analgesic, and possesses the latter quality in a comparatively superlative degree, being more effi- cient, in doses less than half so great, than antipyrine. The following is an excellent formula for its administration : Dissolve two drachms of exalgine in two ounces of diluted alcohol, 45 per cent. ; add the same to either two ounces of the syrup of tolu or fluid extract of licorice, and administer in tea- spoonful doses as indicated. Nearly all our essen- Fennel. tial oils are germicides of the first order, and their use is sadly neglected in practice. For example, the oil of pepper- mint has an antiseptic property in it, a potency for good, a field of therapeutic utility, vast in extent and importance, greater than yet known or suspected. The greatest of all desiderata in diphtheria is a germicide like this, which can be fearlessly applied, in the greatest quantity and frequency, which is innocuous, whether it be absorbed or swallowed. The oil of fennel has not such active germicide properties, although a grateful aromatic and carminative. Fennel seed exercises an important action on the broad liga- ments of the uterus, and is utilized with rare success in all cases of prolapsus. An infusion of the powdered seeds, twenty grains to a drachm to a pint of water, is an excellent form for administration. Fennel {^Fceniculuin vulgare) \ a, a flower. BACTERICIDES. 1317 A gliicoside froiii fiunarina officinalis or fiinii- Fumarine. tory ; a most remarkable vegetable bactericide. A simple decoction used as ^yf^ a mouthwash or gargle kills the oidium albicans. As an eye lotion, completely sterilizes all bacteria and other micro- organisms in ophthalmia. A fluid extract is exceedingly useful in congestion of the liver and spleen. It is a very valuable remedy in sterilizing the micrococci of the eruptive fevers. The general properties of this remedy are tonic, alterative, and, in large doses, laxative and diuretic. Its pro- longed use diminishes plethora and will Fumitory. produce anaemia ; so it should be administered for about ten days, left off for four or five days, and then resumed. The whole plant has an agreeable, aromatic Gaultheria. odor and taste, owing to the presence of a vola- tile oil, which is stimulant and highly germi- cidal. An ordinary fluid extract of the plant has in ordinary doses a direct sedative action upon the genito-urinary organs of both sexes. It is an anaphrodisiac, allays irritation and inflammation ■of the bladder, prostrate urethra ; ovaries, uterus and vagina. The oil of partridge-berry yields salicylic acid in great abundance. The glycerite of wintergreen is prepared from the oil, and is with- out a doubt the most valuable of all its preparations, being a cerebral stimulant and vitalizer, and when administered in proper doses, in acute rheumatism, having such a chemical affinity for the lactic, buty- ric ferment or germ in the blood and tissues, completely neutralizes and annihilates it. It lowers tempera- ture, equalizes the circulation. It is a perfect substitute for salicylic acid and its salts, the latter being a chemical derivative of the former. In its use in rheumatism, it has many advantages ; it is prompt and efficient in action — few relapses when used ; no cardiac complications. It is best to administer it in frequent Procumbent Gaultheria {giultheria procumbens) ; a, fruit : b, flower. I3i8 DISEASE GERMS. doses, till temperature is lowered. It is a local anodyne to» inflamed joints. The best method of administration is in frequently repeated doses, continued in diminished doses throughout convalescence. Its use possesses the advantages of being unattended with any toxic effect or gastric disturbance. Glycerite of Wintergreen. — In acute rheumatism this remedy supersedes its derivatives, salicin, or salicylate, in neutraliz- ing the lactic and butyric acid ; besides, it is a great promoter of nutrition. Salicylate of ammonia is useful when we desire ammonia administered; salicylate of potash is an excellent substitute for the soda salt ; it is to be preferred whenever we desire to introduce potash into the system, as in the gouty dia- thesis ; salicylate of lithia is the ne plus ultra of all drugs in gout ; salicylate of quinine is used with considerable success in neuralgia and rheumatic pains ; and the salicylate of cinchonidia is verj^ useful as a tonic and anti-periodic in neuralgia, gout, rheumatism. Cinchonidia (C2H24N2O) is an isomer of cinchonia, but possesses left instead of right polarization and is more soluble. In chronic rheumatism, as a stimulant to the appetite and general tonic, it is of great utility. Glycerite of Wintergreen (Ozonized^, Gaultheria. — Indicated in all cases of acute or chronic rheumatism. When administered it unites with the lactic and butyric acids, and renders them inert, at the same time its tonic and antiseptic action upon the organs of digestion and assimilation prevents the formation of those acids ; hence its use stamps and starves out the disease. A perfect substitute for salicylic acid and soda. The superi- ority of this preparation is seen in the rapid cure of both acute and chronic cases, the infrequency of relapses, and the prevention of cardiac complications. All physicians who use this prefer it to the various compounds, produced by artificial means. Perfectly annihilates the bacillus amylobacta of rheumatism. Dose: From one-half to one teaspoonful every two hours. The bark of the root of the yellow jessamine Gelsemium. is a nervine, antispasmodic and an energetig genital sedative. A pure nerve tonic of the highest order and a germicide of great power, being capable of destroying the malarial germ, so that it is used either alone or combined with quinine with the greatest success in all malarial fevers. It has a powerful influence on the sympathetic nervous system^ BACTERICIDES. 319 siological allays nervous irritability, as may be seen by its use in all nervous- diseases, neuralgia, headache, tetanus, epilepsy, delirium tremens,, hysteria and convulsions. It is invaluable in all forms of reflex irritation, arresting the symptoms so produced. As a genital sedative, exceedingly valuable in gonorrhoea, allays urethral irritation, and is of the greatest efficacy in nocturnal emissions when they are dependent on irritation of the prostatic portion of the urethra, or if there is an inflamed prostate or rectal ulcer. In all cases of sperma- torrhoea it is invaluable, soothing to the damaged parts, cuts off for the time being all sexual desire which, when its use is discon- tinued, are restored to their full vigor. To secure its full phy- action it should be large doses at bed- time ; a tincture of the fresh root is the best form. The active principle is unfit for use, being toxical and unreliable in its action. In puerperal eclampsia lobelia and gelsemium combined are excellent. In severe cases ad- minister a teaspoonful by the rectum, first emptying the lower bowel by enema. The dose maybe repeated in half an hour, and so on till the convulsions are abated. When given by the mouth half teaspoonful doses are in order. Very useful when a person is under the influence of an alcoholic stimulant or is men- tally excited, the face is flushed and the eyes have the appear- ance of being bright. The excitement is in the base of the brain and the vaso-motor tract at the same time is in a s^ate- bordering on paresis. Here are found the centres for respiration,, circulation and secretion. Here are points wherefrom emanate controlling influences that either stimulate or inhibit ganglia and their nerves. It is in this state that gelsemium is remarkably- valuable. Vasomotor dilator excitation prevails. There are vaso-dilator centres through the medulla and cord. When these are excited we have full capillaries and veins, and low arterial- Gelsemium. I320 DISEASE GERMS. pressure, dilated pupils. Pulse soft and temperature high, func- tional excitement and the vital energies of the centres are being depressed. Gelsemium is a wonderful medicament in all these conditions. The irritation of nerve centres, restlessness, fever, bright eye and flushed face, soft pulse, low blood pressure, weak heart sounds, pains of that kind that indicate irritation of centres and not of nerves. Gelsemium must be fitted to the case in each person. Some require larger doses than others to be of value ; too small a dose is worthless, too big a dose is paralyzing. Remember g-elsemium is a stimulant. Gentian. This remedy possesses in a high degree the tonic properties which characterize simple bitters. It excites the appetite, invigorates digestion, in- creases the vital forces of the body. It may be used when- ever a tonic is indicated in all conditions of debility, but it is the condition of the stomach and of the system generally,. not the name of the disease, which must be taken into considera- tion in prescribing it. It is a germicide of some value, destroying the bacteria and oidium albicans in malig- nant and sloughing ulcers. It can either be sprinkled on or in- corporated in a poultice and applied to the sore. It kills the germ streptococ- cus, or chain of micrococci, which is present in impetigo. The powdered gentian is incorporated in ozone ointment, and applied to the scalp morning and night. The same ointment, as a hair dressing, is a prophylactic to this disease, which has been epidemic in our public schools and certain streets. Common Gentian; a, capsule; d, capsule cut across , c, vertical section of seed, magnified. The root of the cranesbill, or spotted geranium. Geranium, is an astringent and antiseptic; a decided tonic, bracing to all mucous surfaces. It is a vitalizing and restorative agent, promotes instead of suppressing the normal mucous secretion. It is most efficacious in cholera infantum and BACTERICIDES. I32I the summer diarrhea of children ; pecuHarly serviceable if there is much pain, griping or flatulency. On account of its pleasant taste and efficient action, it is par- ticularly suitable for administration to children and persons of a delicate constitution. It is of great service alone to check the vomiting of cholera, and can be combined with salicylate soda when a powerful antiseptic action is needed. It cannot be valued too highly as a safe and efficient astringent, and it is indicated in all forms of infantile diarrhea. In fissure, ulcer of the rec- tum, it is of the greatest effi- cacy. A tincture is the most eligi- ble form for administration. Probably one of the most profound of our physicians and certainly one who is a keen ob- server of morbid action, says : *' There are few remedies which possess a wider range of usefulness than geranium ma- culatum, and which are so de- void of harmful properties. In all forms of hemorrhage, v/hether internal or external, it is without a superior. Haemop- tysis can usually be promptly arrested by drachm doses of the fluid extract given hourly until the attack subsides. Re- lapses may be prevented by continuing the same dose at longer intervals for three or four days. Hsematemesis may be effectually controlled in the same manner after ergot, matico, sulphuric acid, iron, ice and other styptics have failed. In hemorrhage from the kidneys and the intestinal canal better results can be obtained from the adminis- tration of smaller doses twenty drops four times daily, for an extended period. Epistaxis may be speedily checked by plug- ging the nostrils with cotton dipped in a solution composed of one part of the fluid extract of geranium and three parts of water ; or by syringing the nasal passages with the same solution. Hemorrhage resulting from the extraction of a tooth is occasion- ally obstinate in character, persisting for days, defying the cau- Cranesbill. 1322 DISEASE GERMS. tery and other methods, enfeebling the patient and alarming the family ; but it can invariably be promptly arrested by filling the socket with a piece of cotton saturated with the undiluted extract of geranium maculatum, and applying firm pressure for a few minutes. Hemorrhagia can be most effectually abated by the internal administration of geranium combined with vaginal injec- tions of the same remedy." Ginger. A well-known root, indi- genous to both the East and West Indies and China, but the best is grown in Jamaica. It is a diffusible stimulant, and aromatic and an- tiseptic. To weak, germ-laden stomachs it is a remedy of rare value. It makes an excellent tea, which should be taken either warm or cold, as desired. In the preparation of an infusion of ginger it should never be boiled, as that impairs its antiseptic properties very much ; valuable carminative, useful in colic, de- bility and laxity of the stomach and uterus. It is invaluable combined with quinine in uterine hemorrhage, either in infusion, say half an ounce of pulverized ^^ vp >r^a^ ^ ginger to a pint of water; or, syrup of ^ '/ ^'^ ^^l^ ginger, three ounces ; sulphate quinia, twenty grains. Mix. A teaspoonful as indicated. Common Ginger {Zingiber offici- nale) ; a, flower, detached ; b, perfect anther. Gillenia Trifoliata. Bark of the root of the gillenia tri- foliata is a safe and mild emetic ; a most reliable and effica- cious agent in diseases where emetics are indicated. Besides it can be employed with great benefit in all dropsical conditions. It is of most value in gastric catarrh, where the sarcinae ventriculi and yeast plant are on the stomach. It might fairly be named an emeto- hydragogue, cathartic and antiseptic. For an alterative action, best to administer doses, and continue for some time. Indian Physic. in very small BACTERICIDES. 1323 The fluid extract is the best form for general use. When it is desirable to administer it in large doses, it should be combined with fluid extract of collinsonia, which entirely mitigates its irri- tating effects. An invaluable germicide and parasiticide. Glycerine. Glycerine is a sweet substance, the basis of fats, being combined in them with the peculiar fatty acid characteristic of each. Accordingly, when these fats are decomposed by the addition of an alkali, as is done in making soap, the glycerine is set free, and the new combination of fatty acid and alkali constitutes soap. It is also obtained by distilling the fats by means of superheated steam. Thus obtained, the glycerine is a sweet liquid, colorless, and syrupy, oily to the touch, yet mixing readily with water. The solution of it in water does not ferment with yeast, and it does not dry up on ex- posure to heat of a moderate temperature. Its properties are very valuable, it readily dissolves many substances, and not drying up readily, it constitutes an excellent basis for applying them to the skin. It is chiefly as an adjunct to lotions that glycerine is of use. Lotions containing it do not dry up, and so the skin is kept soft and moist, and the bad effect of drying in forming scabs is avoided. It has been tried internally instead of cod liver oil, and it is used as a basis for some remedies, as gallic acid and tannic acid, when they are applied to the throat. In this way,, too, borax may be made of use in aphthae with advantage. Dose: one drachm, locally applied, in the proportion of a desert- spoonful to eight ounces of water, and taken internally, in doses of one to two drachms, is curative of impetigo, prurigo, pruritis, lupus, and herpis exedens. It is a good application to fetid ulcers, skin scurf, dandruff, chapped hands, chilblains, acne, rosacea, eczema, and to prevent pitting in small-pox. It is a good application, alternated with boroglyceride, for cracked nip- ples, cracked lips, and hands, burns, scalds, wounds, and erysipe* las. It is valuable in dry eczema of the ear, alternated with boric acid. It prevents fermentation of the stomach, and given^ with nux, is a tonic. Glycerine has been lauded in constipation ; glycerine when brought into contact with the mucous membrane of the rectum,, withdraws water from it, thus causing hyperaemia and irritation of the sentient nerves of the rectum, which in its turn leads re- flexly to powerful peristaltic contraction, ending in defecation. The larger the accumulation of faeces, the greater is the effect. There is no discomfort or pain, but the action takes place at 1324 DISEASE GERMS. once. Sometimes, however, a little throbbing is felt in the rec- tum for a few minutes afterwards. This repeated exhausting of the serous coat of the rectum renders it weak, liable to prolapse or deposit of the cancer germ, so that the so-calied " glycerine suppository " so freely adver- tised, is productive of great damage. Internal nse of Glycerine. — Prof. C. L. Souder, M. D., Burrows, Ind., prescribes it as a stimulant to the digestive organs in the non-febrile stage of phthisis, when for any reason cod-liver oil ceases to be tolerated. The following mixture is given daily in two or three doses : glycerine, forty grammes, and rum or cog- nac, ten grammes, with one drop of essence of mint. This aro- matic alcoholized compound, of agreeable flavor, is well tolerated by the stomach, and even after long uninterrupted use, it causes neither satiety nor disgust. The addition of the rum or brandy has simply in view the modification of the insipid taste of the glycerine, and to assist its digestion. The amount of the gly- cerine may be raised to fifty or sixty grammes, but only in per- sons who do not exhibit any signs of abnormal excitability of the heart or nervous system ; and restlessness, unusual loquacity, obstinate insomnia, or an increase of temperature, announces that the proper dose has been exceeded. It diminishes constipation in almost all cases, and yet moderates diarrhea when it is pres- ent ; and under its use sleep becomes calmer. It has an evident effect on nutrition, its employment in most cases, leading to an increase in weight after the first fortnight. In tuberculous cases it induces a considerable amendment in the functional manifesta- tions of the disease, such as dyspnoea, cough, and sweating. The expectoration is the symptom which is least influenced. The local condition of the lung also remains stationary, and the physical signs undergo no change. The action of glycerine on the liver is exhibited by the increase of its size, and by the more abundant flow of bile. With respect to its action on the kid- neys, there are observed a more abundant diuresis and an absolute and relative increase of the urea, chlorides, and phos- phates eliminated by the urine. In affections of the genito- urinary organs, it has been found that under the use of glycerine the alkalescence of the urine seems to diminish, while purulence, when present, becomes considerably lessened. Glycerine -Gelatine Preparations. — Their nse iii Skin Diseases. — The glycerine gelatines are distinguished above all the agents used for promoting the absorption of secretions, and especially in comparison with the pastes, by their adhesiveness, which con- stitutes a most useful addition to their other valuable character- istics. The most important of them is the germicide preparation. BACTERICIDES. 1 325 which finds a very extensive field of utiHty, no less as indepen- dent therapeutic agents than as auxiliaries to the use of other agents. Slight superficial eczemas and erythemata, especially such as occupy the flexor surfaces of the joints, or are distributed over large tracts of the body-surface, can be treated by means of it both quickly, safely, and pleasantly. The preparation is ren- dered fluid in a water-bath, then painted on to the skin whilst still warm with a broad bristle brush, after which the layer is dabbed over with a flock of cotton-wool. By this means the layer is soon dried, and takes on the nature of a fabric. From places which are free from hair, it can be stripped off in a single sheet on the following day, but from places which are covered with lanugo, it must be washed off with warm water. A gelatine covering does not interfere with the perspiration of the skin, but rather tends to increase it, so that there need be no hesitancy in painting the patient all over with it, if the case de- manded it. Glycerite of Kephaline, (ozonized). — Indications. As this is a true brain essence, it is of the greatest efficiency in all nervous dis- eases, as mental and physical exhaustion, wasting diseases, loss of memory, vertigo, worry, struggle, nervous debility, decay of brain power, premature and otherwise, nervous prostration, neu- ralgia, loss of vital power, general vital deterioration, sleepless- ness, paralysis, white softening, typhoid, effectual and permanent cure in all cases of nerve debility ; builds up the brain, restores lost energy, refreshes the nerves, stimulates the sexual appetite and supplies it with nervo-vital fluid. It thus is a positive cure for seminal weakness, impotency, or loss of power in the genera- tive organs. It is also of great efficacy in leucorrhoea, female weakness, and change of life. Gives intellectual vigor and vivacity. /. /. Tempest, M. D., D. C. Z., 32 Bank st., Bradford, England, Europe, a close clinical observer, and eminent physician, when speaking of kephaline, says : ** I regard it as an excellent brain food, a nervo-vital essence ; when administered, it will repair, or reconstruct chaotic nerve force, deepen the typical fissures of thought, refresh the nerves when tired by worry or study ; re- pair lost energy, stimulate and supply the elements of the molecular growth of brain tissue, by its vitalizing action on the lymph glands, or blood raisers. " It is of pre-eminent utility in this age of cerebral exhaustion, and anaemia; every man and woman should use it." More recently, this great English physician has used kepha- line in paralysis, white softening, and various other so-called in- curable conditions, with great success. 1326 DISEASE GERMS. Whenever the tubercular bacilli ap- Glycerite of Ozone, pear in the blood or any weakened part, it annihilates the microbe in all the fluids and solids of the body ; the factor of pulmonary con- sumption being destroyed — wasting ; debility ; cough ; loss of voice ; expectoration ; night sweats ; haemoptysis, and difficult breathing cease ; under its use the pulse slows ; heat, respirations diminish; phosphates and chlorides in urine become normal. The remedy either in stomach or rectum liberates its ozone, which enters the blood, acts as a scavenger and vitalizer to germ-laden blood, cleansing it. It is very efficacious in tubercular menin- gitis, tabes mesenterica, diabetes, pink marrow engorgement, typhoid fever, Bright's disease, and in all diseases due to the presence of micrococci in the blood. Dose : fifteen to thirty drops for the first fourteen days, then increase it slowly to sixty- drops every three hours. Joseph Redman, M. D., Carson City, Nevada, an eminent bacte- riologist and excellent physician, one who is regarded as standard authority, says : '' Of all germicides the glycerite of ozone stands unrivalled in tuberculosis, for both annihilating and sterilizing the germ, in the following manner : Beginning with ten drops three times daily, the dose is run up rapidly to twenty, twenty-five, or even thirty drops. Short interruptions were allowed, and this remedy was universally well borne and exhibited no toxic effects. In cases of laryngeal phthisis, in addition to the glycerite of ozone inter- nally, resorcin was used locally in substance with the best results. Even in advanced cases the treatment was carried out, not so much in the hope of curing as for the reason that it seemed equal to any other in alleviating the symptoms of the later stages. Even in such cases real benefit often followed. Con- trary to expectation, in intestinal tuberculosis and the diarrheas referred to it, glycerite of ozone was of benefit. In general miliary tuberculosis it is efficacious, and the forms of disease most benefited have been those with hemorrhages, or with caseous or fibroid degeneration. During actual haemoptysis the use of the remedy is suspended. The author thinks the most decided value of the treatment results from improvement of the gastric and intestinal digestion, the immediate cause of whfch he leaves undecided. The rapid improvement of appetite and assimi- lation soon appears manifest in increased weight and renewed vigor, and through the latter the patient is rendered more capa- ble of withstanding fresh inroads of disease. So evident was the effect on the alimentary tract that the author was led to use glycerite of ozone with benefit in ordinary cases of dyspepsia and gastric catarrh. In bronchitis it was used with satisfaction.'^ BACTERICIDES. 1327 Though not a germicide, is an invaluable Gutta-Percha. agent for the purpose of holding germicidal and parasiticide remedies in direct contact Avith a microbe, fungi or parasite, in order to insure their destruc- tion. The method of preparing and applying it is as follows : Take of purified gutta-percha, in thin slices, one ounce ; chloro- form, eight ounces ; carbonate of lead, in fine powder, one ounce. Add the one ounce of gutta-percha to six ounces of the chloro- form in one bottle. Shake frequently till a solution is effected. Add the carbonate of lead to the remaining two ounces of chloro- form. Shake ; after both have become thoroughly incorporated, mix the two together. This is a most elegant menstruum for the exhibition of germi- cides in cutaneous disease ; it is applied by painting it on the skin with a brush, and allowing it to dry. This forms a delicate neu- tral, durable dressing, perfectly elastic, and exceedingly well adapt- ed for the treatment of chronic skin diseases. Nothing so convenient, so effective, as the preparation itself to protect the skin in light burns ; the rapidity with which the chloro- form evaporates, leaving a thin elastic, nearly colorless coating, is astonishing. It does not shrink, but is soft, and abraded parts heal almost immediately under it. The following germicides are added to it and used with brilliant success : Resorcin, thallin, chry- sarobin, iodol, naphthol, ichthyol, oil of cade, salicylic acid, siegesbeckie. In the large proportion of skin affections, as eczema, psoriasis, lepra, scabies, the different forms of tenia, they prove most efficacious. Traumaticine consists of a solution of one part of purified gutta-percha in ten parts of chloroform. This forms an admirable adhesive, and continues unchanged and adherent to the skin for two or three days, or even longer. On the contrary, in his expe- rience, the layer of gelatine is apt to separate in a few hours, in consequence of friction by the clothes or movements of the limbs, and needs frequent renewal. Again, the traumaticine pro- duces a much thinner and more delicate film than does either collodion or gelatine, and therefore occasions neither tension nor pain. The traumaticine is more readily applied than gelatine ; Guttapercha, i, a flower : 2, a pistil; 3, a branch with leaves and flowers ; 4, transverse section of ovary ; 5, vertical section of ovary ; 6, transverse section of fruit; 7, fruit, scarcely mature; 8, anther. 1328 DISEASE GERMS. it does not stiffen so quickly, and the brush does not become matted into a stiff mass. The solution in traumaticine is perma- nent ; the gelatine tends to become mouldy, even with the addi- tion of salicylic acid. Psoriasis can be admirably treated with a solution of chrysarobine in traumaticine as follows : After the chief part of the scales have been removed by means of a simple bath of soap and water, a ten-per-cent. solution is not only painted on, but rubbed in, with a narrow, short-haired painter's brush, to the patches. The application can be repeated every day, or every second or third day, in proportion to the extent of the disease. A bath is taken after each three or four applications. After at most twelve paintings the infiltration and scales will have disappeared, and in place of them are visible white patches bounded by a red or violet-brown areola. Neither in children nor in adults did any untoward results follow even a very exten- sive application to the body and face of the chrysarobine- traumaticine. Gold Chloride et Soda. A bactericide of some power in the destruction of the bacillus of tubercle and syphilis ; it acts best when the microbes are on the bones. Dose, i-iooth grain of muriate doses, is especially called for in the treatment of chronic bone and glandular affections, and attended with mental gloom. It is also of value in hypertrophy of the liver. In ozaena, especially, where the nasal bones are affected, it is a very positive remedy. In chronic nasal catarrh it acts well, but is only applicable in this form. In chronic otorrhoea it is also used with benefit, as also in syphilitic bone affection. Gold Thread resembles hydras- tis in all its varied properties, only more feeble, yields the same alkaloids. Borogly- ceride and an infusion of gold thread make a valuable remedy in nasal catarrh. The fluid extract is prepared in the same manner as that of hydrastis. Makes an excellent combination with peroxide of hydrogen. ~-?