f ':'-. ;-_i.ij- ..■:■/: .::.'■'_ l: Lt "_■-_■_■. .&-':-ii_t—w 1.1J-— =_. 1 LIBRARY OF CONGRESS, Shelf .....SA-' UNITED STATES OF AMERICA. THE General Practitioner. A MANUAL FOR THE PRACTICE OF MEDICINE, EMBRACING NEARLY ALL THE DISEASES OF THE VARIOUS BRANCHES OF THE HEALING ART, WITH THEIR SEVERAL DEFI- NITIONS, SYMPTOMS AND CAUSES. THE DESCRIPTIVE PART OF THE WORK IS PRECEDED BY A CHOICE COLLECTION OF REMEDIES IN THE FORM OF Select Prescriptions, WITH FULL NOTES OF THEIR PROPERTIES AND VALUE, AND CLEARLY STATED RULES AS TO THE MANNER OF THEIR EXHIBITION. AN APPENDIX CONTAINS COMPARATIVE TABLES OF WEIGHTS AND MEASURES, AND AN EXCELLENT METHOD OF TESTING URINE. BY THEODORE STREHZ, M. BRIGHT ^ ^ h |' 24 1890 C ;)' Chicago: IHb&ftV PUBLISHED BY THE AUTHOR/^ 1889. Entered according to Act of Congress, In the Office of the Librarian of Congress, at Washington, D. C. IN THE YEAR 1889, BY THEODORE STREHZ. LC Control Number tmp96 028750 TO DR. JOH. NEP. RITTER VON NUSSBAUM, PROFESSOR AT THE ROYAL UNIVERSITY OF MUNICH, GERMANY, SURGEON IN CHIEF OF THE ARMY, ETC., ETC., IN RECOGNITION OF HIS DISTINGUISHED ABILITY AS A SURGEON AND HIS NOTED LABORS IN THE FIELD OF MEDICAL SCIENCE, TO- GETHER WITH HIS PERSONAL AMIABILITY AS GENTLEMAN AND FRIEND, THE AUTHOR TAKES PLEASURE IN DEDICATING THIS VOLUME. PREFACE. In launching this book into the sea of medical life, the author is very well aware that it is not a full ship ; but among the smaller craft it is sure to take the rank of a trustworthy life-boat. As would be expected, the matter treated of in this work is neither new nor original; but the author claims for the form in which it has been pressed, not only originality, but real practical utility, and as it is expected to furnish to a large circle of the medical profession a veritable hand-book, "for reference, of service, in any case, whatever its nature may be," hopes that it will prove a true friend to many a practitioner into whose hands it should fall. To avoid a wrong interpretation of the above assertion it will be necessary to add, that "any given case" will have something of an analogon "of service" to the reflective physician. The therapeutical part, with an introductory paragraph on poisoning and other cases of emergency, which require prompt and energetic treatment, is presented in three divisions: Inter- nal, hypodermic, and external medication. The medicines for internal use are classified according to their physiological and therapeutical action in Chapter I, while the remedies for hypo- dermic medication (which form, after all, a part of them) are arranged alphabetically in Chapter II; and the topicals, with which are also classed electricity, hydropathic items, and those remedial agents used for inhalations, rectal, urethral, and vaginal medication— since they for the most part belong to the domain of surgery and collateral branches — are enumerated in Chapter III, under the heads of the various organs to which they are applied for curative purposes. The omission of many new, though perhaps important remedial agents, will be excused, because the reliability of the work must largely depend upon v. vi. Preface. the employment of drugs of known properties, and beyond the stage of experimentation. Part II. gives in concise form the essentials of the medical art, including Obstetrics, Gynaecology, Pediatrics, Neurology, Dermatology, and all those branches, which, being treated of in purely medical and surgical works but sparingly, if at all, represent that important part of sub- divisions which claim of late the special attention of thera- peutists. As by far the greater number of prescriptions are selected from standard works, though not authenticated by the names of their respective originators being attached to them, they may be used with perfect confidence; and the formulae, both of official and non-official compounds much in use, and to be pre- pared ex tempore, will be a welcome addition, especially to the country practitioner. The occasional dosage of these formulae and prescriptions, par excellence, in metric weight, is calculated to make him acqainted with a system which before long is sure to be adopted in the United States, as it is already in use in most European countries. Besides a table for converting one kind of weight into the other, the doses of all the remedies are given in apothecaries' weight, with its equivalent of the decimal system. I may mention that I have advisedly made an indiscriminate, though by no meaus exhaustive, use of the different names of one and the same remedy in the prescriptions for the purpose of bringing into full view the existing confusion, and if, with regard to t! e chemicalp, I have given a preference to the no- menclature employed in Germany, it has been on the ground that it is the one in conformity with the symbols used in works on chemistry, not only in that country but also here and in England. In conclusion I wish to say that the views held in this work are strictly in conformity with the teachings of authorities on the various subjects here and abroad — thus representing the present state of medical science — and I need scarcely add, that nobody will make me responsible for their correctness, as I am perfectly aware of their not infrequent collision with the opinions and theories of practitioners of undoubted ability. THEODORE STREHZ. CONTENTS. PART I. THERAPEUTICS. PAGE. Introductory— Drowning, Hanging, Strangula- tion, Asphyxia from breathing Noxious Gases, Poisoning, and other cases of emergency, which require prompt and energetic treatment, - - 1 CHAPTER I. INTERNAL MEDICATION. Section 1.— Reconstructions, comprising Alter- atives, Antiperiodics, Antistrumous, Anti- syphilitics, Antiseptics, Antizymotics, etc., with notes relating to their physiological action and their therapeutic value, besides rules to be observed in their exhibition in certain diseases, etc. ^ Section 2. — Sedatives, including Anodynes, Narcotics, Antispasmodics, Hypnotics, Ances- thetics, etc. - Section 3.— Correctives and Eliminatives, com- prising Acids, Antacids, Expectorants, Dia- phoretics, Diuretics, etc. Section 4. — Astringents, etc. Section 5.— Restoratives, comprising Stimulants and Tonics, -..-"■" Section 6.— Cathartics, ---.-'- Section 7.— Emetics, " Section 8.— Vermifuge, ... - 102 40 59 69 CHAPTER II- HYPODERMIC MEDICATION, - - - 106 vin. Contents. CHAPTER III. PAGE. EXTEENAL MEDICATION. 1. For Eye and Ear Diseases, - - 111 2. For the Air Passages and adjacent parts, including Inhalations, - - 115 3. For Genitals of Man, - - - 122 4. For Female Genitals and Womb Dis- eases proper, 124 5. For the Rectum, including Enemata, 134 6. For the Head, Face and Skin — 138 a, Erysipelas, Neuralgia, Rheumatism and Eruptive Feveis. by Ulcers, Tumors and Skin Diseases proper. c, Affections from Heat and Cold. d, Bites and Stings of Insects, etc., and other Wounds. 6, Hydropathic Items. f 9 Electricity. APPENDIX. 1. Table of Weights and Measures (Metric and Apothecaries'), - - - 152 2. Analysis of Urine, - - - - 154 PART II. GENERAL NOSOCOMIUM CONSISTING IN AN ALPHABETICAL ARRANGE- MENT OF THE DISEASES, with their sev- eral definitions, symptoms (whenever possible pathognomic) and causes, together with diag- nostic hints, and the remedies usually em- ployed in their treatment, according to the present state of medical science, - - - 158 PART I. THERAPEUTICS. Introductory — Drowning, Strangulation, Pois- oning and other cases of emergency which require prompt and energetic treatment. (For other cases of Asphyxia, Insolation, Poisoned wounds, etc., see part II). Asphyxia from Drowning — Let the head hang down for two seconds, that the water may run out of the month. Now lay down the body with the head raised, wipe out the mouth and throat, draw the tongue well forward and dry the face; then have the wet clothes stripped off and the rest of the body rubbed dry. If breathing has not quite ceased, the nose and fauces may be tickled to excite sneezing, coughing or vomiting, and the circulation and respiratory acts should be roused by brisk friction, occasionally dashing cold water on the face, neck and chest, and then wiping them dry with a warm towel. If these means fail, Artificial Respir- ation.* Warm spiced w r ine may be given, if the patient can swallow, if not, it maybe introduced into the stom- ach by means of a flexible catheter and syringe. Warm * Marshall Hall's Plan — Have the patient placed on his chest, with one wrist under the forehead; then roll the body over on the side far enough to remove the pressure of its weight on the thorax, to facilitate respiration; now, after two seconds, return it to its normal position, in which you leave it also for two or three seconds. In this prone position the expir- atory act may be increased by some pressure with the hands along the back. These movements of alternate compression 2 Death From Hanging. enemata, with, salt and mustard, or of brandy and water, may be of service in the early stage, whilst the heart's action is faltering. One point is to be enforced: Treat the patient instantly on the spot, in the open air, freely exposing the face, neck and chest to the breeze, except in severe weather. Death from Hanging or Strangulation, which is usually induced by a mixed cause — suffocation and apoplexy (the latter, when the rope or strangling imple- ment has been applied so high on the neck, that the jugulars are more effectually compressed than the wind- pipe), seldom by dislocation of the neck, requires a similar treatment: dashing of cold water on chest and face; if the latter be turgid, bleeding from the jugular vein; and Artificial Respiration, (p. 1*). In cases not complicated with apoplexy, the diaphragm may be ex- cited by the passage of a galvanic current from the nape of the neck to the pit of the stomach. Asphyxia from Breathing Noxious Gases, is treated on the same principle: The body must be stripped at once, cold water dashed over the head and chest and Artificial Respiration, (p. 1*). Chest and limbs should be rubbed with stimulating embrocations, and electric shocks sent through chest and diaphragm may be tried. and expansion should be gently but perseveringly continued until natural respiration sets in, but no longer. By Pectoral Concussion— About fifteen consecutive move- ments are made with both fists, placed in the ileo-ooecal region, in the direction of the diaphragm and heart, followed each time by a few brisk slaps in rapid succession on the chest over the heart with the palm of the hand. The single movements must be performed with a certain vigor, as if the contents of the chest had to be forced out of the mouth. In all cases, before commencing artificial respiration^ clear the mouth and air passages from obstruction. Poisoning. 3 Afterward the patient should be put in a warm bed and Stimulants given. Asphyxia from Lightning claims the same treatment: Stimulants internally and electricity are said to be here especially useful. Suspended Animation Induced by Intense Cold. — Here the body is first rubbed with snow or iced water, then with water of the usual temp., which is very gradually replaced by warmer water, when the patient is put to bed in a temperate room, where fric- tion with the warm hand should be continued for some time. (The same procedure is indicated if only part of the body is affected, because the sudden application of heat would be sure to cause mortification.) Volatile Essences applied to the nose; Stimulants internally or by injection; and, if necessary, Inflation of the lungs. Antidotes* to Anorganic Poisons. — Green of Paris and other arsenical preparations : The principal anti- dote is freshly prepared Hydrated Sesquioxide of Iron, given in large quantities (p. 80). Besides milk gruel, Albumen (156); Magnes. (112); Aq. Calcis, etc. Mercury and its Salts: Albumen in the shape of the white of eggs (156). Catechu as infusion (p. 63); flour * General Treatment of Poisoning. — In addition to the treatment of Gastritis, which is always caused by acrid and corrosive poison*, the evacuation and neutralization of the poisonous substance claim primary attention. Emetics (pp. 100 and 101) are to be promptly given, and, if they fail, the stomach- pump (297) must be resorted to, provided the poison be one which can be ejected. After having the stomach evacuated, the required antidote may be given, followed, if necessary, by Ca- thartics and Diuretics. In poisoning with corrosive acids the necessary antidote has to be given at once, and the vegetable irritants, as Aloes, Elaterium, Jalap, Croton,etc, require after the emetic warm and copious Demulcents, with Cordials or Narcotics, according to circumstances. Drowsiness or insensi- 4 Poisoning. and water, followed by an Emetic (p. 100). The stom- ach-pump. In chronic poisoning {Salivation) : Pot. chlor. or Pot. jod. (298 & 300) as gargle. Verdigris and other Copper preparations : Albumen (156); Pot. cyanat. (66); Milk; Tea. Infusion of Oak- bark, etc. (no acids). White Vitriol and other Zinc preparations : Albumen (156); Soda (p. 55); Tannin (p. 62); Milk; OakbarJc. If vomiting, plenty of warm waxer. Nitrate of Silver: Table salt in solution freely. Lead and its Salts: Magnes sulf. (p. 95); Sod. phosph. (p. 97); Acid, sulfuric, (p. 61); Alumen (p. 63). To relieve pain and spasms: Opium (p. 35). In the chronic form: Iodine (p. 15); Strychnine (p. 83). Tartar Emetic: Tannin (p. 62); Tea; Oakbark, etc. Besides Stimulants. Mineral Acids : Alkaline Carbonates or Soap; Plas- ter from the wall with milk or water; Chalk; Magnesia (112). In Sulfuric acid poisoning : Plaster or Soap without water, afterward flaxseed tea. In Oxalic acid poisoning: Chalk or Magnes. but no Alkalies. In Car- bolic acid poisoning : Soap or Magnesia; Sod. sulf. or bility as a consequence of narcotic poisoning may be treated with strong hot coffee, after the stomach has been evacuated by means of Purgatives, or Apomorph. hypod. (p. 107), or some other emetic; and if syncope or paralysis of the respiratory movements have been induced by the poison, Stimulants must be given to counteract the former, whilst the latter may be treated with cold affusions, irritation of the skin, artificial respiration, excitation of the Pneumogastric by Atropia, etc., etc. As the Antidotes act either chemically, by destroying the properties of the poison, or physiologically by their antagonistic power, it is of vital importance to arrive as soon as possible at a correct diagnosis. Poisoning. 5 Sulf. acid. (p. 16); Sacch. Calcium in strong solution. In Bichrom. acid, poisoning : Chalk or Magnesia with milk. Ammonia and Alkalies: Vinegar and Vegetable acids; Oil and Demulcents. Alcohol: Strong Coffee; Cold douche; Ammon. (p. 43); Salt (p. 101); Brom. (p. 25); Cocaine (pp. 77 & 109). Bronx.: Amylum; Magnesia (112); Ammonia (p.43). Chloral: Counter-irritants, Cardiac Stimulants and maintaining the bodily heat (as in Opium). Chlorine : Album. (1 5 6) ; Magnes.( 1 1 2) ; Mucilag. drinks. Chloroform : Head low and feet elevated; Inhalation of Ammonia (316); Cold water to chest and ice to rec- tum. Brandy hypoderm.; Artificial Respiration (p. 1*). Creosot.: Albumen (156). Iodine: Amylum; flour and water; afterward vine- gar and water; and mucilaginous drinks. Phosphor.: Magnesia (112); Terebinthina (150). Antidotes (p. 3*) to Organic Poisons. — Aconite: Warmth, friction and veget. Astringents (p. 62); Opium (p. 35); Digital, (p. 78), to support the heart's action. Belladonna: Vegetable Astringents (p. 62); Morph. hypoderm. in small and repeated doses (p. 110); Jabor- andi (109); Apomorphine (p. 107). Calabar: Atropin (pp. 23 and 108), to antagonize the respiratory depression. Artificial Respiration (p. 1*). Cannabis like Opium. Cantharis: Opium (p. 35); Camphor, (p. 28); De- mulcents and warm bath. Colchicum Coffee; Tannin (p. 62); Demulcents and Stimulants. Digitalis (p. 78); Opium (pp. 35 & 48). Conium: Stimulants; Atrop. (pp.23 &108); Strychnin (p.83); Opium(pp. 35 & 110); Artif. Respiration (p. 1*). 6 Poisoning. Cyan. (Aq. laurocerasi — 01. Amygd. am, etc.): Cu- prum (p.100); Ferrum(143); Ammonia (p. 43). Cold douche and Artificial Respiration (p. 1*). Digitalis: Horizontal position; Tea; Coffee; Stimu- lants; Tannin (p. 62); Albumen (156); Opium (p. 35). Ergot: Brandy and Demulcents with hot applica- tions to body. Digitalis (p. 78). Gelsemin: Brandy; Ammon. (p. 44); Digital, (p. 78); Bellad. (pp. 23 & 108); Artificial Respiration (p. 1*). Hyoscyamus like Belladonna. Lobelia: Brandy; Counter-irritation; Tannin, (p. 62); Anodynes (p. 20). Opium: Continuous motion; strong Coffee or Tea; cold Douche; Emetic (p. 101); Caffein (163); Tannin (p. 62); Cocaine (pp. 77 & 109); Bellad. (pp. 23 & 108;; Digitalis (p. 78); Artificial Respiration (p. 1*). Santonin: Emetics and Laxatives (p. 104); Chloro- form (pp. 30 & 109). Strychnin: Coffee; Tea; Brandy (p. 73); Tannin (p. 62); Brom. (p. 27); Chloral (p. 30); Calabar (270); In- halations of Chlorof . or Amyl. (304 & 308). Inf us.Chamom. p. os et p. anum; Tobacco-enema. Artif. Respir. (p. 1*). labaccum: Brandy (p. 72); Opium (p. 35); Digital, (p. 78); Strychnin (p. 83). Inhalation of Ammonia and Artificial Respiration (p. 1*). Veratrum viride: Brandy by mouth and rectum (p. 72); Ammonia (p. 43); Opium (p. 35); friction to body. Animal Poison (Snake-bite, etc.): Cauterization of wound with Arg. nitr. or Nitr. Acid (329). Alcoholic Stimulants (p. 72); Ammon. (p. 43); Cedron (p. 10). SECTION I. EECONSTEUCTIVES. They comprise Alteratives, Antiperiodics, Anti- strumouSj Axtisyphilitics, Antiseptics, Antizymot- ics, in fact, all those medicines which have a decided effect on certain cachectic conditions of the blood, and through either their destructive or reconstructive power assist the vis medicatrix naturce in her efforts to repro- duce the natural state of the various constituents of the human body. Acid, nitric, d: Alterative, Antilithic. Arsenic: Alterative Antiperiodic, Anticonvulsive, Nerve Tonic. Aurum: Antiscrofulous, Antisyphilitic. Baptisia: Antiseptic, Cathartic. Barium : Antiscrofulous, Anthelmintic. Cedron: Antiperiodic. Chinin. : Antiperiodic, Antiseptic, Antispasmodic, Antineuralgic, Antipyretic, Tonic. Chrom. : Antiseptic. Fucus : Alterative. Guayacum: Alterative, Diaphoretic, Stimulant. Hydrargyrum: Alterative, Antisyphilitic, Antiphlo- gistic, Cholagogue, Sialogogue, Cathartic. Iodum: Alterative, Antiscrofulous, Antisyphilitic. Naphthalin: Antiseptic. Phenol : Antiseptic. 1 Hecons tructives. Pulsatilla: Alterative, Emmenagogue. Resorcin: Antiseptic, Antipyretic, Haemostatic. Salicin: Antiperiodic, Antizymotic, Antiarthritic. Sarsaparilla: Alterative, Diuretic. Silicia: Antiarthritic. Sulfides : Antisuppurati ve. Sulfites: Antizymotic. Thymol : Antiseptic. Antiperiodics, Antiseptics, etc. 1. 5 Acidi nitric] d. 3 j. Dec. Saiza* Oj. To be taken during one or 2b. I> Liq. arsenic. Donov. 3 ij. Gtt. x ter die p. cibum. Tumor within Brain. two days. Syphilis. 2c. 2a. I£ Sol. arsenic. Fowl. 3 ij. 5 Arsenici iod. 0.2. Gtt. v. ter die p. cibum. Extr. Conii 2.5. Gastralgia. F. pilula3 35, ut singula? 3a. contineant 0.005 7. IJ Auri et Sod. Chlor. gr. j. j ter die p. cibum. Argilla? 3ij. Gout (rheumatic). Divide in 20 p. nequales. Gutan. Erupt. j ter die. Spermatorrhoea. Acidum nitricum dil.: gtt. 2—20 = 0.15 —1.5. Arsenicum album: gr. 1.40—1.8 = 0.0015—0.008. 11 iod.: gr. 1-20—1-5 = 0.003 —0.012. " Sol. Don.: gtt. 3—15 = 0.2 —1.0. " " Fowl.: gtt. 2—10 = 0.12 —0.6. Auri et Sodii Chlor. : gr. 1-20—1-10= 0.003 —0.006. Acid, nitric, dilutum is also used in Physometra. Gtt- viij — x sextis horis in Intermittens. See sections in & v. Arsenic must never be given on an empty stomach, and it must be stopped when there is itching of the con- junctiva. Its specific effects aside from the itching are: (Edema and stiffness of the eyelids and face, tenderness of mouth, itching of the skin and uneasiness about the stomach. It is frequently used in Chronic Eczema, Lichen, and the scaly diseases — Lupus, Lepra, Psoriasis; and in some skin diseases it is valuable for subduing pain. It is also used in Chronic Bronchitis, Cystic Goitre, Chorea, and Vomiting of Drunkards. In Rheumatic Gout it is said to be superior to any other remedy, and in conjunction with Tannin it is pref- erable to Quinine. The average dose isgr. 1-10 ter die; gr. 1-20 ter die in Cancer or Irritable Uterus. 10 RECONSTRUCTIVE 8: Alteratives. 3b. 5a. 5 Auri et Sod. Chlor. 0.1. ^ Barii Chloridi Aquae destillatae 50.0. Extr. Conii ^ 2.0. Gtt. xx. ter die. Syphilis. Vini stibiat. 5.0. (secondary) Aq. destillatae 20.0. (To increase to 50.) Gtt. xx— xxx tertiis horis. 4. Orchitis {chronic). r> Tr. Baptisiae Rd. 5b. " Gentian.comp.^ 3ij. 1J Barii chlorati 2.0. Glycerini § ss. Aq. destillatae 30.0. Gtt. v — xx omni hora. Gtt, v— x semel vel bis die. Typhus. (2 to 3 years.) Scrofula. 4b. 6. IJ Tr. Baptisiae 3 ij. 5 Cedrcn. Simab. Elix. simp], ad | ij. Con. Cinchonae T 0.5. 3 j hourly. Scarlatina. During cold stage. (malignant. ) Intermittens. BaptisiaTr.: gtt. 20—60 = 0.65—2.0. Barii Chloridum: gr. 3 — 10 = 0.20 — 0.65. Fowler's Solution: gtt. v — x ter die in Intermittens. Arsen. chlor o-phosph. : gtt. xv — xx ter die post cibum in Sexual Weakness, Nervous Exhaustion, Loss of Memory, or Threatening Insanity. Cigarettes made of paper, saturated with a strong solution of Sod. arsen. are smoked in Asthma. Donovan's Solution: Arsen. iod. Hydr. biiod. aTgr. xxxv, Aq. § viij. Auri et Sod. Chlor. is similar in its effects to Sublimate, but is most used in premature decline of sexual powers; and in Locomotor Ataxia, early and persistently exhib- ited, it will arrest the disease(?) — As sugar and other organic substances reduce the gold, the salt should be given in Aqua destillata, or as pill with Argilla. Baptisia is sometimes given in Diphtheria and in putrid ulceration of the buccal mucous membrane. Cedron is with the inhabitants of Dutch Guiana a popular antidote for snake bite. Dose, gr. j — ij. Antiperiodics, Antiseptics, etc. 11 7a. 7c. IJ Chinini Sulfatis IJ Chin, sulfurici Acid. sulf. d. 7 3 ss. Extr. Gentiana?, ? 3 j. Syr. Aurant. C. 3 ij. F. piluloe 24. Aq. font. 3 jv. j vel ij quartis horis. 3 j omni hora. Pneumonitis (Until cinchonism; and to {abortive.) begin, if possible, in the 7b. sweating stage. ) Intermittens g, Chinini sulf. 3 ss. 8. Tr. Ferri chljr. 3 ijas. IJ Cinchonid. tannici 1.0. Aquae footana* 3 v. Syrupi Rhei 40.0. 3 ss quartis horis. 3 j bihorio vel tertiis horis. (The first dose may be Teething. doubled.) Septicemia. (with constipation^) Chin. Sulfas: gr. 1—40 = 0.065—2.6. Cinchonid.: gr. 3 — 30 = 0.2 — 2.0. Quinine has a marked influence on pulse and temper- ature, lessening at the same time the amount of uric acid and urea in the urine. Taken for some time, or in large doses, it produces Cinchonism — tinnitus aurium, with partial deafness, coupled with severe headache; sometimes dimness of sight, (suffused eyes and dilated pupils) with flushed face; and not unfrequently de- lirium, even convulsions may supervene. In In- termittens and other fevers of malarial origin, it is the remedy, p> ar excellence. In pernicious Intermittens 3j every 3 hours unless Cinchonism; per rectum the dose may be larger. In the varieties of Typhus, especially that termed Cerebro-Spinal Meningitis, it is given in similar doses, in conjunction with alcoholic stimulants. A 3j dose in Bronchitis is said to be abortive, and from ±)i to 3ij may be given in Typhoid before the evening exacerbation. It is contra-indicated during menstruation, as it may produce hypogastric pnin. See section v. Cinchonid. tann. 0.1 — 0.3 every hour or half hour in febrile diseases and Cholera Infantum; and in weak children, with worms, it is very valuable. See sec. viii. 12 HECONSTRUCTIVES: Alteratives. 9. 12a. g, Pot. Chromatis 0.1. r> Calomel, gr. xxj v. vel Bichrom. 0.01. Opii gr. jv. Aq. dest. 40.0. F. pil. 12. 3 j ter die Syphilis, j bis die until ptyalism; then (secondary.} every-other-night one. 10. Chancre. 1$ Extr. Fuci vesiculosi Vel: Elix. simpl. 7 1 j. fy Mass. Hydrargyri 3 ss. 3 ij ter die. Adipositas. Opii gr. jv. 11 F. pilules 16. Same. ]J, Tr. Guayaci ammon. Vel: Tr. Cinchonae 'a 1 j. % Hydr. iod. fl. gr. vj. 3 ij bis die e cyatho lactis. Extr. Conii 3j — ij. Rheumatism (chronic.) F. pilulse 24. Same. Chrom.Pot.: gr. 1-6 —5-6 = 0.01 — 0.05 ter die. Bichrom. " gr. 1-12— 1-4 = 0.005— 0.015 " Fucus, Extr. fl.: 3 j — 3 = 4.0 —12.0. Guayac.Tr.amm.: 3 ss — 2 = 2.0 — 8.0. Calomel: gr. 1-6 —2 = 0.01 — 0.13. Hydrarg. Massa. : gr.l — 15 = 0.065 — 1.0 _ a Chrom. As organic substances reduce chromic acid, the salt must be dissolved in Aq. dest., or mixed with Argilla as pill. Pot. bichrom. in doses of 0.05 is sure to produce Gastro-enteritis, and may even cause death ! Fucus requires the following diet: Roast meat, fish, fruit and vegetables; but no potatoes and other farina- ceous articles. (Bread, sparingly, and either stale or toasted.) Tea and coffee without milk and sugar, a little wine and Succus Citri to quench the thirst. Guayacum is also used in Syphilis; occasionally in Amenorrhoea and Dysmenorrhoea. Mercury (see Iodine) has to be suspended or stopped altogether as soon as salivation sets in. The latter is soonest produced by Blue Pill; Calomel comes next Calomel in larger than 2 gr. doses acts as a purgative. See sec. vi. Hydr. c. Creta, gr. 1 ter die is recommended Antiperiodics, Antiseptics, etc. 13 12b. 14c. fy Calomel, gr.j. 5 Hydr. bichlor. gr.f . Opii, gr. | to £. Pot. iod. $]. Tertiis vel quartis horis. Tr. Cinchonae Dysentery. Tr. Rhei ^ § ss. 13. Gtt. xxx ex aqua bis die: IJ Hydr. c. Creta gr. ij. (6 years). 1 yearrgtt. x. Every third night, followed Vaginal Discharge. in the morning by salts 3 j. (fro?n Scrofula.) Jaundice. 14a. 14d. 5 Hydrarg. bichlor. t> Hydr. Bichloridi gr.j. Ammon. chlor. ^ gr.j. Pot. Iodidi T)ij. Micae Panis, q. s. Extr. Cinchon. fl. § ss. F. pilulae 12. vel Syr. Ferri iod. § j. j ter die post cibum. Aq. fontanae ad § viij. Tumor within Drain. § ss ter die ex aqua. Chancre. 14b. 15. r> Hydr. bichlor. gr.j. r> Hydrarg. biiodati 0.1. Tr. Ferri chlor. 3 ss. Pot. iodati 8.0. Extr. Fuci mar. fl. 3 jss. Pot. bicarb. 3.0. 3 j ter die ex aqua. Decocti Sarzae 180.0. Pharyngitis. § ss ter die. Syphilis. {syphilitic.) [secondary and tertiary.) Hydr. Bichlor.: gr. 1-32—1-8 = 0.002—0.008. Hydr. Iod. rbr.: gr. 1-32— £ = 0.002—0.008. Hydr. Iod. v.: gr. 1-6 —2 = 0.01 —0.13. Hydr. c. Creta: gr. 1—12 = 0.065—0.8. as preventive of secondary Syphilis; 0.02 ter die will relieve the swelling in Parotitis. (?) Hydr. Dichloridum (Hydrargyrum bichloratum) gr. 1-60 — 1-30 ter die ante cibum in Gastric Ulcer; and in chron. Diarrhoea this dose may be gradually increased. Hydrarg. Iodidum rbr. (biiodatum No. 15) in syphi- litic Iritis and Pharyngitis. Hydrargyrum iodatum flavuni is the protoioduret. 14 RJBCON STBVGTIVES: Alteratives. 16a. 18. 5 Pot. Iodidi 3ij. 5 Pot. iod. 3 j. Inf. Quassiae § jv. Tr. Cinchonae § ss. | j bis die. Syphilis. Aq. font, ad § vj. {secondary.) § ss ter die. Pharyngitis. 16b. Vel : r> Pot. iod. 3 j. 5 Pot. Iodidi Extr. Xantoxyl. fl. 3 ij. Pot. Bromidi Aq. Fontis | vj. Amnion. Chloridi -j 3j. | ss. ter die. Rheumatism. Aq. destillatae § vj. (chronic.) 19 a. ( TF%A cedemat. extremities.) rj Kalii iodati 3 iij. Syr. Ferri iodati f ij. 17a. Tr. Colombo § vj. ^ Kalii iodati 5.0. 3 ij ter die ex aqua. Natri biearbonici 1.0. Chronic Peritonitis. Aquae fontanae 400.0. [pelvic.) | ss bis die. Pimples. 19b. (of young people.) rj Pot. iodati 8.0 17b. Aq. destillatae. 50.0. IJ, Pot. iod. gr. ij. Ferri sulfurici 6.0. Pot. bicarb, gr. v. Post agitationem admisce: Extr. Sarz. fl. 3j. Tr. Cardam. comp. vel Ext. Cinchon. fl. gtt. viij. Syrupi simpl. 'J 25.0. Aq. fontanae § j. 3 j ter die. Amenorrhoea. 3 jbis die. Scrofula, (with headache and pains in (1 year.) pelvis.) Iod. Pot.: gr. 3—30 ===== 0.2 — 2.0. Iod. Ferr. Syr.: gtt. 15—45 == 1.0—3.0. (5ij - 1.5.) Iodine. Pot. iod. must not be given with narcotic alkalies, metal salts, acids and Aq. Amygdal. am. Its use has to be stopped for 5 — 10 days if there appear inflammatory eruptions of the skin. If in use, Calomel, even externally, must not be employed, as Hydr. iod. may form, nor Pot. chlor. or Syr. Ferr. iod. must be used, as Iodine may separate and produce intoxication. Antiperiodics, Antiseptics, etc. 15 20a. 3 Iodi 2.0 Pot. Iodidi 10.0 Aq. destillatre 250.0 3 ijterdie ante cibum ex vino rubro vel aqua. Paraplegia. 20b. IJ Iodi 1.5. Pot. iodati 3.0. Aquae destillataa 30.0. Gtt. v — xxx ter die ex aqua saccharata. {Liq. iodatus Lugol.) 20c. 5 Iodi 1.0. Solve leni calore in Glycerini 100.0. 20d. 5 Iodi 0.2. Alcoholis 2.0. Glycerini 200.0. 1 j — j g s per diem. Substitute of Ol. Jecoris. 21. IJ Naphthol. (Beta) Bism. salicylici • Magn. carbon. ^ 0.3. This dose quartis horis. Furuncles. 22a. 5 Liq. antisept. P. 25.0. Tr. Catechu 15.0. Syr. simplicis 150.0. 3 ij semis horis. Cholera. Iodum: gr. \ — 1 IodiTr.: gtt.2— 10 Naphthalin.igr. 2 — 8 Phenol: gtt..i— 3 0.015—0.065. 