^~ :-^^^ Gold Thread. BACTERICIDES. I^20 This remedy has become well estab- Grindelia Robusta. lished in cases of asthma and kindred diseases ; in asthma and hay fever ten to twenty drops of the fluid extract may be given in sweetened water or milk every half hour until the microbe is killed and relief is obtained. Preparations : Fluid extract (one drachm represents one ounce of the plant) and tincture. Doses : Fluid extract, one half to one fluid drachm, repeated every three or four hours, as required. Tincture, one half drachm every one or two hours in hooping-cough. An excellent formula for asthma is the following : Fluid ex- tract grindelia robusta, one ounce ; fluid extract lobelia, three drachms ; fluid extract belladonna, one and a half drachms ; iodide potassium, two and a half drachms; syrup tolu, q. s. ad four ounces. Teaspoonful as needed to keep down the attacks. from which the resin is obtained, grows in the West Guaiacum, Indies. The wood is known as lignum vitae, and is excessively hard. The wood is employed for various purposes, and the chips and turn- ings obtained in preparing it for these are saved and made use of in medicine. The resin is also got by boring a hole in the log, and putting one end of it in the fire ; as it burns the resin melts and runs from the hole. More commonly it is obtained b}' boiling the chips already referred to in salt and water, when the resin floats on the top. The resin is insoluble in water, but soluble in alcohol. The preparation commonly em- ployed is the ammoniated tincture, con- sisting of the resin dissolved in aromatic Guaicum officinalis, spirit of ammonia, and an ordinary alcoholic tincture. Either taken internally is a powerful stimulant and bactericide. It steri- lizes the bacillus amylobacta of rheumatism ; the venereal bacil- lus and sterilizes the tubercular microbe. By steeping ordinary blotting paper in the alcoholic tincture and drying, then placing it beneath the leaves of a book for preservation, it affords one of the best characteristic tests for ozone, being colored blue by that and all oxidizing agents. It contains guaiacic acid which closely resembles benzoic acid, and yields, on distillation, certain definite compounds known as guaiacine, pyroguaiacine and hydride of guaiacyl. 84 I330 diseasp: germs. Sunflower {Helianthus annuus). pneumonia. A colds, influenza, A glucoside has are feeble. syrup from catarrh. been isolated Common sun- Helianthus. flower ; is an in- valuable germicide and ozone generator. Planted in the vicinity of a deadly malarial marsh, they yield, if properly cared for, enough of ozone to destroy the ma- larial germ as fast as it is evolved from the decaying vegetable matter. Its ozone generating properties or faculty is even greater than the eucalyptus, although its antiseptic properties are much less. The seeds yield a fixed oil which is a valuable article of diet in all bronchial complaints, and as a local application to the chest in infantile the seeds is of great efficacy in but its medicinal properties Hepatica. (Liverwort)) The entire plant yields to boiling water a peculiar ac- tive cholagogue, which effects remarkable results m chronic hepatitis. The formulas in use are either drinking ad libitum a decoction of equal parts of liverwort and chionanthus Virginia, rr: fluid extract of hepatica and chionanthus Virginia, equal parts of each. Mix. A tablespoonful thrice daily. An effective and most powerful Hoang-Nan. germicide, sterilizes and kills the {Strychnos Gaultheriana) microbes of rabies or hydrophobia, elephantiasis, leprosy, cancer, snake- bite, malignant ulcers. Its physiological effects* are most potent on the nerve-centres ; rrioderated doses produce a feeling of intense fatigue, general in- disposition, vertigo, tingling in the hands and feet, invokmtary movements of the jaws. This remedy effectually annihilates the microbes above enu- merated; when administered, the microbes imbibe this poison and die. BACTERICIDES. I33I The remedy should be boldly and energetically given in all suspicious cases, until its physiological action is experienced. As soon as this takes place the microbe is killed. Dose is very variable. The root of this plant is highly trmgent Hound's Tongue. ( Cynoglossum.) cidal and as- it is thus an excellent alterative wherever there are disease germs in the blood, and its astringent mucilaginous properties are of great utility in diarrhea, dysentery, coughs, catarrh and haemoptysis ; locally to burns, ulcers, tumors, infiltrations and goitre. Administered internally or applied locally, it sterilizes and kills numer- ous of the disease germs. An inspissated extract, or the juice, or succus of the green root, applied to a snake-bite or the bite of a rabid animal, effec- tually kills the poisonous breeding germs, and at the same time paralyzes the motor and sensual nerves of the part to which it is applied. It is an herb which merits further inxestigation. Hound's Tongue (Cynoglossum officinale) . >-^X//\ Hop {Humulus Lupulus"). The action Hops, of the hop, when admin- istered in almost any form, is tonic, soothing, anodyne, germicidal. The infusion is thus prepared : To one pint of boiling water add six drachms of hops, mace- rate for four hours in a loosely covered vessel and strain. Dose, from one to two ounces. The tincture is pre- pared thus: Six ounces of hops are added to two pints of alcohol ; mace- rate for fourteen days 1332 .disp:ase (ierms. and percolate. Dose, from one to two ounces, or ten drops of the fluid extract. These are tonic and vermifuge. Hop-bitters are made thus : Haifa pound of hops, two ounces of buchu, boiled in five quarts of water, and two ounces of the essence of wintergreen, added to flavor. A pillow stuffed with hops is valuable in insomnia. A glucoside is prepared from the hop. Lupuline, combined with equal parts of the glucoside from the black willow is invaluable in seminal emissions. A poultice of hops relieves pain and prevents suppuration. Horse- Chestnut. The fruit of this tree is an antiseptic, astringent, narcotic, cholagogue, etc., and is often successfully used in intermittent ; locally in the form of ointment to ulcers, swell- ings ; also of great utility in hemorrhoids. To the latter it relieves the rec- tal congestion by its stim- ulant and depurant action on the liver, and applied to the piles in any con- venient form, its astrin- gent action causes them to disappear. Its stimulant and anti- septic action renders it of great utility in nasal ca- tarrh, relieving the con- gestion of the sinuses of masses of germs that are blocking up the nasal fossa. The oil of horse-chestnuts on the painful joints of rheumatism affords almost instant relief. An excellent liniment may be made of it, thus : To eight ounces of alcohol add one ounce each of the oil of horse-chestnuts, menthol, oil of cajeput, and oil of wintergreen. Mix well. Apply three times a day. Horse- Chestnut fluid extract. — Useful in piles, by relieving the portal circulation ; also in ointment form. Dose, fifteen to thirty drops, added to water, every three hours. The powdered kernel of the nut is a sternutatory of utility in Horse-Chastnut — Leaves, flowers the head, and often bringing away BACTERICIDES. 1333 nasal catarrh. The fixed oil which the nuts contain is very use- ful as a local application in rheumatism. The flowering summit Hyssop, and leaves are the parts used. They have an agree- able, aromatic odor, and a warm, pun- gent, bitterish taste, which is due to the presence of a volatile oil, which is highly germicidal. Its infusion has been much employed in chronic nasal catarrh, as it retards germ evolution, facilitates ex- pectoration. It is a most excellent drug in hoarseness and bronchial obstruction. An acetic syrup makes an excellent remedy for difficult breathing and or- dinary colds. It is a drug specially indicated for the aged or debilitated suffering from any affection of the respiratory organs. The leaves, crowded in and simmered in olive oil, make one of the finest ger- micides for local use to the throat in diphtheria and scarlet fever, and to old, germ-eaten ulcers. Common Hyssop {Hyssopiu officinalis). Hydrastis Canadensis. {Golden Seal.) Hydrastis Canadensis. The fluid hydrastis, made by digesting the root in water or glycerine, or by displacement with this vehicle, is the best medicament in the treatment of gastric and duodenal catarrh. Hydrastis is a powerful local remedy ; acting on the blood supply of parts it is applied to in virtue of its vaso- constrictor action on the arterioles. A decoction of the ground root, made by boiling four ounces of the root in a mixture of sixteen fluid ounces each of water and glycerine for two or three hours, adding water from time to time as the fluid boils away ; at the end of the boiling process the quantity of fluid 1334 DISEASE GERMS. must measure thirty two fluid ounces. This is the most univer- sally successful local application known in the treatment of gon» orrhea, chronic inflammations of mucous membranes, diseases of the uterus of a catarrhal and leucorrhoeal nature, ophthal- mia, etc. The influence of hydrastis over inflamed parts locally used, is well known to eclectics, and has been used for years by them as a local medicament in lieu of other astringents and local stimulants. The white principle of hydrastis, in my experience, is nearly worthless ; so is the sulphate of hydrastine. The combination of fluid hydrastis and hamamelis forms a valuable medicament in the treatment of menorrhagia. Hydrastis and pulsatilla combined is one of our best prepara- tions in the pains and nervous troubles, and the hemorrhagic gushes often encountered in women entering the. climacteric of life. Pulsatilla and belladonna combined afford us a fine heart sedative in nervous excitement of women in the menopausis. Hydrastis canadensis is indicated where there are thick, ropy discharges from mucous membranes, loss of appetite and feeble digestion. Dose : twenty to sixty drops of the tincture, twenty to thirty drops of the fluid extract. In small doses, this article acts well in all cases of feeble digestion, especially if from catarrh of the mucous membranes. It is recommended in jaundice, chronic bronchitis, constipation, if given in drop doses. In chrOnic oph- thalmia, or for granulated lids, a solution in water, of the sul- phate of hydrastia two grains, in distilled water one ounce, applied three times a day, often cures this trouble. The fluid extract of hydrastis canadensis is indicated as a tonic in all weakened states of the digestive organs ; its obviates constipation by stimulating a free flow of bile from the liver ; added to water, makes an excellent wash for ulcerated sore throat or in ophthalmia. Dose : ten to thirty drops, added to water, every four hours. Hydrastine sulphate is indicated as a stomach tonic and to increase the flow of bile ; in atonic dyspepsia, tubercular diar- rhea and enlarged spleen. Valuable astringent, antiseptic gargle in syphilitic sore throat. Dose : two to five grains, in pill or powder, every four hours. A most valuable bactericide, hav- Hydrocotyle Asiatica, ing the power, when administered persistently in small doses, of utterly annihilating the venereal bacillus. BACTERICIDES. 1335 It is extensively used in Hindostan, and is being gradually introduced into this country. The dose is from five to ten drops of the tincture, added to a little water. This valuable derivative of coal tar is no Hydronaphthol. longer an experiment, but has fairly won a permanent place high up in the list of modern antiseptics. After severest tests and experiments in both hospital and private practice, it has been accorded a place second only to mercuric bichloride in point of germicidal power, ,an.d being non-poisonous and non-corrosive, it is preferable to that well-known agent for all the purposes for which it is recom- mended. Hydronaphthol is free from the odor and escharotic properties of carbolic acid and other phenols, hence it is a pleas- ant and valuable internal antiseptic. Therefore, aside from its value as a general antiseptic, disinfectant, germicide and pre- servative, it is being used with great satisfaction as an internal remedy in cancer of the stomach, chronic dyspepsia, gastritis, typhoid fever and in other diseases of the alimentary canal ; also in enuresis, cystitis, rheumatism and gout. The very learned 5. H. Holbrook, M. D., of Salem, and other eminent dermatologists of Massachusetts, have found hydro- naphthol an excellent remedy in ulcers, eczema, scabies, all forms, of tinea. It is a most excellent bactericide for the preservation of ana- tomical preparations without shrinkage or decay. Hydronaphthol is a secondary compound of betanaphthol, differing from it in having a molecule of hydrogen displaced by an equivalent of hydroxide. Considered as a germicide, it is one of the highest rank, sufficiently powerful to destroy the bacillus of anthrax, subtilis, variola, leprosy. Administered in- ternally in small doses as an antiseptic ; but it is found to be of the greatest service in washing out septic or germ-laden cavities or wounds. It is most convenient either to make use of a solu- tion in alcohol, in which it is soluble to the amount of i in 2 parts, or with glycerine added to the alcoholic solution, so as to make it of the strength of i in 10. It is soluble in oil to the ex- tent of I in 20, but it is only dissolved in cold water to the amount of i in i ico. In making this last solution it is best to see that the water is tepid. A solution of i in 300 in warm water possesses very great germicidal powers. nP DISEASE GERMS. is a peculiar product obtained from a bituminous Ichthyol rock found in the Tyrol. It occurs iii the form ol a ^reddish brown liquid, clear and syrupy, of a peculiar herb- like odor, and of a faintly alkaline reaction. It is soluble in Avater, partially so in alcohol and ether, but more soluble in a mixture of alcohol and ether. From its aqueous solution it is precipitated by hydrochloric acid. It is a remedy of intrinsic value in all parasite skin affections, as in impetigo, eczema, sycosis and other forms of tinea, where fatty agents in- crease their growth. A most reliable formula consists in three parts of ichthyol to glycerine and dextrine each ten parts, mix. Equal parts of ichthyol. and spirits of turpentine, a mixture of great efficacy in dry and moist chilblains ; the burning and itch- ing passing away the moment it is applied. Three parts ichthyol to one of chloroform is a never-failing remedy for toothache. In burns and scalds, psoriasis, in prurigo, pruritus, ichthyol has been used both internally and external^ with success. As a germicide it stands unrivalled, being even efficacious in nasal catarrh, chronic bronchitis, and chronic rheumatism. Our best dermatologists regard ichthyol as a cutaneous germi- cide, most efficient, superior to many other remedies ; painted over the affected part it protects it from the air and dust by forming a coating over it ; relieves congestion by causing con- traction of the arterioles, thus diminishing the vascularity of the part. In eczema, one drachm of ichthyol to one ounce of distilled water, when painted over the affected part with a camel's hair brush, relieves the itching and tingling. For squamous eczema, an ointment made of one drachm of ichthyol added to one ounce of ozone ointment. The same ointment applied over affected parts in rheumatism has a sterilizing action on the micrococci of that affection, for it unquestionably relieves the fever; the swelling and the joint- pain leave — thus killing the germ where it was localized. Ichthyol has found a rival in thiol, a new product of chemical synthesis, obtained by artificially sulphuretting unsaturated hydro-carbons, and charging these with ten per cent, of sulphur. Chemical and therapeutical researches prove its exact identity with ichthyol. Thiol consists of a brown fluid of the consistency of syrup ; it is completely soluble in water, is totally inodorous, and has therefore a decided advantage over ichthyol. There exists also a dry thiol, which has two and a half times the strength of fluid thiol, otherwise having the same properties as BACTERrCIDES. f3^7 the latter. Thiol is used like ichthyol in the following diseases: Acne, acute and chronic rheumatic arthritis, other rheumatic affections, contusions, decubitus, eczema, erysipelas, neuralgia, ischia, leprosy, frost-bites, prurigo, pruritus, ulcus cruris, burns and scalds. Thiol and ichthyol are identically alike ; thiol will replace the latter when the natural sources of that remedy are exhausted. is a remedial agent which, since its comparatively Ingluvin recent introduction to the medical profession of the United States and Europe, has gained for itself a repuation perhaps hardly equalled in so brief a period in the case of any other preparation Icnown in pharmacy. It is prepared from the ventricu'us callosus gallinaceus ; the gizzard of the do- mestic fowl- — pullus gallinaceus. Since its introduction no remedy of modern times has excited more attention among physicians far and near, or received a higher endorsement, than ingluvin. As the source of its manufacture and the substance from which it is derived are made public, the profession has not hesitated to prescribe it in all cases where pepsin is indicated as a. remedy, and its use has been attended with more uniform bene- ficial results than that afforded by pepsin, which has been found so variable, perhaps on account of its various strengths and dif- ferent modes of preparation. Ingluvin, unHke pepsin, is not in- compatible with alkalies. ' The diseases in which the use of ingluvin is indicated are indigestion m its various forms, known as dyspepsia, and sick stomach or nausea caused by debility of that organ. It was originally discovered to be a remedy, indeed a specific, for vomiting in pregnancy ; in this respect it stands above all other medicinal agents. In all that is here set forth the manufacturers claim no more than is sustained by medical authority of the highest standing. The practitioner is especially cautioned to avoid fraudulent substitutes and imitadons, which the manufacturers are aware have been offered, and which are but the crude powdered gizzards of the fowl. Ingluvin diff-rs from this by its extreme refinement, and its association wdth simple substances for its preservation as animal matter. It is therefore essential to his success, and for the welfare of the patient, that the practitioner should be guarded against unscrupulous competition that would offer powdered gizzards, and seek to profit by the success of the true prepara- tion. Dose : From five to ten grains. 338 DISEASE GERMS. Indigo. A substance derived from a great variety of plants ; many compounds of great chemical and medicinal value have been derived from it. Indigo, itself, and all its alkaloids and glucosides,. are potent germicides, it was from this agent that aniline was first derived, from which such a host of invaluable antipyretics have been prepared. The wild indigo, or its gluco- side baptisin, is of great efficacy in the destruction of microscopic life; one ounce of the crude plant (root) to a pint of boiling water, infuse over night, and drink freely the following day, will kill the germs of typhoid fever, epidemic dysentery, chronic diarrhea, sore throat. The glucoside baptisin has been effectually used in epileptic and nervous cases. It is also a valuable remedy in chronic irritation of the liver^ with albuminuria. Indigo Plant (Indigo Tinrtoria) b, block of indigo. pod; The bark of the root of this plant yields an active Ipecac, principle of great value called emetine. This vege- table alkaloid in very small doses is an active stimu-^ lant to the mucous membrance of the bronchi. All preparations of this bark are of great value. In large doses it is a mild and efficient emetic ; whereas in small doses it allays ir- ritation of the gastric nerves. In medium doses it does good work either alone or combined with muriate of ammonia in bron- chitis. Also a good remedy in the treat- ment of infantile pneumonia. It is an excellent remedy in small doses for nausea and vomiting, and exer- cises a sedative action on the mucous membrane, whether diar- rhea or dysentery be present. Ip«cac. . BACTERICIDES. I 33^ All preparations of iodine are highly germicidal. Iodine. Its use is indicated wherever there are disease germs in the human blood. Dose, ten to fifteen drops of the officinal tincture, five to seven drops of Lugal's solution. lodol in pills, one to two grains. Dose of iodide of soda, five to six grains. Uses. — Iodine is a remedy for croup, of the membranous variety, or spasm of the glottis. It is a good remedy for cancer. It is a good injection in a corrosive leucorrhoea, diluted to pre- vent irritation. One part to ten or fifteen of water at first. Lugal's solution in doses of six to eight drops, three times a day, is a good remedy for chronic malarial poisoning, where there is induration of the liver and spleen or other glands. It is a good inhalation in the early stage of pneumonia. It prevents suppuration, if used in time, especially if iodoform is used on the ulcer. For tubercular and skin affections, iodine, in doses of one to six drops three times a day, is almost a specific, and it is valuable in syphilis. It is a positive remedy for leucorrhoea. Alternated with diluted bromine, the inhalation of iodine is a remedy in hay asthma and hay fever, bronchitis and catarrh. Iodine is a good mouth wash, as it removes tartar from the teeth, and cures diseased gums, and heals ulcers of the mouth and gums. Iodine (tincture) kept applied, cures orchitis. Iodoform lotion, one part to fifteen of water, constantly applied, re- moves abnormal growths of the mam- »;?,f?jH?m:L"lngorgrd" u^,h°/ mary glands. It also cures house-maid's pneumococcus; an lodoi jacket -' o 1 1 1 • *vas applied for 24 hours, every knee, and also purulent ophthalmia. microbe disappeared, leaving ihe An ointment of iodoform, applied fre- 'ung dear on percussion. quently, cures enlargement of the prostate. In powder it is the best antiseptic dressing for ulcerations of the external surface. lodol, containing as it does nearly eighty nine per cent, of iodine^ is next to iodoform, the strongest iodine preparation extant ; and is much superior to iodoform in germicidal power, and its ab- sence of odor and of toxic properties makes it preferable to iodoform. An iodol jacket in consolidated lung either with the bacilli of tubercle, or the pneumococcus of pneumonia, is most effective in the annihilation of the germs, thus clearing up lungs partially dead. Iodol sprinkled on chancres, specific. Iodol as a snuff in nasal catarrh and ozaena, destroys the amoeba in the former, and the oidium albicans in the latter. I340 DISEASE GERMS, It destroys the tubercle in the thyroid, and thus cures goitre ; annihilates the bacteria of erysipelas and boils ; kills all fungi, as the different forms of tijiea. It is destructive to all microscopic life, vitalizing to the higher grades of animated existence. Iodized oil for external application has numerous advantages, it is readily absorbed ; does not stain ; may be applied to the most delicate skin without irritation; it is of immense value in pulmonary consumption and in tubercular disease of joints. Dr. W, H. Flesher, Green Ridge, Mo., a physician of great culture and experience, says : " lodol, or tetraiodopyrol, has a light-brown color, and is almost odorless, in which respect it offers a decided advantage over iodoform. Unfortunately, it is not very soluble in water, only in a proportion of i to 5000. In alcohol it dissolves in three times its weight The drug is employed in the following manner: i. As a powder, in the same manner as iodoform. Being a finer powder, it enters and covers the part more com- pletely than the former. It forms no scurf (in opposition with iodoform) on the wound, renders the secretion odorless, favors the formation of healthy granulation, and has^a general salutary influence on the nutrition of the affected parts. 2. As solution, in sixteen parts of alcohol and thirty-four parts of glycerine, for the saturation of uterine or rectal tampons. It is also injected in this form into empty or scraped-out abscesses. 3. As gauze. 4. In combination with vaseline and collodium. In no instance, in spite of its extensive use, were any symptoms of intoxication observed, nor was ever any iodine after its use discoverable in the urine. It is probable that its action depends on the genera- tion of free iodine, though we have no definite data yet regarding this point. At all events, its action is prompt and harmless, and offers no small advantage over the iodoform in the absence of any odor, though its poor solubility and its (at present) high price are equally great objections.'^ Its special advantages are : when applied, the iodine which it contains is set free by lung bioplasm, kills microbes ; when sprinkled on a wound, movements of leucocytes, renders the sur- face dry, prevents suppuration, and encourages granulation, while at the same time its local anesthetic action lessens pain. It seems to have a special destructive action on the tubercle bacillus, and is therefore employed with advantage as a local application for tubercular disease of the larynx and tubercular abscesses. One great convenience of iodoform consists in the fact that it can be applied as a powder over any surface, and will there exercise its antiseptic action for a long time without the necessity of any dressing being applied over it, but as I have BACTERICIDES. said, it is not without its dangers, and, although sparingly -oiu ble, it may yet be absorbed from wounds or cavities to such an extent as to produce poisoning. The symptoms of poisoning are particularly interesting, as they consist of a peculiar combi- nation of the action of iodine itself with that of an alkyl. Like an iodide, it may pro- duce unpleasant taste and smell, running at the nose, and gastric disturbance, but it behaves also like a mem- ber of the alcoholic series in causing special symptoms of poisoning which are connect- ed with the nervous system, and consisting of loss of memory, variable temper, headache, sleeplessness, and especially mental distur- bances, sometimes amount- ing to furious mania, alter- nating with coma. Fatty de- generation of the heart and other organs is usually found after death. Ozonized iodine is a remarkable active form, and has acquired a big reputation, which it justly deserves in sterilizing the blood. During a recent epidemic of influenza, it was administered with remarkable success in getting rid of the microbe, and re- lieving the intense pain in the muscles and bones. The microbe of epidemic influenza, which appeared in ihe U. S, I'go; which was completely ster- ilized by the administration of ozonized iodine in altei nation with the sulphate of quinine. Erery Case yields to these remedies. Sozoiodol is a compound of such well-known Sozoiodol. antiseptics as iodine, carbolic acid, and sulphur, and is chemically described under the name Di- iodoparaphenolsulphonic acid. It is destined to act as an odor- less substitute for iodoform. Sodium-sozoiodol occurs in colorless tubular crystals, which dissolve easily in water or glycerine at an ordinary temperature, to the extent of about one in twelve. The glycerine solution remains quite unchanged when exposed to sunlight, but the aqueous solution slowly alters its color on exposure. Potassium-sozoiodol dissolves only to a slight extent in water and glycerine, these fluids dissolving only about a fiftieth part of their weight of the salt. This property makes the potassium 1342 DISEASE GERMS. salt preferable to the sodium salt in the treatment of cases which require the application of dusting powders, etc., because of the greater duration of their efficacy ; the effects of both salts are, however, the same. Sozoiodol has been applied not only in the solution, but in combination with talc, lanolin, sugar of milk, and with much success, in the pure state. It is perfectly odor- less, and experience has shown that it is without any injurious after-effects whatever, so that it seems to be entitled to promi- nent rank among antiseptics. Its chemical nature permits of combinations with almost every metal, opening thus a vast field for therapeutic treatment, and enabling the physician to combine the action of certain me- tallic bodies with that of the antiseptic substance proper, such as aluminum, magnesium, lead and zinc, which compounds are easily soluble. Also the ammonium, barium, mercury, and sil- ver salts, which are difficultly soluble. The sozoiodol salts have been used in skin diseases of a para- sitic character : eczema, even of long standing. Dry eczema may be treated with sodium-sozoiodol ; damp eczema with zinc, either as a powder or with talc ( i to lo), and in very obstinate cases of syphilitic eruption, mercury-sozoiodol has been used with great success. In diseases of the ear, nose, larynx, and pharynx, potassium- and sodium-sozoiodol, either pure or mixed with an equal weight of powdered talc, yield good results. For conjunctivitis, five to ten per cent, solution of sodium-sozoiodol forms an excellent lotion, and for gonorrhea, zinc-sozoiodol in one to three per cent, solution, and it can be applied to ulcera- tive cancer surfaces with advantage. Their application is indi- cated everywhere in the place of iodoform, and the fact that here the long-looked- for desideratum, an odorless substitute for iodo- form, has been found, should induce all medical men to give them a fair trial. a remedy of decided value in the treatment of a Jaborandi, large number of febrile and inflammatory dis- eases, is not a germicide, but possesses the most extraordinary faculty, when the blood is germ-laden, of driving the entire brood of bacilli and micrococci to the cutan- eous surface and salivary glands of the mouth, where they can be readily annihilated with bactericides. It does this by its potent diaphoretic and sialagogue action, consequently in a large percentage of fevers, and inflammations, as in oedema of the glottis, laryngitis, bronchitis, pleurisy, pneumonia, rheumatism, erysipelas, diabetes, malarial fever, etc., it is of signal efficacy in the management of the cases. HACrERLClDES. 