0.065—0.32. 0.13 —0.5. 0.032—0.2. Iodism is characterized by Eruptions of Skin, Laryn- gitis, Intestinal Catarrh, Vertigo, Fainting, etc. Pot. iod. gr. 15 — 3 j p. diem, if it be borne, in Lead Colic; gr. 5 — 10 quater die in Cellulitis and second stage "of acute Cerebral Meningitis. Syr. Ferri iodati gtt. xxx ter die in Scrofulaand Chlorosis. Forchildren: gtt. 15bis die (4 years); gtt. 6 — 10 ter die (2 years). In convulsions from loss of blood it is sometimes very valuable. Tr. Iodi gtt. v ter die in Retention of Menses. In gtt. j doses it is said to check the vomiting in cholera; and t. die with Laudan. gtt. ij it is recommended as prophylactic. Iodine is also used in Fibroid, LTterine Cancer, Ovar- ian Dropsy, Bronchocele, Ringworm, etc. Naptholin is a good antifermentative and germicide, and therefore recommended in intestinal disorders; it has been given as much as 3 j per diem. Naphthol 2,5 p. diem in Typhoid. 16 BEGONSTJRUCTIVES: Alteratives. 22b. 23b. 5 Acidi carbolic! 5.0. ^ Extr. Pulsat. fl. 3 ss. Glycerolati Arayli 10.0. Aq. Menthae § jss. Radicis Calami 5.0. 3 j bihorio. Hysteria. Rad. Althseae q. s. 24. TJt fiant pilulae 200. (quarum 5 Resorcini 1.0 — 2.0. singulae contineant 0.025). Aq. destill. 100.0. j quater die. Pruritus. Syr. Aurant. Cort. 30.0. (To increase to 3 daily.) | ss bihorio. Intermittens. 23a. 25. 5 Hb. Pulsatilla 5 Salicini Extr. Pulsatilla T 5.0. Pepsini 'J 1.0. 01. Menthae pip. gtt. j. Glycerini 40.0. F. pilulae 75. Leni calore solutio efficiat. j vel ij ter die. Amaurosis. 3 j ante cibum. Dyspepsia. Pulsat. Extr. h\: gtt. 2— 6 = 0.065—0.2. Pulsat. Tr.: gtt. 30—60 = 1.0. —2.0. Salicin: gr. 3—60 = 0.2. —4.0. Phenol is said to be excellent in tapeworm. (See section vm). Sod. sulfo-carbolic. 3j with Syrup bihorio in Variola. Intoxication from repeated Carbol. applica- tions may be treated with Sod. sulf., vel Acidum sulf. dilutum: Sulfo-carbolic acid is formed, and the dark color of the urine soon disappears. Liq. antisepticus Pernes: Acid, carbol. 10.0. Aqua. dest. 300.0. Mixtis instilla. Bromi. 5.0. Pulsatilla is also employed in skin diseases, catarrhal affections of nares, fauces and larynx, urinary passages and intestines. Pesorcin is equal to Quinine as antipyreticum, but by no means as tonic; to Phenol it is equal as antiseptic. The latter is a monhydroxylbenzol, whilst Resorcin is a dihydroxylbenzol. Salicin has not the disagreeable effects of Acidum sali- cylicum; and Sod. salicyl. is also milder than the acid, and therefore preferable; moreover, as it is decomposed by AntiperiodicSy Antiseptics, etc. 17 26a. IJ Acidi salicylici 5.0. Spir. Vini Gallic! Vini Hispanici 7 100.0. Syr. Aurant. Cort. 50.0. 3 j bihoriovel quartis horis. Vel: Diarrhea. IJ Acidi salicylici 10.0. Liq. Amra. acet. 60.0. Aq. destillatae 230.0. 3 j omni bora. 26b. IJ Acid, salicyl. Sod. bicarb. 7 3 ss. Spir. Vini Gall. 3 ij. Glycerini 3 vj. Aq. font, ad 3 ij. 3 ij omni hora. Same. ( 4 years.) Vel: 3 Acid, salicyl. gr. xij. Cretae praep. gr. viij. Divide in 10 vel 6 partes. j every 2 or 4 hours. ( 2 months to 3 years.) 27. rj Acidi salicylici 5.0. Sod. phosph. 13.0. Liq. Amm. caust. 2.0. Glycerini Aq. fontanae ? 10.0. H.somnisumenda.7 7 y/>/ms. 28. rj Acidi salicylici gr. x. Natri salicylici gr. xv. Ter die. Rheumatism. {cirtic. acute.) 29a. IJ, Sod. Salicylatis Sacchari ^ 1.0. Tales doses 5. j ex aqua. Migraine. 29b. t> Sod. Salicylatis 6.0. Sod. Bicarbonatis 2.0. Glycerini Aquae fontanae £ 25.0. The whole at once, or in 2 doses within -J- hour. Typhus. Salicyl. Acid. gr. 6 — 6-0 = = 0.4 —4.0. Salicyl. Sod.: gr. 10—20 = = 0.65—2.6. Carbonic acid, the acid is liberated in the stomach. As antipyreticum, Salicin is inferior to Nitre, and in heart and kidney diseases, it is moreover contra-indicated. In intestinal disorders, which are due to fermentation and putrefaction in the alimentary canal, Sod. salicyl., espe- cially combined with Bismuth, has been lately much employed. Treble the quantity of Acid, salicylicum will rep' ace Acidum earbolicnm? Salicylismus. Tinnitus, Vertigo, Vomiting, Deafness, General Malaise, Urticaria, Petechia?, etc. 8 dicin. 0.3 — 1.5 bihorio vel tert, horis ante cibum REG ON STRUCT IVES: Alteratives. 29c. 31. IjL Sodii Salicylates tj Dec. Sarzae comp. § iij. Sodii Bicarbonatis Liq. Potassae 3 ss. Tr. Cannab. Ind. T 3 j. | ss bis die. Scrofula. Ext. Rhei fl. 3 iij. (3 years.) Atrophy. Elix. simplicis | j. 32. Aq. Fontis ad § iij. IJ, Acidi silicici. 0.05 — 0.1. | ss bihorio. Cephalalgia, Sacchari Lactis. 0.05. [periodic.) Tales doses 12. Diabetes. (with cons tip. and languor). j ter die. 30. 33a. IJ, Natri boro-salicyl. IJ, Calcis sulfuratse Spir. Vini Gall, a 10.0. Gr. j bihorio. Boils , etc. Vini albi 150.0. Vel: Glycerini 40.0. R Sodii Sulfitis gr.x — xx. | ss bihorio vel tertiis horis. Tales doses No. 10. Gout, etc. j ter die. Thrush. Sarzae co. Extr. fl. : gtt. 15—60 = 1.0 — 4.0. Sulfid. Calcis: gr. ^—5 = 0.008—0.32. ex aqua in Catarrh and Diarrhoea; bis vel ter die as tonic. 2.0—4.0 during intermission in Intermittens. 2.5 — 6.0 in Typhus and Parametritis. Sod. and Acid, salicyl. (No. 28) in Neuralgia, Lumbago and Ischias. Sod. salicyl. 0.5 ter die in Polyuria. 0.5 — 2.0 omni hora vel bihorio: antipyretic. 1.0 quater die: anaphro- disiac. 3.0 — 6.0 ter die in Hectic Fever. 5.0 — -8.0 p. diem in Arthritis nodosa. Sod. salicyl. 5.0 — Acid, salicyl. 4.1. Sod. bicarbon. 2.5. Sod. boro-salicyl.: Borac. 20.0; Sod. bicarb. 9.0; Acid, salicyl. 55.0. (Acid, salicyl. combined with Acidum boricum has a bitter taste, though neither acid in itself is bitter). Acidum silicicum. is frequently used in Chronic Rheu- matism, and sometimes in Carcinoma. Sulfides (N. 33 a ) prevent or arrest suppuration. The Antiperiodics, Antiseptics, etc. 10 33b. 34 a. 5 Sodii Sulfitis 3j — 3 ss. r> Acidi thymici gr. v. Bihorio vel tert. horis. Spir. Vini Gall. § jv. (In caps, amy lac.) Sarcind. Glycerini 3 ij. ( Vomiting.) 3 ij vel 3 ss bihorio. Vel: Scarlatina. 5 Sodii Bisulfitis 3j. 34b. Glycerin i IJ Thymoli 0.5. Aq. Fontis T 3 j. Kali chlorici 5.0. 3 ii bis vel ter die. Chin, sulfurici 3.0. 33c. Glycerini 80.0. IJ Sod. hyposulf. 10.0. Spir. Vini Gallici 250.0. Aq. destillatae 50.0. Acid, hydrochl. d. 1.0. Syrupi simplicis 100.0. 3 j omni hora. Diphtheria. 3 j ter die. Skin Diseases. (2 — 5 years.) Sulfis and Hypos. Sod.: gr. 3—20 = 0.2—1.3. same may be said of the Sulfites and Hy po sulfites ; they avert putrefaction and suppuration. (Sodii Hyposulfis — Natrum subsulfurosum — is soluble in 01. Terebinthinae and deodorizes it almost wholly). Acidum thymicum is similar to Phenol, but milder. Its depressing effect must be counteracted by the adminis- tration of Stimulants. See section viii. SECTION II. SEDATIVES. They include Anodynes, Antispasmodics, Narcot- ics, Hypnotics, Anaesthetics, etc. They have an exalting or depressing influence on the nervous system, thereby relieving pain, producing sleep, or causing insensibility, without affecting the structure of the nerve fibre. Aconite: Sedative, Anodyne, Antiphlogistic, Dia- phoretic, Diuretic. JEther: Sedative, Antispasmodic, Anaesthetic, Stimu- lant, Inebriant. Amyl: Antispasmodic, Anaesthetic. Anilin : Antispasmodic. Antimony: Sedative, Antiphlogistic, Alterative, Expectorant, Emetic. Asa fcetida: Antispasmodic, Diffuse Stimulant, Ex- pectorant. Belladonna: Antispasmodic, Cardiac Tonic, Diu- retic, Deliriant. Bromum: Antispasmodic. Camphora: Antispasmodic, Sedative, Diaphoretic, Expectorant, Stimulant. Cannabis: Anodyne, Antispasmodic, Antineuralgic, Hypnotic. Castoreum: Antispasmodic, Stimulant. Sedatives. 21 Cerium: Nerve Tonic. Chloral: Antispasmodic, Sedative, Hypnotic. Chloroform: Antispasmodic, Anaesthetic, Anti- emetic. Coccus: Antispasmodic, Anodyne. Cokium: Antispasmodic, Sedative, Anodyne. Curare: Sedative. Cyan.: Sedative, Antispasmodic, Cypripedium: Sedative (like Valeriana). Dioscorea: Antispasmodic, Alterative, Dunoisix: Antispasmodic (like Belladonna), Gelsemium: Sedative. Grindelia: Antispasmodic. Hyoscyamus: Antispasmodic, Sedative, Hypnotic, Deliriant. Lactucarium: Antispasmodic, Sedative, Hypnotic, Diuretic, Laxative. Lycopodium: Antispasmodic, Diuretic, Aphrodisiac. Opium: Antispasmodic, Sedative, Diaphoretic, Diu- retic, Soporific. Ruta: Antispasmodic, Emmenagogue, Stimulant, Valeriana: Antispasmodic, Sedative. Vanilin: Antispasmodic (like Moschus). Veratrum viride: Sedative. Viburnum prunifol: Sedative (uterine). Xanthium: Sedative. 22 SEDATIVES: Anodynes, 35a. fy Extr. Aconiti gr, jv, Extr. Papaveris gr, xij. F/pilulae 4, j omni hora. Neuralgia, with a soothing rubefacient. 35b. IJ Tr. Aconiti gtt. viij. Aq. Amygd. am. c. Sp. nitrico-aeth. ^ 3 j. Aquae fontanae ad § j. 3 j bis vel ter die. Hypertrophy without valv. lesions. 35c. IJ, Tr. Aconiti gtt. vj. Extr. Gelsem. fl. 3 ss. Kali nitrici ±)]. Aquae destillatae § iij. | ss bihorio vel tert. horis. Nephritis. Urethritis. 35d. r> Tr. Aconiti gtt. j. Glycerini § ss. Aq. destillatae ad ^ ij. | j orani hora. (1 year.) Febrile Diseases. 46. rj iEth. acet. vel sulf. Alcoholis ^ 3 ij. Gtt. x — xxx ex aqua. Fainting. 37. tj Amyl. aeth. nitrosi Alcoholis ^ 2.5. Gtt.ij— jv. Spasm. Glottid. 38. ty Anilini sulfurici 0.05—0.15 ter die in pil. (0.14 p. diem.) Chorea. (13 years.) Epilepsy. After a few days the dose may be doubled. Aconit Rad. Tr. : gtt Aconitin: gr. 1-400— ^Ether acet. ^Ether sulf.: Amyl Nitris Anilin: 2—8 = 1-100= gtt. 10 — 3 ss= gtt. 20— 3 j = gtt. 1—5 = gr. 1 — 4 0.065. —0.26. 0.00015—0.0006 0.25 —2.0. 0.5 —4.0. 0,03 —0.15. 0.065 —0.25; 1.0 p.diem. Aconite: In febrile diseases, if skin hot and dry, and the pulse rapid and strong, see Veratrum. If much pros- tration or the pulse becomes feeble, it must be stopped or given in smaller doses. Contra-indicated in asthenic cases. It is also used in sudden suppression of Menses, Tonso- litis, Pharyngitis, Pneumonia and Basedow's disease. In Headache, Pleuritis, Cellulitis, Tr. Aconit. gtt. j every 15 minutes fori or 2 hours; afterward gtt. j hourly. In Abortion, with Sod. salicyl. gr. xv every 3 hours. Antisjiasmodics, Narcotics, etc. 23 39a. 41a. I£ Tart, emetici gr. jv. IJ Asa* foetidae. Aquae destillatrc 3 jv. Extr. Valeriana? £ 3ij. 5 ij omnihora. Craving for Ferr. sulfurici 3j. Drink. F. pilulae 20. 39b. j mane nocteque. Chorea. IJ Tart, emetic, gr. v. y e j. Kalinitrici 3j. ^ Tr." As® foetid* 3 ii. Divide in p. aeq No. 6. rft , Valeriana 3 ss. j tert horis. ^n^j^tc. 3 j ter dJe Flatu i ent Colic. II Atrop. Sulfatis 0.1. _ _ A 4lb ; , Strychn. Nitratis 0.2. * Tr. Asa, foetid* 10.0. Chin. Sulfatis 2.0. Jr. Castorei Canad. Pot. Bromidi Jr. \alerianae a 5.0. Extr. Trifolii ? 10.0. „ Tr ' °P 11 _. rx 2 ; 5 ' Rad. AlthttSB 3.0. Gtt 30 - 50 ter die * ^W™" Rad. Artemisia? q. s. 42. F. pilulae 200. Epilepsy. # Pil. Atrop. gr, 1-120. j daily the first fortnight. Hora somni. Night Sweat. j bis die the next. 43a. j ter die afterward for one 5, Extr. Belladonnas 0.25. month (if they be borne; Aq. Laurocerasi 15.0. after this to decrease again. Gtt. xx — xxx quater die. Antim. Pot. Tart.: gr. £ — 3 = 0.008 — 0.2. Asafoetida: gr. 5 — 30 = 0.32 — 2.0. Asafoet. Tr.: gtt. 20— 3j = 1.0 —4.0. Atropia: gr. 1-200—1-50 = 0.0003 0.0012. Bellad. Extr.: gr. \— 2 = 0.032—0.13. Antimony: In the first stage of Rhinitis, Pharyngitis and Bronchial Catarrh. In Delirium of Typhoid, gr. 1-16 — 1-8 every \ hour. In No. 39b the Antimony may be increased in the next six powders to gr. vi. They are reputed to extinguish any fever. Belladonna (see Hyoscyamus) prevents secretion of milk, arrests profuse perspiration and prevents griping of some cathartics. In Asthma, Tr. Bell. gtt. x bihorio until vision affected. In Epilepsy, Extr. Bell. gr. 1-5 per diem. 24 SEDATIVES: Anodynes, 43b. IJ, Extr. Belladonna? gr. j. Sacchari Lactis 3j. Divide in 10 partes, j hora somni. Pe7*tussis. (1 year); double for 5-10 yrs. 43c. IJ Extr. Bellad. fl. gtt. viij. Spir. nitrico-a3tb. 3j. Syrupi simplicis Aq. Cinnamomi T § j. Gtt. ij for eacb year ter die Preventive of Scarlatina. 43d. 5 Extr. Bellad. fl. gtt. jv. Tr. Xantoxyl. gtt. x. Aq. Amygd. am. c. 3 j Aq. Flor. Tilige 3 iij. 3 j every 1 5 min. Hypertrophy, ^ Syr. Belladonna 30.0. Aq. Laurocerasi 10.0. Aq. Flor Tilise 110.0. 3 i j bihorio. Pertussis. 44. $ Extr.Berb. aquif. fl. § j. Ext.Viburniprunif. 3 ss. Tr. Pulsatilla? 3j. Syr. Tolu, ad § jv. 3 j ter die ante cibum. Dysmenorrhcea. Leucorrhoea. 45a. ^ Bromi (gtt. 3) 0.1. Kalii bromati 0.25. Aq. destillatae 120.0. 3 j omni bora ex aqua. Diphtheria. Bellad. Extr. fl.: gtt. 1— 4 = 0.032—0.13. Bellad. Tr. " 8—30 = 0.025—1.0. Berberis,Extr. fl.:" 15— 3 j = 1.0 —4.0. Brom.: gr. 1-10— \ = 0.006—0.03. It is also used in Palpitation and Vesical Irritation. Berberis is said to be of especial benefit in Leucorrhoea, not dependent on mecbanical causes. (See section v.) In Cardialgia it is sometimes of service. Brom must be mucb diluted if used internally; a solu- tion of 1-100 gtt.10 — 20may be given hourly or every two hours, Acid, hydrobrom. dil. in 3 i doses makes with sugar-water a good lemonade, or with Sod. bicarb. ( 3 ss) a pleasant efferverscing draught. Bromides reduce the amount of blood to the brain; reflex irritability of the spinal cord, and excitability of the generative organs. Lithii Bromidum (Lithium bromatum) by its anaesthetic influence through the Antispasmodic*^ Narcotics, etc. 25 45b. IJ Bromi (gtt. j.) 0.03. Kalii bromati 0.1. Aq. destill. 150.0. Syrnpi simplicis 50.0. 5 ss omni hora. Croup. 46. 5 Acid, hydrobr. dil. 5.0. Aquae Menthse 200.0. Syr. Aurant. Cort. 50.0. - 3 ss tertils horis ex aqua. Dyspepsia. Vomiting of Pregnancy. 47. IJ Lithii Bromidi 5.0. Aq. destill. 200.0. Syr. Aurant. C. 50.0. 3 ss ter vel quater die. Epilepsy. Hysteria. 48a. 5 Pot. Bromidi 3j. Chlorali gr. v. Bihorio. Erysipelas. ( if delirium. ) 48b. IJ Kalii bromati 3.0 — 5.0. Chlorali 1.0—1.5. Sleepingpowder (in water). 48c. IJ Pot. bromati Chlorali 2 gr- v. Aq. fontana? 5 j. 3] every 15 minutes. (1 month.) Convulsio7is. 49a. r> Pot. Bromidi 3 ss. Elix. Valer. arnm. 3 j. Spir. Vini Gallici 3 ss. Alcoholism. Acid, hydrobrom. dil. Brom. Ammonii: " Lithii: " Potassii: gtt. 15— 3 i gr. 3—30 gr. 3—15 gr. 4—40 1.0 —4.0. 0.2 —2.0. 0.2 —1.0. 0.25—2.6. afferent nerves, allays any excitement of spinal origin, like most Bromides; but as it does not affect the heart's action, like Pot. brom., it may be used for a long time without producing any apparent deleterious effects upon the circulation. It is, moreover more powerful than Potass., and as easily soluble; and may be combined with Belladonna, Cannabis, Chloral, Hyoscyamus, Opium, etc. Potassii Bromidum (Kalium bromatum) influences heart, respiration and temperature; too much used, it will cause low temperature, fatigue, slowness of speech, forgetfulness and general cachexia, etc. Aver- age dose, 0.3 — 1.0 bihorio vel tert. horis. 1.0 — 3.0 bis 26. SEDATIVES: Anodynes, 49b. ]J Kal. bromati § ss. Extr. Cocae fl. 3 iij. Tr. Capsici 3 i. Elix. Val.amm. ad f jv. 1 ss every hour until re- lieved. ( Wakefulness after debauch, headache; and to allay itching.) 49c. r> Pot. Bromidi 5.0 Liq. Ferri Chloridi Tr. Strychnin. a 1.0. " Capsici 2.0. Aq. fontanse 150.0. | ss quater die. Mixt. potatorum. 50a. r> Pot. brom. 3 iij. Extr. Cannab. fl. 3 ss. Aq. destillatse § vj. ? ss.ter die. Asthma. 50b. r^ Pot. brom. " bicarb. ^ 5.0. Extr. Gelsem. fl. 0.5. Aq. destill. 60.0. 3 j ter die. Migraine. Neuralgia of Quintus. {Especially dental nerves.) 51a. £>, Kalii bromati Chlorali, 7 3 ij. • Morph. sulf urici, gr. jss. Aq. destillatoe § vj. | ss ex aqua every 4 hours while in pain. Dysmenorrhea. ( Ovarian and membran.) 51b. Ijfc Pot. Bromidi 3 ij Sol. Morph. U. S. § ij. 3 j bihorio while in pain. Abortion. Brom. Sod.: gr. 5—45 = 0.32—3.0. vel ter die. Sodii jBromidum (Natrium bromatum) is superior to the Potass., as it has none of its unpleasant effects, and moreover debilitates less the muscular sys- tem. Bromism: Idiotic expression, vacant look and stag- gering gait. Arsenic and Strychnine are recommended, if large doses have been employed, to prevent intoxication. In Epilepsy, Amm. brom. 0.5 — 1.5 ter die; children according to age; Lith. brom. gr. ij — x, well diluted. In severe cases either has to be used constantly for about 6 months. Pot. brom. 3j ter die, to be gradu- ally increased to 3 j pro. do si until Bromism. In Per- tussis, Amm. brom. 0.1 — 0.4 ter die. In Hysteria, Lith, Antiperiodics, Antiseptics, etc. 27 51c. IJ Pot. Bromidi 3ij — 3 j. Sol. Magendie gtt. ij. Syr. Acacise 3 j. Aq. destillatxe 3 iij. 3 ij ter die. Pertussis. (1 year) 52 a. IJ Kalii bromati Amnion, brom. a 10.0. Aqua? destillata? 50.0. 3 j orani hora. Delirium tremens. 52b. U Pot. Bromidi 30.0. Aram, Bromidi 7.5. Pot. Iodidi 4.0. * Bicarbon. 2.5. Inf. Colombo 180.0. 3] ter die ex aqua ante cibum et 3 j hora somni. Epilepsy. 2.0. 4.0. 53. IJ Kalii bromati Extr. Ergota? fl. ? 3 ij. Spir. Amm. arom. Tr. Xue. Vomic. 7 3 j. Aq. Mentha? ad 3 viij. 3 ss quartis horis. Haemorrhoids. 54a. IJ Camphora3 Ergotae G. arabici q. s. F. pilulse 50. j mane nocteque. Pollu- tions, (nocturn.) 54b. IJ Camphone 3 ss. Extr. Hyoscyami vel Extr. Humuli 3ij. Rad. Ipecac, gr. x. F. pilulae 20. Strangury. ij ter die. Spermatorrhoea. Camphora: Spiritus: monobrom. gtt. gr. 2—10 = 0.13—0.65. 10—40 = 0.32—1.3. 3—15 = 0.2 —1.0. brom. 0.5 — 2.5; in Delirium tremens and Spermatorr- hoea, 10.0 p. diem. In Cellulitis, Pot. brom. gr. xto 3j tert. toris; in Headache and Delirium of Pneumonia, 3j ter die. In Convulsions, gr. ij — v every half hour if necessary. (1 month — 2 years.) Also in Enuresis, Spasm of Bladder and Rectum, Dentition and Strych- nine poisoning. Camphora allays nervousness and quiets restlessness, producing a general placidity of feeling. It is an effi- cient remedy in Strangury caused by Cantharides, and in some forms of Colic, especially of hysterical subjects. 28 SEDATIVES: Anodynes, 54c. IJ, Camphorae Pulveris Doveri Extr. Hyoscyami 2 3j F. pilula3 20 j mane nocteque. Dysmenorrhea, (nervous.) 55a. IJ Camphorae 0.12. Amm. carbon. 0.5. Sacchari 1.2. Dentur tales doses 10. j semis horis. Cholera. Vel: 5 Camphor liquidae Tr. Valerianae ^ 5.0. Gtt. xx — xxx c. Sacch. 55b. fy Camphorae 1.0. ^Eth. acetici 12.0. Tr. Opii 3.0. Gtt.x — xv. every 15 or 30 m. Cholera, (asphyct.) 55c. ]J Camphorae Mih. acetici 7 10.0. Tr. arom. acidae 5.0. Alcoholis 15.0., Gtt. jv. — vj. Preventive of Cholera. 56. 1)6 Camphorae 3 hs. Sacchari § ss. Amygd. decort. No. 6. Contere, dein adde gradat. Aq. Menthae | viij. Pars 1-6 quartis horis. Neuralgia, (hysteric.) Vel: ^ Camphorae 3.0. Chloroformii 17.0. Gtt. x ter die. Neuralgia. 57. IJ Ext. Cannabis Indie. Pulv. Valerianae ^ 3j. F. pilulae 40. j ter die. Hysteria. Cannab. Ind. Tr. Extr. fl.: gtt. 1- gtt. 10- -4 -60 0.032—0.13. 0.32 —2.0. In Congestion of Kidneys, gr. ij — v. may be given. In Dysmenorrhoea (ovarian), the Monobr. gr. v. • Cannabis is in small doses stimulating to the nerves, especially the sexual; in large, hypnotic. It is some- times used in Tetanus, Acute Mania, etc., and although uncertain, it is often a very efficaceous narcotic in Sleep- lessness, Neuralgia and other painful diseases. In Metrorrhagia and Dysmenorrhoea (ovarian and neuralgic), Tr. gtt. xxv quartis horis. In Incontinence of Urine from paralysis vesicae, Extr. fl. gtt. ij bis die. Antispasmodics, Narcotics y etc. 29 8.0. 2.0. 58 a. R Tr. Castorei JEtheris sulfurici Vel: R Tr. Castorei 6.0. Spir. camphorati 4.0. Gtt. xv — xxx ter die. Hysteria. Vel: \\ Tr. Castorei 3 j. Tr. Camph, comp. Spr.Lavand.comp/a 3 ss. I Bsbihorio vel tertiis horis ex aqua. Hysteria. 58b. IJ Tr. Castorei " Valer. aeth. 1 10.0. " Opii crocat. 5.0. Gtt. xv — xxx ter die. Same. Vel: 3 Tr. Castorei 40.0. " Valerianae 10.0. Aq. Laurocerasi 50.0. 3 Bfl tertiis horis. Same. Vel: Q Tr. Castorei 3j. JEtheris Laud an i 7 gtt. x. Aqua? Cinnamomi § jss. Same. Castor. Tr.: 3 ss Cerii Oxalas: gr. 1 Chloral: gr. 10 58c. 5 Tr. Castorei " Valeriana? a 5.0. Spir. a?therei gtt. xv. Aq. Fceniculi 100.0. 3 ss tertiis vel quartis horis. Antispasmodic. Vel: t> Tr. Castorei " Valeriana? Liq. Amm. succ. ^ 3.0. Tr. Opii 1.0. Gtt. xv — xxv ter die. 59. I> Cerii oxalici gr. v — x. Sacch. Lactis gr. ij. Dentur tales doses 6. j ter die. Cough. {Phthisis.) 60a. 5 Chlorali 5.0. Aq. destillata? 10.0. 3 j ex vino, cerivisiavel inf. 8. lini. Liq. somni ferns. 60b. fy Chlorali 4.0. Glycerina? 40.0. Aq. Mentha? 150.0. 3 ss ter die; 3 j hora somni. Mixt. ant iphth isic. — 3j == 2.0 —4.0. —5 = 0.065—0.32. 40 = 0.65 —2.6. Cerium \< sometimes employed in Pertussis, 0.03 (1 year) 0.08 (7 years) once a day before breakfast. Chloral,** sedative: 0.5 — 1.5 omni hora vel bihorio 0.1 — 0.2 for children; as hypnotic: 2.5 — 5.0. For child- ren, 1—3 years: 1.0 — 1.5; 3 — 5 years: 2.0 — 3.0; 5 — 1 30 SEDATIVES: Anodynes, 60c. 5 Chlorali 20.0. Natri nitrosi 3.0. Tr. Stramonii 10.0. Aq. Menthaead 120.0. 3 ii quartis horis. Asthma. 61a. ]J Chloroformii 10.0. Alcoholis 25.0. Tr. aromaticse 30.0. Gtt. xx — lx. Migraine. Neuralgia, etc. Vel: 5 Chloroformii 10.0. Tr. Valer. geth. 20.0. Morphii acetici 0.1. Gtt. xxx ter die. Hysteria, etc. Vel: ^ Chloroformii 5.0. Alcoholis 40.0. Mixtis adde conquassando Syrupi simplicis 140.0. 3 ij — § ss pro dosi. Colic. Asthma. 10.0. 15.0. 75.0. 61b. g, Chloroformii 5.0 Tr. aromatic83 10.0 " amarae 30.0 3 ] ex vino subinde. Sea-sickness, Vel: 5- Chloroformii Alcoholis Mixtis adde Glycerinse Turn fortiter conquassa. 62a. IJ, Tr. Cocci Radem. § ss Aq. destillatae 3 iijss I ss ter die ex aqua. Chronic Nephritis, [Painful and frequent mic- turition. ) 62b. 5- Cocci gr. x. Pot. bicarb. 3j. Aq. Fontis § jv. 3 ij ter die. Pertussis. (1 year). Chloroform: Coccus: gtt. 6—30 gr. 1-6—1-2 = 0.16—0.78. = 0.01—0.032. years: 3.0 — 4.0. In neuralgic Headache, gr. xlv. in three doses within one hour. In Tetanus, 2.0 ter die; 8.0 per diem. In Delirium tremens, 7.0. In Dysme- norrhea (neuralgic and ovarian), 3j every 8 hours. In Enuresis nocturna, 0.5 — 1.5 in 2 or 3 doses half hourly in the evening. (3 — 10 years.) However, of the great- est value it is in Parturition, especially in case of rigid os: 3ij in 2 doses within half an hour. Chloroform is contra-indicated in valvular lesions; and in acute febrile diseases it has to be used with care. Antiperiodics, Antiseptics, etc. 31 63. IJ Coniini 0.005. Alcoholis 1.0. Aq. destillata? 12.5. Gtt. xv — xxx ter die. Photophobia. 64a. IJ Ext. Conii 11 Hyoseyamu gr.xv. Opii gr. jv. F. pilulae 6. Peritonitis. j nocte. {if much pain.) Vol: IJ Extracti Conii Pulveris Doveri H 3 ss. F. pilul» 12. j vel ij subinde. Same. 64b. IJ Extr. Conii fl. " Hyosc. fl. T 3 ss. Sol. Chlorali (3ij) § ij. 1 ss at bedtime. Hypnotic. IJ Curare gr. : V. Sacch. Lactis gr. ij. Dent. tal. dos. 6. j ter die until general pare- sis. Tetanus. Gr. J to be repeated in 1 5 min.; and after 1 hour gr. \ if necessary. Hydrophobia. 66a. IJ Acidi hydrocyanici dil. m. iv. Pot. bicarb. gr. x. Aq. fontana} 3 ss. This dose bis die. Irritable Stomach. 66b. IJ Kalii cyanati 0.05. Aq. destillata3 5.0. Gtt. xv — xxx ter die. Gastralgla. Conii Extr,: gr.l — 8 = 0.065—0.5. Con i in: gr. 1-60—1-30= 0.001—0.002; 0.003 p. diem. Curare: 1-60 — 1-12= 0.001 — 0.005. Cyan. Pot.: gr. ^— i = 0.008— 0.015. " " Acid, hydroc. dil. gtt.: 1—5 = 0.085—0.43. In Colic, gtt. xx at short intervals, with hot fomenta- tions. In Colica saturnina, gtt. v — xx tertiis horis. In Cholera and Congestion of Brain, 2.0 — 3.5; in com- mencement of Intermittens, 3 j in water to induce sleep. ' bnium causes muscular relaxation, and is employed in enlargements of liver and abdominal organs. Its effects are much heightened when combined with Morphine. Cyan-Praep. are of variable and consequently un- certain strength, and as they belong to the most deadly poisons, they have to be employed with the greatest 32 SEDATIVES: Anodynes, 67. 68b. 3 Aq. Amygd. am. c. ^ Aq. Laurocerasi Sod. Bicarb. 7 3 ij. Tr. Hyoscyami ^ 3 j. AquaB fontanae § vj. V el Extracti fluidi gtt. xx. I ss vomitione urgente. Aq. Aurant. Fl. 3 ij. 68a - m 3jomnihora. Gastritis. ]J Aq. Laurocerasi 7.5. 68c Tr. Digitalis 5.0. n A T Gtt. xx ter die. Palpitation. » Aq. Laurocerasi jw. Vel- Syr. Fl. Aurantn § ]. 9 Aq. Laurocerasi K A * ^sarum ad 1 jv. Tr. Valerianae 3 ss ter die - Laryngitis. Spir. aeth. sulf. 69 - '< camphorati ^T3j. r> Extr. Cypripedii fl. 3 ss ex aqua. Hysteria. Aq. Aurant. Fl. ^. 5.0. Spasmus Glotticlis. 3] ter die. Migraine. Cyan. Aq. Laurocerasi: gtt. 5 — 3 ss = 0.3 — 2.0. " " Amygd. am. c.:gtt. 20— 50 = 1.2 —3.2. 01. Amygd. am. aeth.: gtt. \— | = 0.015—0.03. Cypriped. Extr. fl.: gtt. 15 — 30 = 0.5 —1.0. caution. Aciclum hydrocyan. dil. contains 2 p. cent of anhydrous acid. About gtt. ij should be given at the beginning and gradually increased until its effect is obtained; and the intervals need not exceed two hours, as it is improbable that the drug exerts any influence whatever upon the system one hour after ingestion. (ScheeWs medicinal acid contains 5 p. cent, of anhy- drous, therefore 2 m. of it are equal to 5 m. of the IJ. S. acid). Potass, cyan, is sometimes used instead of the acid, as it is less liable to undergo decomposition. Aqua Amygdal. TI. S. is mostly used as a vehicle, though it should not be given in larger than 3 ij doses. Cypripediumis a very valuable nerve tonic in hysteria, and all cases of nervous irritability; and in certain diseases it is preferable to Opium, producing no constipation. Antispasmodics, Narcotics, etc. 33 70. IJ, Extr. Dioscorece fl. 3 ss. " Cypripedii fl. " Helon. fl. 7T 3 ij. 3 ss — 3 j omni hora. ( hUc, [bilious.) 71. 5 Extr. Gelsem. fluidi Elix. simp]. ^ 3j. Gtt. x- -xxx bihorio vel tert. horis. Wakefulness. 72. IJ Extr. Grindel. rob. fl. GlyceriDae ^ 3 ss. 3 j every 15 min. during fit, afterward gtt. xv — xx ter die. Asthma. 73a. IJ, Extr.Hyosc.gr.x — 3 ss. Pulv. Liquiritiae q. s. F. pilulse 10. Peritonitis. j bis die. {if much pain.) 73b. IJ Tr. Hyoscyami gtt. xv. Spir. Amnion, foet. 3 ss. Aq. Amygd. am. c. 3 j. Aq. destill. q. s. ad 3 ij. 3] ter die. Laryngismus (1 year.) stridulus. 73c. IJ Tr. Hyoscyami 3 ij. Vini Ipecacuanha § j. Gtt. xx subinde. (3 months.) Pertussis. Dioscor. Extr. fl. Gelsemium " Hyoscvamus " Tr.: gtt. 10— 30 = 0.32—1.0. gtt. 3 — 20 = 0.1 —0.65. gtt. 5 — 20 = 0.16 — 0.65. gtt. 20— 3 j =1.0 —4.0. Gelsemium in too strong doses produces dilatation of pupils and Ptosis; afterward difficult respiration and paralysis of tongue and muscles. In Cellulitis it may be given until dilatation of pupil or Ptosis, and it is best to begin with small doses: Extr. fl. o.Oo—O.l (gtt. ij— iij.) In Toothache, Tr. gtt. x— xx (3 doses the most necessary). In Delirium tremens, gtt. v bihorio vel tert. horis; besides milk until vomiting ceases. Hyoscyamus may be given until dry throat and dilata- tion of pupils. Hyoscyamin, Daturin and Duboisin are identical, and similar to Atropin (as Stram.to Belladonn.) To procure sleep in children (2 years), Tr. gtt. x hora somni; in Spasm of Limbs, gtt. iij bis die; (1 month); in Strangury, gtt. iij — vj bihorio in 3 j of water. 34 SEDATIVES: Anodynes, 74. 75b. $ Lactucarii 5.0. Rd. Althaeae 0.5. 5 Tr. Lobeliae 15.0. Olei Anethi gtt. v. Mucil. Acaciae q. s. Aq. destillatae 185.0. F. pilulae 50. Asthma. | j tertiis horis. Asthma. j hora somni. Cough. 75a. 75c. r>, Tr. Lobeliae 3 ij. 5 Tr. Lobeliae " (Digitalis) Aq. Laurocerasi " Hyoscyami Spir. aetherei H 3 iij. Tr. Digitalis 3 ss. Spir. aetherei ? 5.0. 3 ss omni hora. Mixt.Camphoraead § vj. 3 ss pro re nata, vel durante Asthma. paroxysmo. Asthma. Lactucarium: gr. 3 —12 = 0.2—0.8. Lobelia Tr. gtt. 20— 3 ij = = 1.0—8.0. .Lactucarium is similar to Stramonium, but milder; it is occasionally used in nervous irritation and where Opium is to be avoided. In conjunction with Cam- phora monobromata it geems to be of especial benefit in phthisical cough. Lobelia is milder than Nicotine and must be employed with caution. (Girls working at manufactures of tobacco get weakness of muscles, with or without Anaemia). Too strong doses produce Vomiting, Diarrhoea, Giddiness, Contraction of Pupils and Convulsions. Its action as emetic is too violent for its safe administration, but it may be used as enema to fulfill the indications of Tobacco. It is most employed in Asthma, Angina pec- toris, Neuralgia of heart and the dry and spasmodic cough from Hyperaesthesia of Pneumogastric: Tr. m. iij — v every 1 5 minutes, or gtt. xv every hour until slight nausea and relaxation. Its efficiency in these cases may be increased by giving it in conjunction with Ammon. brom. or iod. It has been recommended in habitual Constipa- tion, from atony of the muscular coat of the bowels. Antipcriodics, Antiseptics, etc. 35 7 (3a. - 77 a. IJ Lycopodii 10.0. IJ Tr. Opii Extr. Viburni fl. 6.0. " " camph. ^ 3 ss. Syr. Althaeas 20.0. " Valeriana} 3 ij. Aq. destillata^ 64.0. " Rhei aquos. 3 j. 3 ij — 3 ss omni hora. ^Eth. sulf. gtt. xxx. Cramp. Tr. Aconiti gtt. xv. 76b. Dose, gtt. xx — xxv. I> Lycopodii 3j. Vel: Pulv. aromat. gr. x. Tr. Opii 1.0. Vanilini gr. ij. " Valer. 33th. 20.0. Boleti cervini gr. v. Vini Ipecacuanha 3.0. D.tal.dos.6 in caps, amylac. 01. Menth. pip. 0.15. j hora sonmi. Aphrodisiac. Gtt. xxx subinde. Cholera. Lycopodium: gr. 20 — 40 = 1.3 — 2.6. Opium: gr. J— 1 = 0.032—0.065. " Tr.: gtt. 6—24 = 0.25 —1.0. Opium: In all painful affections, but especially use- ful in inflammation of serous membranes, as Peritonitis, Pleuritis, Meningitis, etc. To a weak and dilated heart it is a tonic; it strengthens the heart's action, increasing the arterial tension and making the pulse fuller and firmer. It has, moreover, a specific influence on the action of orbicular muscles, such as the uterus, impart- ing an increased force of contraction, strikingly in con- trast with Belladonna, Hyoscyamus and other narcotics, which relax the muscular fibre. In order to avoid large doses and yet increase or modify the effect of Opium it is sometimes advantageous to combine it with other soothing remedies (Xos. 51, 54, 61, etc). In gastrointes- tinal disorders Opium should not be used if there be deficiency in proper secretion, as it arrests all secretions except that of skin, and in cases of Pneumonia it should not be given in full doses if there is an accumulation of mucous secretion in the bronchial tubes. As regards 36 SEDATIVES: Anodynes, 77b. 5 Tr. Opii gtt. Ix. Acidi nitr. dil. gtt. jv. Spir. nitrico-aeth. 3 j. Mixt. Camphorae | jv | ss post sing. sed. liquidas. Diarrhoea. 77c. ^ Tr. Opii gtt. x. Acid. nitr. dil. gtt. j. Mixt. Camphorae § j. Aq. destillatae § ij. 3 ij postsing.sedesliquidas. (3 years.) Cholera Infant. 77d. IJ Tr. Opii 0.5. Spir. nitrico-aeth. 2.0. Aq. Fl. Aurantii 100.0. 3 ss bihorio. After pains. 77e. rj Tr. Opii gtt. xv — xx. Spiritus Carvi § ss. Aq. Menthae § j. During fit. vel Morph. gr. \ — \ on tongue; to be repeated in \ h. or 1 h. if necessary. Gastralgia. Morphina: gr. 0.2 p. diem; 0.0005- 0.008—0.015. -0.003 for children. Bright's Disease, there is no fear of Opium being dan- gerous, on account of the blood being surcharged with urea; on the contrary, it will render the nervous system more tolerant of the uraemic poison. Children of less than 2 years should never have Opium, but if indicated Morphium is to be preferred. The latter affects the bowels and head less than Opium; neither does it inter- fere with the secretions of the mucous membrane, nor is it diaphoretic; but it affects more the contractility of the bladder. In using large doses of Opium, pupil, breathing and its soporific effect should be watched: somnolence should never become so great that the patient could not easily be aroused; and respiration should not be reduced below 12 p. min. (Morph. gr. j in 2 injections within 2 hours has produced deep narcotism; on the other hand, Opium gr. xxjv in Dysentery have been given with good result within 24 hours.) In spurious Insolation (if only faintness, pale skin, pulse weak and pupils dilated, etc.), it may be of ser- Antispasmodics , Narcotics, etc. 37 78a. $ Tr. Opii campfa. 3 ss. Aq. Amygd. am. e. Extr. Liquir. fl. a 3 ij. " Bell. fl. gtt. viij. Aq. fcenicttli ad 5 vj. 1 sa tertiis horis. Cough. 78b. 1> Tr. Opii camph. 3 j. Extr. Bell. fl. gtt. j. " Ipecac, fl. gtt. jv. Grlycy rrh i zae fl . 3 j . Aquae Anisi ad 3 ij. 3 j bi boric. Cough. (4 months.) 79a. 5 Pulv. Doveri gr. v. " aromat. gr. ij. Tbis dose every 6 or 8 brs. if necessary, vel Morph. gr. 1-8 — 1-6. Diarrhoea. 79b. IJ Pulv. Doveri gr. x. vel Morph. sulf. gr. \. vel Code in. gr. ^. Hora somni with toddy and a hot pediluvium. Bronchitis. ( abortive.) Opii Tr. camph.: gtt. 20 — 3 j— Codeina: gr. JL ]J_ 4 i ■> = 1.0 —4.0. 0.015—0.1. vice: Tr. Opii gtt. x, with brandy § ss. (In true Inso- lation it would be dangerous; see part II.) In Cerebrospinal Meningitis, Opium gr. j every bour or two. In Cellulitis and Endometritis, gr. j tert horis, avoiding narcotism. In Enteritis, Tr. gtt. xv — xx with turpentine stupes. In Convulsions from exhaustion, gtt. j with v of brandy to infants of less than 1 year. In Trismus nascentium, gtt. j omni hora. In Vomiting and Nausea of Pregnancy, Sol. Magendie gtt. ij — iij ex aqua. In Peritonitis (general or pelvic), Morph. gr. J — J bihorio. In Asiatic Cholera, gr. j on tongue, to be re- peated in half bour until dejections cease. Here, as well as in sporadic Cholera, Morph. may be given again at once if rejected; but if again rejected, Opium may be tried in enema, and if this be once or twice quickly returned, then hypodermically. Either remedy should not be repeated before half an hour, as a shorter inter- val might produce narcotism. In Diabetes mellitus, Codein. gr. \ ter die, to be increased gradually to gr. ij. 38 SEDATIVES: Anodynes, 80a. 3 Morph. acetici 0.1. Glycerine 20.0. Aq. Cinnamon. 100.0. Aq. destill. 180.0. 3 ss ten. vel quartis horis. 80b. 5 Morph. sulfur, gr. j. Atrop. sulfur, gr. -J. Cerii oxalici Sacch. Lactis ^ 3 ss. Divide in part sequal No. 16. jquaterdie. Gastric Ulcer. 80c. 5 Morphin. Acetatis 0.25. Aceti purl 5.0. Aq. destillatse 30.0. Gtt. x hora somni. Hypochondriasis. 81. ]J Aceti RutaB ( § j) Oj. 3 j ter die. Chorea. 82. $ Tr. Valeriana 30.0. Spiritus setherei 4.0. Gtt. xx — lx subinde. Colic. Ruta, Extr. fl. gtt. 20 - -40 = 0.65- - 1.0, Valer. " u gtt. 15- -3j — 1.0 - - 4.0 " Tr.: 3j- -3SS= 4.0 - -16.0 Tr. Opii gtt. 20 = gr. j; 2r. Opii carnph. | s^= gr. j. Sol. Morph. TJ. S. § j =gr. j; Magendie, 3 ss = gr. j. Syr. Morph.: Morph. acet. 0.1, Acid. acet. dil. gtt. v. Syr. spl. 200.0. ( 3 j = 0.002 pro dosi). JPulv. Ipecac comp.: Pot. sulf. gr. viij. Ipecac, and Opium, 7 gr. j. Chlorodyne: Morph. sulf. gr. jv, Extr Cannab. gr. viij. Chloroform, 3 j, 01. Menthse pip. gtt. jv. Tr. Capsic. gtt. ij, Alcoh. et Glycerin, ad § j. Dose, gtt. 20; for children, gtt. 3 — 8, according to age. Ruta has a decided influence on the uterus and is used in Amenorrhea as well as in Uterine Hemorrhage; in the latter, when it is dependent on an atonic state of the organ. It may be given gr. 15 — 3 ss. ter die in infusion. It is sometimes very effective in Colic, especially of hysterical subjects. Valeriana'^ as Antispasmodic one of the most popular remedies in Germany. Especially valuable in Hysteria and some cases of Hypochondriasis (Nqs, 41, 58, 77). Antispasmodics j Narcotics, etc. 39 83. 84c. IJ, Vanilini 0.05—0.15. fy Tr. Veratri vir. gtt x. Bis vol ter die. Syr. Scillre comp. 3 ij. Antispasmodic. " tolutani ad § ij. 84a. 3 j tertiis horis. 5 Veratrini 0.05. (4 years.) Bronchitis. Alcoholis 2.0. 85. Syr. simplicis 50.0. 5 Extr. Viburn. prunif. fl. Aq, Fontis 120.0. Extr. Helon. fl. £ 3 ij. 3 ss bihorio until sick feel- " Dioscor. fl. 3 j. ing. Febrile Diseases. Gtt. x— xxx ter die. 84b. Dysmenorrhcea. IJ Tr. Veratri viridi 1.0. [neuralgic.) Syr. simplicis 30.0. 8$. Aq. fontana3 100.0. ]J Extr. Xanth. spin. fl. 3 ss every 15 or 30 minutes. Gtt. x — xx ter die. (Children 3 j. ) Cholera. Hydrophobia. Vanillin: gr. \— 2 =0.03 — 0.13 ter die. VeratrurnTr. gtt. 2 — 12 =0.065—0.4. Veratrin: gr. 1-40 — 1-12=0.0015— 0.005 ter die. Viburn. Extr. fl. : 3 ss — 3 jss=2 0—6.0. Xanth. Extr. fl.: gr. 2—10 =0.1 — 0.6 ter die. Vetairum : In febrile diseases where pulse is weak and rapid. (See Aconite.) As soon as nausea or diaphoresis begins, it has to be stopped or at least to be diminished. In puerperal convulsions hypodermically (page 110). In Abortion, Cellulitis, etc. Tr. m. j — ij bihorio with Sod. salicyl. gr. xv tert. horis. Viburnum is used in Uterine Hemorrhage, and as prophylactic in Abortion, threatening or habitual. In Dysmenorrhcea (without mechanical obstruction), Extr. Viburn. comp. fl. 0.5 — 1.0 ter vel quater die. In Cramps of legs or feet, Tr. gtt. x ter die. Xanthium (No. 86 )has to be used at least for a month, though its efficiency is more than doubtful. For child- ren is the dose 0.3. SECTION III. CORRECTIVES AND ELIMINATIVES. Under this head are counted Acids, Antacids, Ex- pectorants, Diaphoretics, Diuretics, and all those medicines which correct and improve digestion by sup- plying the system with the required material; or which eliminate various substances from the body by increas- ing the activity of the secretory glands at fault. Acidum citricum: Refrigerant, Antiscorbutic. Acidum hydrochlor. d. : Antalkaline, Antiphosphatic, Alterative. Acidum nitricum dil: Antilithic, Alterative. Acidum nitro-muriaticum d.: Antilithic, Antiphos- phatic, Antisyphilitic. Ammonium: Antacid, Diaphoretic, Diuretic, Expec- torant, Stimulant. Apomorphina: Expectorant, Emetic. Benzinum: Vermifuge. Benzoin: Expectorant, Antispasmodic. Bismuthum: Antacid, Antiseptic, Stimulant. Blatta: Diuretic. Buchu: Diuretic, Stimulant, Tonic. Cantharis: Diuretic, Stimulant. Carbo: Antacid, Absorbent. Cimicifuga: Diaphoretic, Diuretic, Anodyne. Colchicum: Diuretic, Antiarthritic, Sedative. 40 Correctives an d Elim i natives. 4 1 Copaita: Diuretic, Stimulant, Cathartic. Creta: Antacid. Digitalis: Diuretic, Tonic. Jaborandi: Diaphoretic, Sialogogue. Lithium: Antacid, Diuretic. Magnesia: Antacid. Opium: Narcotic. (See section n.) Pareika: Diuretic, Astringent, Tonic, Sedative. Potassium et Sodium: Antacid, Diuretic, Refriger- ant. Sanguinaria: Expectorant, Alterative, Refrigerant, Emmenagogue, Emetic. Scilla: Diuretic, Expectorant, Stimulant. Toxicodendron: Diaphoretic, Diuretic, Stimulant. 42 CORRECTIVES and ELIMINATIVES: 87. 89. t), Acidi citrici 5.0. IJ Acidi nitr. d. 3 jss. Glycerinao 100.0. Aqu*e Fontis ad 1000.0. Tr. Card. comp. 3 ij. Aq. Fl. Aurant. § j. During the day. Potits Diabeticorum. Syr. simplicis ad § vj. 3 ij omni hora vel bihorio. 88. ^ Acid, kydrochlor. d. 3 j. Glycerinse § j. (2 years.) Pertussis. 90a. ]J Acidi nitro-mur. dil. Aq. fontanae ad § viij. | ss bihorio and as gargle. Spir. nitrico-seth. ^ 3 ij. Aq. fontanse ad § viij. (4 — 7 years.) Scarlatina. § ss ter die. Oxaluria. Acid, citricum: gr. 10 — 30 = 0.65 — 2.0. " hydrochl. d.: gtt. 5—30 = 0.35—2.15. " nitr. dil.: gtt. 2—20 = 0.15—1.5. " nitro-mur. d.: gtt. 2 — 20 = 0.14 — 1.4. Vegetable Acids form, properly diluted, refreshing drinks in febrile diseases. Acid. citr. is more used than Acid. acet. because the latter produces often Colic or Diarrhoea; however in Typhus, Scarlatina, etc., vinegar is preferable. Acid. tart, is a good substitute to citric acid, on account of its being cheaper. Acid. citr. 3j to sugarwater Oj is a refreshing lemonade. Succus Citri et Aqua, JT will often afford relief in Vomiting of Preg- nancy. Acidum aceticum dilutum (Vinegar), 1:7 Aqua. Mineral Acids, when properly diluted, allay not only thirst, but increase also the appetite. They correct moreover the morbid alkalinity of the blood in Typhoid and other essential fevers; and in Dyspepsia, when de- pendent on a deficiency of the gastric fluid, they are of great benefit, especially when combined with vegetable tonics. See section v. In Kater (Alcoholism): Acid, mur. d. gtt. viij — x e cyatho aquae. In Diarrhoea: Acid, nitr. d. gtt. j — ij ex aqua (it acts sometimes like a charm.) See part II. In Oxaluria: Acid, nitrohydro- Acids, Antacids, Expectorants, etc. 43 90b. R Acid, nitro-mur. d. 3jss. Extr. Pareirae fl. \ ss. Aq. font an ae ad 3 vj. 3 ss ter die p. cibum ex aqua. Phosphates. 91. II Acidi phosph. dil. Tr. Card. comp. 7 3 j- Inf. Colombo 3 jv. 3 j ter die p. cibum. Same. 92a. IJ Liq. Amm. acet. 3 ij. Spir. nitrico-aeth. 3 ss. 3Iixt, Camph. ad 3 viij. P. J quartis horie. Dropsy. 92b. tj Liq. Am. Acet. 3 j — 3 jv. Spir.nitr. oeth. 3 j — 3 iij Tr. Aconiti gtt. j— iij. Bihorio (if pulse full and bounding.) Erysipelas. 92c. IJ, Liq. Amm. acet. 3 jv. Tart, emetici gr. j. 3 ij every half hour with water until eruption re- appears. Convulsions. (in Scarlatina, etc.) 93a. 5, Amm on. carbonici Extr. Colombo fl. ^ 3 ss. Tr. Cardam. comp. 3 ij. Aqua3 Fontis 3 vj. I j bis die. Flatulency, (in gouty habits.) 93b. IJ Ammon. Carbonatis 3 j. Extr. Senegse fl. 3 ij. " ScillcT fl. 3 j. vel Tr. Scillse § ss. Syr. tolutani § j. Aq, fontanae ad § viij. 3 ss ter die. Cough. Acid, phosph. d. gtt. *0— 60 = 0.65— 4.0. Ammon. Acet. Liq.: 3 ss — § ss = 2.0 — 16.0. " Carbonas: gr. 3—10 = 0.2 — 0.65 chlor. dil. gtt. x — xv ex aqua on empty stomach, espec- ially if taste foul or insip'd. Ammonii Acetas (Ammonum aceticum) is in small doses refrigerant, and in large ones diaphoretic and diuretic. It is readily prepared ex tempore by neutral- izing Acidum aceticum dilutum (m. xxvij: 3 ]) with Amnion, carb. (gr. xxiv.) In Dropsy, 3 ss ter die ex aqua. In Congestive Dys- menorrhea, 3 ij ter die ex aqua. In Convulsions from suppressed eruption of Scarlatina, to a child of 3 years, 3 j ex aqua every 10 minutes after a mustard bath. 44 CORRECTIVES and ELIMESTATIVES: 94a. IJ Ammon. Chloridi Extr. Eucalypti fl. " Glycyrrh. fl. a 3 ij. Tr. Opii camph. § ss. Aq. Fontis ad § viij. 1 ss tert. horis. .Phthisis. Vel: 5- Ammon. nmriatici Succi Liquiritiae^ 5.0. (Tart. emet. 0.05.) Aq. fontanse ad 200.0. § ss bihorio. Catarrh. 94b. r> Ammon. Chloridi. Potass. Iodidi ^ 3 j. Succi Glycyrrh izae 3 ij. Aq. Fceniculi § vj. | ss ter die. Emphysem. 94c. 5 Ammon. chlorati 1.5. " picrin. 0.06. Succi Liquiritise 4.0. Aq. fontanae 100.0. 3 ij omni hora. Pertussis. (I — 2 years; 3 j, 6 months or less.) 94d. IJ Ammon. chlorati 3 ij. Extr. Xanthii fl. 3 j. Aq. Melissae | viij. 3 j ter die. Hydrophobia. 95. r> Tr. Apium mellif. 3 ss. " Pulsatilla 3 ij. Elix. simplicis ad § jv. 3 j ter die. Masturbation, (iiocturnal emissions.) Ammon. Chloridum: " Liquor: " Spir. arom.: " Picras: gr. 3 — 15 = 0.2 — 1.0. gtt. 5—30 = 0.32 —2.0. gtt. 15— 3j= 1.0 —4.0. gr. • \—l =0.015—0.065. Aqua Ammonim. Aside from being used in acidity and flatulence, it is the physiological antidote to Alcohol, and a very good stimulant for speedily arousing the vascular and respiratory system; therefore, its employ- ment in Syncope, low forms of fever, etc. It is best given as Spir. Ammon. arom.; yet as antacid, stimulant and stomachic, Ammonii Carbonas is generally pre- ferred, (p. 73.) Ammonii Chloridum is not admissible if there be much inflammation. In Kater (Alcoholism): Aqua Ammoniae gtt. x — xxx e cyatho aquae; in Diabetes: Ammon. chlor. 1.25 quartis horis; in Intermittens: 3 j of the same during intermis- sion; in Facial and Dental Neuralgia: gr. x — 3j bihorio. Acids, Antacids, Expectorants, etc. 45 96a. ^ Apomorph. hydrochlor. 0.01 — 0.03. Acid, hydrochl. d.gtt. v. Syr. simplicis 50.0. Aq. Fontis 100.0. 3 ss bihorio. Asthma. (pituitosa.) 96b. I> Apomorphini gr. j. Acid, hydrochl.d. gtt. jv. Syrd^i simplicis § j. Aq. Melissa? 3 iij. 3 j omni hora. Cough. 3 years, ( 3ij: 7 years). 97. 1£ Benzin. lithanthr. 01 ei Carvi Spirit us aetherei Gtt. xx — xxx ter die cibura. 98. IJ Acidi benzoici 2.0. (Sod. bicarb. 5.0.) Sod. phosph. 10.0. (Tr. Hyoscyam. 10.0.) Aq. Cinnamomi 200.0. § sster die. Lithiasis. 98b. IjL Natri benzoici 2.5. " silicici 1.2. Extr. Aconiti 0.2. Colchici 0.6. Saponis medicati 0.5. F.pilulse20. Chronic ij — jv ter die. Cystitis. 98c. IJ Magn. Benzoatis 7.5. Glycerini 20.0. Syr. simplicis 50.0. Aq. destillatae 100.0. 3 ss bihorio veltertiis horis. Fla tulency. Gravel. 5.0. 1.0. 10.0. post Apomorph in gr. 1-30- Benzoin. Acid.: gr. 8- 30 = 0.002—0.008. 0.5 —2.0. Apomorphin is a prompt emetic and mostly used hypodermically, especially in narcotic poisoning, (p. 3*.) As expectorant it may be given 0.001 — 0.003 tert. horis. Benzoin resembles in its effects Myrrh. Acidum benzoicum abstracts in its passage through the system nitrogen from the elements of urea, being changed into hippuric acid, hence its use in urasmic poisoning. Sodii Benzoas is more easily soluble and tastes less sharp: 13.3 = 10.0 Acid. The effect of the Soda on the blood is greater than that of Acid, salicyl., and it is the best dialytic by inclination to Lithiasis. Natruni benzoicum 46 CORRECTIVES and ELIMINATIVES: 99a. ]J Bismuthi nitrici pr. Calcar carbon. IT 5.0. Opii 0.25. Divide in partes 10. j bis die ante cibum. Chronic Diarrhoea. Vel: fy Bism. subnitrici Cretae praepar. ^ gr. v. Morph sulfuric! gr. 1-6. Dentur tales doses 6. j tertiis horis. Diarrhoea. (in Erysipelas^) 99b. IJ Bism. Subnitratis 3j. Sod. Bicarb, gr. v. Morphinae gr. 1 6. Dentur tales doses 6. j tertiis horis. Dysentery. 99c. ^ Bismuthi Subnitr. 3j. Pulv. aromat. gr. v. D. tal.dos. 6 in caps, amylac. j post cibum. Pyrosis. 99d. IJ, Bism. subnitrici Natri bicarb. T gr. xv. Tr. Opii camph. 3 ij. Syr. simplicis | j. Aquae fontanae § ij. 3 j tertiis horis. Diarrhoea. (3 months). Vel: IJ Bism. subnitr. gr. x. Hydr. c. Creta gr. iij. Opii gr. ss. Sacchari 3j. Divide in partes 10. j tertiis horis. (3 months.) Bism. Subcarb.: gr. 5 — 30 = 0.32 — 2.0. " Subnitras.: gr. 5 — 30 = 0.32 — 2.0. and lemonade are quite sufficient to render alkaline urine of normal reaction. Jn Red Gravel, Acid, benzoic, gr. v— x ter die. In Phosphates, Gout, Albuminuria, Incontinence of Urine, Laryngitis (chron. with hoarseness) etc., No. 98a, or Sodii Benzoas, 0.1 — 1.0 quater die e cyatho aquae — the water to assist its dissolving property. In Diphtheria, ^ ss — 3vj in 24 hours. In Tuberculosis, Magn. ben- zoic. 0.15 — 1.0 bihorio vel quartis horis is curative (?). Bism. nitricum pr. is very valuable in that form of Dyspepsia where the formation of sulfurated hydrogen is a prominent symptom. In many cases the efficiency of Bism . Praep. is materially increased by combining them with Napthol, Salicin and other antiseptic agents. See p. 15 et sequelse. Acids, Antacids, Expectorants, etc. 47 100. IJ BlattcT orientalis Sacch. Lack 7 0.2— O.G. Dentur tales doses 6. j ter die. Dropsy. 101. r> Inf. Fol. Buehu 3 viij. . (ex 3ij.) Daily in divided doses for about a week. Incontinence of Urine, 102. \\ Cantharid. pulv. Scillse Radicis Mass. Hydrarg. 7 gr. xij. Folior. Digitalis gr. ij. F. pilulse 12. j bis die. Albuminuria. 103. IJ Carbonis vegetab. 3 j. Pulv. aromat. gr. x. Divide in partes 6. j post cibum. Flatulency. 104. IJ Extr. Cimicif. fl. 3j. Aq. Mentha 5 jss. 3 j ter die. Chorea. 105a. r> ViniColchici 12.0. Tr. Opii 2.0. Gtt. xx ter die. Gleet. 105b. ]J Vmi Colchiei 18.0. Tr. Opii crocat. 2.0. Gtt. xx — lx tert. vel quartis. horis. Asthma. Buehu Extr. fl.: Cantharides: Tr. Carbo Ligni.: Cimicifuga, Extr. fl.: Colcbicum Vinum S. 3 ss— 3 j gr. 1.6—1 gtt, 4 — 15 gr. 10—40 gtt. 15— 3 ss gtt, 15— 3 j 2.0 —4.0. 0.01—0.065. 0.13—0.5. 0.65—2.6. 1.0 —2.0. 1.0 —4.0. Buehu (Diosma crenulata), or TTva Ursi, as infusion, to be taken ad libitum, or Extr. fl. 3 j ter die, is more or less valuable in all affections of the genitourinary tract. Cantharis (p. 75) is mostly used in diseases of the urino genital apparatus, upon which it has a powerful influence. At the appearance of strangury or priapism, which latter is sometimes very painful and obstinate, it must be discontinued and Camphor given, (p. 5.) In Albuminuria, to remove the congestion of the kid- neys; in Retention of Menses, Tr. Cantharidum gtt. x ter die; in Incontinence of Urine from paralysis of neck of bladder, the same dose in linseed tea. 48 CORRECTIVES and ELIMINATIVES: 105c. g, Tr. Colchici Sem. " Guayaci ?10.0, Gtt. xxx — xl ter die. Vel: 5 Tr. Colchici S. 25.0. " Aconiti 10.0. " Digitalis 5.0. Vinialbi q. s. adlOOO.O. 8 c. c. bis die. Rheumatistn. 105d. # Tr. Colchici S. 3 ij. Kalii iodati 3 ss. Aq. destillatse | iij. | ss ter die. Neuralgia, 106a. 5 Copaivae 3 iij. Mucil. Acaciae ? j. Tr. Ferri chlor."3ij. Aq. Fontis ad § viij. 1 ss — | j ter die post eibum. Gonorrhoea. Vel: r> Copaivae 50.0. Alcoholis 10.0. 01. Menth. pip. 0.5. Gtt. xl — 1 qnater die ex aqua saccharata. Gonorrhoea, (if chronic.) Colchic. Extr. fl. gtt. 5- -20 = 0.2- -0.65. a Tr.: gtt, 15- "3j = 0.5- -4.0. Copaiva gtt. 15- -3j= 1.0- -4.0. Colchicum is by no means a true diuretic — its action on the kidneys being no greater than it is on the skin, liver and mucous membrane; but it has a decided anti- arthritic influence, not only on account of its diminishing the uric acid in the urine, but also probably arresting fermentation of this acid in the blood. Its effect should be watched as it produces in too strong doses Gastritis, bloody stools, etc., with great nervous excitement. (See p. 5.) It is generally administered till an effect is pro- duced on the bowels, unless it is desirable to act more on the skin, when it must be combined with Opium. Copaiva acts analogous to the Terebinthinates, stimu- lating the secretions from the mucous membrane. It is almost exclusively used in Gonorrhoea and will act here under proper directions to a certainty. Though of benefit in painful hemorrhoidal affections and the chronic form of Bronchitis, Diarrhoea and Dysentry, it is seldom Acids, Antacids, Expectorants, etc. 49 106b. IJ, Copaivae 3 ij — 3 iij. Liq. Potassae | ss. Tr. Aloes comp. 3 ij. Aquae fontanae ad 3 viij. I j ter die post cibum. Gonorrhoea. Vel: 3 Copaivae 3 ij — 3 iij. Pepsin, in frust. 3 ss. Aq. Fontis ad § viij. § j ter die post cibum. 106c. IJ Copaivae 30.0. Chloroformii 3.0. Tr. Ferr. acet. aeth. 10.0. Gtt. xl— 1 ter die. Vel: PJ Copaivae 25.0. Tr. arom. acidae 5.0. Gtt. xv — xx quater die. Vel: I£ Copaivae 01. Terebinth. " a 3 ij. Gtt. xx quater die. Cystitis. 107. I£ Cretae praep. gr. xij. Calomelanos gr. vj. Opii gr. j. Divide in partes 12. j bis die. Dysentery. (6 months.) Vel: r> Pulv. Cretae comp. gr. ij. " Cretae comp. cum Opio gr. j. After each stool, or every hour. (1 year.) (3 years: double the dose — 5 years: treble — 10 years: treble every half hour.) Diarrhoea. Creta Mixt.: " Pulv. co.: gr 3 ss ~ , 15- 3j = 16.0—32.0. 1.0— 4.0. employed on account of its horrible taste. LiquDr Potassae and Pepsin emulsify it; but if combined with vegetable or mineral styptics, Acacia must be used for that purpose. Combined with 01. t?rebinthinae (in Cystitis) it makes the alkaline urine soon sour. The best way of taking Copaiva is to swallow two or three capsules before a meal, or at bedtime, and to take the other ingredients of the mixture separately. Pulv. Cretoecomp.: Creta, 1^; Acacia, 1; Sacchar. p. 2\. Pulv. Cretw cornj). c. Opio: 2>ij =gr. j. Mixt. Cretce: Pulv. Cretae comp. 3j; Aq. Fontis 3 j. In Vomiting of Pregnancy: Aq. Calcis cum Lacte. 50 CORRECTIVES and ELIMINA TIVES: 108a. 5 Tr. Digitalis Vini Colch. Sem. ^ 3 ij. Kali nitrici 3 j. Roob Juniperi § j. Aq. Fontis ad § viij. 3 j bihorio. Dropsy. Vel: fy Tr. Digitalis 3 ij. " Scillse Syr. Aurant. C. "i Mixt. Camph. ad | ss ter die. Vel: r> Tr. Digitalis f ss. " Apocyni § j. Aquae Fontis ad | | j quater die. ij. "]• Vll]. 108b. $ Tr. Digitalis Vini Colchici S. 7 10.0. Spir. muriatico-aeth. 2.0. Gtt. xx quartis horis. Hydrothorax. 109. 5- Inf. Folior. Jaborandi (ex 10.0) 200.0. Pars semis at once; of the rest | ss hourly with as much wine. Poisoning by Atropin. 110a. 5 Lith. benzo-salicyl. 3 jss. Extr. Hydrang. fl. | ij. Aq. fontanae § vj. 3 i j ter die. Hcematuria. Digitalis: gr. f— 2 =0.032 " Extr. fl. gtt. 5—40 =0.18 - " Tr.: gtt. 10—80 =0.32 —2.6. Jaborandi Extr. fl.: gtt. 15 — 3 j=1.0 — 4.0. Pilocarpin: gr. 1-30—^=0.002—0.02 ■0.13; i-P p<» 1 3 m ' Digitalis (p. 78), slows the pulse and is occasionally valuable in Spasmodic Neuralgia, Genital Irritation and Insanity. The tincture may be given in 3 ss doses in delirium of Typhoid. Jaborandi usually produces after 10 minutes adminis- tration profuse ptyalism, nausea and diaphoresis. Its antidotal power (No. 109) is based upon the fact that it slows the heart's action by stimulating the same ner- vous apparatus which is paralyzedby BeIladonna,namely, the intra-cranial inhibitory apparatus. Pilocarpin some- times causes headache, vomiting, singultus, dysuria, cold extremities and collapse. Duboisin, Atropin and Daturin are the antidotes; secretions of skin and contraction of Acids, Antacid*, Expectorants, etc. 51 110b. IJ Lith. benzo-salicyl. 3jss. Extr. Gelsem. fl. gtt. x. ;< Hyoscyami fl. 3 ij. " Hydrangeas fl. \ ij. (Pot. brom. § ss.) Aq.Fontis ad § viij . 3 ss quartis horis ex aqua. Cystitis. 110c. IJ Lithii citrici 4.0. Glycerini 30.0. 4 c. c. bis die. Gout. Vel: IJ Lithii Citratis 3j. (Tr. Colchic. S. 3j.) Aquae f on tame 3 vj. 3 ss bis vel ter die ex aqua. Ilia. IJ Magn. carbon, f ss. Spir.Lavand. comp. 3 jss. Olei Carvi gtt. vj. Aq. fontanie 3 jv. 3 j subinde. Diarrhoea. 111b. IJ Magnes. carbon. 3 ss. Extr. Rhei. fluidi Spir. Aram, arora. a 3 ij. Aq. Fceniculi ad 3 jv. 3 j bis vel ter die. ZharrAo a. 112a. IJ Magn. usta3 10.0. Aq. fontanae 100.0. Glycerini 40.0. 16 c. c. every 15 — 30 rain. Poisoning by acids, etc. Lithii Carb.: gr. 2 — 8 = 0.13—0.5. « Citras: gr. 2— 8 =0.13—0.5. Magn. carb.: gr. 15 — 3 ij = 1.0 — 8.0. " usta: gr. 15— 3 j = 1.0 —4.0. pupils are stopped at once (see Hyoscyamus, p. 33). Pilocarpin is advantageously used in Uraemia of Ty- phoid, if hydragoguea are contra-indicated by abdom- inal symptoms; but it should not be employed in heart and lung diseases; nor in hydrops of pregnants. In Ascites: Extr. Jaborandi fl. 3 j hora somni. In Neuralgia, Nervi Quinti, 3 ss — 3j before the expected return of the fit. In Urremia of Typhoid and Perni- cious Intermittens, Pilocarpin hydrochlor. gr. \. Lithium : The salts of Lithium are double the strength of those of Potassium. As Litholyticum: Lithium ben- zoicumO.l — 0.2 tertiis horis; Lith. carbonicum 0.2 — 0.5 ter die (1.5 per diem). 52 CORRECTIVES and ELIMINATIVES: 112b. 5 Magn. ustse gr. vj. Aquae Fontis | jss. 3 j ter die. Stomatitis. (8 months.) 113a. ]J Tr. Opii camph. § ss. Extr. Scillae fl. 3 j. Mueil. Acacia 5 ij. Syr. Pruni Virg. § j. Aq. fontanae ad § vj. ^ ss subinde. Bronchitis. 113b. IJ Tr. Opii camph. 3 ij. (Amnion, chlor. 3j.) Extr. Bellad. fl. gtt. ij. " Ipecac, fl. gtt. jv. Aq. Laurocerasi 3 j. " Anisi ad § jv. 3 ij tertiis horis. (3 years.) 114. IJ Extr. PareiraB fl. § j. Spir. Junip. comp. § ij. Acidi benzoici 3 j. Morphii sulfurici gr. j. 3 j ter die. Irritable Bladder. 115. 3 Picis liquid, pulv. 20.0. Vini Hispanici 1000.0. Sepone interdum agitando per diem, turn filtra. | j pro dosi. Chron ic Br on chitis . 116. B.Tr.Pimpinellae 20.0. Syr. Morphini Aq. Melissae 7 100.0. 3 ij tertiis vel quartis horis. Hoarseness, Pareira Extr. fl. : 3 ss — 3 j PimpinellaTr. gtt. 20— 3 j 2.0—4.0. 1.0—4.0. Lithii Citras 10.0 = Acid. citr. 9.6 andLith. carb. 5.3. The average dose is from 0.5 — -1.0 ter die. Both the Carbonate and Citrate are very valuable in Gout, from the fact of their low combining power, and the great solubility of the Urate of Lithium, thus enabling them to eliminate easier the uric acid from the system. They are best given largely diluted, and the Carbonate in Carbonic acid water. Magnesia is a favorite laxative for infants — its com- bination with Rhubarb is known in Germany as Infant's powder par excellence. See section VI. Pareira is an excellent remedy in chronic diseases of the urinary passages, particularly chronic Inflammation of the Bladder; it is also slightly aperient. Pix liquida pulv. =Pix liquida p. 1; Carbo Lignip. ij. Acids, Antacids, Expectorants, etc. 53 11 7a. IJ Pot. Acetatis |bs. Tr. Rhei 3 x. Vim stibiati 3 ij. Gtt. v — x ter die. (To in- crease to 30.) Rickets. 117b. IJ Kali acetici 5.0. Oxym. Scil he Syr. simplicis ^ 15.0. Aq. Petroselini 125.0. 16 c. c. biborio. Diuretic. 118a. IJ Liq. Potassa* Spir. nitrico-aeth. 1 3 ij. Extr. Gent. comp. fl. 3 ss. vel Tr. Gent. comp. § ss. Aq. fontanae \ v j« 3 j ter die. Gardialgia. 118b. IJ Kali carbonici 3 j. Spir. nitrico-aeth. 3 ij. Tr. Oinnam. comp. |bs. Inf.Gent.comp.ad 3 viij. 3 ssterdie. Ovar. Dropsy. 11 fa. IJ Pot. Bicarb. 3 ij. vel Liq. Potasc Extr. Hyoscyami fl 3ss. vel Tr. Hyoscyami 3iij. Mixt. Camphor, ad 3 viij. 3 j ter die post cibum. Red Gravel. 119b. IJ Kali biearbonici 3j**. Amnion, carbonici 3 ss. Aquae fontanae 3 vj. 3 j bis die. Antilithic. Potass. Acetas: gv. 5—30 = 0.32—2.0. " Liquor: gtt, 5—30 = 0.32—2.0. « Carb. gr. 5 — 30 = 0.32—2.0. " Bicarb.: £r. 5—30 0.3 2 — 2.0. Potassii Acetas (Kali aceticum) like all alkaline salts containing a vegetable acid, is changed in the stomach into a carbonate, and eliminated by the kidneys, making the urine usually alkaline. In large doses a gentle cathartic, it is in small ones diuretic, increasing the flow of urine, yet diminishing both the uric acid and urea, hence it prevents more or less the formation of uric acid calculi. It is much employed in acute Rheu- matism and Dropsies; and it has also been found useful as an alterative in cutaneous affections. Salts of Potassium or Sodium used as antacids (with vegetable tonics) in Dyspepsia, accompanied with excess of acid in the primae viae, promote the digestion of fatty 54 C0RBEC1IVES and ELIMINATIVES: 9 119c. Pot. Bicarbonat. 3 j. " Iodidi gr. xij. Aquas destillatse § vj. | ss bis die. Bronchitis. 119d. §, Kali bicarbonici Spir. Amm.arom.a 3 j. Aq. destillatse § jv. § j ter die cum Acidi citrici gr. 1 5 antea in Aqua solut. Chron. Vomiting. 120a. ^ Sod. Bicarb. 3 iij. Spir.Lavand. comp. 3 ss. Aq. destillatse § vj. 5 ss tertiis vel quartis horis. Jaundice. Vel: 5 Natri bicarb. 3 ij- Rad. Rhei 3 ss. Cort. Cinchona3 1 j. F. pulvis. 3 j ter die. 120b. IJ Sod. Bicarbonatis 3 j. " Nitratis 3 ss. Aq. fontanse § iij. 3 j omni hora. (4 years.) Diphtheria. 