1543 A good form to administer is to take of the fluid extract one ■drachm, and add to it a cup of hot water, and if free salivation and diaphoresis does not occur in half an hour, give a second dose; it is rarely necessary to repeat. The saliva in all cases must be spit out as fast as it accumulates in the mouth, as it is invariably loaded with the micro-organisms of disease. Another formula is the fol- lowing : Fluid extract of jaborandi, four drachms ; aromatic spirits of ammonia, one drachm ; sim- ple syrup, one ounce. Mix. One teaspoonful to be given every ten minutes till free per- spiration is induced. The alkaloid pilocarpin hy- drochlorate, one-fourth grain in solution, injected hypoder- mically, has been extremely efficacious in dropsical effu- jaboraudi. sions, as the result of interstitial obstruction of the kidneys. Tetanus has been successfully treated by subcutaneous injection of the same alkaloid, but the dose used has been very large. The purport of treatment is to drive the microbe from the cerebro- spinal centres to the skin. The hypodermic use of the same alkaloid has been well spoken of in alopecia. Pilocarpin removes the urgent symp- toms of asthma. Jalap. Jalap. The therapeutic action of this remedy is so well known that it seems superfluous to enumerate it ; but as it has such a de- cided action in relieving modern cere- bral congestion, it is worthy of notice. It is of unquestionable utility, a most valuable cathartic in disease of the 1344 DISEASE GERMS. brain ; its derivative action is unexcelled. The best combination ifor use is one part of powdered jalap, two paits bitartrate potassa, and sufficient pulverized ginger to keep it from griping. It is also of value in dropsical effusions. With all our new remedies, this very frequently comes into excellent service. In small doses, combined with leptandra, it does excellent work in torpid states of the liver. Jamaica Dogwood. A fluid extract prepared from the bark of the root is a powerful narcotic, germicide and parasiticide — annihilates many species of germs when brought in contact with them — the root thrown into water will stupely fij^h. In five to ei^ht-drop doses, it will sterilize and destroy the mycelia of hooping-cough, the germs of toothache, erysipelas, and of bron- chial catarrh. Extremely valuable in insomnia, affords in all cases most refreshing sleep. It possesses all the desirable effects of chloral, bromide of potass, opium, urethan. If administered dur- ing parturition, it will lessen the pains of labor without interfering with uter- ine contractions. It is of great utility in all forms of neuralgia. The following is an excellent for- mula in gastralgia: Fluid extract of Jamaica dogwood, fluid extract American columbae, comp. tincture matricaria — of each one ounce. Mix. Dose: from fifteen thirty drops, added to a little water, as indicated. Jamaica Dogwood. of of to Jambul. {Syzygium Jambulanmn) The seeds and bark are power- fully germicidal, stomachic, carmi- native, diuretic, astringent. When introduced into the human stomach, and passed into the process of secondary digestion, thence into the blood, they have a specially destructive action upon the glucose or sugar fungus, not only annihilating it, but preventing its formation by some peculiar action upon the starch formed in BACTERICIDES. 1345 the liver. In this way it controls the disease, and all its promi- nent symptoms disappear under its use, such as prostration, debility, emaciation, thirst, ravenous appetite, extreme restless- ness, excessive secretion of urine of high specific gravity. • While taking iambul, there need be no restriction of diet, the urine becomes normal. For easy adminibtration, and better to preserve the properties of the drug, two and one-half grains are encased in a capsule; two of these should be taken three or even six times a day, according to the indications of each particular case. By taking these pearls in diabetes thrice daily, the specific gravity, the percentage of sugar and the quantity of water passed are astonishingly reduced. The berries are stimu- Juniper. lant, antiseptic, diuretic ; chiefly used in dropsical affections. Its antiseptic properties causes it to be a drug of great value. Whenever we desire to impregnate the body with a natural ozone scavenger, juniperus is indicated ; valuable in dropsy, in blood and cutaneous affec- tions, and in those states where there is a bleeding fungus in the bladder associated with retention of urine and catarrh of that organ. The compound spirits of juniper is thus prepared : take of juniper berries, well bruised, one pound; caraway and fennel seeds, pul- verized, one ounce and a half of each ; dilute alcohol, one gallon ; macerate two weeks, then add half a gallon of water and distill off one gallon. The infusion is an excellent one for administration, prepared by adding one ounce of crushed berries to one pint of boiling water, whole of this is to be taken in the twenty-four hours, extracts are worthless. Common Juniper. {J cn7!i7itiin{s) ^ a, branchlei with male flowers; b. part of branchlet with Icmale flowers; c, unripe fruit. The Alt Kaki, {^Pulverized Root Japanese Persimmott) 8 It is indicated in gastric catarrh, chronic diarrhea, typhoid fever, dysentery, ulceration of the bowels, catarrh of the colon and rectum. Decidedly one of the best reme- «346 DISEASE GERMS. dies ever introduced, as it excites a renewal of life in the various coats of the entire intestinal tract; a sovereign remedy in the diseases enumerated. Dose : One to two teaspoonfuls to a half pint of boiling water ; when cool, permit patient to drink freely. Fluid extract; a bactericide of great efificacy in Kalmia, sterilizing the syphilitic bacillus. Dose for that (Laurel.) purpose, twenty to thirty drops thrice daily. Kalmia, in one-drop doses, has proved valuable in albuminuria, curing twenty-five per cent. It mitigates the pain of rheumatism very quickly, and acts positively in neuralgia. It wards off rheumatism of the heart. In headache, coming on in the morning and going off at night, this remedy acts like a charm. In influenza, with watery eyes, sore throat and much aching in the bones, the kalmia gives quick relief In all aches and pains, think of the kalmia. It may be given in drop doses, with two to five drops of gelsemium, every hour or for five or six hours, then lessen. Dose : fluid extract, twenty to thirty Kava-Kava, drops; tincture, thirty to sixty drops (Piper Methysticum,) three times a day. A remedy for tooth- ache, neuralgia, small doses of this drug will give relief quickly. in painful urination, this is a remedy, in doses of eight to ten drops every three hours, or in extreme cases give twenty-five drops. It may be combined with pareira brava, one drop at a dose. These remedies may also alternate benzoate of lithia in gravel, cystitis and catarrh of the bladder. It may be combined with hydrangea in gravel, or with liatris spicata in cystitis. These remedies often give relief, where there is excess of acid in the urine, then it will require lithia in addition. In gonorrhea, kava-kava paste entirely replaces the old reme- dies. It does not cause gastro-intestinal irritation ; neither does it impart any odor to the breath, but it kills the gonococcus, the discharge is very speedily reduced to a slight oozing. In chronic catarrh and suppurating nephritis, it very soon diminishes the amount of muco-purulent matter. Cures very obstinate cases of cystitis. The tincture and fluid extract are worthless, have no germicidal action. The paste invariably does its work well. Dose : A piece the size of a bean every three hours. BACTERICIDES. 1347' The nut of cola acuminata, or stercidia, a native Kola Nut. of the tropical parts of the western coast of Africa, and cultivated in other tropical countries. The natives value the nuts very highly, and often take a portion of them before meals, believing that they improve the appetite and destroy all microbes in what they eat and drink, even render- ing putrid meat and stagnant water fresh. The nuts are the size of eggs and possess identical properties with the coca erythroxy- lon and caffeine. In all its forms it is a germicide ; it has marked aphrodisiac properties and retards tissue waste. It has a most decided action in heart disease with renal obstruction, promotes diuresis by increasing the general vascular tension. It acts as a nutrient and tonic, an aperient and gastric stimulant. It cannot be too highly extolled in chronic alcoholism, appeases the appetite, removes stupefaction, prevents dis- agreeable after-effects. It has a remarkable prophylactic action — ■or rather guarding effect to the liberation of large doses of iodide of potassium in the blood in cases where the blood is germ-laden with the syphilitic microbe. The Liberia kola nut is the best, and it is from this that a laxative and refreshing fruit lozenge has been prepared for the relief and cure of constipation and its attend- ant maladies, as headache conges- tion of the liver and spleen, piles, dyspepsia, and all disorders of the alimentary canal. With Americans, who consume a highly concentrated diet, and possess a normal condition of the brain, liver and digestive organs, one evacuation of the bowels in the twenty-four hours, following the morning meal, is to be regarded as a healthy standard. When defecation is less frequent, slow, prolonged or retarded, it constitutes constipation. Habitual constipation is one of the most common affections incidental to young or old, in all sections ot our country, due to neurasthenia in nearly all cases, and this poverty of nerve force is aggravated by our highly ozonized atmosphere, by malaria, by the use of stimulants ; erroneous drug treatments, adulterated food, hasty mastication, nerve strain, worry, struggle for existence, Branch and nut of the Kola Sterculia. 1348 DISEASE GERMS. brain exhaustion ; chronic disease, sedentary habits, etc., give rise to ineitia or sluggi.-hness, deficiency of bile, which give rise to arrested perisaltic action, a faulty condition of the intestinal secretions and constipation. Assuming, then, that a lack of nerve force is the source of this vi'ide.^pread affection, it would seem to be most erroneous and pernicious to treat this affection with purgatives, and still further increa>e the debility. Constipation, or faecal accumulation, is a fearful source of headache, fetid breath, dyspepsia, torpidity of the liver and spleen ; piles, insomnia, mental depression, apoplexy, neivous disorders of all kinds — the brain and rectum suffer most in all cases. The poisonous activity of human faeces even in a healthy indi- vidual is very gieat. There are formed in the intestines of an adult in twenty-four hours a quantity of cadaveric alkaloids, which, if excretion were stopped and all were absorbed, would be sufficient to destroy life. No one can doubt the .seriousness of retained faeces and the injurious effects of constipation, for when it exists those poisons are absorbed at the rate of dimini^shed perisaltic action. The only true method of curing constipation is by increasing the vital jorce of the affected individual, and the removal of all apparent causes. The remedy must not be either a pur- gative or laxative ; it must increase the vital stamina; by this means procure a free flow of bile, remove congestion and unload the bowels. For this purpose the active nerve-stimulating principle of the kola nut has been isolated and made into a pleasing, palatable form which, when taken, relieves this difficulty. This active, isolated principle is free from all bitter and astringent prope'ties, incidental to the drug, while the nerve-cell elaborating principle is even more energetic by this elimination. This principle is one of immense power ; it not only stimulates the brain by its action in generating more gray matter, but in some mysterious manner vivifies the great sympathetic which covers the bowels and energies the eighth pair that supply the liver. Such a remedy speedily affects the liver, restores that gland to its pristine activity, the bowels become regular, the complexion clear, the breath sweet, and the whole body seems rejuvenated and pervaded by a feeling of buoyancy, which shows that the liver has resumed its normal function. The remedy is indispensable, not only in constipation, but in all diseases of the liver and bowels, as it increases cerebral force, acts upon the sympathetic which supplies the intestines and pro- BACTERICIDES. 1349 motes the nutritive assimilative forces, rouses up the secretion of the liver. It riQVQr causes any pain or f^ripin^r, or nausea, no de- ran ^ement or inconvenience, but in all cases constipation dis- appears. The individual taking the remedy must be the judge of the dose. EioucTh should be taken before retirin ^ to cause only one comfortable, ifree, copious evacuation after the m.ornin^ meal. It is a gentle and effective aperient for the mist debilitated as well as the strong, affording agreeable and effective relief from constipation. Its use, unlike other medicines, does not necessi- tate continuous repetition, and. however frequently taken, its action being so gentle, no evil effects can arise therefrom. A native of Abyssinia. The panicles are uni- Kousso. sexual. Both the male and the female flowers, but chiefly the latter, are collected and exposed to the sun to dry. As they reach this country, they are in com- pressed clusters, entire or more or less broken, or in subcylindrical rolls, bound to- gether with transverse bands, or in small fragments. The clusters or rolls vary from ten to twelve inches, of a green- ish-brown color, and have a pleasant, herby, tea-like odor, but very acrid and disagree- able. There is found in the entire plant a volatile oil, a bitter acrid resin, and the alkaloid koussin, which is inert. An infusion is the only form which is eligible for use. Two ounces to a pint of water, simmered down to half a pint. The usual precautions being observed, as to diet, it should be drank freely and is most effectual in destroying all forms of tape-worm. Kousso. prepared from the kurchicine, are most Hindoo Bitters, efficacious. These bitters excel all others in point of real merit, and their fine bitter orange flavor makes them as pleasant as they are useful. They are a reliable remedy for dys- pepsia, indigestion, constipation, ague, and diseases of the stom- I350 DISEASE GERMS. ach, bowels, liver, and kidneys. They purify and enrich the blood, tone and impart strength to the system, stimulate the di- gestion, regulate the bowels, promote a healthy appetite, dispel nervous exhaustion, cure general debility, give buoyancy to the spirits, and are especially recommended as a true tonic and restorer for invalids, females and delicate persons. They will be found extremely beneficial in regulating the various functions of the body, and a reliable antidote and preventive for chills and fever and all malarial diseases. The Hindoo Bitters are not an intoxicating beverage, nor can they be used as such by reason of their cathartic properties, and being purely vegetable, they are classed strictly as a medical agent, and can be given at all times with beneficial results. When taken after meals they aid digestion ; when taken before meals, they produce a healthy appetite, and as a morning tonic they have a charming effect. In cases of dipsomania, or for persons having an unnatural desire for liquor, they will be found peculiarly suitable, as the use of these bitters will enable them to free therfiselves of the pernicious habit, by acquiring a strong and healthy appetite for solid food. The same remedy is put up in pill form, and there is also an alkaloid extracted from the same — sulphate of kurchicine. Concentrated tincture of kurchicine highly ozonized is of im- mense utility in the quotidian, tertian and quartan types of mala- rial fever, as it destroys the micro-organisms which give rise to that class of pernicious fevers. So definite and potent is its ac- tion that after the first dose the odoriferous character of the dead germs can be detected in the sweat, saliva, urine. The bowels must be opened ; all fluids strictly forbidden, either with the remedy or for several hours subsequently, or between doses, as watery fluids supply a pabulum to germ evolution in the blood. The remedy causes the malarial "germ to speedily disappear from the blood and tissues. It is valuable in small doses in all fevers or states of debility. It changes the electrical forces of the body from a negative to a positive state. This is a most eflficient germicide in certain Lactic Acid, forms of dyspepsia, and for the removal of phosphatic deposits in the urine. From one to two drachms is added to a half or a pint of sweetened water and drank like lemonade, this being the dose for twenty-four hours ; in one-half drachm to the pint of water, taken daily, of utility in diabetes. A solution of one part of the acid to five of water has been BACTERICIDES. 135, efficacious in dissolving the false membrane of croup and diphtheria. A small amount of the acid added to pepsin increases its sol- vent powers in a most remarkable degree. An eighty-per-cent. solution painted over ulcerating lupus is most effectual in the destruction of the tubercular bacilli. Obsti- nate cases of ulceration of a phagedenic or cancerous type are successfully treated with this acid. More recently it has done good work in the removal of large patches of epithelioma in, around and on the os uteri. The acid locally, and Chian turpen- tine internally in cancer of the uterus often effect radical cure. The application of the acid in all cases should be limited to the diseased parts. The great value of lactic acid in the diarrhea of infants is well established, especially in cholera infantum. The best result is obtained from small doses, frequently repeated. The following formula operates well : Lactic acid C. P., half a drachm; simple syrup, one ounce ; water, three ounces. Mix. In teaspoonful doses, repeated as occasion requires. For corns, acid salicylic, ten parts ; acid lactic, ten parts; col- lodion, eight parts ; carbolic acid, two parts ; apply to the corn several coats, allowing each previous one to dry. E. D. Reed, M. D., Frederick, Md., in a recent essay read before the Society in that State, says : " Lactic acid has been found to possess some very remarkable properties. It has no corrosive action upon healthy mucous membrane, but attacks and destroys unhealthy and sloughing tissues. The diseased tissues turn a dark, dirty brown under its application, and quickly slough off, leaving a healthy appearing surface which tends to granulate and heal. It is a valuable remedy when the pain is severe and the discharge very offensive and flooding frequent. These symptoms are greatly relieved by the application of the acid twice a week. It does not produce pain when applied, and when used freely twice a week relief is almost immediately experienced. The manner of application is as follows : An ordinary Furgeson speculum is introduced, the cervix cleansed; then a mop made of absorbent cotton and saturated with the acid is freely applied to the sloughing mass ; v/ater is then thrown in, and the acid again applied, after which a tampon of cotton is placed, and the patient allowed to go. The treatment should be practiced once or twice a week, according to the gravity of the case." . Disappointment in the use of lactic acid is frequently experi- enced on account of the poor quality of the drug. Hence the necessity of procuring the article of a reliable chemist. 1352 DISEASE GERMS. E. S. Pixley, M. D., Pittsfield, Mass., has had most extensive experience with dilute lactic acid in the treatment of summer diarrhea and cholera infantum ; he has also found it useful in headache and rheumatism, having the effect of clearing the in- testinal tract of all microbes. Children take the remedy easily; as it forms an agreeable beverac^e, and its continuous use does not in any way interfere with digestion. The whole herb in the form of a saturated Lachnanthes tincture, is a bactericide of considerable power ; Tinctoria. administered in pneumonia, typhoid, and other {Red Root) fevers, it kills the spores, and the full fledged microbes. It also has a most remarkable action in sterilizing the tuber- cle bacillus, hence it is of great utility in the cough of bron- chitis and phthisis. The tinc- ture is prepared as follows : Coarsely ground herb, one pound, cover with alcohol of a seventy-five per cent, strength. Let it macerate one month. Then percolate. A few drops of this tincture is excellent in hoarseness, laryn- geal cough, and for our hay- fever cough of spring and fall. In the recent epidemic, influenza, the physicians of New Jersey have been using the tincture of the red root with salicy- late soda with wonderful success. It certainly is a valuable addi- tion to our respiratory antiseptics. Red Root. There seems to be a considerable future before Lactose, lactose as a diuretic. Milk itself can be used as a diuretic, but it tends to produce a temporary gly- cosuria. Lactose has none of these disadvantages. Very con- siderable diuresis is produced by the administration of one hun- dred grammes of lactose, that is to sav. the amount contained in two litres of milk. The diuretic effect produced by a potion containing that amount of lacto.se is greater than any produced by drugs ; it quickly re iches two and a half litres of urine a day, BACTERICIDES. 1353 almost always risin^ to three arid a half and even four and a' half litres on the third day. During- this period dropsical effu- sions disappear, and the blood is dehydrated Its effect is cer- tain in cardiac dropsy; in renal dropsy, on the other hand, its action is much more doubtful. In cardiac cases it fails only when the complication of Bright's disease exists, and when the albumi- nuria amounts to from sixty to ninety centigrammes per litre of urine. Diarrhea or copious perspiration may also lessen the diuretic effect of lactose by dehydrating the blood. The remedy is, as a rule, well borne. It should be continued for eight or ten •days, when the administration should be interrupted for a few days, and afterwards resumed. The blood pressure is not raised hy lactose. It is far superior in this respect to strophanthus and digitaline. The milky juice of the lettuce, added to Lactucarium. the ozonized syrup of tolu, is a most valuable preparation. Possesses the hypnotic, sedative, and calming properties of the opiate preparations, without provoking constipation, cerebral congestion, want of appetite, etc. It is ^ one of the very few preparations that can be efficaciously employed for children without any inconvenience. In co4i- sumption it moderates the cough and expectoration, destroys the bacillus. A shrub of the ujint Lavender, family, possessing all the germicidal properties of its class; besides being an aromatic stimulant and tonic, it is much esteemed in the form of a decoction in nervous debility ; as a tonic to the stomach ; a gargle to the mouth and throat ; in cases of aphonia. Vinous tincture of the flowers make an excellent aromatic wine for colic, and where ptomaines are irri- tating the bowels. Its oil is obtained by distillation, forms a pleasant and invigorating per- fume, and the amount of ozone devel- oped in the atmosphere by this volatile antiseptic is immense. Thus it may be used in an atomizer for laryngeal irritation, or in the form of a cerate. Laveuuc 354 DISEASE GERMS. Oil of lavender, two ounces ; vaseline, two ounces ; oil of sweet: almonds, one ounce; oxide of zinc, two ounces; carbolic acid., thirty grains. Mix. Apply to the nostrils in catarrh. Lemon. AH the fruit germicidal, the rind stomachic. Lemon juice specific for the cure and prevention- of scurvy. Administered in large doses in rheumatism it annihilates the lactic ferment, but not essentially curative. It greatly intensifies the action of some alkaloids ; lemon juice and quinine added to strong mocha coffee is pre-eminently de- structive to the malarial germ. Citric acid or lemon juice added to caffeine affords us a reliable remedy for the headaches incidental to breathing sewer gas. As a local application, with a sriiall amount of cocaine added, never-failing in pru- ' ritis of the scrotum ; for freckles equal parts of lemon juice and glycerine, say two ounces of each, and one grain of bichloride of hydrargyrum added; for painting over the diphtheritic patch. Take it all in all; it is a remedial agent of much potency. ' ' Citric acid has powerful germicidal action. It is cooling and refreshing to the taste, and is decomposed in the system, acting, probably, in the same manner as sugar. When taken in the form of lemon juice, or in the fruits of the orange family of plants, it is eminently antiscorbutic. On this account ships going a voyage of more than six weeks are com- pelled to take a supply of lemon or lime juice, and sailors should take at least half-an-ounce a day. The crystallized citric acid does not appear to act as an antiscorbutic. Citric acid and the juices which contain it are employed for making effervescing d'-aughts, when mixed with alkalies. Fourteen grains of citric acid, or ha f-an-ounce of lemon juice, mixed with twenty grains of bicarbonate of potash, makes, with one ounce of water, an ex- cellent effervescing draught. Lemon {Citrus Lemonum). BACTERICIDES. 355 Black root or Culver's Physic, the root of Leptandra. leptandra virg., is a mild alterative, cholagogue and tonic. It is a slow acting remedy, but effi- cient, reliable and powerful in stimulating the granular structure of the liver, cor- recting the hepatic secretions and pro- moting a free flow of bile. It is an effi- cacious remedy in all diseases of the liver : if combined with phosphate of soda, it operates efficiently in jaundice or whenever the liver needs the aid of a remedy to promote biliary secretion. The fluid extract from the fresh root is the most reliable and best for ordi- nary use. The so-called leptandrin is simply a solid extract in a state of trituration, not entirely useless but nearly so. The glucoside leptandra (American preparation) is reliable, as it is prepared from the fresh root. It forms some splendid compounds. Glucoside leptan- dra, two drachms ; citrate of caffeine, one drachm ; strychnine, half a grain. Mix. Make sixty pills, one thrice daily of great efficiency in constipation of Bright's disease. Leptandra, hydrastin, quinine, of each thirty grains ; solid extract of nux- vomica, grains seven. Mix. Make thirty pills. One thrice daily, good tonic. Licorice root contains a Lficorice. valuable substance called glycyrrhizine, closely allied to sugar; yellow, transparent, uncrys- ^ ,. ,^^, tallizable ; soluble in both water and C^^Ji^SI^^^Vx^' alcohol, forming compounds with acids and their bases. Leptandra. It is much used, not only for its antiseptic properties, but for a vehicle to disguise the taste of bitter drugs. Fluid extract of licorice, for quinine mixtures, is very generally used by physicians, but all may not be aware how eifectually it disguises the bitterness of quinine. The desired dose of the 1356 DISEASE GERMS. quinine ia powder should be added to a teaspoonful of the licor- ice and thorouf^hly mixed before being swallowed. An aromatic elixir of licorice should be used like the fluid extract. Common Licot ice C Glycyrrhiza • glabra). Cocardu';. (Magn'fietl 225 diam.) A highly noiymorphic species of mould which is very prone to appear upon aqu ous ex- tracts of Glxcyrrhiza, and renders ihem worthless. Ammoniated Glycyrrhiza. — The sweet principle of licorice, glycyrrhiza, in combination with ammonia. Used to blunt the gustatory nerve and to mask the bitterness of quinine. Dose ; One grain every three hours. Instead of obtaining this by decomposing Liquid Ozone, the atmosphere, we can now more effectually obtain it in greater abundance and purity by compressing strongly ozonized oxygen to the extent of 125 at- mospheres at a temperature of — I02.5°C. ( — 153.5° f^ )• We have practically dispensed with pressure and employed cold alone. At a degree of heat — or shall we 'sdiy cold? — represented b)' — 181.4° C.( — 194.5° F.), the temperature now known as that of the boiling-point of fluid oxygen, ozone condensed to a deep, purple-blue liquid, the color of which is so intense that a layer of it about two and a half mm. is to all intents and purposes opaque. The ozone remained liquid as the temperature was al- lowed to rise gradually (controlled by fluid ethylene), until at about — 106° C. ( — 168.8° F.), as indicated by a " hydrogen ther- mometer," the ozone begins to boil. The boiling-point of ethy- lene itself is not very different, being — 102.5° C. ( — [52.5° F.). Very great care must be taken in order that the ethylene and the ozone do not come into actual contact with each other, as if they do so. an explosion of terrific violence immediately occurs. Re- cent chemical manipulations have led to the discovery and intro- BACTERICIDES. 1357 duction of apparatus by the aid of which those wonderful products of modern science — liquid oxygen, hydros^en, nitrogen, et::., and even the solid form of these so-called " permanent " gases — were made. ■ Carbonate of lithia, valuable in relieving, cystis ; Lithia. affords relief in irritable states of the prostate. The bromide of lithia acts efficiently in all cases of gout or rheumatism. Benzoate of litiiia neutralizes uric acid in the blood and overcomes the uric acid diathesis ; it is also a remarka- ble solvent to calculi in the bladder. The benzoate of lithia in five-grain doses alternated with salicylate soda in the acetate of ammonia does g^ood work in chronic rheumatism. The carbonate of lithia rendered soluble by the peroxide of hydrogen is one of the chief ingredients of the uric acid solvent ozonized. The salicylate of lithia is an excellent bactericide, has a destructive effect upon the bacillus arnylobacta. Lobelia, Indian tobacco, the leaves and seeds are used medically for a variety of diseases, as it is an emetic, expectorant, sedative, antispasmodic, and has the invaluable property of sterilizing all disease germs. It is a most powerful and active emetic, provided its administration is pre- ceded by copious warm alkaline drinks, as it is not absorbed in an acid menstruum. It is very useful in all fevers, as it keeps the germs, the factor of fever, quiescent ; it relaxes the system, produces diaphoresis. As a relaxant and sedative, it is a most efficient agent in the treatment of epilepsy, hysteria, spasm, cramp, convulsions, tetanus. It acts well upon the motor nerves of respiration, hence it is often of the greatest utility in asthma, bronchitis, laryngitis. The immense resources of modern thera- peutics have not been able to supersede it. The vast future of medicine will require lobelia. Noses njay wither with the amoeba of catarrh ; eyes fail from steady use ; ears become dull by excesses ; tissued-starved teeth may vanish and drop out; but the cleansing of the stomach from the fungus ■^^i^t b Lobelia. 35« DISEASE GERMS. sircinae needs lobelia. We do not claim it to be an antiseptic, it cannot destroy micrococci, it sterilizes them and also the nutrient soil upon which they live. No drug has superseded it in teta- nus ; its action cannot be explained ; meets the etiological and vital condition, renders the germs of this fatal disease quiescent in the blood and retards organic changes. Lycopodium Vegetable sulphur, is an invaluable germi- . cide. The plant, moss or fern, possesses properties of a high anti-bacterial character, for a cecoction of it kills that terrible parasite malady \.\\q plica polonica. It is extremely useful in that peculiar burning of the cutaneous surface when it is loaded with the germs of disease, in painful boils ; in that aggregation of the germ syph- ilitica on the bones called nodes ; in all tu- bercular skin af- fections ; it ope- rates like ordi- nary sulphur upon the liver, stimulating that gland, removing that dirty, yellow hue of the skin, which is so common in torpid liver. Besides it is invaluable in relieving irritable bladder, espe- cially in the enuresis of children. Club Moss (Lycopodium) . Bugleweed, the Lycopus. herb either in de- coction, tincture or fluid extract, is astringent, tonic, sedative and narcotic. It is so soothing when admin istered that it diminishes heat, pulse, respirations, and its action is incomparable in incipient pul- monary tuberculosis, in retarding germ evolution and growth — in preventing bacterial development in diarrhea and dysentery. Bugleweed. BACTERICIDES. 1359 It is this peculiar germicidal action that renders this plant so efficient, so highly prized in all haemorrhages from the lungs and stomach. Its action upon the heart resembles that of bromide of soda. Besides, it is valuable in toning up and promoting digestion^ and allaying all uneasiness or irritability of the alimentary canal. The best preparation for use is either the tincture or fluid •extract, in doses according to the effect desired. The physiological action of bugleweed is directly on the nerve. The combination of this property and its germicidal properties is what renders it of so much value in pulmonary and intestinal tuberculosis. This invaluable anthelmintic consists of an Male Fern, ethereal extract or oleoresin extracted from the rhizome. This is the only preparation fit for medicinal use ; it is a thick, dark green liquid, has the odor of the fern, nauseous bitterish acrid to the taste. On standing, a granular, crystalline substance ap- pears on the surface, which is the active ingredient, and should not be sepa- rated. Dose from thirty to sixty grains is the proper quantity, administered in capsules. If capsules are not ac- ceptable, it may be ad- ministered conveniently in the following combination : Ethereal extract male fern sixty grains, rubbed up in mucilage of gum acacia one ounce. To be taken at one dose, followed by copious drinks of slippery elm. Castor oil to be taken two hours after- ward. Common Male Fern. is a powerful germicide, having a special affinity to Manaca destroy the microbe of syphilis, the bacilli of tubercle and the germs of rheumatism. It excites the action of the lymphatic system most energetically, and eli- minates morbid or waste material from the system. In alterna- 1360 DISEASE GERMS. tion with the saxifraga, it is the ne plus ultra of all drugs in syphilis. Prof. Day, M. Z>., of America, and E, Mather ^ M, D., of England, have had undoubtedly the most experience with this drug. They state, and both agree that, if very carefully guarded in its administra- tion, it will destroy the bacillus of syphilis and amylobacta of rheuma- tism. It is of special utility in phrenal syphiHs, affording relief in all cases from the noctur- nal pain. Manaca. Marjoram A perennial plant, with a stem about a foot high; ovate leaves; roundish, panicled, crowded heads of purple flowers, with large bracts. Its properties are germicidal, used in cooking for seasoning. Stimulat- ing and diaphoretic in the eruptive fevers, has a sterilizing action on germ evolution. The powder is nearly equal in antiseptic proper- ties to the horse-chestnut in nasal catarrh. An infusion is the best method of administering. Drink- ing it cold it warms, invigorates and soothes the nervous system. The essential oil of sweet marjoram mixed with olive oil in various proportions, is an excellent remedy for baldness, as it is inimical to the different forms of tinea of the scalp. , Sweet Marjoram {Ori^aKum Ma'rjo- rnnn); 2. Common Marjoram {Ori- g-iiumvuUare). Horehound is a most efficacious germicide Marrubium. upon all micro-organisms on the mucous mem- brane of bronchi and larynx, and also upon germ-laden sputum from the substance of the lungs, as we have BACTERICIDES. 1361 in pulmonary tuberculosis and pneumonia; consequently, al- though entirely ignorant of its annihilating action upon the germs of catarrh and bronchitis, j^^ and its sterilizing action upon the tubercular bacilli, and the pneumo- coccus, the remedy has been em- pirically prescribed with the best results in chronic catarrh and bron- chitis, attended with very copious germ-laden expectoration. Besides its action as a bronchial stimulant and antiseptic, it is a safe and efficacious tonic, acting as a most efficient stimulant to the kid- neys, skin, but especially the liver, giving us copious biliary secretion. UQTf:ho\xn^{Marrudiumvui!gare). An infusion of one ounce to the pint of boiling water. Dose: a wineglassful, either warm or cold, as desired, answers well; but better still is the tincture, which holds its aromatic properties in a more perfect state. Japanese peppermint, a camphoraceous body, Menthol, having the same bactericide properties as thymol. Menthol is somewhat soluble in water, as shown by its taste being imparted to water, and by the slug-like move- ments of the crystals when covered with water, and placed under the microscope. Sometimes the movements in the water to- wards and from the dissolving crystals, are as rapid as those formed by an active rotifer or vorticel. These movements are rendered visible by minute objects floating in the water, as infu- soria and algae. They approach the crystals of menthol with ve- locity, and are ejected with violent electric motion. Menthol left exposed, will evaporate and disappear at the ordi- nary temperatures of the rooms. Its smell is like peppermint, but less pungent. Taste is somewhat sharp, and penetrates the whole mouth. It looks like the sulphate of magnesia to the naked eye, but more talc- like. It is rather bulky, one ounce filling a two-fluid ounce bottle. From what I can judge, it is a very agreeable medicine, and would make an acceptable substi- tute for the smelling-salts of elderly ladies. There is nothing unclean about it. Its volatility renders it easy to administer in diseases of the air passages, even to infants and very feeble persons. Menthol is a bactericide, has the remarkable property when 86 1362 DISEASE GERMS. administered, of sterilizing the blood to many disease-germs. The following are a few of the formulae in general use : For internal administration. — Menthol, one drachm ; three ounces each of fl. ext licorice, water, alcohol ; twenty drops each of oil of cajeput and carbolic acid. Mix. Four drops every two hours. For applying to the nostrils in hay fever. — Menthol, one drachm; ozone ointment, two ounces ; hydrochlorate of cocaine, one grain. Mix. For piles, eczema, pruritus of the genitals, fistulce, rectal excoria- tions. — Menthol, one drachm ; ozone ointment, two ounces : chaulmugra oil, half an ounce; cocaine hydrochlorate, two grains. Mix. As a gargle for sore mouth, scarlet fever, syphilitic and tubercular ulceration. — Take of each menthol and carbolic acid, twenty grains; two ounces each of fluid extract of licorice and glycer- ine ; peroxide of hydrogen, one drachm ; one pint of water. Mix. In pruritus. — Take one drachm menthol ; two ounces of alco- hol ; thirty grains carbolic acid ; the same of the benzoate of soda ; add the whole to six ounces of rose water. This drug is used by the natives as Mudar Bark. a remedy for epilepsy, paralysis, bites {Calotropis Gigantea) of poisonous animals, worms, etc. In cutaneous affections, especially lep- rosy, It is frequently employed. Its active principle, discovered by the late Dr. Duncan, of Edinburgh, called mudarine, pos- sesses the extraordinary property of congealing by heat and be- coming again fluid when cooled. Dr. G. Playfair found the milkly juice to be very efficacious in leprosy, lues venerea, herpes, dropsy, rheumatism, hectic and intermittent fevers ; and Dr. Duncan considered that it agreed in many respects with ipecacuanha, and that it might eventually supersede the latter. (See Major Heber Drury's "Useful Plants of India.") in the form of a tincture of the green plant, that Marigold is, flowers, leaves and stem, is a bactericide ot (^Calendula), the first order; hence it is of intrinsic value in all cuts, bruises, wounds, and contusions. It is altogether superior to arnica in ecchymosis. The mother tincture diluted one-half with water and applied to a wound or ulcer, pro- motes rapid cicatrization by destroying the bacteria. BACTERICIDES. 363 Asa germicide its range of action is large ; it sterilizes the oidium albicans of aphthae and sore nipples. It combines well with peroxide of hydrogen, and when four volumes of that invaluable agent are added, it is of the greatest possible utility in threatened gangrene, purulent ophthalmia, abscess, carbuncle, etc. Menyanthis Trifoliata. {Buck Bean.) A most intense- ly bitter tonic and germicide. In some sections of the country it is used quite extensively in the treatment of our indigenous fevers, rheuma- tism, jaundice and parasite cutaneous diseases. It is alterative and purgative. It is often administered in infusion — half an ounce of the pulverized plant to a pint of boil- ing water. Dose, a wineglassful repeated fre- quently. Also in the form of a fluid extract in doses of thirty to sixty drops. Buck Bean. Mexican Ointment. {For Rupture) This ointment is in very general use in Mexico as an ointment for hernia. Its true composition has as yet not been definitely settled. It is applied externally over the hernial aperture, and has the remarkable faculty of contracting the orifice, and at the same time, without the slightest irritation, causes thickening of the parts, and forever after prevents the rupture from taking place. It is a most excellent remedy to prevent the occurrence of rupture. It is spread on a piece of leather morning and night and ap- plied. It is a most excellent local bactericide when applied to the skin in any form, of either vegetable or animal parasitic disease, it al- most immediately kills it. Its action is perfectly painless. The whole plant is germicidal, and is a remarkable agent to render labor easy, it is also diuretic, tonic and astringent. It resembles the aleteris farinosa. The comp. syrup of partridge berry is the most important -agent ever presented to the profession in the treatment of dis- Mitchella Repens. {Partridge Berry) 1364 DISEASE GERMS. eases of the female reproductive organs. This syrup is emrriena- gogue, parturient, antispasmodic, diuretic and tonic, and is par- ticularly efficacious in the treatment of engorgement, inflamma- tion and induration of the uterus, dysmenorrhoea, menorrhagia, leucorrhoea, amenorrhoea, prolapsus uteri, hysteria, melancholia, pruritus vulvae, impaired vitality, vomiting of pregnancy, habitual abortion and uraemic eclampsia. It being a powerful uterine sedative, is the remedy par excellence in dysmenorrhoea or threat- ened abortion. Mulberry. Some of the most common affections, spring and fall, when the vicissitudes of temperature are great, are inflammatory affections of the glands of the mouth and larynx, chilliness, fever, pain in de- glutition, and as it progresses, swallowing becomes exceed- ingly difficult, if not imprac- tible. The tongue coated white or brown, mouth dry, and if the inflammation is not promptly checked by the use of antipyrine, small vesi- cles make their exit : in these the oidium albicans make their appearance. In such cases the glycerite of sul- phur, one teaspoonful every hour, and the throat packed from ear to ear, with a strong infusion of the inner bark of the white mulberry. As a gargle and mouth wash, the same infusion is unexcelled, as it destroys all germs in the mouth. It is also an infallible remedy in nursing sore mouth and ulceration of the nipple. The root has considerable reputation as a vermifuge. Common Mulberry (Morus nigra) \ fruit, leaf, and female flower. Arrowroot, is a variety of starch, extracted from Maranta, the roots of certain plants which grow only in tropical countries, and is much valued as a deli- cacy, a light, nutritious and easily digested food for children and invalids. The tuberous roots contain a large percentage of farina. That growing in the ozoniferous atmosphere of Bermuda BACTERICIDES. 1365 is a foot long when a year old, and when reduced to a pulp, by repeated raspings and washings, yields one of the finest antisep- tics in medicine. A small quantity of this extract in- troduced into albuminoid bodies preserves them for many months, without de- terioration or chemical change. The use of this antiseptic in all fevers, and in all diseases in which albu- minoid changes take place, is worthy of serious consid- eration. The amount of fecula or starch present in the root of the maranta varies ac- cording to age and soil, runs from eight to twenty-six per cent. The latter stage is reached when the plant is about a year old. A green tincture prepared from the fresh root is highly germicidal, and is an antidote to the stings and bites of venom ous insects and reptiles. Arrowroot ; tubers ; b, leaf and flowers ; c, stamen land style. Mistletoe. ( Viscurn Album.) Mistletoe {l^iscum Album), This parasitical shrub, which de- rives its nourish- ment from the liv- ing tissue of the tree upon which it grows, and from which it seems to spring, has been held in high repute by both German and British Druids as a germicide in sterilizing the microbe of hooping-cough and the bacillus of hay- fever. It has a decided medicinal pro- perty in chorea, epilepsy, convulsions, and stands high as a pain-alleviating remedy. It is used most extensively in this country as a uterine tonic and vitalizer. The very best results are obtained by administering the elixir of the mistletoe during the last four months of preg- 1366 DISEASE GERMS. nancy, equal to the wine of the aieteris farinosa. Sure to reheve pregnancy and parturition of many compHcations, and insure ease and safety ; and still more, when its action in labor is aided by the uterine cones, we bring about the phenomenon in midwifery practice of " painless parturition." Mura Puama. — Fluid extract more powerful than damiana as an aphrodisiac. It forms the chief ingredients of the sexual invigorating fluid and pills. The fluid extract of mullein leaves is indicated Mullein, in pulmonary phthisis ; efficacious to relieve cough and ulcerated bowels ; obviates phthisical diarrhea. The smoke of the burnt leaves relieves irritation of the bronchial mucous membrane. Mullein oil, valuable in all cases of aural disease, as deafness otitis media, otorrhea, otalgia. This oil is prepared by polarised light and by peroxide of hydrogen. One to three drops in the ear. Dr. Mather, the celebrated English physician says : Mullein oil was worth a trial in bad cases of deafness, especially when labyrinthine mischief was suspected. I commenced its use in a large number of cases, with most satisfactory results. In nearly all cases complaining of pains and presenting signs of hyperaemia of the middle ear, the instillation every two or three hours of two or three drops of this oil rapidly arrested the pain, and prevented suppuration and perforation of the membrana tympani. In every case of otorrhea or otitis media, after the ear was washed out with tepid water and castile soap, it was dropped ; following its use there was no more odor, no muco-purulent dis- charge, not a vestige of the 'streptococcus pyogenes could be seen. In cases of labyrinthine deafness the result was extremely satis- factory. In some instance the cure was gradual ; in others at once. The mullein oil treatment of aural diseases excels all others, especially of an otalgic or suppurative character. BACTERICIDES. 1367 This is a substance Myrrh, which exudes from the bark of the balsamoden- dron myrrha, a tree peculiar to the tropics, in oily yellow tears, which gradually thickens, and finally be- comes hard, and darker in color. It is an invaluable germicide, was ex- tensively used by the Egyptians for embalming, and by the moderns as a remedy to destroy micro-organisms in the mouth and alimentary canal ; hence useful in all forms of oral ulcer- ation, spongy gums, fetid breath ; it destroys the bacteria of ulcers, hence if sprinkled on them promotes heal- ing ; of value to sterilize the amoeba of catarrh and bronchitis. A tinc- ture is good form for general use. Myrrh {Bacsamodendron myrrha). Ten drops of Myrtle, ozone et chlorine were added to six- teen ounces of tepid water, and when used an ounce of myrtol was added. Used as a mouth wash and douche by the nose; Most excellent results followed, a general improvement took place, a complete change from worse to better, ?o much so that I dete- rmined to try the myrtol inter- nally. The preparation I used was an ozonized distillation of the leaves and flowers of the common myrtle ; being a liquid possessing all the perfume of the plant. It is of less density than water, and evaporates at ordinary temperature. It has a slightly Myrtle in acrid, astHngcnt taste, followed by a sensation of freshness. It is a powerful germicide, stimulates all the vital functions of life, inimical to microscopic life. It is a great appetizer, a sedative Myrtle. I, Myrtle Flower. Flower. 1368 DISEASE GERMS. to the nervous system, enters the blood, acts as a scavenger to that fluid, and after disinfecting the entire body is freely elimi- nated by the breath, skin, and kidneys. It has a decided affinity to disinfect the respiratory mucous membrane, completely anni- hilates the amoeba of catarrh, laryngitis, bronchitis, asthma; also of glanders ; changes the opaque, gangrenous, purulent secretion, at the same time inducing a healthy condition. It is an unsur- passed remedy in chronic fetid bronchitis, complicated with paroxysmal asthma and emphysema. (CioHg) is a derivative of benzol, and allied to Naphthaline phenol. It appears as thin white shining rhombic crystals, with a strong pungent odor and burning taste. It is insoluble in water, but readily dissolves in alcohol, ether and fatty and ethereal oils. Externally it has been found of value in the treatment of venereal ulcers, ol wounds and of scabies. This substance was recommended. for certain intestinal affec- tions by Dr. H. Warner, Springfield, Mass. The purest naphthaline alone should be used, and he found it invaluable incase of chronic intestinal catarrh and cholera morbus in children, as well as in typhoid fever. In intestinal tuberculosis he found that it caused some improvement, but no radical change, and for acute diarrhea it was no better than opium and suitable diet. Dr. Warner's success was not attained by others who used naphthaline according to his directions, and they reported that it produced hypogastric pain, strangury, tenesmus, and urinary appearances suggestive of carbolic acid poisoning. Moderate success was reported, however, by a few writers. The author, after extensive and careful use during a sufficiently lon'^ period of time to warrant conclusions, decided : 1. That naphthaline is ineffective in the so-called dyspepsias which are characterized by frequent movements of the bowels, and usually by the vomiting of coagulated milk, and is inferior to other medicaments which are in general use for such con- ditions. 2. In all other forms of intestinal catarrh in children naphtha- line should be preferred to all other known means of medication. In simple acute diarrhea the preparations of opium would be pre- ferable, but for the fact that naphthaline checks fermentation pro- cesses, and in this way prevents an acute intestinal catarrh from developing into a chronic one. Naphthaline is a powerful antiseptic, insoluble in water, alkalies, BACTERICIDES. 1369 -and acids ; may be administered in capsules two to eight-grain doses without any noteworthy absorption by the stomach and in- testines. Excellent results are obtained from the use of this germicide in acute and chronic intestinal diseases, tubercular affections, diarrhea, dysentery, infantile diarrhea and cholera. It kills the germs of disease in the alimentary tract ; besides it dis- infects the entire passages of the germ-laden, green stools, so common among children in crowded cities during the hot season of the year. In cholera infantum it has achieved most wonder- ful results. An excellent formula for all cases, to destroy the bacteria and disinfect the entire alimentary tract, is the following : Naphthaline, sacch. lac, of each, two ounces ; oil peppermint, one drop. Ft. twenty chart. One every hour, and less frequent, according to the evacuations. Externally in a pure form, or in an ointment, it is useful in scabies, herpes tonsurans, eczema. Prof. Fuchs^ M. D., New York City, N. Y., several years ago, called attention to the value of this agent in the treatment of cer- tain diseases of the skin, and particularly of scabies. He em- ploys naphthol in a ten-per-cent. alcoholic solution, or in the form of ointment, and says that one or two applications will cure the most inveterate cases of common itch. He has had equal suc- cess with naphthol in psoriasis, eczema and ichthyosis, and there is nothing better, he says, to allay tormenting itching of prurigo. Dr. Fuchs speak in high praise of naphthol as an external agent (alcoholic lotion or pomade) in the skin diseases mentioned above. Van Harlingen, moreover, has seen favorable results from naphthol in obstinate cutaneous affections. The experiments to which allusions has been made, have led Bouchard to regard naphthol as one of the best and safest of antiseptics. According to these a three-per-cent. solution markedly retards the development of the typhoid bacillus, as well as that of the bacillus tuberculosis. The same solution is fatal to the microbes of several of the parasitic diseases of ani- mals, and prevents fermentations. Bouchard gives naphthol internally in typhoid fever, and believes that, if it does not abort this disease, it certainly renders its course milder. He regards a dose of forty-iive grains (2.50 grammes) a day as realizing the conditions of intestinal antisepsis, and affirms that in such doses there is no antiseptic agent which is more innocuous. This use of naphthol in typhoid fever has been followed to some extent in this country with apparently favorable results. 