120c. 5 Natri bicarbonici gr. x. Ferri c. Saccharo Bism. subnitr.1Tgr.viij. D. tal. dos. 6 in caps. amy], j ter die post cibum. Endocarditis. Sod. Bicarb.: gr. 5—60 = 0.32—4.0. matter. Their action in Gout and acute Rheumatism depends also on the neutralization of the excess of acid with which the blood is charged. By neutralizing the acid, the alkalies relieve also the irritability of the urinary organs; hence their use in Ardo Urinse accomp- anying Gonorrhoea, Pruritus Ani, Uterine and Cutane- ous Irritation, etc. The preparations of Sodium are less irritating and less depressing than those of Potassium; and though they are inferior as antilithics, being less powerful solvents of uric acid, they are better antidys- peptics. In the treatment of Red Gravel, etc., the exhibition of the alkalies should be but sufficient to neutralize the urine; for, if it be made alkaline, the phosphate formed may be deposited around the uric acid calculi. Liquor Potassce is more irritant to the stomach than Pot. bicarb.; therefore less eligible for protracted use. Acids, Antacids, Expectorants, etc. 55 121a. 3, Pot. Chloratis 3 ij. Acid.hyd^ochlor. d. 3 ss. Syr. simplicis 3 j. Aq. fontana3 | v. I ss — 3 j quartis horis. Bronchitis. 121b. IJ Kali chlorici 10.0 " nitrici 5.0 Extr. Hyoscyami 1.0 Syr. simplicis 30.0 Aq. Fontisq s. ad 200.0 5 ss bihorio T^^r. Diseases. 121c. 5 Pot. Chloratis 3ij. Tr. Ferri Chlor. 3j. " Digitalis 3 ss. Aq. fontanaa § iij. 3 ij bihorio. Scarlatina. (4 years.) 122a. IJ Kali. nitr. 3>ij — 3 j. Tr. Aconiti gtt. iv. vel Tart, emetic, gr.ij. Aq. Melissa? 3 jv. 3 ss tertiis horis. Pleuritis. Pot. Sod. Chlor.: Citras: Nitras: Boras: Nitras: g 1 '- g r - g r - g r - g r - 5—30 = 0.32— 3—30 = 0.2 — 3 — 20 = 0.2 — 2—20 = 0.13— 10—40 = 0.65— 2.0. 2.0. 1.3. 1.3. 2.6. Potassii Carbonas (Kali carbonicum) is especially useful in torpor of the liver. Sodii Bicarbonas (Kali bicarbonicum) in large doses — 3 j — 3 iij p. diem — should not be used for more than ten consecutive days, to avoid superalkalinity of the blood. From 3j — 3 ijss, followed by Acid, tartaricum gr. xv — 3v areused as a diagnostic test in dilatation of the stomach. Borax, which is also a mild refrigerant, is chiefly used for its emmenagogue properties. Potassii Citras (Kali citricum) is an excellent refri- gerant, and generally given as Potio jRiceri: Pot. bicarb, and Acidum citricum a 1.0 separately dissolved in a little water. To be mixed and taken with sugar water as an effervescing draught. (In Vomiting of Pregnancy.) In defective Menstruation: Borax, 0.5 — 1.5. In Dia- betes Mellitus: Sod. bicarb. 3jper diem, to be increased to 3 iij daily for about a week in each month. In artic. 56 CORRECTIVES and ELIMINATIVES: 122b. IJ, Kali nitrici " bicarb. ^ 3 j. Aq. Amygd. am. c. 3 ij- Aq. fontanae § vj. § sstertiis horis. Bronchitis. 122c. ^ Pot. Nitratis 2.5. Sod. Nitratis 5.0. Succi Liquiritiae 8.0. Aq. Foeniculi 155.0. 3 ij omni hora. 7 — 9 years. ( 3 j bihorio 1 — 3 years.) Febrile Diseases. 122d. 5 Pot. Nitratis Aq. Laurocerasi ^ 7.5. (Extr. Hyoscyami 0.4.) Syr. Papaveris 30.0. Aq.Fontisq. s. ad 250.0. | ss omni hora vel bihorio. Gonorrhoea. 122e. U Potass. Nitratis Succi Glycyrrhiz. ^ 7.5. Extr. Hyoscyami 1.0. Liq. Amm. anisati 15.0. Aq. fontanae ad 250.0. 16c.c. bihorio vel tertiis horis. Bronchitis. Vel: r> Kali nitrici Kalii iodati IT 3 j. Extr. Senegae fl. 3 ij. Syr. tolutani 3 j. Aq. Anisi ad \ vj. I ss ter die. Emphysem. 123a. fy Kali nitrici 3 ss. Tr. Digitalis gtt. xx. Aq. fontanae § iij. I j tertiis vel quartis horis. Abortion. (If feverish and plethoric.) Rheumatism (acute), Sod. vel Potass, bicarb. 3 j — 3 ij bihorio vel tertiis horis until urine alkaline. Potassii Chloras (Kali chloricum) 0.5 as dose. See Iodine, section 1. 4 — 8.0 p. diem for adults. 2.0 p. diem: (3 years;) 1.25 infants; in Stomatitis: (3j) | iij 3 ij bis vel ter die. (8 months); in Scarlatina: 3 j to Oj of water as drink during the day. (4 years.) Potassii Nitras (Kali nitricum) is a valuable refriger- ant and sedative in fevers; in doses of gr. x — 3 ss it is diaphoretic and diuretic. See Salicin p. 17. In doses of 10.0 — 20.0 it may cause death. Sodii Nitras (Natrum nitricum) is milder, and much used as drink, especially in Dysentery: § ss— §j per diem in a mucilaginous vehicle. Sodii Nitris (Natrum nitrosum — No. 60c.) is seldom employed as a remedial agent. Acids, Antacids, Expectorants, etc. 57 123b. IJ Potassii Nitratis Tr. Digitalis a 3j. Aq. Melissre 3 jv. 3 ss tertiis horis. Pleuritis. (if effusion.) 123c. IJ Pot. Nitratis 3j. Tr. Digitalis 3 ij- Aq. f on tan re 3 vj. 3 ss eextis horis. Dropsy (5 years.) from Scarlatina. Vel: IJ Pot. Nitratis 3j. Tr. Digital. 3j. Spir. nitrico-aeth. 3 ij. Syr. simplicis 3 j. Aq. fontanse ad 3 viij. 3 ssbihoriovel tertiis horis. (4 years.) 124a. IJ Kali nitrici 3 ss. Pulv. Doveri gr. xxjv. Divide in partes 6. j qtiartis horis until diapho- resis. Ascites, (12 years.) (from cold.) 124b. IJ Kali nitrici " sulf.a 0.5— 1.0. Pulvis temperans. (More than 3.0 are objectionable.) EfXciti nu rU from fright, 125a. IJ Xatri phosphorici 50.0. " bicarbonici 5.0. Aquce Fontanae 600.0. During the day with Acid. citr. 5.0. Rheumatism. Sodii Phosph. : 3 j— 3 j = 4.0—32.0. In acute articular Rheumatism, Pot. nitr. gr. v quartis horis; vel Sod. Nitras 1.0 — -°>.0 bihorio vel tert. horis. (The same dose of the latter salt in Dysentery.) In Cholera Infantum and Scrofula: Solutio Xatri nitrici(l 0.0) 40.0 — 3 ij omni hora vel bihorio ex aqua. In febrile diseases of children, Sol. Kali nitrici (gr. x) 3 ij with Tinctura Aconiti gtt. j: 3 j bihorio; infants should have half this dose. Sodii Phosphas (Natruni phosphoricum) is mostly used on account of its laxative property. See section vi. In Gravel: 2.0 — 6.0 ter die; vel Sod. phosph. ammon. gr. x ter die. Sodii CMoridum (Xatrium chloratum 3 j — 3 j during intermission is said to cut sometimes the fever in Intermittens. (See page 101.) 58 CORRECTIVES and E LIMITATIVE S. 125b. ^ Sodii Phosphatis 10.0. Acidi benzoici 1.5. Aq. fontange 180.0. In 5 doses during the day. Gravel. 126a. g, Scillse pulv. gr. iij. Opii gr. ss. Cinnamomi gr. x. Dentur tales doses 6. j bis die. Cardiac Dropsy. 126b. £} Extr. Scillse fluidi " Ipecac, fl. ^ gtt. x. " Bellad. fl. gtt. j. Aq. Laurocerasi gtt. xv. Syr. Acacise Aq. Anisi~ \\. 3 ss omni hora. Cough. (5 weeks.) 127. t> Extr. Toxicod. fl. 3 j. Gtt. ij ter die. Neuralgia. Scilla: gr. 1—3 = 0.065—0.2. " Extr. fl.: gtt. 2—10 = 0.065—0.32. « Tr.: gtt. 10—60 = 0.32 —2.0. Toxicod. Extr. fl.: gtt. 1_10 = 0.032—0.32. Scilla promotes, in small doses, secretions from the mucous membranes and the kidneys — its diuretic effect being much the most marked. In large doses it excites nausea and vomiting, accompanied sometimes by purg- ing; and in excessive doses it acts as acro-narcotic poison — 24 gr. having proved fatal. In cardiac dropsies it is generally combined with Digitalis; and Calomel is often added with a view to its action on the absorbents. It is, however, contra-indicated in cases complicated with degeneration of the kidneys or inflammation of the bladder; nor should it be used in inflammatory bron- chial affections, though it is an excellent expectorant in chronic cases. Acetum Scillce =1:10 Acidum aceticum dilutum. Syrupus Scilloe = Acetum p. ij, Sacharum p. iij. Rhus toxicodendron is sometimes used in Chronic Eczemata, Gout and Amaurosis. It is, however, little reliable, and its effects have to be closely watched. SECTION IV. ASTRINGENTS Suspend the ex- and secretions of the various organs, or restrain profluvia or hemorrhage, by producing con- traction of the muscular fibre, or by coagulating the albumen of the blood. Acidum gallicum: Astringent. Acidum sulfuricum dil. i Astringent, Refrigerant, Antiphosphatic. Acidum taxxicum: Astringent. Agaricus: Astringent. Alumex: Astringent, Antispasmodic, Antiseptic. Argextum: Astringent. Capsella bursa pastoris: Astringent. Catechu: Astringent, Tonic. Cinxamonum: Astringent, Aromatic, Stimulant. Coto: Astringent. Creosot.: Astringent, Antiseptic, Antiscorbutic. Cuprum: Astringent, Anticonvulsive, Tonic, Emetic. Ergota: Astringent, Oxytocic. Erigerox t : Astringent, Diuretic, Tonic, Stimulant. Ferrum: Astringent, Tonic. ELemamelis: Astringent, Sedative. Krso : Astringent. Macis: Astringent, Aromatic. 60 ASTBINGENTS. Plumbum: Astringent, Sedative. Ratanha : Astringent. Rhus aromatica: Astringent. Terebinthina: Astringent, Expectorant, Anthel- mintic. "Ova ursi: Astringent, Diuretic, Stimulant. ASTBINGENTS. 61 128a. 128c. IJ, Acidi gallici gr. v. $ Acidi gallici 3j. Opii gr. ss. Extr. Cannab. Ind. gr.v. Dentur tales doses 4. F. pilulse 5. j tertiis vel quartis horis. j hora somni. Sweats. Hemoptysis. ( Colliquative.) 128b. 129a. 5 Acidi gallici gr. xv. IJ Acidi sulf. dil. 3 ij. Tr. Hyoscyami 3j. Syr. Aurant. C. |j. Aquae fontanse § iij. Aq. Fontis ad § viij. |j ter die. Hematuria. |j ter die. NigJit-siceats. Acidum gallicum: gr. 5 — 20 = 0.32 — 1.3. " sulf. dil.: gtt. 10—30 = 0.75—2.3. " " arora.: gtt. 10— 30 = 0.75 — 2.3. Elix. acid. Halleri: gtt. 2—15 =0.15— 1.0. Acidum gallicum given by the stomach, is more efficacious than Tannin. Gr. jv. — vj in pill quartis vel sextis horis in Albuminuria, Diabetes, Hemorrhage from Carcinoma, etc. Acidum sulfuricum dilutum is chiefly used in Typhoid, Colliquative Perspirations, Cholera and Choleric Diarr- hoea; and it is the best corrective for Phosphatic Lithi- asis. As astringent it is given from gtt. xx — xxx ter die ex aqua; and it should be sucked through a glass tube, to prevent injuring the teeth. [Acidum sulfuricum aromaticum — Tr. aromatica acida — is more agreeable to take. See sections in. and v.) In Gastritis, gtt. xv ter die ex aqua; in Purpura gtt. v — xv bihorio; and in Lead Colic it may be given as lemonade — 3 j in sugar water Oj during the day. Acidum sulfuricum aromaticum: Alcohol 3 xjv. adde gradatim Acidi sulfurici 3 ij. Post refrigeration em adde Tr. Zingiberis 3 j; 01. Menth. p. gtt. j; Alcohol, q. s. ut f. | ijss. Elix. acidum Halleri — Acid, sulfur, pars j; (Mixt. sulf. acida.) Alcohol, partes iij. 62 ASTRINGENTS. 129b, IJ Acidi sulf . diluti Extr. Ergotse fl. 7 3 ij. Aq. fontanae ad § viij. 1 j ter die. Metrorrhagia. 129c. ]J Acid. sulf. dil. 3 ij. Tr. Cinnamomi | j. Syr. Aurant. C. 3 ij. 3 j ter die. Chlorosis. 130a. ^ Acidi tannici " benzoici ^ 3j. Sacchari albi 3 j. F. pulveres No. 20. j bihorio. Pertussis. (3 years.) 130b. 5- Acidi tannici gr. vj. Extr. Bellad. fl. gtt. jv. " Conii fl. gtt. xv j. Syr. Flor. Aurant. § ij. Aq. fontanse § vj. 3 ij bihorio vel tertiis horis. (3 years.) Pertussis. 131. §- Agaricin gr. j. Extr. Hyoscyami Rd. Althcfeae ^ gr. iij. F. pilule 6. Consperguntur Pulvere Cinnamomi j vel ij hora somni. JVight-siceats. Phthisis. 132a. g, Aluminis 3 jss. Aquae Fontis § v. Syr. simplicis | j. I ss bis die. Menorrhagia. 132b. ^ Aluminis 3 ss. Aq. Melissae Syr. simplicis a § ij. 3 j tertiis vel quartis horis. (3 years.) Pertussis. 132c. 5 Aluminis 0.4. Opii 0.03. Dentur tales doses 5. j bis vel ter die. Diarrhoea. Acid, tannic: gr. 2- Agaricin: gr. 1-12- Alumen: gr. 8- -10 = 0.13 —0.65. . ■§.= 0.005—0.032. -30 0.5 —2.0. Tannin. It is believed that, owing to its coagulating influence on albumen, it is not absorbed in the stomach, and cannot produce constitutional effects, until converted into gallic acid — hence, given by the stomach this is preferable; — but the gallic acid is probably again changed in the blood into Tannin by combining with Glucose. In Nightsweats, Tannin gr. ss — ij hora somni; in atonic Menorrhagia gr. ij tertiis horis in pill. ASTBINGENTS. 63 132d. 134b. IJ Aluminis 3j — 3 ij. IJ, Tr. Caps. Bursae Past. Tr. Opii gtt. xl. Syr. simplicis a 3 j- Syr. simplicis 3 ij. Extr. Uvae Ursi fl. Aquae Fontis § vj. < Scutell. fl. 7 3 ss. | jtertiishoris. Leac/ Cbftc. 3 ss ter die ante cibum. 133. Same. 5, Argenti nitrici gr. ss. 135a. Aq. Cinnamomi § iij. IJ Catechu 40.0. Syr. Flor. Aurantii § j. Cort. Cinchonae 20.0. 3 j quartis horis. Diarrhoea. Pulv. aromatici 10.0. {non-inflammatory.) 3 j ter die. JPulvis (3 years.) Ebriosorum. 134a. 135b. r> Tr. Caps. B. Past. | ss. IJ Catechu gr. xv. Elix. simplicis 3 jss. Pulv. Cretae comp. cum 3 j ter die. Enuresis F. pulvis Opio 3j. nocttcrna. After each stool. Diarrha a. Argenti Nitras: gr. £ — 1 = 0.015—0.065. Catechu: gr. 10 —30 = 0.G5 —2.0. Alumen is a powerful astringent; in large quantities the astriction may be followed by vomiting and purg- ing; even inflammation will set in. To prevent nausea it may be combined with aromatics; but it is perhaps most palatable in the form of whey, prepared by boiling 3 ij with milk Oj and straining. (Dose 3 ij.) In Gastralgia: Alum. gr. x ter die in caps, amy lac. {Astringents, mineral and vegetable, when used to check morbid discharges from the bowels, are better combined with Opium, as they do not restrain the peristaltic movements of the intestines without the latter.) Gapsella Bursa Pastoris is a very popular remedy in some parts of Germany for diarrhoea and almost all forms of hemorrhages. About 25.0 of the fresh, or 10.0 of the dried herb to one pint of water as tea, which is to be taken in 3 doses at intervals of two or three hours. 64 ASTBINGENTS. 135c. ]J Tin ct. Catechu 3 j. " Ratanhae 3jss. " Opii gtt. xv. Mixt. Cret. comp. § jss. After each stool. Dysentery. 135d. r> Tr. Catechu " Ratanh.'Jgtt.x — 3j. Mixt. Cretae comp. § ij. 3 j bis vel ter die. Diarrhoea Ablactator. 136. 3 Tr. Cinnamomi Elix. simplicis ? § j. Tr. arom. acidae 3 j. 3 j ter die. Palpitation. 137. $ Cotoinae 0.05—0.08. vel Paracotoin. 0.15 — 0.25. Alcohols dil. 10.0. Glycerini 30.0. Aq. destillatae 120.0. | ss omni hora vel bihorio. Diarrhoea, 138a. 3, Creosoti gtt. vj. Saponis med. J)j. F. pilulae 6. j after each vomiting. Vel: fy Creosoti gtt. vj. Acid, acetici dil. 3 j. Aq. fontanae § vj. 3 j bihorio vel tertiis horis. 138b. g, Creosoti gtt. x. Acaciae 3ij. Aquae Fontis § jv. 1 j fcextis horis. Dysentery. 138c. 5- Creosoti 5.0. Alcoholis 20.0. Glycerini 225.0, 4 c. c. ter vel quater die. Tuberculosis. 138d. ]J Creosoti gtt. j. Syrupi Acaciae 5 j. 3 j bihorio. Vomiting. (1 year.) Catechu Tr.: gtt. 20— 3 j = 1.0 —4.0. Cinnamom.: gr. 10 — 20 — 0.65 — 1.3. " Tr. gtt. 20— 3 j = 1.0 —4.0. Coioina: gr. 1—3 = 0.065—0.2. Creosot: gtt. 1—3 = 0.065—0.2. Cinnamonum is more of an aromatic stimulant than astringent, and chiefly used for its flavor. Creosot is an efficient remedy in Gastric Irritation and Haematemesis. In chronic Bronchitis, Creosot. 0.1 — 0.4 per diem in Malaga or 01. Jecoris is excellent; but it has to be used for a long time. ASTRINGENTS. 65 Vel: IJ Aq. Creosoti § ij. JEtheris gtt. x. Syr. simplicis \ j. 3 ij ter die. Cholera (3 years.) Infantum, 139. IJ Cupri sulf. gr. v — x. Opii gr. x. F. pilulae 10. j ter die. Dysentery. 140a. IJ Ergote pulveratse Cinnamomi 20.5. Dentur tales doses 5. j every 10-15 min. ex aqua. Vel: IJ Secalis cornuti Elaeosacch. Chamomili. Boracis T0.5. Pulvis obstetricus. 140b. IJ Extr. Ergotoe 1.0. Tannini 2.0. Aq. fontanel 225.0. 1 ssoainihora. Hematuria. Vel: IJ Extr. Ergote fl. 3 ij. " Digitalis fl. " Ipecac, fl. 2 3 j. 3 ss — 3 j pro dosi. Haemoptysis. Cupri Sulphas: gr. J — 10 == 0.015 — 0.65. Ergot. Extr. fl.: gtt. 10— 3 j = 0.32 — 4.0. " Tr. 3j— 3iij=4.0 —12.0. Ergotina: gr. 3 — 10 = 0.2 — 0.65. Cuprum (pp. 77 & 100) is occasionally of great benefit in some of the most obstinate forms of diarrhoea, and it is said to be a sure ta?nicide. See section vin. Ergot (Secale cornutum) is used in all kinds of hem- orrhages: in Dysmenorrhea, and to expel hydatids or polypi from the uterus; it is also valuable in Paralysis of the bladder. Being a most reliable oxytoxic its chief use is in midwifery, especially after delivery, to prevent flooding, etc. If taken too much it produces Ergotism, which assumes two forms, one attended with convul- sions, the other with dry gangrene on the limbs. In Diabetes Insipidus: Extr. fl. 3 j ter die; in Pulmon- ary Hemorrhage, 3 j — 3 ij omni hora vel media hora si opus est; in hemorrhage from Subinvolution, Hyper- plasia, Soft Engorgement, with profuse menstruation, Polypi, etc., Tr. 3 j ex aqua bis vel ter die. 66 ASTBINGENTS. 141. Ijt Extr. Erigerontis fl. 3 ij. Elix. simplicis ad | ij. 3 j ter die. Incontinence of Urine. 142. IJ, Tr. Ferr. acet. seth. 25.0. " Cinchona 50.0. Acidi citrici 3.0. Glycerinse 22.0. Gtt. xxx — lx ter die ex vino. Scorbut. 143a. ^ Tr. Ferri chlor. 3 iij. Spir. nitrico-seth. 3 vj. Tr. Cantharidum 3 ss. Aq. fontanae ad § viij. P. sexta bis die. Gleet. Spermatorrhoea, 143b. ^ Tr. Ferri chlorati 3 j. Aq. Cinnamomi § vj. | j ter die. Haemoptysis. 143c. ^ Tr. Ferri Chloridi 3 j. Ferri Sulphatis gr. x. Aq. Fontis § j. Followed by Pot. Carb. 3j, dissolved in water. Cyan Poisoning. 144. # Liq. Ferri Nitrat. 3 j. vel " " Subsulphatis Syrupi simplicis § j. Aq. destillatae | v. | ss ter die. Diarrhoea, (with Ancemia.) Erigeron Extr. fl.: ; Ferrum acet. Tr. gtt. " chlor. Liq.: gtt. " " Tr.: gtt. " nitr. Liq.: gtt. " subsulf.Liq.:gtt. ^ss — 3j= 2.0 20— 3j= 0.7 2—10 =0.13 10—60 = 0.35 2—12 = 0.13 —4.0. —4.0. —0.65. —2.0. —0.8. 1 — 8 = 0.065—0.5. Erigeron Canadense is mostly used in nephritic dis- eases, Gravel and Hemorrhages. Oleum Erigerontis , gtt. 5 — 20 bihorio in Metrorrhagia. Ferrum — Though the preparations of iron are more or less astringent, they are chiefly used as tonics. See section v. As astringent, Tr. Ferri Chloridi (Tr. Ferri chlorati) — Liq. Ferri Chlor. partes 35 et Alcohol, partes 65 — is generally preferred, which has moreover some specific action on the urino-geuital apparatus. Liq. Ferri nitr. may be replaced by Liq. Ferri chlor. (pond. spec. 1.48) et Aq. p. 2. Liq. Ferri subsulf. (Monsel's Solu- tion): Gtt. 1 — 3 ex aqua in Hsematemesis. ASTRINGENTS. 67 145. IJ Tr. Kino 3 ss — 3]. Mixt. Cret. comp. § ij. 3 j tertiis horis. Diarrhoea Ablactatorum. 146. IJ Olei Macidis 2.0. Spiritus aetherei 25.0. Gtt. xij bihorio. Colic, (hepatic.} 147. IJ Plumbi Acetatis gr. j. Opii gr. \. Dentur tales doses 6. j ter die. Dysentery. Vel: IJ Plumbi acetici gr. ij — iij. Opii gr. ss. Placenta Prcevia. 148. IJ Extr. Ratanhae 5.0. Aq. Cinnamomi 150.0. Mixt. sulf. acid. 1.5. Syr. Aurant. C. 25.0. 1 6 c. c. omni hora vel biborio. Metrorrhagia. Vel: IJ Extr. Ratanhae Glycerini 1 10.0. Glycerolati simpl. 80.0. 3 j omni hora vel bihorio. 149. IJ Extr.Rhud.arom.fi. 3 ss. Tr. Strychni gtt. x. " Ferri chlorati 3 j. Elix. simplicis 3 iij. Gtt. xx ter die post cibum. Incontinence of Urine. 150a. IJ 01. Terebinthinae 5.0. .Etheris 20.0. Gtt. xv — xxx ex aqua sacch. mane nocteque. Hepatic Colic. 150b. IJ 01. Terebinthinae Sodii Bicarbonat. ? 3 j. Mucil. Acacias 3 j. Mixt. Amygdalar. 3 vij. Pars sexta quartis horis. Hematuria. Kino Tr.: 3 ss— 3 ij = 2.0 — 8.0. PlumbiAcetas.gr. 1—3 =0.065 — 0.2. Ratanh. Tr. : 3 j— 3 ij = 4.0 — 8.0. Terebinth. 01. gtt. 10— § ss = 0.65 —16.0. Kino and Hatanha (Krameria) are similar to Catechu (p. 63,) and much used in Pediatrics. Plumbum: A prolonged use of the preparations of lead in chronic diseases is more or less dangerous, from their liability of poisoning the system, known generally by 68 ASTRINGENTS. 150c. 151b. fy 01. Terebinth. 30.0. 5 Dec. Uvae Ursi 200.0. Vitell. Ovorum No. 2. Tr. Catechu Aq. Menth. pip. 250.0. Syr. Zingiberis T 15.0. Syr. simplicis 50.0. 32 c. c. bihorio. 16 c. c. every \ hour; after- Gonorrhoea secundaria. wards every hour. Vel: Phosphor Poisoning. £} Extr. Uvse Ursi fl. 3 ij. 151a. Tr. Kino r£ Extr. Uvse Ursi 10.0. Syr. Zingiberis ^ § ss. Sacchari albi 50.0. Aq. fontanae § iij. Divide in 30 partes sequales § j quartis horis. Pulv. *\ quater die. Gravel. Incontinence of Urine. UvaUrsi, Extr. fl.: 3ss— 3 j = 2.0—4.0. the characteristic discoloration of the gums, etc. The most common form of lead poisoning is that known as painter's colic. Some forms are characterized by par- alysis or painful cramps. Oleum Terebinthince is best given with some mucilage. Pulvis Saponis makes a good emulsion with it in the proportion of 0.66: 30.0, or 1:50. Hyposulfite of Soda deodorizes it. See Sulfites, section i. In Typhoid, where the abdomen is tympanitic, the tongue dry and the bowels ulcerated, gtt. 5 — 20 of the oil on sugar every hour or two; 3 j tertiis horis in Hema- turia; the same dose every other day in Neuralgia. Uva Ursi (Arctostaphylum) has a particular control over discharges from mucous surfaces; hence its use in Catarrh of the Bladder, chronic Bronchitis with profuse discharge, etc., etc. SECTION V. RESTORATIVES. They ultimately restore general health, by either gradually, but permanently, invigorating nerve-force: Tonics; or by rapidly, though but temporarily, rousing the vital functions of the organism: Stimulants. Acida Mineral: Tonic, Astringent. Albumen: Nutrient. Alcohol: Stimulant. Ammonium: Stimulant, Antacid. Argentum : Tonic. Arnica : Stimulant. Bebeeria: Tonic, Antiperiodic. Berberis: Tonic, Antiperiodic, Cathartic. Caffein: Stimulant, Antiseptic. Cantharis: Stimulant, Tonic, Diuretic. Capsicum: Stimulant. Chininum: Tonic, Stimulant, Antiperiodic. Coca: Tonic, Stimulant. Cuprum: Tonic, Astringent. Digitalis: Tonic, Diuretic. Ergota: Stimulant, Astringent. Ferrum: Tonic, Astringent. Gentiana: Tonic. Glycerina: Tonic, Nutritive, Laxative. Guar ana: Tonic, Astringent. Heloni as : Stimul ant. 10 RESTORA TIVES. Hydrastis: Tonic, Alterative, Antiperiodic, Chola- gogue, Deobstruant. Ipecacuanha: Tonic, Emetic. Mangamm: Stimulant, Antiseptic. Nux Vomica: Stimulant, Tonic. Pancre atinum : Digestive. Paraguayensis, Ilex: Tonic. Pepsina: Digestive. Pepton : Digestive. Phosphorus: Stimulant, Tonic. Rheum: Tonic, Astringent, Cholagogue. Sabika: Uterine Stimulant. Zincum: Tonic, Stimulant. Stimulants and Tonics. 71 152a. IJ, Acid, hydrochlor. d. Tr. Zingiberis a 3 ij. gi Nuc. Vomicar. 3 j. Syr. C. Aurantior. § j. Aq. destillatae ad § viij. § j ter die post cibura. Dilatation of Stomach. 152b. IJ Acid, hydrochlor. dil. gtt. xl. Tr. Nuc. Vom. gtt. xx. Aq. Cinnamomi | j. 3 j ter die. (4 years.) 153. IJ, Acid, nitro-mur. dil. Tr. Zingiberis 7 3 ij. Tr. Nuc. Vomicae 3 j. Aq. fontanae ad § viij. § j ter die post cibum. Dyspepsia. 154a. IJ, Acid, phosph. d. 3 iij. Tr. Ferri chlor. 3 jss. Syr. simplicis f j. Aq. Menthae ad. 3 viij. I ss ter die post cibum. Same, if Anwmia. 154b. IJ Acid, phosph. dil. 3 ss. Tr. Nucum Vomic. 3 ij. Syr. simplicis § j. Aq. fontanae ad 3 viij. I ss ter die. Hectic. 155a. IJ Acid, sulfurici diluti Tr. Card. comp. ^ 3 ij. " Nucis Vomicae 3 j. (Tr. Cinchon. co.) 3 ss. Syr. simplicis 3 j. Aq. destillatae ad 3 viij. 1 j ter die post cibum. Dyspepsia. Acid, hydrochlor. d.: " nitro-mur. d.: " phosphor, d.: " sulfuricum d.: gtt. 5—30 = 0.35—2.15. gtt. 2—20 = 0.15—1.5. gtt. 10—60 = 0.65—4.0. gtt. 10—30 = 0.65—2.3. Mineral Acids are usually classed with tonics, and though they exert a considerable corroborant influence on the system, their action is in many respects peculiar. See sections in. and iv. Acidum nitro-muriaticum should not be given with mercurials. Acidum phosphoricum is very valuable in Softening of the Brain. In Hysteria, Defective Menstruation and Spermatorrhoea, 5.0 — 15.0 per diem. Acidum hydrocliloratum dilutum, 1:3 Aqua; Acidum nitricum dilutum 9 1:4 J. 72 RESTORATIVES. 155b. 155c. $ Acid, sulfurici d. 3 j. IJ Acid. sulf. dil. 3 jss. Tr. Cardam. comp. Spir. setherei | ss. " Gent. comp. ^ § j. Glycerinse | j. Infusi Colombo § jv. Aq. fontanae ad § viij. | ss ter die. Chlorosis. § j quater die. Restorative. Induration of Cervix. {after illness.) Acid, nitrohydrochlor. dilutmn, 3 et 4:25. The mixed acids are left in a bottle for 24 hours, sometimes shaken, and then the 25 parts of water added. Acidum sulfuricum dilutum, 1 :5 Aqua. (p. 61.) Alcohol is the best stimulant to rouse and support the system in asthenic diseases, exhausting hemorrhages and suppuration; and after the use of the wet sheet, etc., if there be a sensation of chilliness. In Typhoid, etc., it probably acts as a physiological antidote to the blood poison, and should be given in the very first stages of the fever. Brandy, § ss — § j hourly (Vinum, § j every 6 — 8 hours) if much prostration, pulse being above 120; or if the systole becomes less intense and resembles more the secSnd sound, as it will produce more force and less frequency of the pulse, even reduce temperature and diminish delirium. (If excitement is produced, it is not indicated, or the doses are too large.) In Diphtheria, with or without Quinine, as much as can be borne without producing Alcoholism, is said to be curative. In Dysentery, if great prostration (40 oz. in 24 hours have produced no excitement.) In functional disorders of the stomach it is generally beneficial; but in Gastritis, brandy frequently produces distress. In Diarrhoea, if much prostration, to child of 5 — 8 months gtt. v in 3 j of milk every 2 hours; the same in collapse of Cholera Infantum. In Sporadic Cholera, \ oz. with water at short intervals, if much prostration and it be borne; in Asiatic, with water for thirst, and \ oz. with 2 oz. of tea as enema every half hour or hour during collapse; in Pneumonia, if pulse frequent, thrilling, but Stimulants and Tonics. IS 156. 5 Album. Ovorum No. 4. Aq. fontanae 1000.0. Cyathus viuosus every 5 — 10 minutes. Sublimate Poisoning. 157a. IJ, Spir. Ammon. arom. " setherei 7 3 j. " Vini Gallici 3 ij. 3 ss — 3 jprodosi. Syncope. 157b. ]J Spir. Ammon. arom. 3 ]- Tr. Card. comp. § ij. Syr. Zingiberis | j. 3 ij semis horis ex aqua. Cholera. 158a. Ij, Ammon. Carb. 3j. Spir. aetherei 3 j. Aq. Menth. pip. § vj. P.quartasubinde. Syncope. 158b. 5 Ammon. carb. gr. xxv. Tr. Card. comp. 3 ij. Aq. Fontis | iij. Pars semis cum Acid. citr. gr. xv. Insolation. 158c. 5 Ammon. carbon. 3 j. Tr. Cardam. comp. " Cinchon. ^ 3 ij. Aq. fontanaa ad § vj. | ss ter die. Embolism. Ammon. arom. Sp. gtt. Ammon. Carbon.: gr. 20— 3 j = 1.0—4.0. 3—10 = 0.2—0.65. compressible. (To child of 14 months 1 oz. was given hourly, besides Ammon. carb. and Morph. and the pulse fell from 200 to 120, and respiration from 120 to 50 per minute.) In Yellow Fever, per os et per amim, to sustain the strength; in Cerebro-spinal Meningitis; in Angina Pectoris; in Insolation or Passive Hyperemia or Embolic Apoplexy, etc. In Tetanus it may be given until intoxication. Ammonii Carbonas (p. 43) is especially valuable in Pneumonia; but it is also employed in expediting the eruption of exanthematous fevers, either as Carbonate pure in powder or watery solution; or converted into the Acetate. With Camphora (No. 55) it is sometimes of especial value in Cholera; and combined with Aci- dum salicylicum, both its internal and external use has been recommended to counteract the effects of snake poison. 74 RESTORATIVES: 158d. r> Ammon. Carb. 3j. Extr. Chelidonii fl. vel " Stilling, fl. 3 iij. Aq. Menthse ad § vj. | ss ter die. Icterus, 159a. 5- Ammon. Carbon. 3jv. Ferri Tartratis 3 ss. Syr. Zingiberis § j. Inf. Colombo § vij. § ss ter die. Hysteria. 159b. 3 Ammon. carbonici Ferri ammoniati ^ 3j. Syr. Zingiberis § j. Inf. Colombo § v. | j ter die. Alcoholism. 160a. t> Argenti nitrici cryst. Micae Panis Acacise ~ gr. x. F. pilulae 12. Paralysis. j ter die. (bulbar.) (for several weeks. ) 160b. r> Argent, oxydat. gr. vj. Extr. Hyosc. gr. xxjv. F. pilula3 12. j bis vel ter die. Epilepsy. 161. Bebeeriae sulfuric. 2.0. Acid. sulf. dil. gtt. xxv. Syr. C. Aurantior. 30.0. Aq. destillatse 160.0. c. c. ter die. Tonic. 5 16 Argent. Nitras: gr. J — 1 Argent. Oxid.: gr. \ — 2 Arnica Tr.: gtt. 15 — 3 j Bebeer. Sulfas. : gr. 5 — 3 j 0.015—0.065. 0.015—0.13. 0.5 —4.0. 0.32 —4.0. Argenti Nitras (Argentum nitricum) is one of the most valuable remedies in Epilepsy. It is also used in Locomotor Ataxia and Chorea. If used for some time it has the effect of discoloring the skin, which is not the case with the oxide. In. Chorea and Neuralgia: Arg. iodatum 0.004 — 0.01 ter die, vel Arg. cyanatum 0.002—0.006 ter die. Argent, tod. 0.1 = Arg. nitr. et Kal. iodatum 7 0.07. Arnica is occasionally of value in Amaurosis, Paraly- sis and other nervous affections. Tr. gtt. xx — xxx in nervous headache with Tinnitus aurium. Bebeerinum (from Nectandra Rodiaei) and Berberina (from Berberis vulgaris and Hydrastis Canadensis) are said to be tonics of first order (page 24.) Stimulants aud Tonics. 75 162 e r> Extr. Berberis fl. § j. Extr. CocaB fl. 3 ss. M Cypripedii fl. M Valerianae fl. IT 3 ij. Elix. simplicis 3 ij. 3 j ter die ante cibum. Uterine Tonic. 163. 5 Coffeini citrici 1.0. Alcoholis diluti 16.0. Chloroformii 12.5. Gtt. xv — xx semis horis. Migraine. 164a. 5 Tr. Cantharidum " Capsici " Colombo ? 3 j. Mucilag. Acaciae ad 3 ij. 3 j ter die. Menorrhagia. 164b. 5- Tr. Cantharidum " Cinchon. comp. " Ferri chlorati " MyrrhsB ^ 3 ij. Gtt. xx ter die. Spermatorrhoea. 165. ]J Capsici pulv. 3 ij. Sacchari albi 3 j. Divide in p. 4. Delirium j omni hora. tremens. 166a. 5 Chinin. sulfur, gr. xv a Acid. sulf. diluti 3j. Tr. Cardam. comp. " Humuli JT 3 iij. Inf. Rosarum ad § vj. I ss bis vel ter die. Chlo?