370 DISEASE GERMS. Indicated as a powerful stimulant to the Nitrite of Amyl. pneumogastric and vagus in angina pec- toris, asthma, epilepsy, syncope. Its action is instantaneous and certain, as it lowers vascular tension by dilating the arterioles ; stiffens up a weak heart, breaks or wards off the spasm. Dose: One, two, three, four, five, ten drops in pearls or glass shells. Crush a pearl in a handkerchief and inhale on the approach of a paroxysm. One of the most valuable stimulants in Nitro-Glycerine. the Materia Medica. Indicated in all conditions of prostration or collapse, in headache, asthma, angina pectoris, albuminuria, neuralgia, ner- vous anaemia. The best form for administration is a one-per-cent. solution. This is the handiest and least liable to change or become worthless. The average dose is one drop, but patients are not all alike in the amount required to produce an effect — some requiring less than one drop, others requiring three or four or more drops to produce the same effect. The effects usually last two to three hours. It is wisdom for the physician in all cases to call the remedy by a less terrorizing name — glonoin, or trinitrin. Physiological Effects. — Dropped on the tongue, the effect is the more rapid, as there is no dilution. By way of the stomach, unless greatly diluted, the effect is apparent in a few minutes, the pulse being increased from ten to twenty beats, and becoming ful and regular. In a few cases there is a slight headache, last- ing for a few minutes. In larger doses the face becomesflushed, a severe headache is experienced, accompanied with a feeling of fulness, singing in the ears, flashes before the eyes, and all the symptoms of an increased supply of blood to the brain. (3n account of this effect on the cerebral circulation, care should be taken in administering the remedy to the aged, as the sudden expansion of the cerebral vessels might cause a rupture of their weakened calcareous walls. Its action on the heart is through the sympathetic nervous system. The vagus nerve and the vaso-contractor nerves of the vaso-motor nervous system are depressed, partially paralyzed. This allows the extensive system of arterioles to dilate, and thus give room within their walls for a greater amount of blood to flow. Thus this enlarged reservoir of tubes relieves the heart of the work of forcing the current through narrow contracted tubes. This and the vagus nerve BACTERICIDES. I 37 I being depressed permits the heart to beat freer, fuller and more rapidly. Of great value in asphyxia.. Best administered by adding the prescribed dose to a little water, or in the form of pill. The antidotes to an overdose are either ergot, strychnine or belladonna. Two of our oldest physicians speak of it thus : J. H. Moon, M. D., Montpelier, Idaho, a physician of the high- est scientific attainments, gives his experience on nitro-glycerine in tinjiitus auriu7n, as follows : " After the usual experience in ear-work, and a gradual accu- mulation of unimproving cases of tinnitus aurium, I began to study the general effects of nitro-glycerine, and to use it in these cases. In some cases there was an improvement ; in others there was none. In the patients where improvement had occurred, there was found to be present a similarity of conditions, and I soon satis- fied myself that there was a class of patients in which the nitro- glycerine treatment was valuable. I found it most serviceable in patients having the tinnitus aurium, without much impairment of hearing, and where but little change had occurred in the naso- pharynx and where it was found on examination that some abnormal condition of the heart existed, either functional or organic. The tinnitus was generally constant, or nearly so. It was not, as a rule, more marked when the patient was in a recumbent position ; occasionally there was some remission in that position. The thermometric and barometric conditions of the atmosphere influenced the tinnitus ; damp weather, with low barometer, usually increased it. Dull, heavy headache, more or less per- sistent, and most frequently located in the parietal regions, though sometimes located in the frontal region, was of frequent occurrence." Wm. McAIillen, M. D,^ Sugar Branch, Ind., one of the most eminent physicians in the United States, and a close clinical ob- server, points out the value of this drug in various affections — angina pectoris, migraine, and neuralgia, (which he describes as angioneuroses), as also in sea-sickness, some forms of anaemia, faintness, palpitation, and other diseases ; depends upon the ex- istence of an irregular distribution of blood, which condition may be inferred from a certain degree of pallor of the skin, es- pecially of the face, often co-existent with a weak pulse and a small rigid radial artery, which frequently «is situated at some depth. When, on the other hand, headache and neuralgia occur in patients with chronic congestion of the subcutaneous veins of 1372 DISEASE GERMS. the face, nitro-glycerine is to be avoided ; and similarly it is of no use in asthma, when the face is reddened in consequence of emphysema. If, however, a pale face exists with angina pectoris, migraine, giddiness, shock, toothace, or sea-sickness, the best re- sults may be looked for by giving nitro-glycerine. The regulat- ing effect of the drug exercises an influence over the congestion of internal organs similar to that brought about by blood-letting; and in these congestions, whether of lung, brain, or kidney* when they are of a temporary character, the pulse is generally found to be slow and of low tension ; a fact which, as the author remarks, is sufficiently well known in reference to the fever-free periods of acute hyperaemia of the lung and kidney. He lays down as a rule, that the condition of the pulse is the best indica- tion for the employment of nitro- glycerine, and the most trust- worthy guide as to the dose with which to commence the treat- ment. The smaller the radial artery is, the more rapidly it dilates under the action of the drug, and the less the secondary effects proceed ; on the other hand, the fuller the pulse with a distended radial artery, the less it is affected ; and finally, the softer the artery, with a weak pulse, the greater the secondary, and the less the general effects. Single-drop doses of the one- per-cent solution are sufficient in cases of small pulse, but with a full pulse, it will be found that the full effects cannot be pro- duced with less than two-drop doses. When there is a soft artery with a weak pulse, subnormal doses only should be given ; a quarter to half a drop. After the trial dose is given, the patient's sensations of pulsation and pain in the head, as well as the distension of the radial artery under the finger of the physi- cian, will be the guides for increasing the dose. Nutmeg {Myristica moschata). A branch showing fruit, and section of ''fruit, with nutmeg enclosed. An aromatic ger- Nutmeg. micide of some power, and in large doses produces alarming senso- rial disturbance and stupefaction. Il is chiefly used as a spice, for its carminative and stimulant proper- ties. Its action is identical with mace, and in both, their virtues depend upon the presence of a volatile oil, which has a remark- able affinity for oxygen. When the oil myristicai is distilled at a temperature 347° F., there are marked traces of comp. oxygen, BACTERICIDES. 1373 and the pure colorless hydrocarbon, which remains after distil- lation, is identical in composition with the pure oil of turpentine. The extract which is thus prepared, is available for internal use. Mix two drachms of the oil with one ounce of pulverized mace ; macerate for a few days in one quart of deodorized alco- hol, then filter. Dose from five to ten drops, thrice daily. The tincture prepared from the seeds of the Nux Vomica, strychnos nux vomica, when administered in small doses, is an excitant or stimulant to the vaso-motor and motor-centres of the spinal, and thereby in- creases the activity of the circu- lation and general tone of the system. It is one of the most valuable of all tonics, and inimi- cal to microscopic life. In anaemia of the brain and spinal cord, in all forms of paraly- sis due to that pathological con- dition, this drug is invaluable, stimulating the cord and rousing up the inertia of the muscular system. It increases the activity of striated as well as non-striated muscular fibres — valuable in in- ertia, in a relaxed state of the stomach and bowels, which give rise to loathing of food, nausea, vomiting, colic, atony of the stomach and liver. Its general action as a stimulant to the ner- vous and vascular systems renders it a valuable tonic to aid digestion, to overcome a sluggish liver, habitual constipation. The dose is variable from a few drops up to fifteen of the com- mon tincture, added to water, thrice daily, before meals. Nux Vomica. Branchlet, leaves and flowers. The root of the white pond lily has Nymphae Odorata. been in use for several hundred years, pulverized and incorporated into poul- tices, and ointments for an antiseptic in gangrenous and phage- denic sores; an infusion has been very generally used as a wash in leuchorrhoea. The root has been recently subjected to a rigid chemical ana- lysis, and a very peculiar astringent, different from tannic and 1374 DISEASE GERMS. gallic acid isolated, which contracts connective, muscular and mucous tissue. Its action is most energetic on sphincteric fibres. If the urine is kept neutral or alkaline in incontinence, and this remedy administer- ed, it causes the sphincter to contract ; locally it con- tracts the walls of the vagina or rectum, if relaxed, and restores them to their pris- tine condition. To those suffering from prolapsus of the rectum, it is invaluable ; to ladies suffer- ing from falling of the womb, or lost contractility of the vaginal walls ; whose gener- ative system has lost its tone and vigor, and has become callous, inoperative to sexual White Pond Lily. enjoymeut, it is the remedy par excellence ; to all who suffer from catarrh and leucorrhoea it is of great utility. Take it all in all, it is a great vaginal con- tractor and rejuvenator. For the convenience of the profession it is put up in the form of pastiles. One to be used every night at bedtime. The glucoside isolated from this old and reliable remedy is attracting well-merited attention. This glucoside has an ex- tremely bitter astringent taste, is very hygroscopic -and not well adapted for internal use, but as a local remedy in all relaxed, devitilized states of the vagina it has no equal. Added to the butter of coca, it forms a most elegant pastile, tonic and astrin- gent to the vagina and uterus. One of these inserted every other night produces a complete revolution in the tissue, and causes contraction and vital tonicity. They are specially indicated in prolapsus uteri, leucorrhoea, sexual lethargy, sterility, and when- ever the reproductive organs are worn out by frequent parturi- tion or exhausted by sexual excesses. Water hemlock, water drop-wort, or CEnanthe Crocata. cowbane, a European aquatic plant, grows in ditches and margins of ponds. In Scotland it grows to a considerable height with a very large, fleshy white root. BACTERICIDES. 1 375 * The entire plant is a virulent, narcotic, acrid poison to man and the inferior animals, and produces in them when inadver- tenth' eaten, giddiness, convulsions, coma, and profound cerebral disturb- ance analogous to a violent epilep- tic fit. The believers in the law of siinilia similibiis curantur, with their apostate brethren the specific medicationist, therefore deem this plant a specific in all epileptic seizures. By repercolation, an alcoholic extract of great power and efficacy has been prepared from a recent importation. The dose is small, a few drops in water, repeated at intervals of every three hours and increased with great care, so as to ward off the fits, stem the current of cerebral explosions. It is worthy of a fair trial. ,,, ^ ^. , ■^ Wa'.er JJrop { (Ii,nanihe oocata). These '' cones " are prepared from the Obstetric Cones, finest butter of coca ; boroglyceride, hydro- chlorate of cocaine and hydrogen per- oxide. Their use is indicated in every case of parturition. vSimultaneously with the first pain, one should be inserted as far up the vagina as the finger can push it, and at the same time one up the rectum. These speedily melt, thoroughly lubricate the parts and produce anaesthesia of the uterine plexus of nerves, rendering the parts soft, moist, easily dilated. In a short time two more should be inserted, and thus repeated 'every half hour, in accordance with the judgment of the ac- coucheur. 'At the same time the abdomen over the uterus and lumbar portion of the back should be rubbed with a mixture of concentrated ozone and chloroform. By these procedures the pangs of paturition are either totally obliterated or reduced to a cipher, the vagina rendered aseptic. The use of these cones in all cases of parturition at full time or miscarriage, is far-reaching. When thus used there is no tedious labor; no inertia of the uterus; no hour-glass contraction; no retained placenta ; no post uterine hemorrhage ; no metria ; no puerperal convulsions ; a speedy convalescence. 1376 DISEASE GERMS. These cones have numerous other valuable properties : they cure the three forms of dysmenorrhea, specific inflammations, in- duration of the neck, leucorrhoea, pruritis, piles, irritable and ulcerated rectum, ascarides. Compound oxygen, or oxygenized water, Oxygen Comp. is a germicide of immense power, destruc- tive to all micro-organisms, completely annihilating the bacilli of tubercle, syphilis, cancer, fungus of diabetes, germs of scarlatina, etc. Vitalizes the blood, promotes the activity of the pink marrow and entire lymphatic system. Very efficacious in general nervous debility, nerve tire, and in debility of the respiratory organs, as in asthma, bronchitis, con- sumption, pneumonia, hooping cough. An invaluable remedy for impure, impoverished, germ-laden blood, or where the blood is literally swarming with myriads of disease germs from over- crowding, sewer gas; in embolism, bacteria-laden blood from imperfect action of the heart, lungs, liver, spleen or skin. Dose : Internally. One teaspoonful three or four times daily, in a glass of cold water, is sufficient to supply the blood with oxygen — at least with all that it will imbibe, or in any form of blood disease, as chlorosis, anaemia, etc. As a Gargle. — In scarlet fever, syphiHtic, tubercular, malignant sore throat, one teaspoonful in half a tumbler of tepid water, every three hours. For inhalation use in full strength in a hot or steam atomizer. Prof. McFall, M. D., in his report to the Board of Health, Nashville, Tenn., says : " When pure atmospheric oxygen is exposed to the action of electricity, it is transformed into ozone, which is an allotropic modification. Ozone, at ordinary temperature, is being con- stantly generated in the atmosphere by the natural electric forces. The health of all animated nature is influenced by its presence ; all diseases, in which disease germs are the factor, are greatly aggravated by its absence, A locality er home in which ozone is freely evolved, is one in which contagious diseases cannot exist, while if only a small percentage exists morbid action is rampant. Oxygen gas is inadmissible as a remedy, as it oxidizes the tissues too rapidly and hastens metamorphosis. This is true, whether the pure gas is used or its combination with nitrous oxide gas. As a medicament, compound oxygen, ozone water, peroxide of hydrogen, are remedies of intrinsic value ; they are germicides ; their use keeps the blood pure and stimulates all the BACTERICIDES. 1377 vital functions of the body ; they restore lost vitality, stimulate the hepatic and renal organs ; a cardiac respiratory tonic. The remedy in one or other of its three forms, if added to a little water, and swallowed, enters the blood, first acts as a scavenger, then as a vitalizing tonic. Oxygen is respirable to a limited extent, but when greatly in excess, hastens destructive metamorphosis. It is essential to the support of animal and vegetable life, and is the most widely distributed of all the elements. It constitutes more than a fifth of the bulk and more than a fifth of the weight of the atmo- sphere. In combination with hydrogen it forms eight-ninths of all the water on the globe, and enters largely into combination with all the solid constituents of the globe, and is found largely in the tissue and fluids of all forms of plants and animals, none of which could maintain existence without this element. Although a great vitalizer and a potent remedy to increase the red corpuscles of the blood, by promoting the activity of the lymphatics, and destructive to all micro-organisms in the blood, it is totally inadmissible for inhaling or breathing, as it hastens destructive metamorphosis in the lungs and other vital organs. It is very different when introduced into the alimentary canal ;: there nature will absorb just what it requires to vivify and renew. Ozone water, which is simply negative oxygen, is one of our best vehicles for the administration of oxygen, as that gas libe- rates itself when taken into the stomach, is speedily absorbed, and does its work in cleansing the blood and tissues of all disease germs and increasing vital power. Comp. oxygen, or oxygenized water, is also a germicide of immense power, destroys all micro-organisms, an antidote to narcotic poisons. It destroys the bacilli of tubercle, syphilis, cancer, hooping-cough, but is not powerful enough to kill the oidium albicans of diphtheria, although it completely annihilates the fungus of diabetes with great promptness ; of great utility in in all our fevers. Its action upon the stomach in small doses is that of a tonic and appetizer, will destroy cancer on that viscus ; it cleanses the blood, imparts oxygen to the tissues, and has a radical effect upon the lymph canals and pink marrow." This compound is prepared from Ozonized Uric Acid the active principles of hydrangea ; Solvent. cleavers ; triticum repens ; iris versi- [Antilithic) color; fringe tree; liverwort ; juniper berries ; pichi ; salts of lithia ; acetate of soda ; nitrate of potassa, with peroxide of hydrogen. 87 12^8 DISEASE GERMS. This compound is valuable in sterilizing and destroying the bacillus amylobacta of rheumatism ; neutralizing the urate of soda of gout; disintegrading uric acid crystals. Dose : from a half to one teaspoonful, added to water every two or three hours. Most efficacious in dissolving uric acid concretions or formations, in both liver and kidneys. No remedy so effectually relieves a crippled kidney as this, it dissolves and washes the debris away, and renders the kidneys able to act as depurators of the blood. It relieves renal inadequacy by its sol- vent action, flushes the tubules and obviates the state of intersti- tial obstruction. The great catarrh annihilator. One Ozone et Chlorine, thorough application not to be repeated sooner than three or four weeks. Pre- cautions while using the remedy by the douche : No sneezing or blowing of the nose, because the moment the amoeba comes in contact with the ozone, it paralyzes them and they aggregate together into masses or colonies, leaving their abode in the head in a thick, ropy mass. Indicated in chronic nasal catarrh, ozaena, eustachian deafness, chronic laryngitis, asthma, bronchitis, and in incipient consump- tion. Before using the remedy paint with a camel's hair brush dipped in the fluid in its original strength, the tonsils, uvula, fauces. Then use the douche in the following manner : From one to two and a half ounces of the compound should be added to six- teen ounces of tepid water, and for the purpose of giving a bril- liant microscopical exhibition of the contents of the nasal cavity in catarrh, with its millions of disease germs, five to ten grains of permanganate of potassa should be added to each sixteen ounces, simply to color. If no microscopical examination is to be made, it can be omitted. The douche or cup for the fluid should be made of maple wood, and placed on a stand eight or nine feet high. The cup is better to hold twenty ounces. The bottom of this receptacle should be perforated large enough to admit a piece of pine wood, which should protrude outwards. This, also, should be perforated, to which a fine rubber hose is attached, long enough to stretch to the ground, to the end of which a nose piece of pine wood, large enough to completely fill the nos- tril, of an oblong shape, and this is to be perforated by burning a hole through it with an ordinary knitting needle. In applying this douche, first put in the water, then the ozone et chlorine mixture, and add the permanganate. Patient is to be BACTERICIDES. I^^g seated in a chair, with a newspaper pinned under his chin, secur- ing the end, and a square slop basin between his knees, head slightly stooping, then run about two ounces or so through one nostril, which, if there is no obstruction, will find its way down the other; then change the nose-piece to the other nostril, and run through about the same quantity, changing from nostril to nostril, till it all passes through. While the fluid is running up and then down, patient must hold breath well, so as to keep it from passing down the larynx. Continue in this manner till it all passes. If there is any difficulty with the ear, and it is desir- able to run the fluid up the eustachian tube to the inner ear, for the relief of deafness, then the patient must hold breath very firm, then suddenly, while the fluid is running through the nose, close the open nostril with the finger and thumb. This will draw up the fluid in the sinuses of the head ; breath held well, none can go down the throat, and the superincumbent pressure in the douche will force it up the eustachian tube to the ears. In this manipulation, the nose-piece must fit accurately, so as- to permit none of it running down its sides. The presence of the fluid in the ear is readily recognized by the pain in that organ. The eustachian tube maybe closed by disease-germs, by lymph, or it may not be pervious from collapse of its walls, and on the first effort it may not be successful ; if this should be the case, rest a few minutes, and try again, raising the douche higher and telling patient to hold breath still more firmly. If not successful at all, give it up for about a week and make another more deter- mined effort, and still another, before pronouncing it a hopeless case of deafness. The permeation of the tube by the fluid indi- cates recovery of hearing. It may have to be repeated every month for a few times. If the fluid reaches the inner ear, and the pain or distress is intolerable, an effort at emesis should be made by tickling the throat with a feather, the gagging efforts will cause the fluid to descend. If there is chronic laryngitis, with ulceration of the fauces, the back portion of the throat should be painted, or brushed over, or smeared with the catarrh fluid, in its original strength, or slightly diluted, before it is ap- plied by the douche. During the interval of changing nostrils, and after it is completed, for several hours patient should breathe by the mouth exclusively, and sit in a stooping posture, head bent forward so as to permit a free gravitation for the discharge with its millions of amoeba from the sinuses of the head. Dose : One application of from one to two and a half to sixteen ounces of tepid water sufficient to cure the worst case of nasal catarrh. 38o DISEASE GERMS. Indicated wherever there are Ozonized Syrup of Tar. bacilli or microbes or micrococci irritating the periphery of nerves imbedded in the highly sensitive and exquisitely organized mucous membrane of the larynx ; thus it promptly relieves the cough of phthisis, by either sterilizing or destroying the bacilli of tubercle. Dose : From a half to one teaspoonful every three hours or more frequently, so as to relieve cough. Ozone Tablet. — Indicated in all diseases of the skin, and is a beautifier of the complexion, an aid to nutrition, a tonic to the whole intestinal tract. Triturated, added to a little water. After meals. The only remedy so far discovered that Ozonized Clay, will absorb internal fibroid tumors in either chest or abdomen or external infiltration ; it causes absorption of effused lymph in true and false anchylosis ; it has most marvellous power of absorption, it penetrates to internal parts by endosmosis, and softens and disintegrates. It is efficacious in all simple or malignant grovv^ths, tumors or swell- ings, of great utility in infiltrated breasts, goitre, consolidation of lungs, thickening of the walls of the stomach, ovarian and uterine tumors, enlarged liver ; very large tumors disappear under its in- fluence with remarkable celerity, no matter where located. Dose: Take sufficient quantity of the clay, add to it cold water, and while pouring on the water, keep constantly stirring until a paste suitable for a poultice is formed, then spread on fine muslin the size of the tumor or growth. Apply for a few hours every day, not long enough to cause erythema of the cutaneous surface. It should be bandaged or strapped over the part. It is invaluable in destroying all micro- Ozone Water, organisms or disease-producing germs in the human blood, annihilates the germs of typhoid fever, of erysipelas, of diphtheria, scarlet fever, small- pox and other contagiunt vivum. It is of great value in all nervous diseases, cleansing, purifying, vivifying, vitalizing and increasing renewed molecular growth of the entire nervous sys- tem. It IS true brain or nerve food, vitalizing and feeding, by promoting good blood for healthy brain. It is of great utility in all derangements of the stomach ; it annihilates the sarcinae of BACTERICIDES. 381 gastric catarrh, corrects faulty nutrition, the outcome of indiges- tion and mal-assimilation of food, promotes gestation and lacta- tion and is a true physical restorer in all cases of sexual debility. See peroxide of hydrogen, with which it is identical in chemical composition. Dose : From half to one teaspoonful in half a tumbler of water every three or four hours. Map out the cancer. Cover sound parts Ozone Paste, with several layers of adhesive plaster, cut a piece of table oil cloth somewhat larger than the size of the cancer, spread it over with ozone paste one-fourth inch thick, then apply. It may remain twenty-four, forty-eight, or even seventy-two hours, but best to renew every morning till it is completely killed, or drops out, then poultice and dress as an ordinary ulcer. Paste can be charged with ozone to any degree of strength, prepared to suit all and any special case. This paste is the most powerful germicide ever prepared, being simply ozone gas condensed by immense pressure into an inert powder, forming a paste of marvellous oxidizing power, which has a special and peculiar affinity to unite with and chemically annihilate all disease germs or microbes or micro-organisms without pain or loss of blood. Although it has a special affinity for the cancer germ, and will effectually destroy it by a process of oxidation, and convert the germ or tumor into an ozonoid or an inert body, nevertheless it is destructive to healthy tissue. What is claimed for this paste is, that it is the most powerful and least painful of all remedies ever discovered for the cure of cancer. For external use only. Indicated in all breaches of continuity Ozone Ointment, as a dressing to protect, heal and kill disease germs. The best application for wounds, cuts, bruises, burns, piles, ulcers and cutaneous erup- tions. Its action is unexcelled in the bites of insects, ivy and sumach poisoning, boils and erysipelas. It annihilates. the germs of variola on the face, nose, mouth and throat ; sterilizes diph- theric and aphthous patches in the mouth or on the nipple. When the tubercular bacilli have invaded lung structures, it can be spread on chamois or linen and applied over the germ colony, aiding the internal remedies in promoting the dissolution 1382 DISEASE GERMS. of the germs. The range of action of this ointment is immense, from the most malignant cancerous phagedenic or syphiHs ulcer, to the simple form of abrasion. Ozone ointment is a most efficient remedy in tinea capitis. A species of epidemic of this parasite recently occurred in one of our reformatories, which resisted ordinary remedies, when this was successfully applied. The disease was accompanied with severe itching and irritation, which at times became so intoler- able as to make the patients lose all control, and in five minutes undo the effect of a fortnight's treatment. All the usual reme- dies, including internal sedative treatment, were tried without avail for over two months. Ozone ointment was then resorted to, and the result was most satisfactory. The disease soon passed out of the acute stage, the itching was relieved, the red papules speedily disappeared, and the discharge ceased. In a very short time the patients became convalescent. Dose : The most efficacious ointment ever introduced. To be spread on linen and applied twice or three times daily. This tree grows in all tropical and sub- Papoid. tropical countries to a height of from fifteen {Carica Papaya.) to twenty feet, with leaves only at the top, where also the fruit grows close to the stem. The leaves are from twenty to thirty inches long. The fruit is of a green color, very similar in appearance, flavor, and odor to a small melon. By the natives it is eaten raw or boiled. The seeds are round and black, and when chewed they have the odor of cresses, bitterish to the taste. The pow- dered seeds and juices of the unripe fruit are most powerful anthelmintics. The juice of the fruit and the sap of the tree have power- ful germicidal properties : even the exhala- tions of the tree will preserve beef, mutton, poultry, game, keep them fresh for an in- definite time if hung up near to it, or on it; besides, it renders the toughest meat tender in a short time. It is a tree of rapid growth, exceedingly prolific, bearing fruit all the year round. The juice of the fruit contains a principle called papoid, a peculiar soluble digestive ferment, which is des- tined to supersede pepsin, as it will dissolve fibrine in the pre- sence of acids and alkalies, and in neutral solutions. Papaw Tree ( Carica Papaya) . BACTERICIDES. 