*osis. Berber, aquif. Extr. fl.: gtt. 20— 3 j = 1.0 —4.0. Caffeina: gr. 1— 2 = 0.065—0.13. Cantharis Tr.: gtt. 4—15 = 0.13 —0.5. Capsicum: gr. 2 — 10 =0.13 — 0.65. " Tr.: gtt. 10— 3 j =0.32 —4.0. Caffeina (Coffeinum) in headache may be given 0.03 — 0.05 every half hour or hour; 0.05 — 02. every 2 — 4 hours. Cantharis (Cantharides) must be used with caution. See page 47. Capsicum is often used as an adjunct, to rouse the susceptibility of the stomach, chiefly in the Dyspepsia of drunkards: Tr. 3 j — 3 ij. Quinince Sulphas (Chininum sulfuricum) is very much used as stomachic or general tonic; only where gastric susceptibility exists, as in convalescence from acute diseases, some of the simple bitters are preferable. 76 RESTORATIVES: 166b. IJ Quininae Sulphatis Acid. sulf. dil. ? 3j. Syr. Zingiberis § jv. 3 j ter die. Anosmia. 166c. 5 Chinim sulfurici 3 ss. Pulveris Rhei 3 j. Divide in partes 30. Same. j ter die. {with Anasarca.) Vel: I£ Chinini sulfurici 3 ss. Extr. Gentianae 3ij. Pilul. Rhei comp. 3jv. F. pilulae 30. j ter die. Vel: rj Chinini sulfurici 3ij. Rad. Zingiberis ±>j. F. pilulae 20. Menorrhagia. j ter die. Mania. 167a. 5- Chinin. sulf. 3ij. Ferri sulfurici 3j. Acid. sulf. arom. gtt. x. Divide in 20 partes aequales in capsul. gelatinos. j ter die ante cibum. Pelvic Abscess. 167b. rj Quininae Sulphatis 3j. Tr. Ferri Chloridi 3 ss. Syr. C. Aurant. § j. Aq. destillatae § vij 3 j bis vel ter die. Pulmon. Gangrene. Vel: t> Tr. Cinchonas " Gentianae 'a -| j Liq. Potassae 3 ij. Aq. Menthae § vj. § j bis vel ter die. Same. 167c. 5 Tr. Cinchon. comp. " Colombo " Gentianae " Quassiae ^ | j. Morph. sulf. gr. j — ij. 3 j ter vel quater die. Delirium tremens. 168a. t> Cocain. hydrochl. gr. j. Alcoholis q. s. Aq. destillatae f ss. 3 j every \ hour if neces- sary. Vomiting of Pregnancy. Cinchon. Tr.: 3 j — 3 iij = 4.0—12.0. In Anasarca, etc., it is supposed to restore the lost albumen to the blood. See page 11. As tonic to child of 4 years may be given gr. \ bis die; in Dropsy from Dysentery, gr. \ ter die. (3 years.) Cocaine. Aside from being a most valuable local anaesthetic, it is one of the best remedies in affections of a nervous nature, General Debility, Hysteria, Spinal Irritation; it is also used in Anaemia and Consumption, Stimulants and Tonics. 77 168b. 170. £> Cocaini hydrochlor. r>, Cupri ammoniati 1.5. gr. iij. Aq. destillatse 25.0. Alcoholis diluti Gtt. v bis die. Chorea. Glycerinae Vel: Aq. destillato 7 3 ij- g Cupri ammoniati 3j. 3 ss — 3 j ter vel quater die. Micae Panis q. s. Angina Pectoris. F. pilulae 40. 169. j hora som^i. Epilepsy. g Tr. Cupri acet. R. 3j. 171a. Aq. destillatae | jv. IJ Inf- Digital. ( 3 j) | vij. 3 j ter die post cibum. Syr. Cinnamomi § j. Albuminuria. § j hora somni. Epilepsy. Cupr. ammoniat. : gr. \ — 1 = 0.015 — 0.065. Digital. Extr. fl.: gtt. 5—40 = 0.18 —1.3. In Angina Pectoris it does not shorten the paroxysms, but it relieves them, and after a few days use they disappear altogether. It is also a reliable aphrodisiac, and in Alcoholism it is said to be the remedy par ex- cellence, as it will even produce disgust of the drinking habit. Unfortunately, if not given with care, it may produce Cocainism, which is to Morphinism what a full grown oak is to a sapling. See pp. 109, 112 and 115. As cardiac stimulant it is usually given in doses of grain \ — 1 bis vel ter die. In Seasickness, Cocaine 1 per cent, solution gtt.v ter die on apiece of ice. Extractum Cociefl. 3 ij — 1 ss in timidity (for public speakers.) Extractum Cocce fluidum 3 j = gr. 1^ of Cocaine (?). Cupri Sulphas (Cuprum sulfuricum) is mostly used as astringent; as tonic, in doses of gr. \ — 1 in pill, repeated, so as not to occasion vomiting, it is a good remedy in obstinate Intermittens, Neuralgia and essen- tial nervous diseases, (p. 65.) Tr. Cupri acetici Rade- macheri is very efficacious in Bright's Disease. (After 3 weeks use the albumen in the urine is usually much diminished, and scarcely any blood left.) Cuprum IS RESTORATIVES: mt>. 172a. 5 Tr. Digitalis $ Ergotinae Spir. aetherei ? 5.0. Ferri sulfurici Tr. Colombo 10.0. Aloes ^ gr. x. 4 c. c. bis die. Palpitation. F. pilulae 10. lYlc. j mane nocteque. 3 Tr. Digitalis 3j. Vel: Spir. nitrico aeth. | ss. 1J, Tr. Ergotae 3 ij. Tr. Cardam. comp. § j, Syr. Croci § ij. Aq. fontanae ad § vj. Dec. Aloes comp. § vj. § j bis die. Valv. Lesions. 3 ss ter die. Amenorrhea. Digitalis Tr. : gtfc. 10—80 = 0.32—2.6. ammoniatum 0.1 — 0.15 per diem in Neuralgia Nervi Quinti is said to be almost specific. Digitalis is very useful in most heart diseases — Dilata- tion, fatty degeneration, failure or irritability of heart's action, and valvular lesions, etc., provided the action be feeble, as it increases the force of the cardiac contrac- tion and diminishes the irregular movement — in incom- plicated Hypertrophy it is, of course, objectionable. On account of its diuretic property it is frequently employed in dropsical effusions, especially in conjunction with Colchi- cum (p. 50) or Potassium (p. 96); even as embrocation it is of value (p.144.) (As cardiac tonic, Strophanthus is said to be superior to Digitalis, as, aside from not causing the slightest disturbance to digestion,it is neither depressing nor cumulative in its effects.) Inf. Digitalis (No. 1*71) in Epilepsy should be given in 1 oz. doses only for one week; in the second week it may be increased to 1-J- oz. and the third to 2 oz., until sickness of stomach and dilatation of pupil, when the dose has to be reduced. In Insomnia and forgetfulness of old people: Extractum fluidum gtt. v tertiis horis; in Delirium tremens: Tr, 3 j in 2 doses after an interval of 4 hours. Ergot (p. 65) is a special stimulant to the spinal marrow and the uterus, hence the remedy par excellence Stimulants and Tonics. 79 172b. 173b. t> Extr. Ergotae i> Ferri carbon, gr. xxjv. Camphor* IT gr. x. Radicis Rhei F. pilule 10. " Zingiberis j bis die. Spermatorrhoea. Extr. Gentian IT gr. xij. 172c. F. pilulse 12. r> Extr. Ergotae fl. 4.0. j ter die. Meteorism. " Viburni fl. 6.0. 174a. Gtt. xv ter vel quater die. 5 Liq. Ferri sesquichlorati Dysmenorrhea. Syr. simplicis ^ 10.B. 173a. . Mixtis adde r> Tr. Ferri acetici 3 j. Liq. Ammoni caust. Syr. Zingiberis 3 j. Spir. Menthae p. ? 5.0. Aq. Pimenti ad § vj. Gtt. xx — xl ter die ex aqua. I j ter die. Exhaustion. Steel drops. Ferr. acet. Tr.: gtt. 20— 3 j = 0.7 —4.0. " carbon.: gr. 5 — 15 = 0.32 — 1.0. " chlor.Liq.:gtt. 2 — 10=0.13—0.65. " " Tr.: gtt. 10— 60 =0.35—2.0. in all cases of uterine inaction, unless the coexistence of certain circumstances prohibits its use. Combined with iron it is very often of benefit in Incontinence of Urine. The addition of Strychnine gr. 1-20 (No. 172a) is some- times particularly useful. {Ergotina is another name of the Extract of Ergot, which has a share in the existing confusion of the present nomenclature — see my re- marks on this subject in Preface.) Ferrum introduced into the stomach is changed into a sulfuret, and it is only during this process that its absorption takes place. Ferri Chloridum (Ferrum chloratum) is the most effective iron salt, a non-poison- ous antiseptic, antizymotic and haemostatic, and milder than Ferri Sulphas, (p. 66.) The liquor taken with Glycerin or with milk will lose the styptic taste, nor will the teeth suffer. No. 174b contains 3 per cent. Ferrum, and if the chloride be of 1.26 spec, gravity, the proportion to Glycerin would be = 33:67. Ferri Car- 80 BESTOBATIVES: 174b. 175b. r> Liq. Ferri chlor. 20.0. I> Ferri Sulphatis (pond, specif. 1.48.) Sodii Bicarbonatis Glycerinae 80.0. Extr. Gentianae ^ 5.0. 3 j — 3 iij ter die e lacte. F. pilulae 75. iij — jv daily. 174c. Vel: 1J Liq. Ferri Chloridi 2.5. IJ, Ferri sulfurici 5.0. Glycerini 97.5. Extr. Myrrhae 4 c. c. every -J- hour. Croup. Galbani ^ 15.0. 175a. F. pilulae 150. IJ Ferri sulfurici 3j. v quater die. Chlorosis. Extr. Gentianae J)ij. Vel: F. pilulae 40. r> Sol.Ferri etPot.Tartrat. ij bis die. Urethral (20.0—30.0) 200.0. (j: 7 years.) Inversion. 3 ij as drink. Ferr. dialysatum: gtt. 10—40 = 0.65 — 2.6. " oxyd. hydr.: gr. 5 — 20 = 0.32 — 1.3. " sulfuricum: gr. 1 — 3 = 0.065 — 0.2. Ferro-Kali tartar.: gr. 2— 8 = 0.13 — 0.5. bonas (Ferrum carbonicum) gr. iij bis die to improve digestion. In Chorea from fright. (6 — 10 years.) Ferrum dialysatum gtt. ij — v bis vel ter die in Heartburn. It is almost tasteless, and with water perfectly miscible. Ferri Oxidum hydratum (Ferrum oxy datum) is easily dissolved in the stomach, therefore small doses of it have the same effect as big ones of the other oxides. Fresh prepared, it is of special value in poisoning with Arsenic, for which reason a bottle with Liq. Ferri ter- sulf. should be always at hand. An expeditious pre- paration of the hydrated oxide of iron in cases of arseni- cal poisoning may be performed in the following manner: To Liq. Ammon. U. S. P. 240.0, previously diluted by double its quantity of water, add Liq. Ferri tersulf. 300.0, previously diluted by 3 liters of water, constantly stirring. Pour the whole on a muslin strainer, and after having pressed with the hand the water all out Stimulants and Tonics. 81 176a. 177. 5- Ferri Vin. amar. § iijss. 5 Inf. Gentian, comp. Tr. Nuc. Vomic. § ss. vel Inf. Colombo § vj. Sol. Potass, arsen. 3 ij. Liquor. Potassae 3 iij. 3 j ter die post cibum ex 3 ss ter die. Induration aqua. Same. of Cervix. 176b. 178. IJ, Ferri Yin. dulc. I> Extr. Guaranse fluidi Tr. Colombo a 3 jv. Elix. Valer. ammon. Kalii bromati 3 v. Glycerini 'a | j. 3 ij ter die ex aqua. 3 j — 3 ijterdie. Heartburn. Pelvic Peritonitis. Cephalalgia. Ferri Vinum: 3 j — 3 jv = 4.0 — 16.0. Gentiana Extr. fl.: gtt. 20— 3 j = 1.0— 4.0. " Tr. 3 j — 3 ij = 4.0— 8.0. Glycerinum: 3 ss— | j = 2.0 — 32.0. Guarana Extr. fl.: gtt. 20 — 3 j = 1.0 — 4.0. of the precipitate, add enough water to make the whole 600.0 (about 20 oz.) Gentiana lutea possesses in a high degree the tonic powers which characterize the simple bitters; therefore its value in cases of debility of the digestive organs, or where a general tonic is required. Glycerinum (Glycerina) is, like alcohol, an indifferent and very hygroscopic substance; and Glycerinismus, chronic or acute, is said to be likewise similar to Alco- holism. It is used in Phthisis as nutritive instead of cod liveroil; in Diabetes mellitus, 150.0 — 200.0 daily, instead of sugar; and sometimes in Dyspepsia (3.0 — 5.0 after meals), especially if feces hard and dry. Barring a few chemicals, which like Argenti Nitras, Potassii Perman- ganas and Acidum chromicum, are decomposed by it, Glycerina is, on account of its great solvent power, one of the most important menstrua we possess — 100 parts, for instance, will readily dissolve 10 p. of Acid, benzoicum, the same quantity of Acidum boricum, 40 p. of Alum, 50 p. of Tannin and 60 p. of Borax. 82 BE STOMA TIVES: 179. 181. r> Extr. Helon. fl. § j. r> Vin. Ipecacuanh. 3 ss. Glycerinse % ij. Gtt. iij omni hora. | ss ter die. Hysteria. Vomiting of Pregnancy. Uterine Tonic. 182. 180a. 5- P°t- Permang. gr. ij — v. IJ Hydrastin. gr. vj. Aq. destillatse § ss. Extr. Capsici gr. j. This dose ter die. F. pilulae 6. Insomnia. Amenorrhea. j ter die. Irritable Stomach. 183. 180b. ^ Extr. Strychni gr. x. §, Hydrastin. 3 ss. " Hyoscyami Extr. Nuc. Vom. gr. jv. Chinin. sulfurici T 3j. F.pilulsel6.Consp.Cinnam. F. pilulge 20. j ante cibum. JDyspepsia. j ante prandium. JPhthisis. Helonias Extr. fl. : 3 ss — 3 j =2.0 — 4.0. Hydrastis " fl.: gtt. 20 — 3 jv = 1.0 — 16.0. Ipecacuanh. Vin.: gtt. 3 — 3j =0.1 — 4.0. Mang.Pot.Per.: gr. f— 5 =0.032— 0.32. Nux Vom. Extr.: gr. -J— 1 =0.008— 0.065. " " Tr.: gtt. 5—20 =0.16 — 0.65. Ipecacuanha is chiefly used as emetic. See section vn. As tonic and stomachic, gr. 1-10 subinde; in Dys- entery, one 3 ss dose in capsul. amyl. v. galatin. every night, after having prepared an hour before its adminis- tration the stomach by Opium (gr. j) p. os, or by Mor- phinum hypodermically. (p. 110.) In Convulsions from eruptive fevers, gr. -J- — J every 10 minutes. (3 years.) Permanganas Potassii (Potassae Permanganas — Kali hypermanganicum) though excellent in Dysmenorrhea from torpor, is contra-indicated in the congestive and obstructive forms. In defective Menstruation its use should be commenced a few days previous to the men- strual period. Sometimes it is employed in Impotence from Anaemia and depression. In the administration of it, glycerin or alcoholic menstrua must be avoided, as it is decomposed by them. Stimulants and Tonics. 83 184a. 184b. IJ, Strychnine Nitratis 0.1. IJ Strychn. nitrici gr. ij. Glycerini 10.0. Conf. Rosarum q. s. Gtt. jv— xij (0.002— 0.00G) F. pilulse 24. bis vel ter die. Paralysis, j bis die. Paraplegia. Vel: 184c. IJ Strychnini gr. j. IJ Tr. Strychnini 5.0. Acidi acetici gtt. ij. Aq. Laurocerasi 10.0. Elix. simplicis | ij. Gtt. x mane nocteque. 3 j mane nocteque. Vomiting of Pregnancy. Strychnina gr. 1-60—4 = 0.001—0.008, Nux Vomica (Strychnos) is the remedy par excellence in torpid or paralytic conditions of the motor and sensi- tive nerves, or of the muscular fibre, if not dependent on structural lesions; hence its value in lead palsy and paralysis from drunkenness. It is no less useful in Par- alysis, the consequence of cerebral hemorrhage, which continues often for an indefinite time after the absorp- tion of the effused blood, as in Amaurosis without cere- bral complications. As general tonic, whenever there is a loss of nerve power, Impotence, Spermatorrhoea, In- continence of Urine, etc., it seldom fails to give satisfac- tion. It has, however, to be used with caution, though a tolerance for it is soon established in the system. In Vomiting of Pregnancy, Tr. Nucis Vomicae gtt. ij — iij bihorio; in Gastralgia or Chronic Vomiting, Extr. Strychni gr. ^, vel Strychninum gr. 1-10 ter die; in Chorea, gr. 1-25. Action and dose of the various salts of Strychnina are about the same. (0.01 is the strong- est dose, and 0.03 per diem — 0.05 may kill.) The best Antidote is Chloral 2.0 — 4.0 or Morphium (1:2 parts Strychn.) in Aq. Amygdalar. amarar. cone. (See page 6.) Tr. Strychnini — Strychnin, 0.1. Alcohol, dil. 20.0. (1.0=0.005.) 84 RESTORATIVES: 185. 187b. IJ, Pancreatini IJ Pepsini 3jv. Acaciae ^ 5.0. Acid, hydrochl. d 3 j. Natri carbonici vel " nitrici dil. Boracis ^ 1.0. vel " phosphorici d. Aq. f ontanae 10.0. Tr. Nuc. Vom. a 3 ij. Olei Jecoris 60.0. Glycerinae \ ij. Aq. Menthae pip. 20.0. Aq. Fontis ad | viij. 8 c. c. subinde. Debility. 3 ss ter die post cibum. 186. Dyspepsia. IJ, Extr. Paraguayens . fl. 187c. Elix. simplicis ^ I N- IJ, Pepsini gr. xv. 3 j- 3 ijterdie. Exhaustion. Acid, phosph. d. gtt. xv. 187a Tr. Cinnamomi 3 ij. IJ, Pepsini 2.0. Syr. simplicis Salicini 1.0. Aq. f ontanae ^ % j. Glycerinae 50.0. 3 j omni bora. 4 c. c. pro dosi. Cholera Infantum. Pancreatin: gr. 5 —25 = 0.32—1.6. Pepsinum: gr. 5- —15 = 0.32—1.0. Pancreatin is a good digestive, especially of fatty matter, and may be given in alcobol or glycerin. Ilex Paraguay ensis furnisbes a beverage, wbich in some parts of S. America fills tbe place of our tea and coffee; but it does not exalt the peripheral nerves like the former. It is very efficient in exhaustion from hunger and fatigue. Pepsine dissolves albuminoid substances and converts them into peptones; but it is, without an acid, inert, and its best solvent is hydrochlor. acid. Whilst pure Pepsine will dissolve 450 times its weight of albumen, the saccharated Pepsine, U. S. P., dissolves only 50. It is probably more efficient in the treatment of children than of adults. Cancer, Erosions and Ulcers of the stomach prohibit its exhibition; in these cases Pepton would be indicated, as this enters the blood without previously undergoing digestion. Stimulants and Tonics. 85 188. 189c. 3 Pepti pultif. 25.0. R Phosphori gr. j. Laclis 1000.0. Strychnini gr. jss. As food. Convalesce?is Ferri carbonici 3 ij. of Infants. Chin, sulfurici 3 j. I89a. F. pil. LOO. Consp. Cinnam. 5 Phosphori gr. ij. 190. 01. Terebinthinae 3ij. 5 Tr. Rhei vinos*© 50.0. Spin Rosinarini 3j. " Cardam.comp. 10.0. iEtheris ad 3 ijss. 16 c. c. ex vino. Stomachic. Gtt. vj bihorio. 191. Palsy of tongue. IJ Radicis Rhei 3 j. ]89b. Natri bicarbonici 5 Elix. Phosphori et Tr. Colombo. 7 3 ij. Damian. § ij. Aq. Menthae ad § vj. 3j ter die. Impotence. 3 ij t.d. Pruritus pudendi Phosphorus: gr. 1-60—1-12 = 0.001—0.005. Rheum: gr. 5—30 = 0.32 — 2.0. " Extr. fl.: gtt. 30—60 =1.0 —2.0. Phosphor is much employed in degeneration of nerve tissue and in nervous exhaustion, especially in Neuralgia and cerebral softening. In overdoses it is a most violent blood-poison; if chronic: Ptyalism, inflammation of gums and respiratory organs, with bleeding ulcers in the mouth; if acute: Gastro-enteritis, faintings, cramps, paralysis, etc. As tonic it may be given in doses of from 0.0003 — 0.0005 ter die; and in Impotence, etc., 0.001 — 0.005; but the use of Zinc, phosph. is decidedly preferable. As for Damiana (189b) it produces Polyuresis, with excitement of the sexual organs, but it may be thor- oughly replaced by Bucco or Ferrum. After its use for 2 — 3 months the sexual functions are said to be re- established, which result is perhaps better obtained with small doses of Ferri Chloridum, Quinine and Aromatics. Rheum (p. 94) is only in small doses a tonic and also a little astringent. (Nos.117 & 166.) As digestive it is given in doses of from 0.2 — 0.5. 86 RESTORATIVES: 192a. # Olei Sabine 2.5. Tr. Colocynthidis " Capsici ? 5.0. " Arnicae 10.0. Gtt. x — xx quater die ex aqua sacch. Paralysis. 192b. IjL Summitatum Sabinae Cort. Cinchona ^ 15.0. F. Infusum "'250.0. Syr. Cinnamomi 30.0. | ss bihorio. Metrorrhagia. 193. I£ Zinci Oxidi 3 j. Extr. Valerianae 3 ss. F. pilulae 30. j ter die p. cibum. Chorea. 194a. P>, Zinci phosphorici 1.0. Acid, phosphor. 7.5. Tr. Cinchonae 10.0. Gtt. xxv ter die ex aqua. Epilepsy. 194b. rj Zinci Phosphidi gr. jv. Rd. Althaeae q. s. F. pilulae 12. j ter die. Sclerosis. ( Cerebrospinal^) 194c. r> Zinci phosph. gr. j — iij. Sacchari albi 3j. Divide in partes 10. j ter die. Impotence Tabes Dorsualis. Sabina Oleum: gtt. 1—4 = 0.032—0.13. Zincum oxydat: gr. 1—5 = 0.065—0.32. " phosph.: gr. 1.16— i = 0.004—0.02. Sabina is one of the best uterine stimulants, and much used in hemorrhage after abortion. Ol. Sabince, 0.05 — 0.2 (gtt. 1 — 6) bis vel ter die with brandy in Paralysis. Zinc Preparations are similar in their effect to the preparations of copper, but milder. Zinci Acetas (Zincum aceticum) gr. 4 — 6 per diem in mucilage is sometimes used in Delirium tremens. Zinci Bromidum is preferable to the Chloride in Tremor senilis, Hysteria, Paralysis, Epilepsy: 0.005 — 0.015 ter vel quater die ex aqua; 0.02 maximum. Zincum cya- natum is best given as powder: 0.005 — 0.015 ter die; 0.03 maxim. — 0.1 per diem. Zincum oxy datum in gr. iv doses ter die, has been found of great service in the profuse perspirations of Phthisis. No. 193: Each week the quantity may be increased by gr. ij per diem until Stimulants and Tonics . 87 195a. 3 Zinci Sulphatis gr. x. Extr. Anthemidis 3 ss. F.pil. 10. Consp.Lycopodio. j ter die. Oxaluria. 195b. ^ Zinci sulfurici Extr. Hyoscyam. ? 3 ss. (Extr. Gentian. 3 j.) F. pilulae 30. Nervous j ter die. Exhaustion. 196a. rj Zinci valerian, gr. ij — x. Extr. Anthemid. gr. iij. Ter die. Same. 196b. r> Zinci Valerianatis 0.1. Elix. simplicis 50.0. Aq. fontanae 100.0. 16 c. c. every half hour. Migraine. Hysteria. Zincum sulfuric: gr. \- " valerian.: gr. \- -30 = 0.032—2.0. 2 = 0.032—0.13. gr. xlv are reached. Zinci Phosphidum (Zincum phos- phoricum) supplements Phosphorus for internal use, and is much easier to employ. Zinci Sulphas (Zincum sul. furicum) is often used as emetic in cases of poisoning. See section vn. As tonic it is of great value in Oxaluria (195), especially if nitromuriatic acid is given at the same time. (p. 72.) Gr. j once daily in Chorea from fright, which may be increased to gr. vj. daily to child of 6 years. SECTION VI. CATHARTICS Remove retained feces, morbid secretions or poison, by- producing alvine evacuations, with or without irritation, increased peristalsis and effusion of serum from the bowels, or of bile from the liver; they relieve spasm or congestion and inflammatory action of the general sys- tem; promote absorption; stimulate the secretions of the liver and purify the blood, invigorating and refreshing at the same time the circulatory and nervous powers. 1. — Laxative: Fruit, Glycerina, Oleum Olivarum, Oleum Ricini, Sulfur, etc. 2. — Laxative and Cholagogue: Mercurial Cathar- tics. 3. — Mildly Hydragogue: Saline Cathartics. 4. — Mildly Acrid: Rhamnus Frangula, Senna, etc. 5. — Mildly Acrid and Cholagogue: Rheum, Aloes, etc. 6. — Drastic: Colocynthis, Elaterium, Cambogia, Jalapa, Scammonium, Oleum Tiglii, etc. 7. — Drastic and Cholagogue: Colchicum, Podo- phyllum etc. (88) CATHARTICS. 89 197a. IJ, Extr. Aloes Ferri sulf. ? 3 j. (Rad. Rhei 3ss.) F. pilulae 30. Chlorosis. j vel ij hora somni. 197b. 5 Aloes gr. xxjv. Acid. sulf. fortiss. gtt.vj. F. pilulae 6. ij quarta quaque hora. Vel: 5 Aloes Rad. Rhei ^ 3 j. Sapon. med. 3 ss. F. pilulae 30. j vel ij subinde. Palpitation. Prolapsus Uteri. 197c. IJ, Aloes Mass. Hydrarg. ^ gr. jv. Saponis medicati gr. ij. F. pilulae 2. Sumatur hora sornni. Pruritus pudendi. 198. IJ, Extracti Aloes 4.0. Tartar! emetici 0.25. F. pilulae 60. ij bis vel ter die. Insanity. 199a. 5 Extracti Aloes 3j. Asae foetidae 2>ij. Extr. Nuc. \ omicae " Belladorin.^ gr. x. F. pilulae 20. j anteprandium. Hysteria. Aloes, which is also slightly tonic and emmenagogue, ranks as purgative between Rheum and Senna, being rather slow in its effect. It is chiefly used in Dyspep- sia with constipation, dependent on a torpid condition of the large intestine or liver, and in Hemorrhoids; as revulsive in cerebral affections and in defective men- struation; but it is objectionable in diseases of thegen- ito-urinary apparatus, pregnancy, etc., on account of its special action on the large intestine and the pelvic vis- cera generally. The dose is gr. v — x; Tr. § ss — |j; Tr. Aloes c. Myrrha 3 j — 3 ij. Ferrum sulfuricum increases its action, and prevents, moreover, griping. In Constipation from retained feces: Tr. Aloes cum Myrrha 3j ter die: in Hysterical Meteorismus: Decoc- tum Aloes semel vel bis die; in defective Menstruation: Pilulae Aloes cum Myrrha gr. v hora somni (to begin a day or two before Menstruation). No. 197b is a very powerful aperient. 90 CATHABTICS. 199b. IJ Extracti Aloes Chinin. sulfurici (Ferri sulf.j a 3j. Extr. Nuc. Vomicar. " Hyoscyam.r gr. x. F. pil. 20. j p. prandium. 200. IJ, Dec. Aloes comp. § viij. Potass. Bicarb. 3 ss. Tr. Aurant. Cort. 3 ij. Cyathus vinos, omni mane. Gout. 201. 5 Tr. Aloes c. Myrrha 3 ij. Ferri sulfurici gr. ij. Syr. Rhei arom. § iij. 3 ij ter die. Gastro-intestin. (8 years.) Catarrh. 202. IJ Extr. Colchici acetici Hydr. c. Creta ^ 3j. Extr. Colocynth.co. 3ij. F. pilulse 20. Chronic j hora somni. Diseases. 203a. IJ Extr. Colocynth. comp. Sapon. med. ^ 3ij. 01. Juniperi gtt. xl. F. pilulse 20. j bis die. Meteorismus. 203b. IJ Extr. Colocynth. comp. Chin, sulfurici ^ 3j. Camphorae 3jv. F. pilulae 40. j ter die. Same. 203c. IJ Extr. Colocynth. comp. Calomelanos ^ gr. vj. Pulv. antimon. gr. j. F. pilulae 3. S. hora somni. Congestive Dysmenorrhea. 204a. IJ Extr. Colocynth. co. 3 ss. " Hyoscyami 3j. Mass. Hydrarg. gr. xij. F. pilulie 12. Constipation. j v.ij subinde. (pregnancy.) Golchicum (p. 48) combined with Salines is much employed where torpor of portal circulation in gouty habits. In Constipation from retained feces: Tinctur. gtt. v — x post cibum. Colocynthis is mostly used to unload the bowels m obstinate constipation; but it acts sometimes very violently, even in small doses, and in overdoses it may produce dangerous enteritis. Dose gr. v — x. It is usually given as pill. JPilulm Colocynthidis comp.: Extr. Colocynthid. p. 16. Aloes p. 50, Scammonium et Sapo T p. 14 Cardamomum p. 6, Alcohol p. 10. CATHARTICS. 91 204b. 206b. # Pil. Colocynth. comp. ^ Pil.Cambog.corap. 3 jss. " Galbani comp. a 3j. Chinini sulfurici 3j. Ferri oxydati gr. xij. p. pilule 30. Theriacae q. s. j sem el vel bis die. F. pilulae 12. Vulvar PJnterocele. ij bis die. Mastodynia. 20Y 205. n - . I .. 3 Elaterii gr. ij. 3 Glycerin* | q. _ Extr. Twaiwi gr. x. e . Kab , bitartanci 3] . F. pilulae 8. ^ as dose# Laxative. j tertiis horis. Dropsy. 208a. 206a. ^ Calomelanos 3j. 3 Pil. Cambog. comp. 3 j, Opii 3 ss. Mass. Hpdrarg. 3 ss. Tart, emetici gr. x. F. pilulae 30. Constipation. F. pilulae 40. ij subinde, (habitual.) j ter die. Hepatitis. Elaterinm is, perhaps, the most important of the hydragogues, being generally used in dropsical affec- tions, and also frequently as revulsive in cerebral dis- eases. Its action is no less violent than that of either Camboge or Colocynthis, and has proved even fatal in overdoses; but if administered in divided doses its effect can easily be regulated. In Bright's Disease, to prevent Uraemia, gr. 1-16 — \ hourly until purgation. Cambogia (Gutti) is also very violent in its action, andoverdoses have proved fatal. Itis usually employed in obstinate Constipation, combined with milder cathar- tics, in order to accelerate their action. Pil. cathartic, comp. — Extr. Colocynth. comp. 8.40. Abstract. Jalapae et Calomel 7 6.50. Cambogia 1.60.— Pilulae 100. Pil. Cambogice comp. — Aloes, Cambogia, Pulv. aroma- ticusjT2.5. Sapo5.0. Syr. simplex q. s. F. pilulae ponderis 0.15. Dose 2 — 4. Glycerin is more used as menstruum and nutritive than as laxative. See page 81, 92 CATHARTICS. 208b. 209b. ]J Calomelanos gr. x. IJ Calomelanos gr. jv. Ipecacuanha gr. j. Jalapse gr. vj. Afterward Salts. Jaundice. Pulv. antimon. gr. j. 208c. Afterwards Senna.- Dropsy. 5- Calomelanos gr. vj. {after Scarlatina.) Rad. Rhei gr. xij. (5 years.) Later 01. Ricini. 210. Chlorosis. ^ Calomelanos gr. vj. 209a. Fol. Digitalis gr. ij. IJ, Calomelanos gr. x. F. pilulse 2. Jalapae gr. xv. j hora somni. Anasarca Pulv. antimon. gr. ij. from gestation. Followed by Senna. To be followed in the morn- Epilepsy. ing by \ oz. of Salts. Jalapa is mostly used with Cream of Tartar (1:2) as Pulvis Jalapae compositus in cerebral and dropsical affec- tions; and with Calomel in bilious fever. It is a power- ful hydragogue, causing often much pain, and an overdose may produce dangerous hyperesthesia. The dose varies from gr. xv — xxx; in combination: gr. x. Mercurial Cathartics are frequently employed with a view of combining a purgative action with an increased flow of bile (many practitioners object to Mercury and use other drugs, especially Podophyllin instead), but are never administered without being followed by some other cathartic, to insure a full action. Calomel is given in doses of from gr. vj — xij, followed in 4 — -6 hours by \ oz. — 1 oz. of Salts, Senna or Castor oil; for children larger doses are required in proportion than for adults, gr. ij — vj being the dose for a child from 2—6 years old, though, generally speaking, Grey Powder is preferable in Pediatrics. Blue Pill is milder than Calomel, and forms, with Black draught, all over England a popular remedy for biliousness. In Suppression of Menses, Calomel gr. x, followed after 6 hours by Senna, or some other cathartic; in CATHARTICS. 93 211. 213. IJ Massre Hydrargyri r> Olei Olivarum § vj. Sapon. med. ^ grs. xij. In one dose, or § ss half Asse fee ti das gr. vj. hourly after a day's fasting. F. pilulie 6. Constipation. Hepatic Colic. j vel ij h. s. (of pregnant s^) 2^ " ]J Podophyllin. gr. j. r> Hydrarg. c. Creta Spir. Vini Gallici 3j. Rad Rhei & gr. ij. Syr. sirnplicis § iij. Ipecacuanh. gr. 1-8. 3 j semel vel bis die. Con vulsions Gastro-intestinal from teething. (8 yea«s.) Catarrh. defective Menstruation at the climacteric period, with Jalapa (Xo. 209); in profuse Menstruation from undue lactation, with Rheum (Xo. 208.) In Constipation of children (1 — 4 years): gr. ij with jv — vj of Jalapa. Hydrargyrum cum Cre f -a gr. x — xij in Amenorrhcea, Palpitation from constipation, etc.; gr. jv in Paralysis for children of 1 — 2 years; gr. ij in Laryngismus stri- dulus from dentition (6 months); gr. j followed by Manna or Oleum Ricini 3 ss (5 weeks.) See section i. Oleum Olivce (Xo. 213) is said to facilitate the passag? of the gall-stones: The patient, after having swallowed the oil, should recline on the left side, with the hips higher than the shoulders. Podophyllin has a special determination to the upper part of the alimentary canal, and as it combines with its hydragogue property a decided cholagogue action, it is an excellent substitute for Mercury, especially in Func- tional Hepatic affections. As alterative it is occasion- ally of great service in Scrofula. Dose of Extractum fluidum: gtt. 20 — 3 ss=l. 0—2.0. Podophyllin: gr. \ — j = 0.015 — 0.065. (0.005 — 0.015 for children of months to 4 years; 0.02: 5 to 14 years; 0.03: over 14 years.) 94 CATHARTICS.\ 215a. IJ, Extr. Frangulae fluidi Sodii Bicarbon. ^ 3 ij. Tr. Colombo velTr. Nuc. Vomic. 3j. Aq. Menthae ad § vj. | ss ter die ante cibum. (12 years.) Palpitation. 215b. Pulveris Rheigr. x. Natri bicarbonici Saccharic Zj. « Olei Lavandulae gtt. v. Primo mane e cochlearibus duobus aquae sumendus. Constipation. 216a. 5 Extr. Rhei 3 ss. " Gentianae 3j. Sapon. med. gr. x. F. pilulae 20. ij bis vel ter die. Prolapsus Uteri. 216b. 5 Syrupi Rhei 20.0. " Sennae 10.0. Tr. Zingiberis 1.0. Aperient. 21 7a. IJ, Olei Ricini 3 j. Tr. Opii gtt. j. For Infants. Rhamnus frangula is a mild acrid cathartic, similar to Rheum, but not so slow in its operation; thus proving a good and cheap substitute for the latter. The griping which it somtimes produces may be avoided by the addition of aromatics. Dose of Extractum fluidum: gtt. 20— 3 j = 1.0—4.0. Rheum is rather a slow cathartic; but it never causes inflammation of the alimentary canal. It is much em- ployed in cases of Diarrhoea, on account of its secondary astringent effect; and in Dyspepsia, on account of its stomachic and tonic properties. (See pp. 51 & 85.) As a mere cathartic it may be fully replaced by Rhamnus. Dose of root and fluid extract as stomachic laxative: gr. v — x; as purgative: 3j — 3 j; of Tr.: § ss — § j; and of Syrup: 3 j for an infant. No. 215b is said to be the most perfect combination of rhubarb; the lavender hides its flavor completely. Syr. Rhei; Extr. Rhei fl. 3 j; Tr. Cinnamomi 3ij; Pot.Carbonas gr.v; Syr. simplex § jv. CATHARTICS. 95 2l7b. ft Olei Ricini 6.0. " Terebinthinae 4.0. Acaciae Aq. fontanae ? 40.0. 16 c. c.bihorio. Tympanitis. {Typhus.} 218a, ft Magn. Carbonatis Rad. Rhei T 3 ij. Aq. Cinnamomi § viij. | ss omnimane. Inversion. 218b. ft Magnes. c. Rheo gr, x. Aquae Foeniculi | ij. 3 j ter die. Constipation. (3 months.) 219a. ft Magn. sulfurics § j. Ferri sulfurici gr. viij. vel Acidi sulf. dil. 3 ss. Aq. Menthae § viij. 3 j omni mane e cyatko aquae. Aperient and tonic. Vel: ft Magn. Sulphatis Pot. Tartratis ? § ss. Tart, emetici gr. j. vel Ferri Sulphatis gr. x. Aq. Fontis § viij. 219b. ft Magn. sulf. 3 j — 1 ss. Chin, sulfurici gr. ij. vel Tr. Nuc. Vom. gtt. xv. Aq. fontanae § jss. Primo mane ex aqua. 219c. ft Magn. sulfuric. 3 ij. Ferri sulfurici gr. vj. Acidi sulf. dil. 5 ss. Infusi Gentianae | vj. | ss bis die. Amenorrhoea. 220a. ft Kali tartarici gr. xv. " bicarbonici gr. xij. Magnesiae gr. vj. Primo mane e cyatho aquae. Chronic Diseases. Castor Oil is perhaps the safest laxative used in gynae- cological and pediatric praxis, as it will open the bowels with the least possible irritation; hence its value in inflammations about the abdomen and pelvis; in affec- tions of the rectum and womb; in Pregnancy, Hernia, Typhus, etc. Dose | ss — § j; children: 3 j — 3 ss. In habitual Costiveness occasional massage or several articles of diet, which have a laxative property, will be frequently of assistance: oatmeal, bran, molasses, honey, and particularly ripe or dried fruit, as apples, prunes, tamarinds, etc. Salines: Magnesia (p. 52,) though laxative, is gener- ally used as antacid, and mostly in pediatrics. Dose as 96 CATHARTICS. 220b. 5 Potass. Tartratis 3j. Jalapae gr. xij. Vel: Tympanitis. JJ Pot. Bitartratis 3 ij. Jalapae 3j. Dropsy, (to prevent Urcemia.) 220c. IJ, Kali bitartarici 3 vj. Extr. Digitalis fl. 3 ss. Aq. fontanae 5 vj. § j ter die. Pleuritis. (if effusion. ) 221. 5 Sodii Sulphatis 10.0- Extr. Taraxaci fl. 5.0. Aq. destillatae 50.0. Syrupi Rhei 25.0. 4 c, c. bihorio. Icterus Neonatorum. 222. r> Sodii Phosphatis Mannae T 3 j. Aquae Foeniculi § j. 3 ij ter die. Constipation. (3 years.) 223a. r> Foliorum Sennae Semin. Anisi a § j. Aquae bulliente Oj. Colaturae adde Pot. Bitartratis § j. § jss every morning before breakfast. 223b. 5 Inf. Sennae comp. § jss. Spir. Nuc. Moschat. | j. Syrupi Rhei § ij. | ss ter die. Prolapsus Vaginae. laxative: 3j ex aqua vel lacte. Magnesii Sulphas (Magnesia sulfurica) is a mild refrigerant purgative, generally used with Senna. Dose § ss — § j. With Ferrum and other tonics (No. 209) it is of service in chronic diseases — ulceration of cervix uteri, Cervical Endometritis, Engorgement of breast, etc. — to drain the congested abdominal veins and to brace the system. Potassii Pitartras (Kali bitartaricum) is in doses of 3 j — 3 ij a gentle diuretic and refrigerant aperient, useful in fevers; in doses of § ss — § j it has hydragogue properties, and is frequently used in Dropsies. Potassii Tartras, though similar to Cream of Tartar, is much less used: No. 220a, especially if the urine red. (Like Pot. Acetas both salts change in the stomach into carbonates. See page 53.) Potassii et Sodii Tartras (Tartarus natronatus) is generally employed in the form of Seid- litz powder, and well adapted to gouty habits and cases CATHARTICS. 97 223c. r> Extr. Sennse fluid. Magn. sulfur. 7 3 ij. Tr. Jalapre Manure ^ 3 j. Aq. fontanse § jv. Vel: After Calomel, t} Extr. Sennas fl. Magn, Sulphatis Tr. Jalapae 7 3 j. Aquoe Fontis § ij. (5 years.) 223d. rj Extr. Sennae fl. 3 ss " Frangulas fl. 3 ij. " Gentian, comp. fl. Sodii Bicarbon ^ 3 j. Aq. fontanre 3 vj. 3 ss ter die ante cibum. Gastro-intestinal Catarrh. Vel: IJ Extr. Sennse fl. § ss. Ammonii chlorati 3 j. Aquae Anisi § vj. 1 ss ter die ante cibum. [If there be Jaundice.) 223e. ^ Extr. Senna? fl. 3ij. M Frangulaa fl. 3j. " Gentian, comp. fl. Natri bicarbonici ^ 3 ss. Aquae Anisi q. s. ad § ij- 3 j ter die ante cibum vel tertiis horis. (2-5 years.) 224a. tj Sulfuris depurati 20.0. Kali bitartarici Sacchari albi ^40.0. Oiei Citri gtt. j. 3 j ter die ex aqua. Hemorrhoids' of uric acid diathesis; but it should not be given in the phosphatic, as it renders the urine alkaline. Sodii Sul- phas (N"a # trum sulfuricum) is similar to Magn. Sulphas, but more bitter, and perhaps more nauseous. Sodii Phosphas is, on account of its agreeable taste, well adapted to all cases of children and delicate persons, especially where there is a deficiency of phosphor, and saline matter,it being a constituent of thebloodin health. Dose 15.0 — 50.0; in Constipation, with red urine, 3 iij every morning ex aqua. See page 57. Senna is a prompt and efficient cathartic, acting on the entire track of the intestinal canal, and producing watery feculent stools; hence its use in febrile and in- flammatory cases. The addition of bitters promotes its activity, and its tendency to gripe may be avoided by aromatics or neutral salts. Dose of Extractum fluidum, 98 CATHARTICS. 224b. g, Sulf. praecipitati 3j. Magnesiae 3jv. Divide in partes 4. j hora somni ex aqua vel lacte. Same, 225a. 9, Olei Tiglii gtt. ij. Ipecacuanhae gr. ij. Calomelanos 3j. F. pilule 10. Amenorrhea. j quartis horis. 225b. r> Olei Tiglii gtt. vj-viij. Sacchari albi 3 j. Aquae fontanae 3 ij. Pars semis, and in 3 hours the rest, if necessary. Coma (if pulse strong). 225c. 5 Olei Tiglii 0.1. Sacchari albi 10.0. AcaciaB Tr. Card. comp. a 2.0. Aq. destillatae 60.0. 4 c. c. several times daily. Meningitis. 226. 5- Saponis Tiglii gr. vj. Pil. Colocynthidis c. Hyoscyam. gr. xxjv. Calomelanos 3 ss. F. pilulae 12. j bis vel ter die. Epilepsy from suppressed Menses. (With Magn. sulf. 3 j every morning). 2.0— 8.0 bis vel ter die; 0.3 — 1.0 bihorio. In Constipa- tion of pregnancy: Electuarium e Senna 3 j — 3 ij bis die. Sulfur is a mild laxative, having at the same time a gentle stimulating property to the skin and mucous membrane; hence its value in chronic cutaneous dis- eases. Dose, 3 j — 1 ss in treacle or milk. The choice between Sulfur depuratum and Sulfur j>raecipitatum is a matter of taste, there being no difference in their effects. Croton Oil is, from the speediness of its action, still more than from the smallness of the dose required, a most valuable purgative in cerebral disorders, especially Coma. Even an external application to the abdomen — mixed with 01. Olivarum — will produce catharsis. Occa- sionally it is used in obstinate Constipation. The dose is gtt. j — ij, though sometimes as much as gtt. viij — x may be taken without affecting the bowels. SECTION VII. EMETICS Remove not only Indigesta and otherwise deleterious substances from the stomach, by exciting that viscus to discharge its contents through the mouth, but expel also foreign bodies if lodged in the throat or oesophagus. They, moreover, relieve spasm, promote perspiration and expectoration, and assist in the removal of obstruc- tions in the viscera generally. Alumen. axtimoxii et potassii tartras. Apomorphinum. Cupri Sulphas. Htdrargyri Subsulphas flavtts. Ipecacuanha. Sin apis. Sodii Chloridum. Zixci Sulphas. Emetics are contra-indicated in Congestion of the Brain, Hernia, Pregnancy, etc. loo EMETICS. 227a. 228a. 5 Ipecacuanhas gr. xv. IJ Cupri sulfurici 1.0. Tart, emetici gr. j — ij. Sacchari Lactis 5.0. Dentur tales doses 3. Divide in partes- 10. j every 15 minutes until j every 15 minutes until emesis. emesis. 227b. (3-7 years.) Croup. IJ Ipecacuanhae gr. jv. 228b. Tart, emetici gr. ^. tj Cupri sulfurici 1.0. With warm water. Aq. destillatae 40.0. (3 years.) Scarlatina. In 2 doses within 15 min. ( if throat stuffed. ) Opium poisoning. Ipecacuanha is the emetic in all cases where a simple evacuation is required, mild and sure, and therefore well adapted in spasmodic Group, acute Bronchitis of chil- dren, etc. The vomiting is promoted by the free use of tepid water; if excessive, it must be checked by de- mulcents, opiates and counter-irritation. Dose, gr. xv — xx; as nauseant, gr. \ — ij ter die; as diaphoretic and expectorant, gr. \ — \\ and as tonic, gr. 1-10 ter die. (p. 82.) The fluid extract 3 ss — 3 j; Vinum Ipecacuanhae | ss — § j; Syrupus Ipecacuanhae 3 ss — 3 j for children of 1 — 2 years; gtt. v — xx as expectorant. In commencement of Cholera: Pulv. Ipecacuanh. gr.vj (6 years.) In Fits: gr. iij — v (2 years.) Vinum Ipecacuanhas: Extractum fluidum 1.25. Vinum ad 20.0. Syrupus Ipecacuanhas .• Extr . fluidum 1.0. Syrupus simplex ad 20.0. Antimonii et Potassii Tartras (Stibio-Kali-tartari- cum — Tartarus stibiatus s. emeticus) Emetic Tartar is very valuable in Parturition if os rigid, and the skin hot and dry. See page 23. Vinum Antimonii (Vinum stibiatum) 1:250 Vinum. Cupri Sulphas (pp. 65 & 11) — gr. v — x in poisoning by Opium; 1.0 in poisoning by Potassii Cyanidum. Alumen (pp. 62 & 63): Dose as emetic, gr. viij — xxx EMETICS. 101 = 0.5 — 2.0. Teaspoonful ( 3 ss) in Croup; tablespoonful in poisoning with Opium. Apomorphinis especially valuable where insensibility- prevents the administration of an emetic by mouth. See Hypodermic Medication, chapter it. Hydrargyri Subsulphas flavm (Hydrargyrum sulfuri- cura). Gr. iij — v of Turpeth Mineral is sometimes used in true Croup. tiincqris is especially useful in atonic conditions of the stomach. Dose 3j — 3 i j = 4.0 — 8.0. One tea or tablespoonful in poisoning by Opium. Sodii Chloridum (p. 57.) A tablespoonful of salt in warm water in Alcohol poisoning. Zincl Sutyhas (p. 86) is perhaps the most reliable emetic in cases of narcotic poisoning. Dose, gr. xx — xxx. SECTION VIII. VERMIFUGE Destroy certain parasites in the human body, by either an antiseptic and inherent vermicidal power, or by in- vigorating the intestinal canal; and thus preventing the accumulation of mucous and slimy matter, without which these animals cannot exist. Agents which destroy the round worm (Ascaris): Cinchonidinum, Naphthalinum, Santoninum and Spigelia. The following either expel or kill the tapeworm (Tcenia) : Aspidium (Filix mas), Chloroform., Cuprum OXYDATUM NIGRUM, GRANATUM (PUNICA), PePO (CuCUR- bita), Phenolum, Terebinthina, Thymolum. In Trichinosis (Trichiniasis) have been successfully used Benzltstum & Salicinum. VERMIFUGJE. 103 229. 5 Cinchonid. tannici Ferri oxyd. hydr. ^1.0 Divide in partes 10. j hourly during forenoon. Ascarides. 230. r> Santonini Sacchari albi ^ gr. iij. Dentur tales doses 12. j ter die. Same, 231. IJ, Rad. Spigeliae gr. vj. Calomelanos gr. jv. Followed by Oleum Ricini. (10 years.) Chorea from worms. Vel: §, Rad. Spigeliae | ss. Foliorum Sennae 3 ij. Fiat Infusum | jv. | ss bis die. (4 years.) 232. r> Acid, carbol. gtt. viij. Glycerin ae § ij. Aq. Fontis § vj. § ss — | jhourlyforoneday, followed by a cathartic. Taenia. 233. g, Cupri oxydati nigri 6.0. Calcariae carbonicae 2.0. Boli albi laevigat. 12.0. Glycerinae 10.0. F. pilulae 120. ij quater die for one week, then iij each time. Same. 234. ^ 01. Filic. maris 3 j. Mucil. Acacias q. s. Fiat Emulsio. Sumatur hora somni e lacte. Same. Cinchonidinum tannicum cum Ferro (p. 11) is an excellent remedy in round worms; but the pin worm is more easily destroyed by appropriate enemata followed by tonics. (Nos. 3 70 & 377.) The dose is gr. iij — xxx =0.2— 2.0. Napthalin (p. 15) has been recommended in doses of from 3j — jv per diem; for children under 3 years gr. ij — iij bis die. Also as taenicide. Santoninum (Santonina) in strong doses produces thoughtlessness and chromatopsia in weak children; and 0.5 may kill. (p. 6.) It should be followed always by a brisk purgative. Maxim, dose: 0.1; 0.5 per diem; 2 doses of 0.025 each during forenoon to child of 1 or 2 years; 3 doses in the same space of time to child of 104 VERMIFUGE. Vel: Vel. ^ Extr. Filicis aetherei g, Emuls. Sem. Cucurbit. " Granat. C. Rd. (ex § ij parat.) % viij. ^ 2.5. This dose several days in Cort. Had. Granatiq.s. succession. Same. F. pilulae 40. Lycopodio Vel: conspergantur. IJ 01. Terebinthinae § ij. iij after a milk-breakfast. Mucil. Acaciae § ss. 235. Aq. fontanae q. s. 5 Dec. Granati Cort. Rd. Fiat Emulsio § vj. (ex | ijss) | xij. Tr. aromaticae 3 ij. In the course of the fore- Pars quarta every half hour, noon. Same. Same, 3 or 4 years; 2 doses of 0.05 each during forenoon: 5 or 6 years; 3 doses — 7 or 8 years. Spigelia should also be followed by a brisk purgative. Dose of Extractum fluidum: 3 j — 3 ij=4.0 — 8.0. Extr. Spigeliae c. Senna fl. § ss ter die. Acidum carbolicum (p. 16.) Dose gr.-J— iij=0.032-0.2. As the worm is nourished by the contents of the small intestines by endosmosis, no fat nor farinaceous food should be given; only beef tea freely. Aspidium Filix mas — The oleoresin is more effective than the extract; but no dinner or supper must be taken to obtain a good effect of the oil. The practice of giving the remedy for tapeworm to fasting patients has lately been condemned. Its administration cne hour or two after a full meal is said to be at least as effective and decidedly less irritating to stomach and intestines. Dose of the oil, gtt. 15 — 30 =1.0 — 2.0; of the extract, gtt. 10—20 = 0.65—1.3. Cuprum oxydatnm nigrum is said to kill the worm without producing the slightest inconvenience to its victim; but during the time that the pills are taken, acid drinks must be avoided. Granatum — The bark of the root has never failed in my hands, but it must be fresh, and I took care to have VERMIFUGJE. 105 236. 237. IJ Benzini 3 ij. IJ, Acidi salicylici 10.0. Succi Glycyrrhiza3 Solve in Mucil. Acaciaa ^ § j. Alcoholis puri iooo.'o. Aq. Menth. q. s. ad § vj. Turn adde 3 ss omni hora vel bihorio. Olei Carvi 2.5. Trichinosis, Tr. aromaticae 50.0. Vel: Syr. simplicis 950.0. IJ, Benzini 3 j. 32 c. c. after having eaten Glycerine § viij. pork suspected to contain 5 ssomni hora vel semihora. Trichinae. the root dug in my presence. Dose gr. xv — 3] = 1.0 — 4.0; of Extractum fluidum gtt. xx — xc = 0.65 — 3.0. (If there be any doubt about the freshness of the root Pelletierine should be taken.) Ol. Terebinth. 3 ij bis die for 2 days, followed by Oleum Ricini § ss and to be repeated in 4 hours unless the bowels open freely, to child of 5 years. See page 68. Chloroform (p. 30) has been given in doses of gtt. 30 half-hourly; or in 3] dose before breakfast in conjunc- tion with Ol. Ricini et Tiglii (gtt j: § j). Thymol (p 19) is recommended as a perfectly safe remedy for tapeworm, if its depressing effect is counter- balanced by a simultaneous administration of brandy or some other stimulant. It is exhibited in gr. x doses every 15 minutes until 3 ij are taken, the last dose to be followed by some cathartic. It appears, however, that Acidum thymicum may be completely replaced by Acidum salicylicum. See page 16. Benzin (p. 45) may be given in doses of 0.065 — 0.65. CHAPTER II. HYPODERMIC MEDICATION. The nature of the remedies used in Hypodermic Medication prevents this form of administering medi- cines from overstepping certain limits in the art of heal- ing; yet in many cases where we can avail ourselves of it, we must confess that it is an invaluable auxiliary. The great advantage of subcutaneous injections lies not only in the rapid absorption and consequent imme- diate action of the remedy on the system, but still more in the fact that they may be employed with the full effect of the remedial agent, where absorption from the stomach is altogether out of question on account of its irritability, as in pernicious fevers, cholera, etc., and last, but not least, where the condition of the patient pre- cludes the exhibition of a medicine in any other way, as in cases attended with more or less insensibility of the sensorium. HYPODERMIC MEDICATION, 107 238. Solut. Acidi arseniosi 1 per cent. gtt. iij — v. vel Sol. Fowleri p. j; Aq. dest. p. ij. 0.6 — 1.0 during the fit. Asthma, (p. 11). S — 10 injections suffice. In Chorea gtt. iij for child of 4 — 7 years, every other day; gtt. v: 11 — 14 years. (15 — 20 injections per month.) 239. Solut. Acid, carbol. (1.0) 30.0; 1.0 as injec- tion. (Superior to Quinine?) Intermittens, (p. 16.) In Acute Rheumatism [articular), Lumbago and Erysipelas, one syringeful near the affected joints once a day of a 2 per cent, solution. A parenchymatous injection of the same strength is employed for inflamed glands and all kinds of tumors. 240. Apomorphin. hydrochlor. 0.12; Aq. dest. 10.0. Per pen ic ilium Ian re vitreae funde (1.0 = 0.012). One syringeful (0.005) during the aura. Epilepsy. Aside from being shortened, the paroxysm, if it should re- appear at all, will be extremely mild — perhaps only a fainting — which may be ultimately cured by using later about 0.0025. (?) 0.006 — 0.012 in Croup or Diphtheria. Solutio Apomorph. (gr. j) 3 ijss. Dose, min. v — xx. Being a prompt emetic, it is especially valuable where insensibility pre cents the administration of an emetic by mouth. See sections in & vn. A successful use of the hypodermic syringe is only to be expected if the following rules are borne in mind and acted upon : 1. The remedial agent has to be of the greatest purity, hence the necessity of using fresh solutions. The menstruum may be distilled water, or, what is as good, filtered rainwater. If, however, we wish to keep a solution for some time. Bichloride of Mercury in the proportion of 1:5000 as menstruum is sure to prevent decomposition? (Bv employing Sol. Hvdr. bicblor. [0.1] 500.0, vfe have in 8 drops 0.0001, or l-6( grain.) Moreover, the solution should be perfectly neutral and always filtered, and 108 HYPODERMIC MEDICATION 241. Atrop. sulf. gr. j; Aqua pura 3 xv. (10 min.= 1-90 gr.) Dose, min. v — xx. Gr. 1-90 in Congestion of the brain (feeling like a tight band round the head, heavy breathing, eyes bloodshot, etc.) Gr. 1-30 every half hour in poisoning by Opium, (p. 23.) For Atrop. cumMorph. see No. 255b. 242. Caffein. gr. x; Alcohol & Aq. dest. ana 3 jss (1 min.= gr. 1-18). Dose, min. jv — xviij 243. Camphora gr. v; Alcohol 3 j. Dose, min. vj — xxx. See section n. 244. Chinin. bisulf . 3j; Acidum boracicum gr. ij; Morph. gr. J; Aq. dest. § j. Gtt. viij=gr. j. The effect of Quinine hypodermically is about four times greater than when taken by mouth, and in this composition the risk of abscesses at the place of injection is rendered like nil. The Carbamide (1 — 2:10 Aqua) is said to produce neither an irritating effect. 245. Chloral, pars j; Aq. pura partes ij. Dose, min. viij — x. Hestlessness. See page 30. there will be no danger of inflammatory swellings or abscesses about the part where the injection has been made. 2. The injection should be made where there is the most abundant supply of cellular tissue — abdomen, arm, thigh, back and calves of the legs; and in case of repetition, another spot should be chosen, to prevent irritation of the part. (Bony pro- minences, inflamed parts and veins are to be avoided.) 3. Before making the puncture, the air contained in the syringe should be expelled, by everting the instrument and pressing the piston just far enough to have at the needle's point a show of the liquid employed. Lastly, having at the place selected drawn up the skin in a tense fold with two fingers, the needle should be thrust as far as possible into the subcutaneous tissue, and the remedy very slowly injected. After withdrawing the needle, it is well to apply the finger over the puncture for a short time, to prevent any escape of the liquid injected. HYPODERMIC MEDICATION. 109 246. Chloroform, min. v — x in Neuralgia, Nervous Excitement, Morbus nauticum. See section n. 247. Cocain. gr. j; Aq. dest. gtt. x bis die. Alco- holism. (Effect within 5 minutes.) In smaller doses it is employed in Melancholia, Insanity, Chorea gravior, Spinal Irritation, etc. See pages 77, 112 & 115. As anaestheticum gtt.viij of a 4 per cent, solution injected at the anterior and the same quantity at the posterior base of the tumor. Sebaceous Cyst. (After 25 minutes a linear incision may be made and the sac pulled out). 248. Coniin.O.i; Alcohol 10.0; Aq. dest. 40.0. One syringeful(=1.0=0.002). ( This dose doublets the strong- est to be admitted.) Asthma, Convulsions, Neuralgia. 249. Daturin. gr. ss; Aqua § j. Dose, min. jv — x. 250. Digitalin. gr. ss; Alcohol, Aq. dest.T 3 ij. Dose, min. jv. — viij vel Tr. Digitalis min. x. Insolatio. (p. 50.) 251. Duboisin. sulf. 0.05; Aq. dest. 20.0. 0.1—0.3 (=0.00025 — 0.00075) as injection. Strongest dose: 0.4. Antidote to Pilocarpin. See Hyoscyamus. (p. 33). 252. Ergotin. gr. xv; Alcohol & Glycerin. ? 3 ijss. Dose, min. v — xxx. (min. 1 = 1-20 gr.) Extr. Ergotae fluidum min. x. (p. 65). 253. Sol. Ferri citr. 10 per cent., gtt. xv daily in Chlorosis (if irritable stomach). 254. Hydrarg. bichloratum 0.25 — 0.5; Aqua pura & Glycerin. ? 15.0. Once every third or fourth day in the arm. Syjihilis. 255a. Sol.Morph.Magendie gtt. x every 8 or 12 hours in Dysmenorrhoea. In Hematocele, if there be great prostration, it may be repeated in-J- hour if it fail to give HO HYPODERMIC MEDICATION. relief. In Cellulitis, Uterine Colic, Pelvic Peritonitis, etc. Morphium gr. 1-5 in Gastralyia, etc. In Cholera, if it has been rejected by mouth. See page 38. 255b. Morph. sulfur, gr. xxjv; Atropin, gr. j; Ol. Amygdal. am. seth. gtt. j; Aqua pura § ij. min. x = Morph.gr. \. & Atropin. gr. 1-96. Morphin. c. Atropin. is usually dosed in proportions of gr. J: 1-100 — gr. -J: 1-120— gr. J: 1-150— gr. 1-6: 1-180— gr. |: 1-200, etc. 256a. Physostigma. The Calabar bean has been em- ployed with good effect in Trismus Neonatorum: gtt. j — v of Sol. Extracti (gr. ijss: 3 j). 256b. Pilocarpin. gr. 1-5; Aqua gtt. x. 2 — 3 minutes after the chill has fairly begun. Intermittens. Pilo- carpin gr. -J- — 1-6; Aqua gtt. x. See Jaborandi, page 50. 257. Strychn. nitricum 0.06; Aq. dest. 7.5. \ syringe- ful near the sacrum. Enuresis nocturna. (2-4 injections are sure to cure?) Strychn. nitr. 0.1; Aq. dest. 20.0 (1.0=0.005); velAq. pura 12.5 (1.0=0.008). Strychnin, nitricum gr. ss; Aqua dest. § ss. Dose, min. jv — xv. See Nux Vomica, section v. 258. Veratrin. 0.1; Acidum aceticum dil. gtt. xij; Alcohol. 2.0; Aq. dest. ad 20.0. See section n. 0.25 — 0.5 — 0.75 to be injected. (0.00125 — 0.0025 — 0.00375). Puerperal Convulsions. 259. Woorara O.lr'Aq. dest. 10.0. Funde per lanam vitream. To begin with 0.15 to 0.2. Epilepsy. Woorara 0.3; Aq.dest. 5.0; Acid, hydrochlor. d. gtt. j. For eight injections. Blepharospasms. Woorara gr. j; Aq. 3 iij. Dose, min. v — x. (In Hydrophobia 0.2 have been in- jected within five hours with success). It may be used until relaxation of muscles ensue. See Curare, section n. CHAPTER III. TOPICALS Act chiefly locally, though some of them, by being ab- sorbed, will affect organs more or less remote from the place of application. DISEASES OF EYE AND EAR. 260. Solutio Acid, borac. (1.0) 30.0. Conjunctivitis purulenta. Acidum boracicum pulv. applied once a day to the lids with a camel's hair brush is excellent in Granular Lids and Trachoma; it is also used in indolent Ulcers of the Cornea. A saturated solution of Boric acid (4 per cent.) is sometimes used as menstruum for Cocaine and other Alkaloids. 261. Solutio Argenti Nitratis (0.03) 15.0. Detur ad vitrum nigrum. Gtt. j to be dropped into the inner angle of the eye bis vel ter die. Conjunctivitis catarrhalis. 0.15:15.0 Aqua: To be applied once a day with a camel's hair brush, and to be immediately wiped off with another brush dipped in a solution of Sodii Chloridum. (The surplus of the caustic is thus made inert, forming Argenti Chlorid. which is insoluble). Gonorrhoeal Ophthalmia. (If the inflammation be severe, two or three leeches 112 TOPIC ALS: should be applied to the inner angle of the eye or to the temples and a cathartic given. In case of pain, warm water compresses, with laudanum, over the eye will be useful, 262. Atrop. purum0.05: Aq.dest. 150.0. To apply to corneaevery three hours. Iritis. Atrop. 0.05 — 0.2; 01. Ricini 30.0. Keratitis. Atrop. sulf. 0.05 — 0.08; Aqua destillata 10.0. vel Atrop. 0.1; Glycerol, simplex 20.0. vel Atropin. 0.01; Glycerin. 5.0; Aq. dest. 10.0. vel Atrop. purum 0.1 — 0.15; Acid, salicylicum 0.05; Aqua dest. 20.0. Collyrium stillatitium. 263. Cocain. gr. v; Atrop. gr. ss; Ungt. Petrolei 3 ij. To be applied with a camel's hair brush. Ophthalmia. (To relieve pain). Solutio Cocaini hydrochlorati 4 per cent. gtt. j — ij to the inner angle of the eye at intervals of three minutes, as anaesthetic, for the removal of for- eign bodies from the cornea. The effect is produced within ten minutes. (A lens of 3-inch focus is required by some for the operation, which is performed best by means of a cataract needle.) See page 115. 264. Extr. Conii 2.0. Aqua -destillata 1.0; Glycerol- atum simplex 20.0. To rub around the eye. Photophobia. Coniinum 0.01; Alcohol dilutus 1.0; Aq. destillata 12.5. JBlepharismus (scrofulous). 265. Duboisin. sulf. 0.05— 0.08; Aq. destillata 15.0. Collyr. stillatitium. (For dilating the pupil it is quicker in action than Atropin. See Hyoscyamus, page 33.) 266. Hydrargyrum amidato-chloratum 0.25 — 0.35; Unguentum simplex 5.0. Applicatur bis vel ter die. Blenorrhoea palpebrarum. Ungt. Hydrarg. rbr. (1:8) 3 i. Ungt. Cetacei 3 ij; vel Hydr. oxyd. rbr. gr. j; Zinc. sulf.gr. ij; Ungt. simplex 3 ij. Ophthalmia Tarsi. Diseases of Eye and Ear. 113 267. Hydrarg. bichlorat. gr. j; Ammon. chlor. gr. iv. Aqua 3 vj. Apply three times a day. Ophthalmia Neonatorum. Conjunctivitis scrophulosa. 268. Calomel is dusted over the affected part with a camel's hair brush. In Conjunctivitis phlyctenulosa Macula Cornece, etc. See Iodine, page 14. Hydr. oxyd. rbr. gr. xv; Tutia gr. vi; Adeps3ij. To be smeared in the edge of the lid night and morning. Albugo. Lencoma. 269. Iodoform., Balsamum peruvianum T f. o. Ungt. Petrolei 4.0. Conjunctivitis, Keratitis. Iodol. 3 j, Ungt. Petrol. | ss. Chronic Conjunctivitis. Iodoform or Iodol dusted over the sore has been lately usedin Ulcus Cornece^ (Iodol is the inodorous substitute of Iodoform, and is said to be superior to the latter. It may be used on tampons for abscesses, etc., in most cases where Iodo- form is indicated. See No. 280). 2 TO. Physostigmin. purum 0.01; Sol. Acid, boric. 4 per cent. 100.0. vel Eserin. salicylicum 0.1; Aq. dest. 30.0 — 50,0. To effect myosis. Iritis. Physostigmin like Muscarin causes myosis and ptyalism. (Antidote: Belladonna, as in Poisoning by Mushrooms .) 871. Strychnin, nitricum 0.1; Grlycerina 10.0. vel Strychn. purum 1.0; 01. Amygdalarum 12.0. Gtt. xv — xx bis die over the eye or forehead. Amaurosis. 272. Veratrin. 0.5 — 1.5; Alcohol. 30.0. Amaurosis, Amblyopia, Neuralgia, etc. 2 73. Spiritus Yini Gallici 3 ss; Aq. § iij. Collyrium. Liq. Plumbi gtt. xv; Liq. Opii sedat. 3 j; Aq. dest. 5 vj; vel Sol. Zinci sulf. (gr. j) % j. Alumen, Cuprum sulfurr cum,Zincum aceticum (gr. j: 5 j) make also good coHyria. 114 TOPIC ALS: 274. Acid, carbolicum gtt. x; 01. Succini gtt. v; 01. Hyoscyami 5.0; 01. Olivarum 30.0. Guttas aliquot ad aurem bis die. Partial Deafness, Otalgia, Otorrhcea, Ulcus, etc. Acid, salicylicum 2.0; Alcohol. 40.0. Aq. dest. 60.0. Applicatur bis die ad aurem. Otorrhcea. 275. Pulvis Aluminis blown in the auditory passage once a day is of great value in Otorrhoea with Fungoid Growth. 276. Solutio Atrop. (0.03:15.0) gtt. iij — v dropped into the ear and allowed to remain there for 10 — 15 minutes. Otalgia, especially nocturnal. (Child under 3 years; when over 10 years 0.1:15.0.) Chloral, Cam- phora 3ij; Glycerin. 3 iij; 01. Amygdalarum 3j. On cotton. Otalgia. 277. Aq. Calcis & Lac ? f j; Tinct. Myrrhae gtt. xij. Otorrhoea (inflammatory). 278. 01. camphoratum 5.0; 01. Cayeputi 2.5. Partial Deafness, Rheumatic Otalgia. 01. Camphorae 15.0; 01. Amygdalarum 30.0; Liquor Ammon, anisatus gtt. viijo Hypocophosis asthenica, etc. 279. Ungt. Hydrarg. nitric & 01. Amygdal. ana in Chronic Inflammation of the auditory canal in children, after cessation of discharge. 280. Iodol. 