1383 The juice of this remarkable fruit has a tendency to undergo butyric fermentation, which is prevented by adding glycerine to it. The active principle is worthy of universal use, as a drug to displace pepsin, very valuable in chronic gastric catarrh ; all forms of dyspepsia. Papoid digests better in the presence of a small quantity of fluid than when much diluted, thus possessing a greater advan- tage over pepsin and pancreatin, which in order that they digest well, require a large amount of fluid. It is a remarkable solvent to the false membrane of croup and diphtheria, more recently it has been used as a solvent for fib- rous growths in the bladder, stricture of the rectum, cutaneous cancer, epithelioma of the lip. Still more recently, it has, by continuous administration, opened an oesophagus closed by car- cinoma, by its powerful dissolving action. Intestinal indigestion may be greatly relieved, and in many cases practically cured, by the judicious exhibition of papoid. It is useful in all forms, but its value is more especially notice- able in those cases where constipation is a prominent factor, ac- companied by distension within a couple of hours after taking food. The method I have adopted, consists in the administra- tion of two grains of papoid powder in capsule before meals, the dose to be repeated two hours later, if flatus occurs. One par- ticularly valuable application which should not be overlooked, is its use in the treatment of attacks of a dull, disagreeable head- ache, depending upon indigestion ; a common affection amongst literary persons. Two grains of papoid powder, dry in capsule, will disperse it generally in from three to five days. It converts five times as much albumen into peptone as the best animal pepsin. It increases the flow of gastric juice by stimulating the peptic glands, acts as well with an acid as an alkali. With ozonized boroglyceride gives excellent results in gastric catarrh, as it kills the sarcinae. It is the greatest galacta- gogue known in medicine, also an abortifacient. Dissolves the germ colony or false membrane of diphtheria. This is comparatively a new hypnotic, and Paraldehyde, one that promises to be of much interest and ^ value in the treatment of the various causes of wakefulness. It stands in the same rank as chloral, but is much safer, acts quicker and gives a more natural sleep. Several have written in high terms of its utility and safety. Like all new remedies, it is somewhat expensive. This dose is from one to '384 DISEASE GERMS. two drachms. The name indicates its oily nature, and this is a difficulty which has to be met in prescribing. It is usually made into a draught by suspending in tragacanth powder, sweetened with syrup. I generally give it with whiskey or brandy in the proportion of one to three. The oiliness disappears when mixed with the stimulant, which is, I am convinced, a most useful ad- junct to every hypnotic. In its action it is gradual, and should it fail to produce sleep, it does not excite. Its use is not followed by headache or gastric disturbance, but it continues to be excreted by the. lungs for many hours afterwards. This is by some con- sidered a great objection. Now it may be, and no doubt is, an objection, but as one writer very truly says : ** Should we not rather look upon the disagreeable breath as a safeguard against the clandestine use of the drug, and not in the light of an objec- tion?" There is no accumulative principle in paraldehyde, and I have not met with a case of intolerance. It, however, is a much more valuable hynotic than sulfonal. Probably the best American authority on this subject is Prof. IV. H. H. Crandall, M. D., of Des Moines City, Iowa, who says : " Aldehydes have a strongly irritant action upon mucous mem- branes, and this is a great objection to their use as hypnotics. But they have a power of uniting with themselves, or polymeris- ing, as it is termed, and these polymeric forms are less irritant. Ethylic aldehyde unites with itself, and when three molecules of it combine it forms a paraldehyde. When several molecules, the number of which is unknown, combine, it forms metaldehyde. Paraldehyde is a useful hypnotic, which does not depress the action of the heart like chloral, and does not give rise to discom- fort next day. The chief objection to it is the unpleasant smell, which it imparts to the breath and which hangs about the patient for many hours." This medicament is excellent to Passiflora Incarnata. relieve the nervousness and insomnia in convalescence from fevers. We have been employing it in some cases of spinal meningitis after the acute symptoms had subsided, when the patients were unable to sleep either day or night, could not endure the bed, and were unable to maintain the sitting posture, with highly satisfactory results. It is administered in small doses. Add ten drops of the mother tincture to half a tumbler of water, teaspoonful every two hours. BACTERICIDES. 1385 They are of the greatest efficacy in all uterine Pastiles. diseases, and are an invaluable boon to both (Ozonizcd}j single and married ladies, if they are suffering from any disease of the womb. They positively -cure whites, falling and ulceration of the womb, induration, granular erosions and catarrh of its neck, all forms of painful menstruation, neuralgia, dragging in the back, and every morbid condition incidental to that potent organ, the motive power of the universe. They also overcome the condition of sterility and impotency, impart great tone, strength and vigor, to the sexual organs. They should be inserted when in the recumbent posture. It should be inserted up the vagina as far as possible with the finger and allowed to remain ; shortly after its introduction it will dis- solve and come in contact with the diseased parts. The v^agina should the following morning be washed out. Discontinue the use of the pastiles during the menstrual period ; when they disappear resume their use again, until the affection is •cured for which they were originally used. Peppermint. {Mentha Piperita}^ Extensively cultivated for its fragrant, bactericide oil, which is obtained by dis- tillation. The oil of mentha piperita the most valuable germicides. The pure oil painted on the diphtheric membrane instantly kills the strep- tococcus, causes it to shrivel up, completely annihi- lating the micrococci and spores ; the membrane peeling off eventually, leaving a health}-, healing surface behind. All varieties possess the same invaluable pro- perties. It has a wide range of action, being a stimulant and carminative. Water Mint. A fluid extract of the common pellitory is a Pellitory. bactericide of considerable power. In doses of from ten to twenty drops it is very efficient in clearing the alimentary canal of all forms of microbial life. Two species of streptococcus have been found in the pulp of decayed teeth, both agents of lactic acid fermentation. They are in the form of cocci, diplococci and chains, and are the cause of toothache. The old germicide remedies, creosote, cloves and 1386 DISEASE GERMS. arsenic are entirely superseded by a saturated or mother tincture of the common pellitory. This is a germicide of great power, in all cases it destroys the micro- organism in the cavity of the tooth. Besides the internal use of the drug, it is of great value as a diuretic, re- frigerant and lithontriptic. Pennyroyal. Pellitory. This is a grate- ful aromatic, car- minative and dia- phoretic — stimulating the stomach, bowels and kidneys, and an elegant efficient diaphoretic. The greatest care should be exercised in prepar- ing the infusion so as to retain its volatile oil, which escapes altogether if permitted to boil. The essential oil is inimical to microscopic life. So the remedy may be used in mucilage of gum arabic as a powerful germicide. The oil possesses all the antiseptic properties of the pepper- mint and eucalyptus, and hence will destroy fungous growths. It is an antidote to the stings of the mosquito and other insects. Pennyroyal. A digestive solvent, of great Pepsin, value in all forms of dyspep- sia, as it supplies a direct de- ficency in the animal economy. A most eligible form is the wine of pepsin, made by cutting up a cleaned call's stomach and covering with good sherry wine, macerating for two weeks, then percolating, and to every pint of it add half a pint of brandy to preserve. A teaspoonful after meals. The ozonized pepsin prepared by peroxide of hydrogen is the best for general use. The field for the use of pepsin seems constantly extending BACTERICIDES. 1387 with the improvements made in the quality of this agent, and it may now be employed with greater certainty as to residts than ever before. The application of pepsin to digest away the mem- brane in diphtheria and membranous croup is not new, and is more or less commended and resorted to by physicians in the treatment of these diseases. Naturally, however, its utility depends entirely upon its diges- tive activity, and on account of the many preparations of pepsin of feeble or no digestive power heretofore at the disposal of physicians the results obtained have been in some cases dis- couraging. As to the value of pepsin, however, in these affections when of proper purity and strength there can be no question. It is to be hoped, and it is certainly highly probable, that the further study of digestive ferments will lead to a pepsin still more active. If the false membrane could be easily digested, and there seems no reason why it might not be with a pepsin of high diges- tive power, we could expect to have fewer grave cases of interfer- ence with respiration and blood poisoning from absorption of septic material, now alas so frequent. The three agents which have been most extensively used as local solvents for the false membrane of croup and diphtheria are papayotin, trypsin and pepsin. Papayotin is a vegetable agent recently introduced, claiming to have the same digestive properties as pepsin. Dr. Cannon treated forty cases of diphtheria with papayotin and gives the following conclusion : First. It exercises a feeble solvent action when the membrane begins to decompose. Second. The deli- cate new membrane is not affected by it. Third. It exerts no effect on the mortality of the disease. Its present high price is also somewhat against it. In the use of trypsin it is necessary to maintain an alkaline condition of the throat, as trypsin acts only in alkaline solutions. The secretions of the mouth and throat in these diseases is strongly acid, and tend to neutralize and destroy the power of the alkaline solution of trypsin. Permanganate Potass. — Emmenagogue, kills microbe of snake bites and the fungus of diabetes. The best preparation ot manganese. ' Dose : One-half to one grain in water. 1388 DISEASE GERMS. The fluid extract of pichi is indicated in all affec- Pichi. tions of the urinary organs ; especially useful in all catarrhal states of the bladder and prostate. It is the primary agent in the uric acid solvent. In that formula it allays irritation, causes the disintegration and expulsion of calculi in the uric acid diathesis. Dose : From a half to one teaspoonful everv^ three hours. The great value of this very ex- Peroxide of Hydrogen, cellent remedy is being seriously injured by its indiscriminate manu- facture by irresponsible parties who have been supplying the drug trade with a highly impure article. To such an extent has this been done as to render its employment in medical and sur- gical practice extremely dangerous. A remedy like this, which is indicated in all microbial dis- eases, should invariably be of the highest possible standard of purity. There is no morbid state, acute or chronic, in which this remedy is not indicated ; in all fevers its use is indispensable ; in mumps, hooping-cough, cholera, dysentery, by killing the mi- crobe, diseased action ceases ; in burns, boils, cuts, wounds, and gangrene, it destroys every vestige of germs. Physicians would do well to keep it in every family who are under their professional care, its employment is safe, its applica- tion never can injure, and it can always be depended on to kill the microbe of membranous croup, and thus save human life. Mothers can readily be intrusted in its use. AphthcB, follicular sore throat, oedema of the glottis, a gargle of from two to four volumes rapidly effects a cure by the de- struction of the germs. In nasal catarrh, after the mass of germs have either been an- nihilated or caused to migrate by a douche of the ozone et chlo- rine, following in a few days with a douche of one ounce of a fif- teen-volume strength of the peroxide of hydrogen to seven ounces of tepid water, and repeating this occasionally, a most excellent cure is the result. In epistaxiSy an eight-volume solution immediately arrests hemorrhage by coagulating the blood, and causing contraction of the blood vessels. The eruptive fevers are deprived of all their malignancy and danger by their treatment with germicides. What a saving of human life is effected in diphtheria and scarlet fever by the use of the glycerite of sulphur internally ; what a destruction of BACTERICIDES. 1389 germs, what a speedy recovery if the child is daily bathed with peroxide of hydrogen. It destroys the germs on the skin, pre- vents the peeling, which is the most infectious media. A ten or fifteen-volume solution applied to any venereal sore or chancre, instantly kills the microbe syphilitica. For inhalation it excels all known bactericides, sterilizes speedily all the tissues with which it comes in contact, stimulates the reproduction of healthy epithelium. The peroxide in an atomizer by the bedside of the patient, yields good results in all cases of diphtheria and malignant sore throat. In addition to other forms of microbic disease, the result of sewer gas poisoning, numerous cases of diarrhea and albumi- nuria are clearly traceable to that cause, sewage poisoning, intes- tinal irritation, nephritic congestion. An epidemic of typhoid, or diphtheria, or metria, or erysipelas, naturally excites attention to the drainage, but no attention is paid to that terrible feeling of goneness experienced by eighty per cent, of the population of our large cities, who are suffering from exposure to its morbific agency. Diarrhea and albuminuria having such an origin, are the result of a physiological effort by the bowels and kidneys to eject the germs and their noxious pro- ducts from the system. Such states are promptly relieved by the internal exhibition of the dioxide of hydrogen, which acts as a scavenger to diseased blood. The injecting of boils, abscesses, with a few drops of the per- oxide, instantly kills the streptococcus pyogenes ; healing the abscess by one application. Dose: half a drachm of the solution mixed with an ounce of distilled water, every four hours. There is a brilliant future for peroxide of hydrogen. In addi- tion to its great bactericide properties, it has a most remarkable property of aiding the absorption of fibroid tumors by a chemico- electric process — by simply keeping the electrode over the tumor constantly moist with C. P. medicinally pure peroxide of hydro- gen ; by endosmosis it enters the tumor, excites an absorptive ac- tion, by a withdrawal of its water and oxygen, at the same time liberating positive ozone, a bacterial destroyer. Electricity is thus a medicament of ponderous value. After each treatment there is a feeling of great comfort and freedom from pain, and eventually complete recovery. The method was first brought to the attention of the profession by Prof John J. Siggins, M. D., of Philadelphia, aad more elaborately carried out by his pupils, A. Parks, M. D., 517 W. Twenty-third street, New York, and F. A. Tuttle, M. D., 233 Main street, Springfield, Mass. I ^Qo DISEASE GERMS. is the acetyl of phenetine, i. e., of the ethyl- Phenacetine ether of the paramidophenal. Its crystals have a great resemblance to those of antipyrine ; they are white, odorless and tasteless. This absolute tasteless- ness renders the administration of the drug very easy. Similar to antifebrine it is very slightly soluble only in water, more so in hot water, but on cooling it is precipitated again. It is more readily soluble in glycerine, most readily in alcohol. The physi- ological action of the drug is that of a powerful cerebral stimu- lant ; as such it acts as a reliable antipyretic in all fevers and in- flammation ; as such it soothes the pain of neuralgia, as head- ache, angina pectoris, sciatica, ovarian irritation ; as such it is of great value in vasomotor neuroses, in the lancinating pains of locomotor ataxia ; it is a strong analgesic, does not produce cyanosis, like antifebrine ; acts very rapidly in spite of its insolu- bility in the gastric juice, and its administration is free from all untoward or depressing influence whatever. As it has a direct action upon the central nervous system, it exercises a powerful effect upon the circulatory system, its use being followed by a copious sweat. a glucoside, prepared from the root of the apple Phlorizin, tree, is a peculiar germicide, sterilizing the blood for quite a number of microbes. It should be administered in small doses, in a high state of trituration. It is most efficacious wherever ordinary bacteria are present in mal- assimilation. It, in a most remarkable manner, increases the transformation of sugar in the liver, and will produce glycosuria. It does this by lessening the normal process of oxidation, by which it should be converted into carbonic acid. Phytolacca. — Next to saxifraga the best vegetable alterative in the Materia Medica ; when ozonized it destroys the microbes of syphilis, cancer and tubercle. Dose : One teaspuonful every three hours. Platinum Chloride. — Useful in syphilis. Dose : One-thir- tieth of a grain triturated in sugar of milk, thrice daily. A germicide, warm, aromatic stimulant, used as Pimento, an adjuvant to tonic and purgative medicine, the taste of which it serves to disguise, while it in- creases their warm, their antiseptic properties, and renders them more acceptable to the stomach. BACTERICIDES. 391 It is specially indicated in dys- pepsia with flatulence. It is an excellent remedy in feeble heart, gives it tone, strengthens its contractions ; valuable in all cases of heart failure with passive hepatic engorgements. The tincture of pimento is of great efficacy in chilblains. The resinoid is a most useful auxiliary to sulphate of quine in the treatment of rebellious paludal fev- ers, and even in paludal dyscrasia. Useful also combined with solid ex- tract of black willow in leucorrhea, gonorrhea, and in constipation due to torpidity of the liver. Pimento. This is really the only genuine prepara- Phosphated tion of oats, differing from all others in Tincture of Oats, containing the entire amount of the glu- {Avena Sativa) coside " avena " in a given portion of the grain; it is prepared from the genuine Scotch oats, and before being tinctured and ozonized, is made to undergo acetous fermentation, so as to evolve its entire phos- phatic elements ; this mode of preparation gives it a strong acid reaction, and holds in it unimpaired, and in a concentrated form, the avena or phosphates. This preparation retains the full amount of nitrogen of the grain, which is the best criterion of its quality. In this form, it is the most nutritious of all agents prepared from the cereals, being strength-giving and sustaining, as well as flesh-forming, besides being the great brain and bone fertilizer. From among all cereals, oats give us the most perfect and highest stratum of brain growth and development. The amount of brain matter in this preparation excels all known com- pounds of the phosphates or hydrophosphites, and in a most assimilable form. This, the true essence of the grain, is a brain fertilizer, supplying that organ with its own constituents ; besides it has a most mar- vellous action in blood formation, stimulates the lymph canals, rebuilds, recruits tissues and forces lost in the destructive meta- morphosis of the body. Our entire nation is neurasthenic. This poverty of the nerve force, this tissue-starved nervous system is chiefly due to I^Q2 DISEASE GERMS. mental work, to sexual excesses, to the destruction of the phosphates in our food, etc. Retarded and difficult dentition, nearly all the cerebral diseases of childhood, are due to those causes and are promptly relieved by the administration of avena. That mysterious languor, that depressing lassitude, undefin- able headache and neuralgia, wandering pains, that feeling of goneness and dyspepsia, are traceable to defective phrenal nutri- tion, and are speedily relieved and cured by the administration of avena. The immense area of nervous diseases — the brain wearing out sooner than of old, civilization being unfavorable for healthy brain growth, and the like — is untrue, for it is to the vices, the excesses of our present state, to the improved methods of adul- terating food, destroying its phosphates, which is aiding in the production of cerebral starvation, and pushing upon us an off- spring with dwarfed brains and paucity of intellect ; all this can. be rectified by the use of " avena!' The decided increase of all nervous diseases is plainly trace- able in the large proportion of cases to defective cerebral nutri- tion, such as epilepsy, chorea, insomnia, brain softening. Wheii no organic lesion exists, the use of avena is curative, because it is reconstructive. The phosphated tincture of oats is a direct stimulant, perma- nent tonic to the sexual appetite at the base of the brain, increases virile power, and more too, its use promptly replaces the drained- off nervo-vital fluid upon which the brain rests (which is frequently exhausted by great mental effort or sexual excesses),, it is the antidote to that terrible base of the brain pain, peculiar to libertines. A tissue-starved brain gives rise in all cases to nervous bank- ruptcy, to depravity eccentricities, suicidal mania, crime, mastur- bation, the creation of habits. It is doubtful whether or not all vice, immorality, or crookedness of life, may not be due to a condition of tissue-starved brains ; all our nation needs the use of avena sativa. This preparation, being a reliable brain food, may be presented in paralysis, epilepsy, chorea, nerve exhaustion, insomnia, cephalalgia, in the alcohol, chloral and morphia habits, with the best results. The tincture, or fluid extract, prepared from the freshly crushed oats, is not nearly so active a brain fertilizer as that prepared by permitting the grain to undergo acetous fermentation. All who have been disappointed in the use of the remedy should try the phosphated tincture. BACTERICIDE^ 1393 All varieties are ger- Plantain. micidal. This property resides in all parts of the plant. The fresh leaves applied to wounds, ulcers, buboes, germinal swell- ings, by their anti-bacterial, antiseptic properties, discuss or heal them. A saturated tincture destroys the ordinary microbe in the mouth, and thus relieves toothache. It is prescribed internally in incipient phthisis, bronchitis, leucorrhcea and hemorrhages, but its action is too feeble to be of much efficacy. The seeds of the plantago ispaglniia, two drachmiS to the dose, taken in an uncomminuted form, in a little jelly, passing through the intestinal tract, de- stroy the bacteria and sarcin^ of intes- tinal catarrh, and heal ulcerations. Greater Plantain {Plantago major) Pomegranate. bark of the root. One of the best and most powerful of the vegetable germicides and parasiticides, much cultivated in warm climates for its fruit and In its wild state it is a thorny bush ; when cultivated it is a low tree with twigg},^ branches. The fruit is as large as an orange, with a thick leathery rind of a golden yellow color, with a rosy tinge on one side. The fruit consists of in- numerable berries densely packed to- gether in the orange-sized globe, the juice of which is highly germicidal, pressed with hot water forms a cooling antiseptic, a decoction of which is of the greatest efficac}' when the oidium albicans is evolved or deposited on the fauces or tonsils, or the bacterial mala- rial germ of dysentery. The bark of the root is used as an anthelmintic in tape worm. A decoction four ounces of the pulverized bark to one pint of boiling w^ater. reduced to one-half pint. Very efficacious taken ir^ two doses, half an hour apart ; some add calomel, ten to t\\ent\' grains, to stimulate the biliary secretion. 88 Section of the fruit of the Pomegranate. IOQ4 DISEASE GERMS. Sulphate and Tannate Pelleterin. — The alkaloid pelleterin, sul- phate and tannate (the latter is usually preferred, as being most active) is administered in doses of five grains, more or less, accord- ing to the constitution of the patient, observing the precaution of. a sweet-milk diet the day before, with no food the day of adminis- tration. Thirty minutes after administering the pelleterin a brisk cathartic should be given, as an ounce of the comp. tincture of jalap, and the same quantity in another half hour. The worm usually follows. Valdivine is a glucoside from the same root, equally efficacious. Another popular formula is: pulverized pomegranate red bark, half an ounce ; crushed fresh pumpkin seeds, one ounce ; ethereal extract male fern, one drachm ; powdered ergot, half a drachm ; powdered gum arable, two drachms ; croton oil, two drops ; add to the whole one pint of boiling water. Simmer down to half a pint, which is to be taken in two divided doses, one hour apart. Valdivine, a glucoside from pomegranate root bark, pump- kin seed, male fern, koussa, kanula and other taenicides. This preparation is identical with the dSk.2\o\di'' pelleturin ;^' put in extract of gentian and capsules, ready for administration. The patient should take very little food for two days, and that little should be of a fluid nature. On the evening of the second day, he should take a purgative (castor oil is best) of sufficient strength to cause an evacuation of the bowels ; in the morning, after the castor oil given the previous evening has operated, and while still fasting, the patient should take seven or eight capsules along with a full dose of castor oil, or other purgative ; follow that with another eight capsules to another dose of castor oil. The worm generally comes away within two hours after taking the second dose of capsules. The ozoniferous properties of the buds and bark Poplar, of this tree are too well known to require a descrip- tion. The leaf-buds are covered with a resinous exudation, which has a peculiar ozoniferous balsamic odor, with a bitter pungent taste. This exudation is highly antiseptic, is present in all species of the poplar and is most abundant in the buds. Poplar buds are as ozoniferous as turpentine, and make a most valuable tincture, liniment and ointment. The formula for the poplar ointment which is so popular is by simmering the leaves and buds for twenty-four hours in lard ; then removing BACTERICIDES. 1395 the crisped leaves and buds and adding more, and so on till the lard becomes saturated. This is to be done over a gentle fire. To this same ointment some add poppy heads, belladonna and hen- bane leaves, and digest them for twenty-four hours. It makes an excellent anodyne ointment for irritable or painful ulcers. The poplar bark makes a very superior tonic, very valuable in indigestion and all debihtated states of the system. It has a special tonic action on the liver and kidneys and corrects their deficient action. It is one of the most serviceable remedies in the Materia Medica. The bark yields largely of sali- cin, benzoic and other antiseptics. Poplar Buds This remedy is indicated in all states of nervous Protagon, bankruptcy. It is both in liquid and crystalline form, containing nitrogen and phosphorus. It does not differ chemically from kephaline. It is called protagon, as it was the first definitely ascertained specific constituent of brain. Dose : ten to thirty drops of the liquid, one to three grains of the crystals, after meals, every three hours. An invaluable non-alcoholic compound, contain- Prunia. ing all the tonic, vitalizing properties of the wild cherry bark, with its innate hydrocyanic acid unim- paired, and four volumes of the dioxide of hydrogen. The preparation is of great efficiency in some cases of pulmo- nary tuberculosis, being a bactericide of average power and operating most activel)'- upon the bronchi, pneumogastric and vagus. It has been found of utility in pneumonia, pulmonary tubercu- losis, bronchitis and other forms of microbial affections. The average dose is a teaspoonful every three hours. One of the leading physicians of Iowa, R. Small, M. D., of Decorah, in speaking of prunia, says : " The compound known as prunia is the most perfect sedative and lung tonic ever intro- duced to the profession; mitigates the intensity of all pulmonary affections, and aids the action of other bactericides. 1396 DISEASE GERMS. This plant, in the form of a mother tincture, or Pulsatilla, an alcoholic extract by percolation, yields a most efficient germicide, alterative and cerebral seda- tive of considerable power. Alone or combined or alternated with the tincture of kalmia, it is most efficient in destroying the syphilitic germ in the blood, and is a remedy of great value in chronic cutaneous affections. It was first brought to the notice of the profession as a therapeutic agent to calm the re- flex centres, in uterine and genital irri- tation transmitted, which gives rise to morbid states termed hysteria, mel- ancholia. Take it all in all, it fills a gap to which the bromides do not reach. In order to illustrate the remarkable action of this drug on the genito- urinary system, a trial of two-drop doses every three hours is suggested in spermatorrhoea, metritis, epididymitis. It exerts a special influence upon the reproductive organs of both sexes, restores normal menstruation, relieves the wander- ing pains incidental to gestation, and even exceedingly useful in neuralgia of the testes. Pulsatilla. is a colorless liquid, of a peculiar odor, readily Pyriden soluble in water and of a strong alkaline reaction when in solution. It is a product of the dry distil- lation of organic substances containing nitrogen and carbon, such as coal, bones. It absorbs water rapidly on exposure to the air. This is an invaluable remedy for inhalation in asthma and dyspepsia associated with disease of the heart. A few drops poured upon a plate, the patient with down-turned face inhales it for a few minutes. This can be repeated three or four times daily ; it affords prompt relief, and continued persistently, for a few weeks effects a cure. is an antipyretic drug, the active ingredient of Pyrodin, which , is acetyl-phenyl-hydrazin. It is in the form t . . :j , . , pf a powder, sparingly soluble in cold water ; having .neither an unpleasant taste nor smell, causing no irritation of the stomach. When administered it acts promptly and powerfully BACTERICIDES. 397 in reducing temperature by destroying the germ, the factor of fever ; hence it is of great utility in all fevers in which a disease germ or microbe is present. It acts well in all cases, but it must be carefully watched. It neither causes nausea nor vomiting, acts quickly and more powerfully than antipyrine, antifebrine, phenacetin. *5i£- The leaves of this plant Raspberry, yield their medicinal pro- perties freely to water. They contain a large amount of tannin and gallic acid ; a decoction, used tepid, pos- sesses in a most remarkable degree, one of the finest astringents in the Materia Medica. It is an excellent vehicle for the admin- istration of bactericides, thus : add some boroglyceride to it, it is an infallible eye lotion in all forms of ophthalmia ; add a small quantity of the eucalyptus distilla- tion to it, most efficacious in gonorrhea and leucorrhea. Raspberry. One of the derivatives of benzol, a germicide of Resorcin. the highest rank : a one-per-cent. solution will re- tard, and a two-per-cent, solution will arrest fer- mentation and coagulate albumen. These strengths do not irritate the skin, but stronger solutions might. Internally, five-grain doses may be readily taken three times a day in any simple vehicle ; but in larger doses, say from ten to thirty, it produces a striking resemblance to the effect of alcohol and other stimulants, quickening the pulse, causing flush- ing, giddiness, tinnitus, sweating, increasing the secretion of tears and saliva. It is an invaluable germicide, being specially inimi- cal to all microbes on the mucous membrane of the mouth, stom- ach, intestines, and bladder. If administered in aphthae, or sar- cinae ventriculi, or cholera infantum; or typhoid fever, or injected into a tubercular rectum or bladder loaded with fungus growths, it annihilates colony after colony of the germs, with a brilliant precision. By killing microbes it reduces heat. You can watch the physiological effects more plainly than of other drugs of this class. When the temperature is down, )'ou can keep it there by re- duced doses, one or two hours apart. 1398 DISEASE GERMS. Being a valuable antiseptic, it would seem to be especially in- dicated in fevers of septic origin. It will be particularly valuable if proved clearly, as circum- stances now tend to show, that it deranges the organs of digestion less than the other antipyretics. Its great solubility renders it of intrinsic value in otorrhoea and purulent ophthalmia, nearly as active a microbe killer as the ozonized boroglyceride. In various skin affections, put up in ozone ointment, or oil of boroglyceride, it gives great satisfaction, being more energetic than the best mercurial preparations. Gelatinized bougies of resorcin and boroglyceride will kill the gonococcus of gonorrhea, and one of them introduced into the uterus in a chronic case of intra-uterine catarrh, will effect in a few minutes what years of treatment could not effect. Most gratifying results can be relied on in cholera infantum and typhoid fever, and in ophthalmic and aural cases ; but its great anti-microbe properties fail before the giant germ of syphilis. The doses of resorcin may vary from ten to fifteen grains a day in light attacks, up to seventy-five grains as a maximum. It should be dissolved in about twenty parts of water or any other excipient, for which orange syrups, glycerine, brandy, etc., are suitable. It will also form good emulsions with almond, etc., or may be given in wafers. Used as a cleansing agent, it produces neither rust, nor does it affect the edges of knives. The odor of iodoform is almost entirely destroyed by it. Resorcin is used with much success in the treatment of epithe- lioma, and other cancerous diseases. Mix resorcin and ozone ointment in equal parts, and use locally to the diseased part, after a day or two, apply a milder ointment of two parts of re- sorcin and three parts ozone ointment. After the eschar is formed, then clean and dust over with iodoform ; boric acid, equal parts. Dress the wound with an ointment, one part resor- cin to ten parts ozone ointment. Resorcin rubbed up in ozone ointment, by its reducing or withdrawing oxygen power, applied in eczema, coagulates the serum and produces a firm germicidal covering, under which a rapid healing takes place. Thio-Resorcin is a combination of sulphur with resorcin, in the form of a powder, without smell and entirely non-poisonous. It is used as a substitute for iodoform, and usually applied as a dusting powder and often made into an ointment with ung. petro- leum of the strength of from ten to twenty per cent., for eczema, psoriasis, scabies, and other vegetable or parasitical skin diseases. BACTERICIDES I ^qq For barber s itch, etc. — Resorsin, -one drachm ; glycerine, water, of each one ounce; lac sulphur, one and a half ounces ; cologne, a half ounce; alcohol, four ounces. Mix. Apply to the af- fected parts several times a day, using a soft sponge. Bath the parts every morning in hot water. Ether, half ounce, to dis- solve the sulphur before adding the latter, makes the prescription more pleasant to use. Reduced by the most careful trituration and sifting to an im- palpable powder, it is highly recommended by the most eminent dermatologists as superior to any other germicide in eczema or irritation of the skin. It is insoluble in water and very sparingly soluble in ether or alcohol. Rhigolene. — This is the impure hydride of amyl, and is the lightest fluid of the petroleum series, and is well adapted for pro- ducing local anesthesia, and its bactericide properties render it very useful as a local application wherever a germicide is indi- cated. in incontinence of urine has passed into Rhus Aromatica household words. In Europe the medi- cament is becoming a well-known agent in the treatment of this affection, and its greatest success is in children. A great deal of trashy stuff is put on the market and sold under this name. When made of the recent article the medicament is well-nigh specific in enuresis and diabetes insipi- dus. It is also a grand heart tonic and valuable in chronic cystitis of old men who suffer from enlarged prostate and chronic catarrh of the bladder. Rhus tox. in incontinence of urine is said by Dr. J. H. Moon, M. D., of Montpelier, Idaho, to be a reliable medicine. He gives several cases of this disease cured with the remedy. In a simple uncomplicated case the following was prescribed : Rhus tox. three drachms ; glycerine, two ounces ; water, q. s. ad four ounces. Mix. Teaspoonful four times a day. Iron was given for the anaemia. The rhus and iron treatment was continued three months, a complete cure was effected. Rhus tox. is also a very valuable medicament in cases when patients (mostly women) complain of the urine scalding the urethra and meatus. It is often a really curative medicament in the severe back ache some women are so much tormented with. 1400 DISKASi: GliKMS. one of the oldest germicides, was Rue, held in high fav^or as a great ozone liberator, and preventive to contagion. It is also a tonic, diuretic, laxa- tive and vermifuge, but its real intrinsic value in fluid extract, decoction, essential oil, or emulsion is as a bactericide ; it kills the oidium albicans, neutralizes, or checks the chemical action of the ptomaines in cholera infantum. A decoction, sweetened for children, cleanses the entire intestinal tract of mi- crobes, thus wards off convulsions or fits, epilepsy due to reflex irritation. Although but a simple herb it is a valu- able stimulant and antispasmodic. Still it must not be administered in large doses, as it produces gastro- intestinal irritation, cerebral derangement, and acts energetically on the uterus. Rue Graveolus , A sweetening substance two Saccharin, hundred and eighty times {Sulphinide of Be?trjoic Acid) greater than cane sugar. A white crystalline powder solu- ble in two hundred and thirty parts of water, but very soluble in alcohol or ether. It has a faint odor of bitter almonds, which is more perceptible on heating. Chemically and physiologically totally different from cane sugar, being a powerful bactericide and unfermentable. It is indigestible, inert, non-toxical ; passes out by the urine unchanged. Its chemical reaction is that of a weak acid. In diabetes, where cane sugar, starch and other products feed the glucose fungus, it may afford the patient sweet nutriment, but in all other respects, that is as a dietary and medicinal agent, it is worthless. The eminent T. H, Goodman, M. D., of East Saginaw, Michigan, says on this subject : " Saccharin is not a food in any sense ; but it is recognized that there are many circumstances under which it is necessary to have a sweetening agent to take the place of sugar. As to the non- toxic nature of saccharin the experi nenters have no doubt, since their experiments confirm those of reliable investigators on the Continent. Saccharin has decided antiseptic properties, and in sufficient quantities is capable of sto})ping the action of organ- BACTERICIDES I4OI ized ferments. As regards its extra-corporeal action on the solu- ble ferments, as regards the peptic digestion of fibrin o.i per cent, of saccharin has no retarding influence, while 0.25 per cent, slows the process decidedly, and i per cent, greatly retards it ; 0.1 per cent, of saccharin is equivalent to 30 per cent, of sugar, which may be said to be a dietetic impossibility. The diastastic solution of starch is not hindered by two per cent, of saccharin. The addition of saccharin to urine hinders ammoniacal fermenta- tion, as does ingestion of saccharin." As regards the intra-corporeal action of saccharin, it was found that a gramme of the substance, equal to more than eight ounces of sugar, did not interfere in the least with the gastric digestion of the dog. The article used in the experiments was " soluble saccharin," equal to about nine-tenths its weight of pure sac- charin. In is as soluble in water as table salt, and when properly diluted is scarcely to be distinguished from cane sugar. Dr. Goodman concludes that (i) saccharin is quite innocuous when taken in ordinary dietary ; (2) it does not interfere with nor im- pede the digestive processes when taken in any practicable quantity ; (3) it may be taken during an extended period without interfering with the digestive and other bodily functions. There is, then, no reason to think that its continual use may be in any way harmful. Dose : Thirty to seventy-five grains in water every three hours. The syrup is thus made : Dissolve ten parts saccharin, twelve bicarbonate soda in one thousand parts of water, at a tempera- ture of 80° Fahr. Useful in diabetes. The compound, as is well known, consists of 40 per Salol. cent, carbolic and 60 per cent, salicylic acid, and is decomposed into its componetjts by the action of the pancreatic ferment. This is a germicide of immense potency. It is a white crys- talline coarse powder, rather like damp table salt. The odor is very mark^, and is identical with that of glycerite of winter- green, which is chiefly salicylate of methyl. When taken into the mouth a fainter impression of the smell is received on the palate, and the taste of carbolic acid is just suggested. The internal administration of salol is certainly devoid of many of the objections that may justly be urged against the salicylic acid. It is well borne by the stomach, is tasteless and devoid ot odor, readily administered in water, and but seldom gives rise to the troublesome tinnitus that constitutes one of the drawbacks to salicylic acid. [402 DISEASE GERMS. It is eliminated from the body very largely by the kidneys, the urine assuming, however, the characteristic appearance and reaction of carbolic acid urines, being dark green or almost black in color. Its reaction remains acid, it is free from albumen, and it deposits no sediment. The characteristic alteration in the color of the urine is manifest after a single dose of ten grains, .and persists for a long time, so that when salol has been given for some time, the color of the urine remains black five days or more after the remedy has been discontinued, showing that it accumulates in the system and is eliminated very slowly. The salicylic acid of its composition appears first as salicylic acid^ the carbolic acid being responsible for the changed color of this fluid. The advantages which are claimed for salol over salicylate of soda, for which it is prepared as a substitute, are dependent first of all on its insolubility in water and the juices of the stomach, and secondly on the ease and completeness with which it is de- composed after passing the pylorus. Being insoluble in water, it is free from the repellant and nauseating effects of salicylate of soda, which some patients find so objectionable that even syncope has sometimes supervened on ingestion. Passing through the stomach unaltered, it undergoes decomposition in the duodenum, where it comes into contact with the pancreatic juice and is broken up into salicylic acid and phenol. Salol can be used with good effects in all rheumatic affections, in chronic urticaria, in sub-orbital neuralgia, as an antipyretic,, in diabetes, in intestinal catarrh, in typhoid fever, in cholera, against intestinal parasites, in catarrh of the bladder, in ozaena, in otorrhea, as a local application in gonorrhea, and as a mouth wash. It is insoluble in the gastric juices, and consequently better borne by weak or irritg.ble stomachs ; its solubility is obtained by the action of the pancreatic secretion, and hence its more pronounced local effects upon the intestinal tract, chiefly upon the duodenum. The buzzing and ringing of the ears, produced by salicylic acid and salicylate of soda, are hardly noticeable with the use of salol. In articular rheumatism it allays both fever and pains better than the respective amount of salicylic acid that it contains. In neuralgia it succeeds fully as well as salicylic acid. Salol will kill the cholera bacillus, and thus prev^ent the for- mation of a poisonous ptomaine. The ordinary dose is five grains every hour, and decrease in frequency as an improvement takes place. BACTERICIDES. I403 in uric acid diathesis is to be considered, Salicylate of Soda and often is prompt in bringing about a cure. Many cases of persistent pruritus, resisting all other approved treatment, yield to ten grain doses of salicylate of soda, and repeated every two to four hours. These are cases in which uric acid abounds in the urine, and often there are manifested other nervous symptoms. The excellence of this medicament in sick headache is now well known. The fact of most of these cases being complicated with uric acid in excess, or rather the former, may be taken as resulting from the latter. It will be found a valuable remedy, administered in decoction of black cohosh in many cases of chronic rheumatism, uric acid in marked excess in the urine in many of these cases. Recently a case of dry pleurisy came under my care, the urine contained much uric acid. Salicylate of soda, ten grains, dissolved in ammonia acetate, one and one-half drachms, and repeated every two hours. The pain • was relieved completely in six hours. Before the second dose was taken, marked relief of pain was obtained. In acute tonsillitis, ten-grain doses of salicylate, repeated every hour, are almost sure to give rapid relief to all the acute symp- toms in a few hours, and a cure promptly brought about. Added to the liquor ammonia acetatis it is a most effective remedy to sterilize and destroy the bacillus amylobacta, the microbe of rheumatism, and protect the heart from the ravages of the micro-organism. Valuable in diphtheria to sterilize the germs in the throat. is a crystalline substance, neutral in reaction, Santonin obtainable from the unexpanded flower-heads of certain species of artemisia. The flower-heads, which can, at first sight, hardly be distinguished from seeds, have a strong odor and bitter taste. To obtain santonin, these are bruised and boiled for a time with water and lime. To this fluid hydrochloric acid is added till the whole becomes curd, when it is set aside for the santonin to subside. The precipitate is well washed and otherwise purified till it is brilliantly white and crystalline. It must be kept away from the light. The crystals have but little taste and no smell, insoluble in cold water, but soluble and subliming with a moderate heat. These brilliantly white crystals become yellow by exposure to light. Nitric acid converts it into succinic acid. Santonin, if given in any quantity, colors the field of vision yellow, so that the patient sees everything of that color. Some- times green takes its place. I404 .DISEASE GERMS. Being tasteless, energetic in the destruction of the round worm, it is easily and readily taken by children. The crystals in trituration with sugar and milk. Lozenges and a glycerite are most eligible forms. Dose : one to two grains. is the product of a tree growing in India and Sandal Wood Ceylon, and also in the South Sea Islands. It occurs in billets of a dark brown color externally ; internally the rings are well marked. The powder is blood red, and has a slightly astringent taste. It is mainly used for the coloring matter, which may be extracted by alcohol or ether, and by alkaline solutions. It is sandal wood which gives the red color to the compound tincture of lavender and to Fowler's solution of arsenic. An oil of sandal wood has recently come into use as a remedy for gonorrhea. Fifteen or twenty drops are usually given for a dose : but k good many people it does not suit ; many cases are not benefited by it. In all instances it gives rise to a good deal of pain. Often it is very effectual. The mistura santal comp., highly ozonized, a combination of pure sandal oil, oil of cubebs, copaiba, kava kava, terebene, with tincture of hyoscyamus, with peroxide of hydrogen. A useful, reliable preparation for the destruction of the gonococcus. It forms, when diluted, an elegant and pleasant mixture, which does not interfere with the digestive organs, and may be given without producing the offensive eructations which follow the administration of copaiba. Its use is especially indicated in the advanced stages of gonor- rhea, and in protracted or chronic gleet, though it may be given with equally good effect in the earlier symptoms, unless contra- indicated by an inflammatory condition. If given as soon as possible after the appearance of the dis- charge, the effect is usually most gratifying both to patient and doctor. The discharge disappears, the scalding ceases, and by continuing the medicine, with attention to collateral treatment, a cure may generally be effected in from two to five days. This remedy has been in use Saponaria Officinalis, throughout Europe and America as {Soap- Wort) a bactericide, chiefly for killing the venereal bacillus, and parasite affec- tions of the skin. It is nearly as powerful a remedy as comp. saxifraga and phytolacca. BACTERICIDES. j.qc For its alterative and germicidal properties, best given as a decoction, or in the form of a fluid extract. It does kill the gonococcus by slow degrees, in about two weeks. Saponin, a proximate principle obtained from the root in large quantities, is" extremely poisonous; although a glucoside, it unites with acids and forms crystals. A germicide and parasiticide, belonging to the Savin, cypress section of the fir family, has an extended sphere of action, both externally and internally. A cerate prepared in the usual manner is most efficacious in tinea capitis ; applied to indolent gangrenous ulcers, destroys the microbes present, and they heal promptly, the savin cerate being equally germicidal to ichthyol. It is all efficient as a lotion, fomentation or powder. The fluid extract internally adminis- tered in small doses, frequently repeated, annihilates the microbe of rheumatism ; rouses up the dormant functions of the torpid liver. In cases of tape-worm, the oil, with a little chloroform added, rubbed over the abdomen for a few minutes, by endos- ' Sabma. mosis so paralyzes the parasite that it is expelled. Its action on the uterus is that of a drastic stimulant. The berries contain diuretic, sedative, Saw Palmetto. nutritive, and gland-stimulant properties ; {Sabal Serrulata) and in the form of a fluid extract are in- valuable, and have a special and decided action upon the glands of the reproductive organs, as the mammae, ovaries, prostate, testes, etc. Its action is that of a great vitalizer, tending to increase their activity, to promote their secreting faculty, and add greatly to their size. It is specially indicated in all cases of wasting of the testes, such as follows varicocele, or is induced by masturbation, or which is often present in sexual impotency. In atrophy of the prostate, so very common in cases of sexual perversion, this drug operates in a most remarkable manner, in overcoming the withered, blighted state of the gland ; so in l4o6 DISEASE GERMS. uterine atropy dependent upon ovarian blight, its action is unex- celled. In gynecological practice it is much used to promote the growth of the mammae. But it is on the prostate gland that this remedy exercises its best effects. Great medical authority states, that when " the hair becomes gray and scanty .... the prostate gland be- comes increased in size," and this, irrespective of age. Nine men out of every ten have enlarged prostate, and one atrophy, ages varying from thirty-five to seventy-five, respectively, the result either of early indiscretion, as masturbation, or excess, or perver- sion of the sexual act, or sedentary habits, or from improperly cured gonorrhea. The prostate is composed of two lobes and a median portion. Sometimes one portion or all may be enlarged ; the part affected influences the function of micturition, whether it be wasted or enlarged. A patient may have enlargement as great as a small cocoanut, and no obstruction to micturition, provided the median portion is only but slightly enlarged. A man with prostatic trouble has always impaired sexual power, verging on partial or complete impotency, with wasting testes ; with urinary trouble, either a frequency, or a dribbling, a lack of power of propulsion. The dribbling, or lack of power of retention is altogether different from stricture, for in the latter the power is good, strong; although it maybe as fine as a thread, or split, or twisted like a cork-screw. Prostatic disease, acting reflexly on the brain, gives rise to in- numerable cerebral affections. Indicated in syphilis, cancer and tuberculosis ; Saxifraga. one of the most powerful vegetable alteratives known to medical science ; stands in the front rank of therapeutics as a great vegetable germicide. It would be impossible to successfully combat syphilis, cancer and tuber- culosis without this remedy. Saxifraga, Comp. Oz. — This preparation is purely vegetable, composed of the active principles of saxifraga, blue flag, tag alder, dulcamara, kalmia, corydalis, phytolacca and yellow parilla, prepared by a process of distillation and highly ozonized, after which five grains of iodide of potass and five grains of chlorate of carbon are added to each drachm. The preparation is en- dorsed by the entire medical profession, as the best of all altera- tives. It is not only the best of alteratives, but a potent germicide when it enters the human blood. It annihilates all disease germs, BACTERIClDEb. 1407 Sterilizes their micrococci and thus cleanses germ-laden blood, while it has the faculty of stimulating the springs of life, the vital elements of nutrition in aiding in the formation of pure and more vitalized blood. It is a true blood scavenger and tonic, strength- ening the system in a remarkable degree. It has a special faculty when it enters the blood, lymph canals and pink marrow of destroying the microbes of cancer and syph- ilis and the bacilli of tubercle. It completely supplants the use of mercury, antimony, arsenic, the iodides and other deleterious mineral agents in the removal of morbid action, destruction of myriads of germs which are always present in chronic maladies. As a great blood purifier and germicide, (the most efficacious in the whole range of therapeutics), it acts as a stimulant to the skin, liver, kidneys and every gland in the body. Dose : One teaspoonful every three hours. As a remedy to sterilize all disease germs or Skullcap, microbes, this one is too much neglected by the profession, especially in the treatment of all ner- vous diseases. It is a remedy of rare value, being a tonic, diuretic, anti- spasmodic. It has been used chiefly in convulsions, chorea, epilepsy, dys- menorrhoea and debility. It allays all irritation of the nerve centres, im- parts tone and quiets cerebral ex- citement. It is esteemed as our best remedy in hydrophobia. In this disease, to be effectual, it must be given in large doses until it produces a sort of paralysis or suspension, and if this is effected the germ dies or is sterilized. The remedy has also the same effect on the vibrios of nervous disease. It yields its properties freely to water, and in the form of an infusion it should be drunk freely, until there is a feeling of pins and needles ex- perienced over the entire body. SkuUcap. 1408 DISEASE GERMS. Senega Root is a famous germicide, possesses important medicinal properties, being a stimulant, diuretic, diaphoretic, and in large doses emetic and purgative. Its administration in catarrh, bronchitis, rheumatism, has a most sterilizing effect upon the germs of those respective ma- ladies. Even the mycelia of hooping-- cough are thoroughly paralyzed in its presence. The following for- mula is effective : Syrup senega, syrup of tolu, of each one ounce ; resorcin, half an ounce. Mix. Dose, from a half to one teaspoonful every two hours. A most wonderful remedy in the cure of diabetes, Bright's dis- ease, cystitis, sciatica, gout, rheu- matism, dropsy, neuralgia and carditis is the ozonized uric acid solvent. The addition of pichi and di- oxide of hydrogen to the com- pound has given it a world-wide reputation in all renal diseases aris- ing from defective assimilation and an excess of uric acid. Physicians using it should see that they have Polygala Vulgaris. the genuine ozonized. Serpentaria. snake stimu- actmg Virginia root is a lant tonic, also as a diaphoretic and diuretic. On account of its peculiar stimulat- ing action on the skin, its use is extremely beneficial in all forms of eruptive fevers ; it has the peculiar faculty of driving all the micro- organisms of those fevers to the surface, thus relieving cerebral and visceral congestion. Of great e|ifi- cacy when the kidneys are blocked up by solid bodies, as the urates Virginia Snake Root. or triple phosphates. It BACTERICIDES. 