25.0; Glycerin. 100.0. Acute Otitis. See preceding page, No. 269. 281. Sol. Zinci sulfurici 0.05:25.0. Otorrhcea. Sol. Potass. Permanganatis 0.1:25.0 (if fetid discharge). 282. Tr. Opii2.0; 01. Olivarum 8.0. Otitis externa. (Besides an emollient poultice — onion or poppies — over the ear, and if necessary two or three leeches round the mastoid process, and perhaps a brisk cathartic.) Diseases of Air Passages, eic. 115 DISEASES OF THE AIR PASSAGES AND ADJACENT PARTS. 283. Tinctura Catechu 20.0; Tr. Cinnamomi 10.0; Aq. Menth. spirituosa 150.0. 16 c. c. with water as mouth-wash. Tr. Catechu, Tr. Cinnamomi, Tr. RatanhaB 7 25.0; Tr. Chime 10.0: Tr. Myrrh as 15.0; Spir. Coch- lear. 50.0; Bals. peruvianum 1.0. vel Tr. Catechu 80.0; Tr. Guayaci, Tr. Ratanh. £ 40.0; Tr. Caryophyll. 30.0; Tr. Myrrh. 160.0; Spir. Cochlearise 20.0; Ol. Cinnamom. gtt. xx; Ol. Rosarum gtt. j; Alcohol & Aqua ~ 315.0. 284. Borax et Saccharum, ana. A little on tongue bis die. Stomatitis. (I use invariably a watery solution, without either saccharum or mel.) 285. Solutio Cocaini 4 per cent, rubbed on the gums twice within three or four minutes will quiet an infant, produce sleep, and even stop diarrhoea. Teething. On absorbent cotton, or applied with a camel's hair brush to the mucous membrane of nose and fauces, it is employed in Catarrh and Hay Fever. (In the asthmatic form it is useless, and better to have at once recourse to Lobelia, Chloroform, Nitre fumigations or inhalations of seda- tive preparations.) Cocaine applied to the pharynx in Hysterical Vomiting frequently gives prompt relief. See pages 11 & 109. 286. Hydrargyrum bichloratum 0.5; Glycerin. 50.0. Syphilitic Ulcers, etc. 287. Potassii Chloras et Saccharum, ana. A little on tongue (besides steam, No. 418). Diphtheria. Acid. salicyl.,Bism. Subnitr. ana. To be blown into the mouth. 288. Solutio Arg. nitr. (gr. v) f j. To be applied once a day. See page 111. (Besides frequent cleansing 116 TOPICALS: of nose with milk or soap and water.) Ozcena. Argentum nitricum (3j : § j). Admovetur ter die ope penicilli caniellinivelprobong armata spongia durante inspiratio. Laryngitis {acute or chronic, ulcer or no). 289a. Acid, carbol. 4.0; Glycerin.; Aqua 2 50.0. Ozcena. Kali hypermanganicum (gr.ij — v:|j,) vel Acidum chromicum 0.3; Aq. dest. 300.0. 289b. Acidum carbolicum et Alcohol T 10.0; Liq. Ammon. 12.0; Aq. dest. 20.0. Wide mouthed bottle of 50.0 should be filled with this to one-third, and then cotton q. s. to suck it up. For smelling in Catarrh. 290. Natrum bicarbon. et Borax ^ 3 ss; Glycerin. § j; Aq. font. | jv. As spray into the nose. — Sol. Zinci chlor. (gr. ij) § j; vel Sol. Zinci sulfo-carbol. (gr. v) | j. vel Glycerolatum Tannini (3ij) § j. Apply with a cotton-wrapped probe. Catarrh. 291. Sol. Sanguinar. cone. (min. x) to be injected into the substance is said to be specific in Polypus of Nose. 292. Iodum 0.12; Pot. Iodidum 2.5; Aq. dest. 30.0. 0.3 — 0.5, as submucous injection; vel Solutio Kalii iodati 2 per cent. Hypertrophy of Tonsils. 293. Tinct.Iodi § ss; Acid. carbol. 3 jss; Glycerin 3 ij. Once or twice a day to the thickened or ulcerated part. In painful deglutition of Laryngeal Tuberculosis. 294. Pot. Chloras gr. x; Pot. Permang., Acid, salicyl. ana gr. v; Aqua | j. Applicatur ter die. Diphtheria. (In Croup, Sore Throat, and other internal inflammations of the throat, Acid, aceticum is sometimes applied by means of blotting paper, cambric or lint as blister.) 295. Laryngotomy. In urgent cases, a penknife is Diseases of Air Passages, etc. 117 passed horizontally through both skin and cryco-thyroid membrane at once — the latter may be felt as a soft de- pression an inch below the pomum Adami — after which the opening may be enlarged laterally to the required extent. 296. Catheter in Laryngismus stridulus. Any cathe- ter may be employed which can be passed through the rima glottidis (moistened with Cocain.4 per cent)? 297. Bougie in Stricture of Oesophagus. The patient sits upright, with the head thrown as far back as possi- ble, and the mouth wide open. A curved bougie, gently warmed and oiled, is passed down the pharynx, taking care that its point slides along the spine. To prevent cough by interference with the epiglottis, the patient should protrude the tongue as far as possible, or perform the act of deglutition, just when the bougie is entering the pharynx. (Cocain may be sometimes of service.) A Stomach pump is managed in the same way. Some- times a gag is placed in the patient's mouth (especially if he be insane), havingahole for the tube to pass through. Before beginning to pump a pint or two of water should be injected into the stomach, and the pumping water in and out should be repeated until it returns colorless. 298a. Antiseptic Gargles. Acidum carbolicum 3j; Glycerin. | j; Aqua fontana § v. Scarlatina. Sol. Kali hypermanganici (gr. x) | v. Fetid Breath. Iodum 1.0; Pot. Iodid. 2.0; Aq. dest. 200.0. Salivatio mercurialis. Sol. Hydrargyr. bichlor. (gr. ss) § ij; Aq. Calcis § vj. Diphtheria. (The sublimate is used on account of its parasiticide properties, and the lime-water for its dis- solving action upon the membrane.) 118 TOPIC ALS: 298b. Solutio Acidi carbolici (3j: § vj) will suffice in mild cases of Diphtheria, without any other medication. It has to be used every half hour until the redness di- minishes, when it must be employed lukewarm, whilst every two or three hours Priessnitz's compress (which has to be warm also, when the inflammation becomes less) is applied to the throat: A linen handkerchief or rag, folded about four times and dipped in cold water, is put around the neck (not dripping wet) and covered with oiled silk or some woolen cloth, that by overlap- ping it on both sides will prevent evaporation. 299. Astringent Gargles. Acidum tannicum 3j ; Spir. Vini Gallici § ss; Glycerin. | j; Aq. Camphorae ad \ viij. Relaxed Throat. Alum. 3 j; Acid. sulf. d. 3j; Dec. Cinchon. | vj. vel Kali chloricum 3j; Tr. Ferri chlor. 5)ij; Glycerin. ;§ j; Aq. font. § vij. Scarlatina. 300. Cooling and Sialogogue Gargles for Acute In- flammations. Acid, hydrochlor. dil. 3 ss; Glycerin. § j; Aq. font. | vij. Pot. Chloras, Pot. Nitras, vel Borax 3 j; Aq. font. | viij. Scarlatina, etc. 301. Stimulating Gargles. Tr. Capsici 3 j — 3 ij, vel Tr. Pyrethri 3 iij; Aq. font. § viij. Acute Pharyngitis. Acid, nitricum gtt. jv; Glycerin. §j; Aq. 'font. § iij. As gargle or spray. Hoarseness. 302. Acid.carbol. 3 ss; Pot. chlor. 3 ij; Glycerin. § ij; Aq. font. | vj. To be inhaled from a hot plate ter die. Pertussis* Solutio Acidi carbolici (gr. ij — 3j)|j. Per atomizer. Pulmonary Gangrene, Phthisis. *InhalatioDs of any kind should not exceed ten minutes at a time, and the first sittings may be from five to eight minutes. Moreover, they should never be performed after a full meal, and Diseases of Air Passages, etc. 119 303. Solutio Tannin, (gr. ij — 3j) § j. Per atomizer. Chron. Catarrh, Laryngeal Ulceration, (Edema Glottidis. 304a. .^7ther. chlor. q. vis, from a handkerchief. Dyspnoea (Phthisis). JEih. sulf . in Emphysema senilis. 304b. ^Ether. p. jx; Chloroform, p. 1. An anaestheti" cum. Some use a mixture of Ether, Chloroform and Alcohol; and Ether pure to continue the anaesthesia dur- ing the operation. (As a rule Ether is safer than Chloroform; but it is contra-indicated in Kidney dis- eases, Pneumonia and Bronchitis. In valv. lesions either are contra-indicated, unless there is compensating en- largement. In fatty or weak heart they are also object- ionable, though Ether less than Chloroform. In opera- tions, as Kelotomy, those involving the peritoneum, and the removal of deep-seated tumors in the vicinity of large vessels, Chloroform is preferable). In any case, respiration, pulse and pupil should be watched, and after insensibility of the conjunctiva is established, its admin- istration should be regulated by the state of the pupils, i. e., the pupils should remain contracted, and only when they dilate, the ansestheticum should be reapplied, bear- ing in mind that a sudden dilatation of the contracted pupil during the application of Chloroform denotes danger. If there is fear or nervous depression, the administration of Chloroform should be preceded by a stimulant and a little morphine. the patient should not expose himself to the fresh air before an hour after the operation. No more than live to eight inspira- tions per minute should be made, the depth of which have to be regulated according to the distance of the air passages to be reached. 120 TOPIC ALS: 305. Sol. Aluminis ( 3 j) 1 ij. To be inhaled for five minutes from a hot plate. Haemoptysis. 306. Solutio Ammonii chlorati (gr. ij — x) § j. Per atomizer. Laryngeal Catarrh. 307. Aq. Amygdalar. amar. cone. § j. Per atomizer, several times a day. Cough. 308. Amyl. aether, nitr. et Alcohol. T 2.5. Gtt. v — x to be inhaled from handkerchief. Angina pectoris, Dyspnoea, Neuralgia, Spasmus Glottidis, Epilepsy, etc. 309. Solutio Argenti nitrici (gr. ss — x) § j. Per atomizer. Pharyngitis. The small dose in the follicu- lar and the large dose in the ulcerative form.) 310. Liq. Pot. arsen. gtt. j — x; Aq. destillata f j Per atomizer. Nervous Asthma. Sometimes the fumes of burning writing paper, which has been imbued with Sol. Fowleri 1.0 (gtt. xviij) and dried, gives relief. 311. Aq. Asae foetid. § j. Per atomizer. Asthma,etc. 312. Extr. Bellad. 0.025: Pot. Bromidum 4.0; Liq. Ammon. Acet. 5.0; Aq. dest. 60.0. To be inhaled ter die from a hot plate until dilatation of pupil. (A two or three days' cure?) vel Sol. Kal. brom. 4—5 per cent. Gtt. xx ter die as inhalation. Pertussis. 313. Bromum (gtt. jx), Pot. Bromidum 0.3; Aqua dest. 150.0. On a sponge or cotton in a tubeLof paraffine paper, to be placed before nose and mouth for five to ten minutes, and hourly repeated. Croup, Diphtheria. 314. Camphora3j; Miher sulfuricus § ss. A few drops to be inhaled. Cephalalgia nervosa. 4 Diseases of Air Passages, etc. 121 315. ^ Extr. Cannab. fl. gtt. j — jv, vel Tr. gtt. x — xx; Aq. dest. 5J. Per atomiser. Irritating Cough. 316. -IJ Chloroform, part, v; 01. Terebinth, pars j. Anaesthetic. (01. Terebinth, is said to prevent (Edema. Antidote : Pulv. aerophor. As an Emetic. Amyl or Am- monia to smell at.) Chloroform, gtt. iij — jv at the time. Trismus nascentium. See No. 304. 317. ^ Sod. chlor. gr. v — x; Aq. font. 3J. Per ato- mizer. Expectorant. Liq. Sod. chlor. 3ss — j; Aq. font. §j. Phthisis. (If breath or expectoration offensive.) 318. ^ Cocain. gr. viij; Pot. chlor., Aq. Amygdal. am. a 3j; Aq. dest. 3 viij. From a hot plate bis die for a few miuutes. Pertussis. 319. t> Extr. Conii fl. gtt. v — xv; Aq. font. |j. Per atomizer. Cough [Phthisis). Vel: Extr. Hyoscyam. fl. gtt. v — x\; vel Morph. sulf. gr. -§-. 320. ]J Tr. Ferri chlor. 3j, vel Liq. Ferri sub- sulf. 3ss ; Aq. font, f j. Per atomizer. Hozmoptysis. 321a. 5 Tr. Iodi, Chloroform, a 10.0; Acid, carbol. gtt. xv. Gtt. v from a glass tube placed in hot water to be inhaled bis die by the nose. Nasal Catarrh. (A one day's cold cure?) 321b. r> Sol. Pot. iod. (gr. ij — xx) 3J. Per atomizer. Emphysema., Chron. Bronchitis. 322. 5, 01. Junip. Bacc. 3ss. To be dropped on a sponge dipped in hot water and squeezed for inhalation ter die. Dropsy. (Where the state of the stomach pre- cludes the internal use of diuretics.) 323. ]J Inf. Picis. liq. |j. Per atomizer. Gangrene. 122 TOPICALS: 324. ^ 01. Terebinth, gtt. ij; Magn. carb. q. s.; Aq. font. f j. Per atomizer. Bronchitis, Emphysema. Vel : Ol. Terebinth, q. v.; Aq. bulliente q. 1. Gangrene. 325. 5- Sol. Sod. nitr. (10. o) 40.0. Liquore plagulae quatuor ad quinque chartse bibulse imbuantur et calore non adhibito siccentur. Asthma. (\ sheet to be burnt at the time.) DISEASES OF MALE GENITALS, ETC. 326. ^ Bism. nitr. 15.0; Aq. dest. 200.0. Injiciatur ter die.* Gonorrhoea {secundaria.} 327. ^ Acid, carbol. 3j; Glycerin. §ss; Aq. font. |vj. As injection in Gonorrhoea; as lotion in Chancroid. Sol. Acid, carbol. (gtt. j) 3j; Alcohol, gtt. ij. Gtt. x — xx as injection in Bubo. (It must be injected deep into the bubo, and pain and inflammation will rapidly subside?) 328. 3 Sol. Acid, chrom. (0.3) 300.0. Injection. Gonorrhoea. 329. Ijfc Calomel. 3j; Aq. Calcis |vj. Blackwash Chancroid. (If the chancroid be under six days old, Nitr. acid is preferable ; but this has to be done care- fully, with a pointed stick — like a match, for instance.) 330. 5- Sol. Cocain. 4$ gtt. x; Aq. dest. 3ss. To be injected. Chordee. A solution of this strength is suf- ficient to render the introduction of a catheter painless ; *The injections must be made after urination, and may be done as often as 4 times a day, each time keeping the liquid in contact with the sore for about one minute, by holding the penis upwards. Diseases of Male Genitals, etc. 123 and a 4 per cent, solution, undiluted, is very valuable in cauterization and excision of Condylomata. In operating on Stricture, 3^s may be injected in three doses, at inter- vals of ten minutes, each time to be retained a little. Then the urethrotome may be introduced, and the canal cut to No. 40 of French scale if necesssary (from 3^ inches back of meatus to corona).* In Phimosis, as hypodermic injection of 12m. at the dorsal base of the penis, and after 15 minutes 5m. more if necessary. The operation may be commenced as soon as the penis has turned dumb, cold and blue, using a clamp. Hemorrhage will be but little, as the haemostatic action of Cocain is very marked. (Or the solution may be painted over the external surface of the foreskin and over the mucus membrane several times within half an hour, by means of a camel's hair brush.) See No. 263. 331. 5 Sol. Fern et Pot. tart. (20.0 — 30.0) 200.0. As lotion. Phaged. Chancre. Vel : Iodol, see No. 269. 332. 5 Tr. Iodi, Aq. dest. a 3j — 3ij. Injection. Hydrocele. The tumor is grasped from behind and a trocar passed into it, taking care to point the instrument after penetration upwards, to prevent wounding of the testicle. Now the canula is pushed well into the sac, to allow the fluid to escape. This dose is injected by means of a glass syringe, the nozzle of which is made to fit the canula. * Aspiration of the Bladder in Stricture from ure- thral or prostatic disease. The puncture of the bladder must be made at the most prominent and tense part of the tumor, and exactly in the median line. (Once or twice a day until the urethral passage is re-established.) i2 4 TOPICALS: 333. 3 Tr. Opii 3j; Pot. brom. 3j; Glycerin. |ss; Aq. font. §ijss. Four injections daily. Gonorrhoea. Vel: Liq. Ferri dialysati |ss; Aq. dest. |ss — §j. Vel: Extr. Hydrast. fl. 3ij ; Aq. font. §jv. Injiciatur bis die. 334. 5 Sol. Pot. permang. (gr. x) |v. Gonorrhoea. If chronic, gr. v — x : |j. The same strength may be used in suppurating Bubo, after having drawn off the contents with an aspirator, if it be still intact. See page 82. 335. Ijfc Sol. Resorcin. 5 per cent. Two to three in- jections. Cystitis. If chronic, 5 — 10 per cent. (397.) 336. ^ Sol. Zinci chlor. (0.2 — 0.4) 100.0. As injection. Gonorrhoea. Vel : Sol. Zinci sulfo-carbol. (gr. xv) §viij. Vel: Liq. Plumbi 3j ; Zinci sulf. gr. x; Aq. font. Iviij. Vel : Liq. Plumbi, Spir. V. Gall, a 3j; Aq. dest. fviij. Vel: Zinci sulf. 0.2 ; Alumin. 1.0; Aq. dest. 100. o, turn adde Sol. Tannini (1.0) 100.0. DISEASES OF FEMALE GENITALS, THE WOMB, ETC. 337. 5 Sol. Acid, carbol. (3j) Oj. As wash in Pru- ritus Vulvae. Vel: Sol. Zinci sulfo-carbol. (3j) lij. Vel: Infus. Tabacci. Vel: (Acid, carbol. 3j), Plumbi acet. 3j; Tr. Opii f ij ; Aq. font, ad Oj. Lead and opium wash. Dossils of lint soaked in it and placed in the vulva. Vulvitis. 338. 5- Sol. Zinci sulf. (3ss) §v. As wash. Leucor- rhoea of children. (The vulva has to be bathed twice a day, after having washed it with soap and water.) Diseases of Female Genitals, etc. 125 339. g, Hydr. bichlor. 3ss.; Tr. Opii |j; Aq. font. 3 vij. To be applied bis die. Pruritus Vitlvce. Camph. 3 j; Amyli 3 v. Apply once a day. Pr.pudendi. 340. IJ Acid, tannic. 3ss; Bism. nitr. 3j; Opii gr. x. To be dusted over the sore. Chancroid. Vel. Pot. permang (334). Cupri acet. v. Alum, usti, Sabin. p. a 3j. To be dusted over the excrescences once a day. Condylo- mata, Vaginitis from warts. 341. 5- Alum. p. q. v. In a linen bag placed in con- tact with the Cervix, and held in place by a tampon (369). Metrorrhagia {Cancer). Vel. Tannin 3 ij, applied dry. Catheter in Retention of Urine. — The instru- ment is to be introduced in an oblique direction from without inward in the urethra of a healthy, unimpregnated woman; but in certain diseases, or the latter stage of preg- nancy the other extremity of the catheter must be depressed as soon as it enters the meatus, the urethra, on account of the ascent of the uterus having become nearly perpendicular, so as to pass along the internal surface of the sy7nph. pubis. In case of retention of urine, when arising from undue pressure against the neck of the blad- der by the gravid uterus, where in spite of the removal of this pressure by the elbow and knee position, the urine can not be voided, the catheter will enter with more facility than in any other position. In every case % of disease, with or without hemorrhage ■ unless the cause be palpable, it is advisable to examine systematically the entire uterus and its surrounding tis- sues in the following manner : 1. The cervix should be 126 TOPICALS: 342. 5. Sod. chlor. p. j; Aq. frigore concret. p. ij. In a linen bag, to be carried up to the ulcerated surface by means of a speculum. Carcinoma. (After removal the pain begins again.) 343. ^ Sol. Arg. nitr. (gr. x) §j. To be applied every other day. Vulvitis follicul. et purulent a, y 2 dr. to 1 oz. in Endometritis. 1 dr. to t oz. applied to vagina by means of a sponge-probang, after having cleansed it, once a week. Leucorrhcea. (Afterwards a Glycerine- tampon [369] for 24 hours.) Arg. nitr. in baculo, applied to erosions, ulcerations, etc., of the Os about once a week, is the best and most simple procedure; every application should, however, be followed by the salt-wash (261), and it should be, moreover, covered by a Carbol-tampon, saturated in Glycerine (369), or it may be protected by a coating of stypt. Collod. (415). investigated by touch, the speculum and the uterine probe. 2. The uterus and the whole pelvis should be ex- amined by conjoined manipulation, palpation and rectal touch. 3. The cervix should be dilated by tents, and the cavity of the body explored by the introduction of the index finger, by the sound and the curette. (It will re- quire generally three and even four tents to open the cavity of the body fully to the finger.) The examination may be made on a table, covered with a blanket, shawl, or rug of some kind, and provided with a small pillow. Should it be necessary to employ a bed, the leaf of a dining table or a wide board may be slipped across the mattress, under the upper sheet and covering, so as to get a hard surface to lie upon. Diseases of Female Genitals, etc. 127 344. ^ Sol. Acid, chrom. (3j) |j. Endometritis. y 2 oz. to 1 oz. to destroy the glands of the cervical canal. Cystic Degeneration. Vel : Hydr. nitr. acid, vel Sol. Zinci chlor. (3j) 3J. 345. 5 Liq* Ferri persulf. 3j ; Glycerin. |j. To be applied twice a day (besides dusting with Amylum, Bism. or Lycopod.) Vulvitis follicuL et pwulenta. 346. 5 Plumb, acet. 3] ; Acid, hydrocyan. dil. 3ij; Cacao §j. Apply after having washed the part with cold water. Vulvitis (if Pruritus). Borac. v. Plumb, acet. 3ij ; Glycerin. |j, by means of vaginal tampon (369). 347. 5 Hydr. bichlor. gr. ij ; Aq. Calcis |j. Con- dylomata. Vel : Cupr. sulf. in baculo. To be applied every five or six days — Cupr. sulf. p. x ; Borac. p ij ; Pulvis subtilissimus c. Aq. font, fiat massa ex qua formatur bacillae. In a first examination the patient should always lie upon her back, with the buttocks very near the edge of the board, the clothing loose around the waist, and the knees drawn up to relax the abdominal walls. When small tumors exist behind and disconnected with the uterus,. or where enlarged or prolapsed ovaries are to be sought for, or in case Sim's speculum or one of its modifications should be necessary, the patient should be placed in Sim's position, that is, on the left side, in such a way that breast and stomach are inclined towards the plane of the table. The left arm must be drawn behind the patient, so as to let her rest on the left side of the chest, and the right leg be so flexed as to let the right knee lie just above 128 TOPICALS: 348. fy Tr. Iodi, Glycerin, a 3ij. Granular Degen- eration, Vel: Tr. Ferri chlor. 3ij ; Aq. font. §j. To be applied once or twiceja week. Iodoform, gr. xv; Pot. iod., Glycerin, a 3ij ; Alcohol 3vj. Twice a week to cervix. Cervical Hyperplasia. 349. ^ Zinc, chlor., Aq. dest. a q. s. To touch the affected part once a day ; and every 3 hours a douche to the vagina. Afterwards an occlusion-pad (371). Puer- peral Diphtheria. (A suppository of Iodoform [374] in rectum will be of service; and, if the uterus be affected, a warm intra-uterine injection of Sublim. [397] must be made.) 350. ^ Ungt. Atrop. (gr. ij) |j. To be applied to the vaginal wall in Congest, and Nerv. Dysmenorrhcea, Vaginismus, etc. Vel : Ungt. Bellad. (3j) ij, vel Ungt. Hyoscyami, Opii, Stramonii, etc. Ungt. Atrop. is also valuable in Pruritus Vulva. the left — the lower trochanter must be by two or three inches nearer the examiner than the upper, or the use of a speculum will not be successful. Speculum, With the exception of Thomas' telescopic speculum, cylindrical instruments render, on account of their length, probing through them, or an examination by touch, quite impossible; as in anteversion it is as difficult to get the cervix into the field, as it is to carry applica- tions to the fundus. It will be best in most cases to employ Sim's speculum, (if there can be had an assistant) or, what may be still better, a modification of the latter. If a cylindrical or valvular speculum is used, the patient lies on her back, whilst the physician sits on a chair. Diseases of Female Genitals ^ etc. 129 351. ]J Bism. nitr. 3j ; Acid, oleic. |j. Solve leni calore, turn adde Ungt. Petrol. 3J. To be applied on cotton. Ulceration of Os. Vel : Iodof. 3 j ; Acid, oleic. |j. 352. 5 Ungt. Creosoti |j. Applicat. mane nocteque. Pruritus vulvce. Vel : Ungt. Chloroform, vel Chloro- form. 3j; 01. Amygdal. §j. 353. 3 Ungt. mercurial., Cerae flavae, Adip. suilli, a 3SS. To lubricate the os uteri bis die, whilst the abdomen is rubbed once a day with the following: Iodi gr. v ; Pot. iod. 3j ; Ungt. mercurial. 3SS; Axung. Porci 3J. To check the growth of Fibrous Tumors, Ungt. Calomel. (3j) 3J. Condylomata. 354. IJ Iodof. 3ss ;. Cacao 3J. To be introduced Into the womb by means of an applicator. Fndometritis . Vel : Cacao in Subinvolution, (The applicator — a silver tube of 4- inch diameter, and 8 inches long — is filled by forcing it into the mass for about 2% inches, and then discharged into the uterus.) 355. 5 Acid, salicyl., Ungt. Petrol, a 3SS. On a sponge- tent of one inch, to be introduced into the cervical canal — to remain for 12 hours — twice a week. Cerv. Endometritis, The finger, having been thoroughly lubricated with soap, is now passed into the vagina to ascertain the position of the cervix, after which the speculum may be well oiled and gently inserted. 2he Sound. While the patient lies on her back, the position of the uterus, resp. the direction of the cer- vical canal must be ascertained by passing the finger first into the fornix vaginas, over its posterior surface, and then along]^the base \oi ^the bladder, over its anterior 130 TOPIC 'A LS: 356. 5 Extr. Bellad. gr. j; Sapon. gr. iv; Cacao 3ss. As suppository at night. Vaginismus, Vel: Iodof. 1.0, Cacao 25.0. Anoayne. Vel: Extr. Bellad. gr, v ; Acid, tannic. 3 i j ; Cacao |j. Suppositoria 20. One at night. Pruritus Vulva. 357. ^ Zinc. oxyd. gr. iij; (Extr. Opii v. Bellad. gr. j); Cacao 3ss. As vaginal suppository, once or twice a day. Granular degeneration. (Instead of Zinc may be used Alum gr. iij, Plumb, acet.gr. v, Tannin gr. ij, Ungt. mer- curial, gr. x, etc.) 358. ^ Tr. Opii §j; Glycerin, fij; Aq. calid. Cij. Emollient vaginal injection, to be used daily for 20 to 30 minutes. Vaginitis, Hyperplasia. Other emollient injec- tions are: Dec. Amyli; Dec. Hordei; Dec. Ulmi; Inf. Conii; Inf. Humuli ; Inf. Hyoscyami ; Inf. Lini ; Aq. Calcis ; Aq. Picis, etc. (In Subinvolution, 1 y 2 gall, hot water — 120 to 125 — against the cervix, will stimulate and thus produce absorption of the redundant tissue.) wall. The speculum is then introduced, the patient retaining the dorsal decubitus, if a- short cylindrical instru- ment be employed; and being turned on the left side if Sim's or one of its varieties be used. As the probe will only pass if it has been properly curved, it must be bent again and again, until the direction of the canal is fully discovered (sometimes the inflection given to the sound must be the arc of a small circle; sometimes a sharp angle; sometimes even a spiral twist is required). Tents. As a general rule, laminaria (sea-tangle) tents are preferable to sponge tents, as they do not become Diseases of Female Genitals, etc. 131 359. 5 Zinc. sulf. 3j; Glycerin, fj; (Tr. Opii lss-j;) Dec. Hordei v. Aq. calid. Cj. Astringent injection, to be used daily for 10 to 20 min. Granular Degeneration^ Pruritus Vagina. (Zinc. sulf. may be replaced by 2 dr. of Alum, Plumb., or Tannin.) 360. 5 Acid, tannic. §j; Glycerin. 31V. ^ oz. to 1 litre of tepid water morning and night. Leucorrhoea. Vel : Liq. Ferri dialysati p. ij, Aq. font. p. j. Tannin. 3ss; Morph. gr. ij ; Glycerin. I'w. On cotton (369) after having painted the vagina with Arg. nitr. (343). Vaginitis. 361. IJ Ferri sulf. 3j; Dec. Quercus Oj. 2 oz. to be injected bis die. Prolapsus Vagince. (The iron may be replaced by Alum, et Zinc, a 3j.) In Gonorrhoea Mangan (334), or Phenol (327), or 1 dr. of Alum or Zinc to one quart of water daily. 362. IJ Acid. nitr. d. 3j; Aq. font. Oj. in mucous and muco-purulent discharges of Carcinoi7ia. putrid like the latter, and may therefore be retained for 24 hours and more. They may be medicated with Morph., Iod. or anything soluble in water (they do not absorb alcoholic solutions or Glycerine), and then dried again to be kept for use. It will be, however, advisable to steep them before use in a solution of Carbolic acid or some other antiseptic. Though they rarely produce any pain or irritation if just before introduction placed for a few minutes in warm water to soften them, it is better to insert several small tents than one large one, as the small ones expand more rapidly than a large one. If the uterus be low in the pelvis and its neck dilated, 132 TOPICALS: 363. 3 Sol. Alum. (gr. xij) |iij. Cauliflower [serous discharge). Vel: Liq. Ferri perchlor. 3ij ; Aq. font. |ij. vel Inf. Matico; vel Tannin. If feior: Sol. Calc. chlor. (3ij) Oj. vel Dec. Carotae. vel Creosoti 3j; Dec. Lini Oj. 364. Sol. Arg. nitr. (3j) |iv. One syringeful every 2 or 3 days. Urethritis. 365. ^ Tn Opii 3ss; Aq. tepid. |jss. Carcinoma (if pain), vel Chloral. 3ss; Aq. font. §ss. To inject at night, Vaginismus. Vel : Pot. brom., Chloral, a gr. xv; Aq. font. |ss. On cotton, by speculum. (It has to be retained by a tampon of dry cotton, with a thread for removal — 369.) JVeura/g. or Congest. Dysmenorrhea, partial closure of Os. a tent may be held in the bite of any pair of uterine dressing forceps and slipped in without the speculum, the woman lying on her back. In ordinary cases they may be introduced through the short cylindrical specu- lum, though in all cases it is most easily done with Sim's: The uterus being fixed and held by a tenaculum, the tent, grasped by a pair of mouse-tooth forceps, is directed in coincidence with the axis of the uterus, as ascertained by the probe, and gently pushed through the cervix. The patient has then to remain in bed until its removal, which is done after from 12 to 24 hours by traction upon the thread attached to it (the cord should always be fastened at the upper extremity of the tent and passed through it). As this mode of diagnosis and treatment is more or less dangerous, the following rules should be observed: 1, No force whatever should be employed, and, should the tent not pass the os internum, it either should be bent so as to follow more^accurately the cervical canal Jas Diseases of Female Genitals, etc* 133 2,66. ^ Liq. Ferri perchlor. |ss; Aq. font. §ij. 2 syringe- fuls, and, if necessary, to be repeated. Carcinoma (if Hemorrhage}. Vel: Liq. Ferri persulf. p. j; Aq. font, part, iv, with a tampon, which fills the vagina (by spec- ulum) ; vel Sol. Zinci sulf. (3j) fxij, as injection. 367. Sol. Ferri persulf. p. j ; Aq. font. p. ij. Vel: Tr. Iodi for injections of the uterus, after dilatation of cervical canal. In serious cases of Metrorrhagia. 368. Acid, carbol., Alcohol, a |j to a quart of hot water as injection of the uterus. Flooding from Abortion. 