409 promptly relieves that sensation of weight and dragging in the loins, fulness in the chest, difficult respiration incidental to nephritic congestion. It augments vital force, increases the power of vital resistance. The comp. tincture and fluid extract are the most eligible forms for administration. Undoubtedly the most powerful Siegesbeckia Orientalis. and valuable of all vegetable germi- cides. Administered internally or applied locally, it either completely annihilates or sterilizes all micro-organisms. For internal administration, a syrup is pre- pared by pounding the green plant, adding sugar and straining, or by adding one drachm of the tincture to two ounces of simple syrup. This is the best form for prescribing in syphilis and cancer, and in cases where any microbes inhabit the human blood. It acts most efficiently upon the syphilitic germ, even exceeding in its germicidal ac- tion bichloride of mercury, iodide potass., saxifraga, kalmiia, etc. As a spinal stimulant it ex- cels nux vomica, ignatia, rhus; hence its value in aphasia, stam- mering, and in incontinence of urine or irritable bladder. As a local remedy to ulcers or sores, syphilitic, gangrenous, it promptly destroys the germs present, then stimulates rapid cicatrization. A very small quantity of the tincture added to a jelly, pre- pared from glycerine of starch, destroys the oidium aphthae and sore nipples. The tincture is a valuable cure, locally, for all forms of tinea, and can be prescribed with invariable success. Apply it in ring-worm, tinea circinata, tinea sycosis (tinea ton- surans), tinea versicolor, typical, well-marked cases, even of the most aggravated form in broken-down subjects; the result is marvellous in the extreme. The drug acts as a stimulant and a parasiticide, and the mode of cure, after it is applied, is that the diseased patch becomes broken up into a series of small patches^ with sound skin intervening. Then the re-application of the drug causes it to break, up into still smaller pieces, when it dis- 89 Siegesbeckia.— The great vegetable Bactericide. I4IO DISEASE GERMS appears altogether, and In their place a small red blush. This only remains for a day or two, and the most stubborn case is thus cured. The prescription in all forms, even the most aggravated and stubborn, is : equal parts of the tincture of siegesbeckia and glycerine, well rubbed into the affected area morning and night. At present it is a high-priced drug, but the dose is small, and its use, if indicated, brings colossal results. The Learned leading physicians of Canada are adopting the germ theory of disease with great avidity. Dr. Cannon, of Sharbot Lake, is pushing bactericides with great energy in his extensive practice. In one of his recent essays, he says : " The siegesbeckia orientalis in typhoid has not received the attention it merits. The time has arrived to lay before the pro- fession the results of an experience in its use extending over two years, comprising a series of seventy-nine cases. The general management of all those cases was : the patient was confined to bed in the recumbent posture, in a well venti- lated room, rigid hygiene, and every effort made to maintain the nutrition of the patient by fresh milk alternated with beef tea, etc. In the entire number of cases, no matter what time I was called, I ordered; one-drop dose of a saturated tincture of sieges- beckia orientalis in a tablespoonful of water in which a teaspoon- ful of the syrup of orange peel had been dissolved. The good effect of the remedy was immediate ; the pulse slowed, tempera- ture fell, tongue cleaned, diarrhea ceased, and the general condi- tion of all the patients improved so much that, as a rule, all anxiety as to the future of the cases was at an end, as they all proceeded to speedy recovery. What induced me to try this drug in typhoid fever was that, in my experiments in the cultivation of the typhoid bacilli and the effect produced upon the micro-organisms when the sieges- beckia tincture was introduced into the cultivating media, perfect annihilation of microbe growth took place. So internally in typhoid. Another reason was, I had applied this tincture in gangrenous ulcers (oidium albicans) with most marvellous results, and had demonstrated most clearly the destruction of the germs and the establishment of healthy, healing action, so I obtained similar results upon the germ-eaten bowels, so much so that I noted over half the cases were aborted on the second week. My seventy-five cases were treated all alike, the prevailing idea being to destroy the germ, and heal the ulcers on the bowels; just as , BACTERICIDES. I4II this great vegetable germicide was administered, so febrile dis- turbance ceased. This remedy owes its antipyretic action directly to its germi- cidal power, to its power over the germ before destroying it — that the germ being destroyed, no ulcers form on the intestines ; recovery from the fever is certain provided no accidental or adventitious cause arises." This is a strong bactericide, non-poison- Silico- Fluoride ous, unirritating to the tissues, inodorous, of Soda. non-volatile, non-corrosive, and not de- stroyed by oxidation. This remedy is very useful for washing out the peritoneal cavity after laparotomy, here using ten grains to the pint ; in cases of strangulated hernia ; in the radical cure for hernia ; in excision of joints ; in amputation of the arm, leg, and thigh ; in washing out the pleural cavity ; in the removal of tumors ; in excision of veins ; in ligature of blood vessels ; in compound fractures ; in osteotomies ; in washing out the bladder ; in wash- ing out the uterus after curetting the interior, and after the re- moval of septic retained membranes ; as a vaginal douche before and after Apostoli's operation for fibroid ; in the irrigation of ex- tensive ulceration in the rectum, where a poisonous antiseptic could not have been employed ; in washing out the stomach ; as an injection in gonorrhea (ten grains to the pint) ; as an injec- tion in otorrhcea ; in syringing out large pelvic abscesses ; as a gargle in hospital and in diphtheritic sore throat; as a nasal douche after removing polypi ; for syringing out empyema of antrum ; and in many other cases. an invaluable ozonized compound, composed Simabicidia, of cedron seed, coto bark, Jamaica dogwood, manaca, tonga and black cohosh, a specific for neuralgia. These remedies are a special combination of peculiar efficacy and highly germicidal. The preparation was first intro- duced by us, and on submitting it to the profession, it was found to possess extraordinary power in relieving neuralgic pain. Neu- ralgia is caused by the presence of living microbes in the blood, impoverishing the nerves. The theory of pain, caused by mi- crobes, or their poisons, was anaemia. Cedron seeds have obtained quite a reputation in the treat- ment of snake bites and other venomous reptiles. They are of undoubted utility in headaches and neuralgias due to the pres- I4I2 DISEASE GERMS. ence of sewer gas, foul emanations, or microbe-laden atmo- spheres. A tincture or fluid extract of the coarsely ground seeds may be used, but for general use the simabicidia answers the purpose best. There is still another explanation which on many grounds has recommended itself, as accounting more satisfactorily for the phenomena observed, both to chemists and biologists. It is that the injurious effects produced by microbes on special nerves are due, not to what they take or to what they excrete, but to what they leave, and this is closely associated with the imperious de- mand they make for oxygen. Being in many instances anacrotic — that is, living and multiplying without direct exposure to air — they must obtain the oxygen they require for the process of life from the tissues by which they are surrounded ; but when oxygen is withdrawn from such complex chemical compounds as those of which our bodies are constructed, the elements enter into new combinations, and then, under the name of ptomaines, are believed to be the really poisonous agents. Attempts have been made to isolate these com- pounds ; and it has been shown that they are of the nature of alkaloids, and resemble, both in their constitution and in their effects, those deadly poisons that may be extracted from digitalis, conium, tobacco, delphinum, and other noxious plants, and that it is its action upon those poisons, in neutralizing or antidoting them, that is effectual and invaluable in all nerve pain. Dose : From half to one teaspoonful in water, three times a day. Relief generally follows the third or fourth dose. No ill effects from larger doses. Seeds of Simaba Cedron. Quarter natural size. This drug has been highly extolled as a remedy Simulo. to sterilize the microbe of neurasthenia and epilepsy. In the estimation of one of our best and most suc- cessful physicians in the treatment and cure of nervous diseases, Thomas L. Barnes, M. D., of Jamestown, N. Y., simulo is entirely worthless. The learned Doctor has tried this much-lauded remedy, and in no single instance does it control any, nay, even the mildest epileptic seizures. BACTERICIDES. 413 A germicide, aromatic, stimu- Solidago. lant. An infusion of the herb, {Szveet-Scented Golden Root) administered warm, is an excel- lent diaphoretic and carminative ; a fluid extract is valuable to cover the taste of nauseous drugs. Its medicinal properties depend entirely upon the presence of a volatile oil which contains all the bactericide properties. It is of great utility to sterilize or destroy all micro-organisms in the alimentary canal ; by doing this it relieves pain in the stomach and bowels, flatulence. It is also of great value for inhaling in all microbial diseases of the respiratory organs. Dose : From two to five drops, triturated with sugar, or cut with alcohol, every three minutes, until relief is experienced. A bitter, astringent tonic, sudorific, diuretic. Speedwell, expectorant, nerve stimulant. Employed jn some ( Vej^onica.) countries as a substitute for tea, makes a pleasant beverage, restores the functions of the digestive organs, strengthens the mental and physical powers. Adminis- tered with great benefit in all cases of depression or over fatigue ^, or exertion, it entirely wipes out that feeling of exhaustion and is unquestionably one" of the most powerful tonics to the muscu- lar system that we possess. The remedy can be specially re- commended to medi- cal men and nurses, and all who require to keep awake and be on the alert, and Speedwell (K^r^mVa). enabling them to do a vast amount of work with ease. Although of great efficacy in combating fatigue and drowsiness, no antidotal properties are claimed for it in any of the habits. I4I4 DISEASE GERMS. Solanin. A glucoside derived from the leaves and berries of the solanum nigrum and other plants. It has an acrid, nauseous taste ; is insoluble in water, but freely soluble in ether or alcohol. It has a powerful germi- cidal action upon all the fluids and solids of the body, has an anesthetic action upon the base of the brain, influencing chiefly the pulmonary plexus, and diminishing the sensibility of the bronchial mucous mem- brane. Its peculiar action upon the respira- tory centre of the brain causes it to slow the pulse, diminish respirations and lower temperature. In large doses it is an irritant and paraly- zer; in small doses it is of the greatest efficacy in destroying the micro-organisms of hooping-cough, bronchitis, carditis, asthma, emphysema, rheumatism, gout, sciatica and cystitis. By its peculiar seda- tive action on the pneumogastric, it relieves Administered in doses of a quarter to one For subcutaneous injection the hydrochlo- Common or Black Nightshade {Solanum nigrum.') gastralgia, vertigo, grain thrice daily, rate of solanin is used in an aqueous solution. is closely allied Spikenard to the valerian family, but has a much stronger odor and is more powerfully germicide. Simmering the sliced roots in oil or vaseline makes an embro- cation of the greatest utility in the successful cure of old fetid ulcers, k is an old remedy, but one of great value, and likely to regain its place in modern therapeutics. A tincture is the most eligible form for exhibition ; being a good nerve stimulant, it affords almost instant relief in innumerable painful affections. Spikenard, BACTERICIDES. I415 consists of the bulb of the sea onion {Urginea scilla Squill or Scilla maratima) sliced and dried. It grows along the shores of the Mediterranean, partly in the water. The bulb is pear-shaped, and often of considerable size. It is covered with brown scales overlapping like those of the lily. The outer ones are membranous, the inner white and fleshy, these being cut across. Squill is commonly seen in small white pieces, consisting of transverse sections of those scales. Squill has a bitter taste and not easily powdered until well dried ; in that state they may easily be converted into powder, but if allowed, the powder speedily absorbs moisture from the atmo- sphere, so that the powder becomes a solid adherent mass. Squill seems to owe its efficacy to a resinous substance, which is not, however, separated for use. Its pre- parations are, vinegar of squill, oxymel of squill, made by mixing squill vinegar with honey, a syrup and a tincture. It is a bactericide of no mean order, and as it yields its properties to acetic acid dilute, we have the advantage of two germicides in one. It is also an excellent remedy to facili- tate expectoration, and for rousing up the action of the kidneys, and to promote the absorption of fluids; hence its value in dropsy. As an expec- torant, use it alone, or combined with syrup of tolu, senega, wild cherry, ipecac. It is one of our best remedies in stubborn dropsical cases in alternation with strophanthus. Squills. Common broom, which grows so Sulphate of Sparteine, abundantly in the temperate lati- tudes of Europe, yields by decoction and alcoholic extract an invaluable cardiac tonic and vitalizer. This property resides in the w^hole plant, leaves, stem and flowers, but specially in the young tops and seeds. Besides its decided action on the muscular structure of the heart, it is an efficient diuretic and laxative. These are the ordinary properties of the scoparius, but the alkaloid is sulphate of sparteine, which is obtained freely from I4i6 DISEASE GERMS. the tops, takes its place in the front rank as a most extraordinary heart tonic. The constant physiological and therapeutic effect of this drug is to strengthen the heart's action, improve its pulsations, increase its growth. The sulphate of sparteine is most effective administered hypo- dermically in the morphia and other habits ; the injection should be given when the craving comes on. Invaluable in asthma. Lakespur or Stavesacre. {Delphinhcnt stapJiisagria.) Common Broom; a, flowering branch- let; ^, end of branchlet, not flower ing, showing leaves with three leaf- lets; f, a pod ; I4. 329- ;t)8. Fa;cal accumulation. Fever, 315. ephemeral, ^19. gastric, 320. bilious, 322. malarial, 322. remittent, 327. malignant biliou typhoid, 330. surgical, 338. typhus 339. relapsing, 341. dengue, 342. yellow, 343. puerperal, 346. hay, 350. cerebro-spinal, 35 4. eruptive, 355. measles, 356. scarlet, 359. small-pox, 363. Filaria sanguinis hominis. Fissure, 369. Fistula in ano, 371. recto-vaginal, 374. vesico- vaginal, 375. Frost bite, 178. Functional disorders, 37b. Fungus, aural, 755. diabetes, 417. yeast, 418. Germ diseases, 378. Glanders, 424. Glaucoma, 427. Gleet, 1 1 80. Gonorrhea, 1175. Gout, 428. Hair lip, 531. Habits, 434. tobacco, 434. opium, 435. caffeine, 435. chloral, 436. arsenic, 4 ]6. Hemorrhagic temperament, 438. Hemorrhage, 438. nose, 439- kidn.'VS, 441. INDKX. ^447 Hemorrhage, lungs, 442. rectum, 4)2. . skin, 443. stomach, 444. uterine, 445. Hemorrhoids, AAl- Headache, 454. Hemiplegia, 761. Hiccough, 457. Home-sickness, 458. Hooping-cough, 459. Hydatids, 462. Hydrocele, 466. Hydrocephalus, 467. Hydrocephaloid disease, 469. Hydrothorax, 469. Hydrophobia, 469. Uypertrophy, breast, 472. heart, 473, livtr, 474. muscles, 475. prostate, 475. testes, 489. Hydrops pericardium, 489. Ichorrhsemia, 489. Ichthyosis, 490. Icterus, 491. Impetigo, 492. Incontinence of urine, 492. Incubus, 746. Imperforate anus, 493. hymen, 494 Impotency, 495. Infantile diseases, 510. Inflammation 538. bone, 544. periosteum, 545. brain, 545. membrane of brain, 553. bowels, 556. bladder, 558. breast, 560. cellular tissue, 562. cornea, 564. ear, 564. eye, 567. heart, 573. heart covering, 574. iris, 576. kidneys, 577. larynx, 592. liver, 595. lungs, 600. mouth, 611. nails, 612. nose, 613. rhinitis, 615. pericardium. 616. Inrianimatiou, o\ary, biS. parotid, 621. pleura, 621. peritonaeum, 624. I prostate gland, 628 rectum 634. '] retina, 635. stomach, 636. spinal cord, 638. ; testicles, 641. tonsils, 643. tongue, 645. \ uterus. 645. j veins, 651. I Influenza, 652. Injuries, 655. Insanity, 656. Insomnia, 669. Invagination of bowels, 671. Keloid, 674. : Labor, 840. I Leprosy, 675. Leucorrhcea. 677. j Leucocythema, 678. I Lichen, 679, j Lupus, 680. i Masturbation, 683. I Mellituria, 249 j Menstruation, 689. I Mesenterica, 690. ; Microbe actinomyces, 401. I dengue, 416. diarrhea, 401. j epidemic cholera, 403 leprosy, 420. dysentery, 403. influenza, 404. boils, 404. malaria, 405. mumps, 418. neurasthenia, 406. rhinoscleroma, 421. bronchitis, 406. croup, 413. Micrococcus endocarditis, 407. gonorrhea, 407. haemophilia, 408. measles, 408. variola, 408. tetragonos, 409. typhus, 409. urea, 410, hooping-cough, 410. Moist tetter, 293. Molluscum, 692. 1448 indp:x. Nails, 693. Neuralgia, 694. breast, 696. ear, 697. coccyx, 698. face, 699. kidneys, 599. intercostal nerves, 700. muscles, 700. sciatic, 70 r. testes, 703. Neurasthenia, 708. brain, 710. sexual, 719. Neurosis, anus, 731. aorta, 733. bowels, 734. brain, 734. clitoris, 735. genitals, 735. heart, 736. larynx, 736. nose, 738. penis. 739. prostate, 740. sexual sense, 740. skin, 742. spinal cord, 742. vagina, 744. general, 745. Nightmare, 746. Obesity, 747. Oidium albicans, 411. Old age, 747. Olfaction, 751. Ophthalmia, 567. infantile, 568. common, 569. purulent, 569. gonorrheal, 571. tubercular, 571. rheumatic, 571. Otha-matoma, 753. Otomycosis, 755. Otorrhcea, 756. Oz;vna, 757. Papul;^, 759. Paralysis, 761. paraplegia, 762. amyloid, 766. mercuric, 766. lead, 767. agitans, 768. infantile, 768. wasting, 770. rheumatic, 770. diphtheric, 770. Paralysis, local, 772. bladder, 772. Paraphimosis, 773, Parasites, 774. mtestinal, 775. ascarides, 776. • lumbricoides, 776. taenia solum, 777. trichiniiie spiralis, 781. lice, 784. itch, 784 ringworm, 786. liver spot, 789. baldness, 791. barbers' itch, 791. Pemphigus, 793. Perineal pressure, 795. Perversion of sexual sense, 797. Phimosis, 802, Phlegmasia, dolens, 803. Phospliorus disease, 803. Piarrhasmia, 804. Pityriasis, 805. Peptonuria, 805, Petechia, 806. Phrenal syphilis, 1190. Pneumococcus, 391. Pneumothorax, 806. Poison, 807, 824. Polypus, 808. aural, 809. nasal, 812. pharyngeal, 816. rectal, 817. umbilical, 820. uterus, 821. urethra, 824. Polyuria, 825. Porrigi decalvans, 826, Pregnancy, 828, Presentations in labor, 840. Priapism, 862. Prolapse of mesentery, 862. rectum, 864. uterus, 8c6. vagina, 869. Prostatorrhoea, 870. Pruritis, 872. Prurigo, 875. Psilosis, 875. Psoriasis, 875. lingua, 876. Pterygium, 878. Ptomaines, 879. Purpura, 883. Pyoemia, 884. Rabies, 886. Races, 888. INDEX. 449 Railway^ 896. Ranula', 897. Rectum, 897. Rectal medical, 898. Reflex irritation, 899. Respiration, S99- Rigor mortis, 904. Retching, 905. Rheumatism, 906. Rhinoscleroma, 917. Roseola, 918. Rupia, 919. Rupture of heart, 919. muscle, 919. hernia, 920. inguinal, 927. femoral, 928 umbilical, 929. uterus, 929. Sanitarv' science, 930. Sarcina ventriculi, 418, intestinal, 419. uicrine, 419. Scurvy, 955. Scythianas, 795. Sea sickness, 956. Seminal vesicles, 959. Sight, 961. Sleep, 964. Sore throat, 965. Spasms, 966. bladder, 967. rectum, 968. Spermatorrhoea, 969. Spermatozoa, 977. Spinal, 979. Spirillum plicatile, 41 1. relapsing fever, 412. Sprains, 982. Stammering, 983. Staphyloma. 984. Sterility, 985. Stertorous breathing, 991. Strabismus, 992. Stryptococcus of diphtheria, 412. cerebro-spinal meningitis, 413. erysipelas, 413. foot disease, 414. pyogenes, 415. puerperal fever, 415. yellow, 416. periostitis, 416. rabies, 417. Stricture of oesophagus, 995. rectum, 995. urethra, 997. Styes, 1 001. Suicide, looi. Sweat, 1003. Syncope, 1004. Synovia, 1004. Syphilis, phrenal, 1 190. Temperaments, 1005. Tetanus, 1006. Thrombosis, loio. Tongue, loii. Tonsils, 1014. Toothache, 1 01 5. Tuberculosis, 10 16. Tubercle in lung, io2i. nose, 1039. larynx, 1039. bowels, 1041. peritoneum, 1044. mesentery, 1045. bladder, 1047. rectum, 1049. prostate, 1051. testes, 1052. eye and ear, 1052. skin, 1053. bone, 1055, 1057. spine, 1061. hip-joint, 1067. knee-joint, 1069. wrist-joint, 107 1. Tumors, 1093. fibroma, 1094. myxoma, 1097. chondroma, 1103. osteoma, 1103, lymphoma, 1104. sarcoma, 1105. myoma, 1108. neuroma, 1 109. angioma, mo, papilloma, 1113. adenoma, 1115. mixed, 11 17. Ulcers, 1 1 21. cutaneous, 1121. healthy, 11 23. irritable, 1123. j indolent, 1124. tubercular, 11 24, varicose, 1125. fistulous, 1 1 25. phagedenic, 1126. bed sores, 1127. gangrenous, 11 27. hospital gangrene, 11 27. syphilitic, 1 1 28. malignant, anthrax, 1129. gastric, 1 1 29. , of the larynx, 11 34. diphtheric, 1 1 35. on the rectum, 1136, 1141, 45C INDEX, Ulcers on the neck of uterus, 1142. on the vulva, 1148. Ursereiia, i [49. Urine, 1150. Urticaria, 1165. Vaginal medication, I168. Varix, 1 1 69. Varicocele, 1171. Venereal disease, 11 74. bacillus, 1 1 83. in the eye, 1189. in the brain, 1190. in offspring, 1195. in the liver. 1 197. Venereal bacillus in the lungs, 1198. in the lymphatics, 1202. in urethra and vagina, 1 202. in nasal cavity, 1 204. in the skin, 1206. in the trachea, 1217. on the tongue, 1219. Vertigo, 1219. Vasico-urethral erethism, 1222. Vulva, shrinking, 1224 Warts, 1225. Wasting disease, 1227, Xeroderma, 1227. BACTERICIDES. Abnis Precatorius, 1 229. Acacia, 1231. Acetic Acid, 1231. Achillea, 1232. Aconitine, 1232. Acta Racemosa, 1233. Adahatoda Vasica, 1 234. Adonidin, 1234. Agaric Acid, 1234. Agrimony, 1235. Aleteris Farinosa, 1236, Alkanet, 1237. Alnus Niger, 1237. Althaa, 1238, Aloe, 1238. Alum, 1238. Aluminum, 1239. Acetate of Aluminum, 1 239. Alvelos Milk, 1239 Amaranthus, 1240. Ammonia, 1240. Amylene Hydrate, 1241. Anagallis Arvensis, 1241, Andromeda Polyfolia, 1242, Anemone Nemorosa. 1242. Angelica, 1242. Antefebrine, 1243. Antimicrobe Pov*rder. 1244. Antipyretics, 1245. Apocynum, 1247. Apiol, 1247. Arnica, 1247. Arnotto, 1248. Arsenic, 1248. Arum Triphyllum, 124(>„ Asclepias, 1249. Aseptol, 1249. Asparagus, 1250. Aspidospermine, 1250. American Ash, 1251. Balsam Copaiba, 1251. Balsam of Peru, 1252. Balm Melissa, 1252. Bay berry, 1253. Benzoin, 1253. Berberis Vulgaris, 1254 Belladonna, 1255. Betin, 1255, Bismuth, 1256. Bistort, 1257. Bittersweet, 1257. Bladder- Wrack, 1258. Bloodroot, 1258. Blue Cohosh, 1259. Boldo, 1259. Boroglyceride, 1260. Bryonia, 1263. Burdock, 1264. Cadmium, 1264. Calabar Bean, 1264. Cajeput Oil, 1264, Calcium, 1265. Camphor, 1266. Campho-Phenique, 1267. Cannabis Sativa, 1267. Capsicum, 1268. Cardamom Seeds, 1269. Carbolic Acid, 1270. Caraway, 1270. Carbonic Acid Gas. 1271 Caroba, 1271. Can-ageen, 1272. INDEX. 145 I Cascara Sagrada, 1 272. Cassia Alata, 1273. Celona Glabra, 1274. Centaury. 1 274. Cerastinum Vulgatum, 1273. Cerebrin, 1275. Cerium, 1275. Cinchona, 1275. Cinnamon, 1276. Camomile, 1277. Chelidonium, 1278. Charcoal, 1278. Chaulmogra Oil, 1279. Chrysarobin, 1 280. Chian Turpentine, 1 281. Chinoline Salicylate Tartrate, 1281. Chionanthus Virginica, 1281, Chloral Hydrate, 1282. Croton Chloral Hydrate, 1282, Chloralamid, 1282. Chlorine Water, 1283. Chloride of Chromium, 1283. Clover, 1284. Coca Erythroxylon, 1 285. Cocculus Indicus, 1288. Cochlearia Officinalis, 1288. Coca Theobroma, 128Q, Coffee, 1289. Columbo, American, 1290. Colchicum, 1291. Collinsonia Canadensis, 1 292. Collodion, 1293. Colt's-Foot, 1294. Comfrey, 1294. Convolvulus Panduratus, 1 295, Concentrated Ozone, 1295. Cendurango Bark, 1295. Conium. 1296. Convallamarin, 1296. Croton, 1297. Corallorhiza Odontorhiza, 1297. Corn Smut, 1298. Cotton Root, 1298. Coumarin, 1299. Creatine, 1299. Creosote. 1300, Creolin, 1301. Cuphea Viscasissima, 126?!., Curare Sulphate, 1303. Cyclamen. 1304. 1 Damiana, 1304. Digitalis, 1305. Dogwood, 1305. Drosera, 1306. Eggs, 1306. Eiaterium, 1306. Elecampane, 1307. Elder, 1308. Elm Bark, 1308. Ephilobium Angustifolium, 1309 Erigeron Canadensis, 1309. Ergot, 1 310. Erythronium Americanum, 1313 Eryngium, 131 1. Eschohltzia Californica, 1312. Eucalyptus, 131 2. Euphorbia Pilulifera, 1314. Euphrasia, 1 3 14. Eupatoreum Purpureum, 1315. Exalgine, 131 5. Fennel, 1316. Fumarine, 131 7. Gaultheria, 131 7. Gelsemium, 131 8. Gentian, 1320. Geranium, 1320. Ginger, 1322. Gillenia Trifoliata, 1322. Glycerine, 1323, Glycerite of Ozone, 1326. • Guttapercha, 1327, Gold Chloride et Soda, 1328. Grindeha Robusta, 1329. Guiacum, 1329. Helianthus, 1330. Hepatica, 1330. Hindoo Bitters, 1349, Hoang Nan, 1330. Hound's Tongue, 1331. Hops, 1 33 1. Horse-Chestnut, 1332. Hyssop, 1333. Hydrastis Canadensis, 1333. Hydrocotyle Asiatica, 1334. Hydronapthol, 1335. Ichthyol, 1336. Ingluvin, 1337. Indigo, 1338. Ipecac, 1338. Iodine, 1339. Jaborandi, 1342. Jalap, 1343. Jamaica Dog^vood, 1345. Jambul, 1344. Juniper, 1345. Kaki, 1345. Kalmia, 1346. Kava-Kava, 1346. Kola Nut, 1347. 1452 INDEX Koussa, 1349. Kurchicine, 1349. Lactic Acid, 1350. Lochnantes Tinctoria, 1352. Lactose, 1352. Lactucarium, 1353. Lavender, 1353. Lemon, 1354. Leplandra, 1355. Licorice, 1355. Lic|uid Ozone, 1356. Lithia, 1357. Lobelia, 1357. Lycopodium, 1358. Lycopus, 1358. Male Fern, 1359. Manaca, 1359. Marjoram, 1 360. Marrubium, 1360, Menthol, 1361. Miidar Bark, 1362. Marigold, 1362. Menyanthis Trifoliala, 1363. Mexican Ointment, 1363, Mitchella Repens, 1363. Mulberry, 1364. Maranta, 1354. Mistletoe, 1365. Muira Puama, 1366, Mullein, 1366. Myrrh, 1367. Myrtle, 1367. Napththaline, 1368. Nitrite of Amyl, 1370. Nutmeg, 1372. Nux Vomica, 1373. Nymph ae Odorata, 1373. Ginanthe Crocata, 1374- Obstetric Cones, 1375. Oxygen, Compound, 1376. Ozonized Uric Acid Solvent, 1377. Ozone et Chlorine, 1378. Ozonized Syrup of Tar, 1380. Ozone Tablet, 1380. Ozonized Clay, 1380. Ozone Water, 1380. Ozone Paste, 1381. Ozone Ointment,* 1 381. Papoid, 1382. Paraldehyde, 1383. Passiflora lucarnata, 1 384. Pastiles, 1385. Peppermint, 1385, Pellitory, 1385. Pennyroyal, 1386. Pepsin, 1386. Permanganate Potassa, 1387. Pichi, 1388. Peroxide of Hydrogen, 1388. Phenacetine, 1390. Phlorizin, 1390. Phytolacca, 1390. Platinum Chloride, 1390. Pimento, 1390. Phospi ated Tincture of Oats, 1391. Plantain, 1393. Pomegranate, 1393. Pelleterin, 1394. Poplar, 1394. Protagon, 1395. Prunia, I395. Pulsatilla, 1396. Pyriden, 1396. Pyrodin, 1396. Raspberry, 1397. Resorcin, 1397. Rhigolene, 1399. Rhus Aromatica, 1399, Rue, 1400. Saccharin, 1400, Salol, 1401. Salicylate of Soda, 1403. Santonin, 1403. Sandal Wood, 1404. Saponaria Officinalis, 1404. Savin, 1405. Saw Palmetto, 1405. Saxifraga, 1406, Skullcap, 1407, . Senega Root, 1408. Serpentaria, 1408. SiegCbbeckie Orientalis, 1409. Silico- Fluoride of Soda, I411. Simibicidia, 141 1. Simulo, 1412. Soldago, 1413. Sozoidol, 1 34 1. Speedwell, 141 3. Solanin, 1414. Spikenard, 1414. Sulphate Sparteine, 141 5. Staph isagria, 141 6. Stillingia Sylvatica,»i4i7. Stramonium, 141 9. Storax, 14 1 9. Sulfonal, 1420. Sulpho-Carbolate of Sodium, 1420. Sulpho-Carbol, 1421. Soluble Gelatine Urethral Hougies, Strophanthus, 1 42 1. Sulphur, 1423. [421. INDEX. H53 Sumach, 1427. Sumbul, 1428, Street Flag, 1428. Tag Alder, 1429. Tansy, 1429. Terebintha, 1430. Tcrpin Hydrate, 1432. Terpinol, 1433. Thallin, 1434, Tbeine. 1434. Thymol, 1435. Thio-Resorcin, 1398. Triticum Repens, 1436. Twbacco, 1436. Thuja Occidentalis, 1437. Tulip Tree, 1438. Uranium, 1438. Urethran, 1438. Uva Ursi, 1438. Valerian, 1439. Veratrum Viride, 1439. Veronica Beccabunga, 1440. Vervain, 1440. Virginia Stone Crop, 141 7. Warburg's Tincture, 1441. Water Plantain, 1 44 1. Witch Hazel, 1442. Wormwood, 1443. Willow, Black, Fluid Extract, 1443. Xanthoxylum, 1444. iO LIBRARY OF CONGRESS 007 197 792 4 # m m !vu;:.;;;;!^ if!;'..' ■ ■''!' ;' ■ -y , M