369. Carbol-Tamfion and Pessary: A wad of absorb- ent cotton — prepared of fine cotton having been im- mersed for about 3 days in a cone. sol. of Bicarb, of Soda, squeezed and washed repeatedly in clean water, and dried in the sun — is dipped in Sol. Acid, carbol (gr. x) f xij, and may now be used, saturated in Glycerine or medicated. (It acts at the same time as local hydragogue, disgorging the tissues.) Uterine Displacements, Granular Degenera- tion, Vulvitis, etc., — most valuable after the application of Caustics to cervix and vagina. ascertained by the probe, or exchanged for a smaller one. 2, It should on no account be introduced at the physi- cian's office, as the patient has to be confined at once to the recumbent position. 3, A tent should never be used where there has been chronic pelvic peritonitis. 4, It should not be allowed to remain in the uterus more than 24 hours, when the vagina should be washed out with an antiseptic lotion, and, if any pain, chilliness or discomfort follow, Opium should be given freely and perfect rest enjoined. 5, The patient should remain in bed for at least 24 hours longer, even if there be no pain, etc. i 3 4 TOPIC ALS: 370. Tampon in Hemorrhage from Abortion, etc., a piece of cloth or lint of about 6x6 inches, dry or soaked in Glycerine, is centrally to be placed over a finger or catheter, and thus introduced into the cervical canal. Then the finger having been retracted, the points of the four corners of the linen must be pushed likewise into the canal. This procedure has to be repeated with one or two pieces more until the desired object is obtained. 371. Occlusion- Pad for lying-in-women. Absorbent cotton wet with Sol. Hydr. bichlor. (gr. ij) §viij is placed over the vulva and covered with oiled silk; on this is put another layer of absorbent cotton, and a piece of muslin to be attached to binder. Prevention of Diphtheria. DISEASES OF THE RECTUM, ETC. 372. Acid, carbol., 01. Olivar. a §ss; Iodof. vel Morph., vel Chloral, q. v. As injection into the substance. Hczmorrhoides. Or the surface of the protruded piles be- ing wiped with lint, a portion of it, (the size of a 5-cent- piece,) is dapped with a wooden stick dipped in cone. Nitric or Carbol. acid. When this has taken effect, any superfluous acid is to be mopped up, some ointment or grease applied, and the parts returned. The patient should keep in bed and the bowels not disturbed for 48 hours. When the slough caused by the acid separates, the surface generally cicatrizes speedily, and leaves the part brazed up and healthy. Diseases of the Rectum, etc* 135 373. Extr. Hyoscyami 1.0; Extr. Opii 0.5; Aq. font. 5.0. Solve, turn admisce Glycerolat. simpl. 60.0. Applicatur bis die. Piles. Vel: Iodof., Bals. peruv. a 1.0; Ungt. Petrol. 4.0. Zinc. oyxd. 5.0; Glycerolati simpl. 25.0. Fissura Ani, etc. 374. Iodof. gr. xv; Cacao gr. x. F. supposit. Diph- theria puerperal. Iodof. 3ss; Cacao 3jss. Div. in 6 sup- positoria. One every night, alternately in vagina and rec- tum. Uterine Excitement j Ovarian Dysincnorrhoea. Vel: Iodof. 2.5; Cacao 40.0. F. 10 supposit (354 and 356). 375. Extr. Bellad. gr. ss; Opii gr. j — iij; Cacao 3j. F. supposit. Oxaluria (if pain). Vel: Extr. Conii gr. ij; Extr. Hyoscyami gr. iij; Cacao 3j. Vel: Extr. Bellad. gr. j; Opii gr. iij; Asae foet. 3ss; Cacao 3jss. F. 6 supposit. Uterine Irritation; Dysmenorrhcea membr. Vel: Extr. Bellad., Morph. a gr. ij; Cacao 3ij. F. 6 supposit. One every 4 hours until pain subsides. Abortion. 376. Ungt. Hydr. nitr. gr. ij; Cacao 3ss. F. 6 supposit. One at night. Oxyuris. Vel: Inf. Absynth. v. Quassiae fij. As enema. Trichocephalus. Vel: Sol. Acid, carbol. (3j) |ij; v. Acet. Vini as injection.* Enemata. Independent of their employment in womb and rectal diseases, they are of much use in hastening the action of Cathartics, taken by mouth, or in the removal of feculent accumulations in the rectum. They relieve, moreover, frequently tympanitis, and for the purpose of revulsion they are most valuable, to say nothing of their value in alimentation in cases of irritable stomach. 136 TOPICALS: 377. Tr. Ferri chlor. 3ij; Aq. Calcis §jv. Half the dose each time for 2 consecutive nights to be injected and followed the next day by a Cathartic. Ascarides. Vel: Syr. Allii, 01. Terebinth, a |ss; Inf. Lini §vj. As enema. 378. Tr. Kino, Tr. Catechu a 3ss; Tr. Hyoscyami 3j; Aq. font. |ij. 3j — ij to be injected twice a day, after hav- ing returned the part by pressure with an oiled sponge. Prolapsus Ani. Vel: Tr. Ferri chlor. 3ss; Inf. Quass. §viij. Also of use in Invagination of rectum. 379. Chloral, gr. iij — viij; Muc. Acac. 3j. As enema. Infantile Convulsions. Urcemic Coma. Vel: Acet. Vini, Aq. font, a |ss, as revulsive; vel 01. Olivar., Aq. tepid, a §ss, to maintain a soluble state of the bowels after having given a purgative. Convulsions from teething. 380. Spir. Vini Gall. 3SS; Inf. Theae |ij. To be in- jected every half hour. Asiat. Cholera. Sp. Vini G. 3j; Aq. font. |ss. As enema during the fit. laryngism. striduL 381. Tr. Opii 3ss — ij; Sol. Amyli 3I1J. To be injected directly after evacuation and repeated once or twice if it be quickly rejected. Dysentery \ Sporadic Cholera. Tr. Opii, Tr. Asae foet. a 3j; Dec. Amyli fiij. As enema and to be repeated after one hour if necessary. Colic. Tr. Opii gtt x; Tr. Bellad. gtt xx; Tr. Asae foet. 3ij; Aq. tepid. I iij. As enema to be retained. Me?nbr. Dystnenorrh. Tr. Opii gtt xx vel Tr. Hyoscyami 3j; Aq. tepid. §iij. As enema every night until quickening. To prevent Abortion. 382. Sol. Acid, carbol. (0.15 — 0.2) 150.0. As enema. Diarrhoea and Rectal Diseases (children 0.05: 120.0). Diseases of the Rectum, etc. 137 383. Ext. Ergotse fl. 3 ij; Aq. font. | ij. As enema. Ulcus stomachale. 384. Sol. Chinini bisulfurici v. Chin, hydrachlor. amorph. as enema. Intermittens, etc. See page 11. 385. 01. Ricini § iij; (01. Tiglii gtt. jv;) Kali carb gr. xv; Sapo3j; Aq. fervida Oj. Apoplexy. 01. Tere binth. | j; Muc. Acac. § ij; Dec. Hordei Oj. Insolatio 01. Terebinth. 12.0; Camphora 1.5; 01. Olivar. 60.0 Vitellum Ovi 1 ; Dec. Hordei 300.0. For 2 or 3 enemata, Tympanitis. Syr. commun, vulgo Molasse, 01. Olivar "a | ij; Sapo. q. 1.; Aq. tepida Oj; vel Sol. Sod. Chlor, ( 3 ij) 3 jv. As derivative. Scarlatina. 386. Aq. fervida f viij — Infusum Sennae ( § ss) Oj. vel Sol. Magn. sulf. ( § ij) Oj. Purgative. 387. Pepton. p. j; Aqua fervida p. ij. As enema. Scraped meat 5 oz. ; finely chopped pancreas l£ oz.; water 3 oz. Nutrient enemata may be composed of very strongbeef or mutton broth,(not to exceed 4 ounces) without salt or spice. They should be preceded by a large enema to clean the bowels; and if the rectum will not retain them a little Laudanum may be added. SKIN DISEASES, ETC. 388. Ferrum sulf. 0.4; Natrium chlor. 10.0; Aqua 100.0. vel Fol. Jaborandi 20.0; Aq. Coloniensis 200.0; Macera. Hairwash. Ammon. carb. 3j; Borax 3ij; Glycerin. | ss; Aqua |jv; Spir. Myrist. Oj. Shampoo. Sod. sulfuret. 3.0; Calc. usta et Amylum ? 10.0. Mixed with water to apply to the part. Depilatorius. 138 TOPICALS: 389. Oleum Ricini §j; Spir. Vini Gallici § vij. Diseased Hair-roots. Bals. peruv. 20.0; 01. Ricini 50.0. To apply to scalp. As dressing iuPanaritiumtwice a day. 390. Naphthol 5.0, Bals. peruvianum 2.5, Alcohol & Glycerin,'? 20.0; 01. Bergamott 1.0. To apply bis die. Pityriasis, Lichen, Scabies, etc. Borax 1.5; Glycerin 30.0; Aq. Rosar. 100.0; Aq. Coloniensis 20.0; Tr. Quillajse 50.0. Pityriasis. Stinking Sweat. Sol.Boracis ( | j) Oj; vel Sol. Kali carb. ( § ss) Oj if much itching: To wash the head in the morning, having oiled it the night before. Ungt. Calomel ( 3 j : § j) if Alopecia. Borax 10.0; Kali carb. & chlor. ? 5.0; Aq. Aurant. flor., Aq. Rosar. ? 75,0; Glycerin 30.0. Moles, Freckles, etc. 391. Cuprum oleatum 3 i j ; Lanolin § j. To apply bis die. Tinea favus. Ungt. Zinci |j. After having detached the scab by moistening it with a Solution of Sod. Carb. ( 3 j: 1 j) and the application of a bread and milk poultice. Crusta lactea. 392. Bism. nitr. prsec, Hydr. prsecip. album'? 5.0; Glycerol. Amyli 20.0. Cosmetique blanc. Kal. iod. 5.0; Natr. bicarb. 1.0; Aq. font. 400.0. Pimples. 393. Bism. nitr. pr., Zinc. oxyd. ? 2.5; Glycerol, simplex 30.0. Intertrigo. Zinc, tannic. 10.0; Glycerol, simplex 30.0. Tinctura Benzoes 2.0. vel Alcohol and Albumen. Decubitus. 394. Sod. Boro-salicyl. 20.0; Aqua font. 100.0; Spir. Lavandul. comp. 50.0. vel Borax 3 ij; Chloral 3 ss; Aq. fl. Aurant. & Rosar. ? | iij. Pruritus, Urticaria, etc. Glycerin |j; Aq. Coloniensis § v. vel Unguentum Petrolei. Pruritus from Scarlatina.. Skin Diseases, etc. 139 395. Acid, salicyl. 3.0; Amylum 10.0; Talcum 87.0. F. pulvis anthydroticus; vel Acidum nitricum gtt. x Aq. font. Oj, as wash. Sweating feet. 396. Plumb, aceticum 25.0 — 50.0; Alum. 12.5 — 25.0. Aq. dest. 500.0. With lint as dressing to foul ulcers. Resorcin 2.5; Glycerin 10.0; Tr. Benzoes comp. 40.0; Aqua 100.0; vel Resorcin & Ungt. Petrolei ana, as dressing for poisoned wounds, accompanied by inflamma- tion of Lymphatics. 397. Hydrarg. bichlorat. 1.0; Acid, hydrochlor. 2.0; Aq. destill. 10.0; vel Sublimate 1.0; Natr. chlor. & Acid, acet. ^ 0.5; Aq. dest. 10.0. Each for 1000.0 of warm water as disinfecting wash for hands, etc. For irriga- tion of wounds a solution of 1 :2000 will be sufficient; and for internal organs, e. g., the uterus, it should not be stronger than 1:5000. * * Antiseptic Wound Treatment. — After having thoroughly cleansed the wound with warm boro-salicylated water (399) and dried it with absorbent cotton, the edges of the cut are brought in apposition and retained there by means of plaster, with or without catgut sutures, care being taken to avoid ten- sion; as it is better to have the wound gaping than its edges dragged by sutures, especially if the tissue is damaged or un- healthy. Now it is dressed with three layers of antiseptic gauze (416a) saturated with boro-glyceride and covered by a few gamgee pads (absorbent cotton covered with antiseptic gauze), which are held in place by means of a gauze bandage. If there be much laceration and bleeding, the vessels must be picked up with forceps and tied with catgut. Then having placed in the wound a drainage tube, or if it be small, a few strands of catgut (which are absorbed in due time), the edges may be brought together with silk sutures, if practicable, and the following dressing applied: The wound being moderately dusted with iodoform, is covered with gauze — provided with holes for the tubes — likewise dusted with iodoform, after having been wrung out of sublimate water (297), over which are placed a few gamgee pads. The whole to be retained by means of a gauze bandage. Nussbaum prefers in all cases, where there is a possibility of 140 TOPICALS: 398. Acid, carbol. 10.0; Aqua 300.0; Brom. 5.0. Dissecting wounds. Acid, carbol. & Alcohol Tl. 0; Glycerol, spl. 50.0. Ulcers. Acid, carbol. 0.5; Zinc, oxyd. 1.0; Liq. Plumbi & Tr. Arnicae 2 gtt. x; Ungt. Petrol. 15.0. Eczema, Herpes, etc. Acid, carbol. 4.0; Ungt. Petrolei 50.0. To apply twice a week. Sycosis, Lupus, etc. Creosot 5.0; Alcohol. 10.0; Glycerin 85.0. Erysipelas. Phenol. 1.0; 01. Olivar. 40.0. Carbolic Oil. 399. Acid, salicyl. 1.0; Alcohol. 2.0. (Tr. Benzoes 1.0); Lanolin. 4.0; vel Pix liq. 10.0; Glycerol. spl. 30.0; vel Bism. nitr. cryst. 5.0; Aqua & Glycerin. ^ 2.5; turn adde Glycerin ad 100.0. Herpes facialis, Ulcers, etc. Acid, salicyl. 2.0; Acid, boric. 12.0; Aq. calida 1000.0. Wash for simple cuts, etc. 400. Extr. Opii, Extr. Bellad., Glycerin IT 3j; Ungt. Resinae § j. Boils. Acid, arsen. gr. ij; Ungt. Petrol. § ]. Onychia maligna. Calomel, gr. jv; Aq. Calcis | j. The ploughing, carbolized gauze moistened with phenol water 2^:100, or a 20 per cent, iodoform gauze, soaked in a solution of boric acid, covered with a few layers of dry gauze and salicylated wadding, which he keeps in place by means of an impermeable bandage. Two points ought to be borne in mind: 1. The wound must be redressed in order to remove the drain- age tubes, which has to be done in a day or two, according to the discharge; or if there is much pain or hemorrhage; though the dressing need not be changed because serum has oozed through it — antiseptic cotton covered over the moist places will here suffice. 2. Each time a wound is dressed, the hands should be disinfected with sublimate (397), and the required instru- ments (forceps, needles, etc.) with phenol 5:100, after having immersed them for a short time in boiling water. In fact, all the articles, which come in contact with the wound, should have been previously sterilized — cotton, catgut, silk, drainage tubes (416 a k b). An irrigator may be improvised by hanging on the wall a bottle upside down, out of which has been knocked the bottom, and in whose neck by means of a perforated cork, a tube has been fitted. Skin Diseases, etc. 141 swelling is to be touched once a day after the applica- tion of a bread and milk poultice with a little yeast. Abscess. Calomel dusted over the proud flesh twice a day, followed by a dressing of Ungt. simplex on lint, is used in Ulceration of Umbilicus (of infants). 401. Iodoform 1.0; Collod. 15.0; 01. Menth. pip. gtt. v. Scrophulous and syphilitic swellings, Orchitis, Arthritis, Ascites, etc. Iodoform 3 j; Ungt. Petrol. § j. Lupus. Half the strength in Variola to prevent pustules. 402. Iodum 1.5; Pot. Iod. 3.0; Aq. dest. 30.0. Ope penicilli applicatur. Tumor albus. Iodum 1.0; Pot. Jod. 6.0; Tr. Opii 8.0; Ungt. Petrol. 60.0; vel Iodum, Pot. Jod. ^ 5.0; Glycerin 10.0. The application is cov- ered with oiled silk and followed after 24 hours by a cataplasma. Lupus, Syphilis. Iodine & Phenol (1:4). Carbuncle. Applied in time, it frequently will abort any kind of boil. 403. Acid, acet. cone. q. s. The neoplasm is to be touched once a day, when it will peel off gradually in thin scales. Hypertrophy of skin (Warts and Corns.) Acid, chrom., Aq. dest. ana (Servetur in vitro epistom. vitreo). Ope penicilli asbest. v. vitr. applicatur. Scir- rhus, Warts, etc. Sol. Arg. nitr. ^ per cent, as sub- mucous injection in Carcinoma, etc. Zinc, chlor. 1.0; Glycerin. 100.0. Cancer , Wounds after operations, etc. Benzol brushed over the ulceration, afterwards dusting with Calomel 2 — 4 times a week; or Potass. Permang. dusted over the sore. Epithelioma. The latter also in snake-bite after having vigorously sucked the wound. 404. Sol. Argenti nitr.( 3 ss — j ) | j. To paint around the affected part in order to prevent spreading. Ery- 142 TOPICALS: sipelas. Sol. Ferri sulf. (3.0) 60.0. To brush over the affected part; vel Alum. 6.0; Hydr. praec. alb. 0.2; Glycerin 20.0. (Useful also in frostbites of second degree), Aramon. sulfoichthyolicum p. j, Lanolin p. ij. After having covered the wound with a iodoform-gauze- coinpress, the erysipelas is to be rubbed with the oint- ment and covered with 10 per cent, salicyl. lint. In Erysipelas of the face ichthyol-collodion, and of the scalp, Ichthyol-soap are said to be preferable. 405. Ol.Lini &Aq. Calcis ana. Burns. Liq.Ammon. 2.0; Glycerin 20.0 {for burns of second degree without Ammonia); vel Copaiva(also used in frostbites.) Cocain. 0.1; Glycerin. 20.0. Burns of first degree every five minutes until pain relieved. Also good for sore nipples. Cocain. 2 per cent., Iodof. ? 3 j; Ungt. simpl \ j. Burns of 2d and Sd degree. (If in the face, a gutta percha cover will be of service.) Burns from Phosphor are best treated with caustic; and extensive burns of any kind, either with carbol-spray, and a wet compress of bor-lint, (4 per cent.) or, after the vesicles having been opened and excised, the entire burnt surface is covered with dry iodoform gauze (20 per cent.) over which gutta percha is placed. The whole is then protected by gamgee (see note, p. 139) kept in position by means of a bandage). 406. Borax 2.5; Phenol 1.0; Glycerin. 20.0; Tr. Opii 1.0; Muc. Acac. 30.0; f or frostbitten ears twice a day. See page 3. Acid. nitr. 15.0; Aq.lOO. Chilblains. 407. Sod. bicarb. & Sod. Chlor. ana. To be applied to bites or sti?igs of insects, etc. Liq. Ammon. vel Acid, nitricum. Snakebite. See Wounds (poisoned), part. II. Skin Diseases, etc. 143 408. Empl. Cantharid. to nuka in Coma. (Typhoid.) Liq. Ammon. fort. gtt. j. As blister, to be repeated when healed. Neuralgia. Chloral dusted over Empl. adhaesivum and applied after gently heating the plaster, will blister in less than 10 minutes, without pain or any constitutional effects. 409. Camphora 3 ij; Alcohol. 3 j; Glycerin. | j. As soothing rubefacient. Neuralgia. Spir. Camph., Gly- cerin. ^ 50.0. Rheumatism. Linim. Ammon. § ij; 01. Terebinth. | j; Tr. Opii § ss. This Liniment without opium to be rubbed on the spine at the beginning of cold stage in Intermittens. Camphor.3.6; Cetaceum20.0; Cera alba 5.0; Ungt. Petrol, albi 25.0. Painful limbs. 410. Aconitin. 0.5; antea triturata cum Alcohol, gtt. aliq. ; Ungt. Petrol. 25.0. Neuralgia. Extr. Aconiti 2.0; Glycerol. Amyli 20.0; vel Kali cyan. 0.5; Glycerin. 10.0. N. Facialis. (The finger which is used for rubbing must have no scratch). Veratrin. 0.3; Morph. hydro- chlor. 0.2; Glycerol, simplex 30.0. Migraine. Vera- trin. gr. x; Alcohol | ss; vel Chloroform & 01. Olivar. ana | ss. Spinal Irritation. 411. Tr. Cantharid. 3 ij; Tr. Arnicae et Tr. Nuc. Vom. "* | j. To be rubbed on the loins and inside the thighs. Nocturnal Emissions. Tr, Opii § ss; vel Tr. Capsici | j; Linim. Sapon. § ss. Congestion of Kidneys. Sparadrap.perfor. Bellad. q.v. Pleuritis {circumscribed). 412. Lith. carbon. 5.0; Glycerol. Amyli. 30.0. Tophi arthritici. Lith.brom. 2.0; Glycerin. 4.0. Pulvis Althaeae. et Farina Tritici ^ 2.5; Aqua q. s. ut fiat massa. As paste to cover the gouty concretions. 144 . TOPIC ALS: 413. Inf. Digitalis ( § j : Oj); vel Ti\ Digitalis, Tr. Scillie ^ | ij. To be rubbed twice a day over the abdomen, which is then to be covered with flannel. Dropsy (if the state of the stomach precludes the in- ternal use of diuretics), or Paracentesis.* Tr. Iodi § j semel in die to prsecordia. Pericarditis (after effusion.) Also in papular stage of Variola. 414. Collodion; vel Chlorof. § ss; Gutta percha q. s. Applicatur semel vel bis die. (In papular stage or if vesicles very small. Variola. Sol. Hydr. bichlor. (gr. j) §vj; as compresses. At the same time cold water compresses on coujunctiva to prevent eruptions there. 415. Collod. 100.0; Glycerin. 1.5; vel Collod. 100.0; 01. Ricini 2.0; vel Collod. 100.0; 01. Ricini 1.0; Tere- binth, laric. 2.0. Elastic Collodion. Tannin. 3jv; Alcohol. 3 ss; iEther. 3 ij; Collod. ad § j. Styptic Col- lodion. As protection in all kinds of ulcerative and bleeding parts — stitched wounds, etc. Morph., Iod., Creosot, or Phenol may be incorporated, if necessary. 416a. Antiseptic Material — Sublimate 5.0; Acid, tart. 20.0; Aq. fervida 900.0; Glycerin. 100.0; Gauze, Cotton, etc., q. v. Acid, boricum 10.0 — 20.0; Aqua calida 90.0 — 80.0; Gossyp. absorb q.v. Acid. bor. 5.0; Acid, carbol. 2.0; Aq. calida 100.0; (Alcohol. 5.0;) Gossyp. absorb, q. v.; vel Acid, carbol. 100.0; Spir. * After having placed the patient in the recumbent position on her side at the edge of the bed, the trocar in a canula being held in the hand so that the tip of the forefinger is about two inches from the point of it, the instrument is pushed through the linea alba, two inches below the umbilicus. In fat persons a preliminary incision with the scalpel down to the aponeurotic structure will be advisble. Skin Diseases, etc. 145 Colophon. (40.0), 2000.0; 01. Ricini. 40.0; Gossyp. vel Lint, q.v.; vel Acid, salicyl. 5.0 — 10.0; Alcohol. 100.0; Aqua 200.0; Gossyp. vel Lint. q. v. As dressing for wounds, etc. (Absorbent Cotton or Lint soaked in dil. acet. acid may be packed between the soft parts of lacerated wounds to stop bleeding). 416b. Sublim. 1:1000; Phenol 3:100; Acid, boric. 3j: I jv Aq. fervida; Liq. Ferri chlor. c. Aq. fervida ( 3 Y'l jv); Iodoform, Ether and Alcohol in the propor- tion of 1:2:8. For medication of sponges. Before sterilizing the sponges by boiling they should be thor- oughly cleansed with soft soap (potash,) or, if necessary, washed with hot water containing hydrochloric acid. Silk for sutures should be treated with sublimate 1 : 1000? after having been boiled for half an hour; or it may be impregnated with beeswax containing 10 per cent, phenol. Catgut is made aseptic by shaking it with ether and then preserving it in 01. Eucalypti. (Nos. 1 & 2 are the best sizes for sutures and small ligatures). Before use it must be dipped in Alcohol to make it pliable. Drainage tubes (1-16 — 1-4 inch by 12 inches) are made aseptic by soaking in phenol 5:100 — glass tubes maybe kept in sublimate 1:1000 after having been boiled. 41 Y. Hot-air-bath. Heated air is introduced under the bed clothes for the purpose of producing diaphoresis, if Hydragogues are not borne and Diuretics will not act. Sulphur-air bath. Sulfur § ss — j is burnt in the sick room, which has to remain closed for a few hours to allow the fumes to permeate it thoroughly. After hav- ing the room thus disinfected, the patient is taken back. Infectious Diseases. In Pertussis said to be specific. 146 TOPIC ALS: 418. Lime-steam-bath. A barrel of quick-lime is slackened in the room daily, whilst the latter is charged with steam by keeping water boiling all the time. Croup, etc. 419a. Pot. sulphuret. § jv; Aqua C.30, as bath in wooden vessel. Lead colic. Pulv. Sinapis § j; Piper rbr. | ss; for a bucketful of warm water, as styptic bath. Dysmenorrhea, etc. Pulvis Sinapis § jv for a foot bath, lb \ for a hip — and lb. j for a full bath. Best stimulant for internal congestion. 419b. Ferr. sulfuricum crudum 100.0 (No. I); Acid* tartaricum 20.0 (No. II); Natr. bicarb. 10.0 (No. III). In this succession the substances are to be dissolved. Balneum ferrugin. mitius . Ferrum sulfuricum cr. 1 5 . ; Sal. marin. 300.0; for one bath. Balneum fortius; vel Ferrum tartaricum 75.0 — 100.0. 420. Sponging with water, or brandy and water, if the skin be hot and dry, and axillary temp. 104 degrees or more; or the Wet Sheet with a sprinkling pot of cold water to be kept up for several hours if necessary — — according to temp, and pulse. In Insolation. In functional Paralysis, Douches of alternately cold and warm water; or the Wet Pack: The patient is enveloped in a wet sheet and closely covered with blankets. In an hour's time, when perspiration is induced, the pack is removed, the body wiped dry and the patient placed in bed. In acute Ascending Paralysis the pack is some- times of great service. In Bronchitis capillaris — where the child should remain packed for from four to six hours — in conjunction, if necessary, with a wet compress round the neck, taking care that the latter overlap the Skin Diseases, etc. 147 chin (298b). In Cholera epidemica, the modified pack: Hot water, with or without a dash of vinegar, being substituted and renewed every two hours.* In Inter- mittens and Yellow fever, sponging, and internally ice- water ad libitum. In Articular Rheumatism, acute and chronic, the pack or sponging. In Scarlatina and Measles the same, once or twice a day. In Typhoid, sponging with cold water, whenever axillary temp. 103 degrees or over, or that of rectum 102-J- degrees, as long as it is attended with comfort, until it falls to 101 or 100 degrees; or wrapping in a wet sheet and sprink- ling at intervals, whilst the thermometer in rectum. (A cot with arrangements for the drainage is convenient.) A sensation of chilliness, feeble pulse or cyanose contra- indicate the continuance and call for wine and spirits. Cold water is altogether contra-indicated if there be in- testinal hemorrhage, sweating, menstruatio?i, feeble pidse or feeble action of the heart. For compresses in affec- tions of throat or in Variola, see Nos. 298 & 414. 421. Electricity. Galvanism is chiefly used for its catalytic, cataphoric and electrotonic action. f In Melan- *If the sheet be washed directly after its use in water, con- taining Chlorin. Soda, three, with as many blankets,will suffice for the procedure; in as much the evacuations will generally cease in the first pack. The stools should be voided into a vessel containing Ferrum sulfuricum ; and if the dejections are passed involuntarily, they must be received on cloth wrung in vinegar. Moreover all the articles of cloth should be cast, as soon as removed from the patient in a wash-tub containing chlorinated water. Vinegar or phenol should be added to the wash water for the use of the attendants. |When the galvanic current is applied for the catalytic effect, no interruptions should be allowed in the circuit — these are, in fact, only required in examination of electrical motility, and for therapeutic use, in cases where the Faradic current fails to 148 TOPICALS: cholia, Functional Insanity and some other diseases of the brain, especially Intracranial Syphilis, before hemiplegia has supervened, a galvanic current is some- times of service. The electrodes must be placed in the nape of the neck and on the forehead; the strength of the current may be gradually increased to about 2 milliam- peres, and one sitting should not exceed 3 minutes. In organic disease of the brain and spinal cord it will gen. erally retard trophic changes and relieve certain symp- toms attending those affections — as pain, anaesthesia, spasm, paresis. In cerebral lesions the diseased peri- pheral structure should be treated at the same time with Faradization. In Facial Paralysis^ in order to reach the medulla oblongata, one pole should be placed in nuca and the other above the larynx. In Neuralgia, where the pain is increased by pressure, a mixture of Cocaine and Aconite may be introduced under the skin by means of the current, or two needles may be deeply obtain motor response, viz., in cases of infantile paralysis, lead palsy and all those peripheral palsies produced by pressure or trauma, which present the reaction of degeneration. It should be only so much increased as to cause the slightest sensation of a change, while the Faradic current should produce but a pleasant tickling. (Very sensitive people will bear the latter better, if they have been exposed to a moderate volume current). One of the electrodes should be placed as near as possible the seat of the disease, the other being applied so that the direct route of the current includes the locus morbi. The choice, of the poles will depend on trial, as the difference in the action of anode and kathode is not yet understood. Faradization is limited to an artificial stimulation of motion and sensation; it will act better than the galvanic interrupter in cases requiring muscle stimulation, with the exception of those characterized by the reaction of degeneration. The slow interrupter will generally be required for treatment, since many muscles, suffering from local or centric disease will re- spond to single stimuli that remain totally impassive, when the rapid succession current is employed. Skin Diseases, etc* 149 inserted at 2 points in the course of the nerve (galvano- puncture). Hysterical Neuralgia is more benefited by Faradization, which is brushed over the painful points. In Hypercesthesia and Ancesthesia the rapid interrupter must be used. The sensorial sedative action is obtained by means of moi^t electrodes, the anode being the pole applied locally; whilst the stimulating effect is pro- duced by the use of a dry electrode, the kathode being the local pole — the moist anode may be placed anywhere. 422 To remove superfluous hair. After having intro- duced the negative needle into the follicle, hard by the hair to be removed (which has been grasped with the epilating forceps), the patient, with the sponge electrode in one hand, is directed to press the sponge against the palm of her other hand. In about one minute the hair will be found loose, and may now be removed — but without traction — taking care not to withdraw the needle before the patient has broken the circuit. More than three dozen of hairs should not be operated upon at one sitting. A battery of 10 cells are sufficient (3 — 5 milliamperes .) Small Ncevi, Angiomata or Erectile Tumors, Warts, Hairy Moles and other small growths are also readily removed by galvano-puncture. Sub- sequent fomentations are sometimes of service. Ence- phaloid, Scirrhus and other malignant tumors are occa- sionally amenable to cure, but require several operations at intervals of from 3 — 5 days. Goitre may be success- fully electrolysed, if the tumor be of a yielding con- sistence and not of too long standing. With the sponge electrode in nuca, introduce a gold tipped negative needle into the tumor, being careful to avoid the large 150 TOPICALS: superficial veins. The strength of the current should not exceed 20 milliamperes, and the weekly sittings 5 minutes. In the cystic variety, both poles must be introduced into the sac by means of needles. In Hydatids (of the liver) 2 negative needles are introduced into the most prominent part of the tumor, about 2 inches apart, and over the hepatic region a sponge electrode is kept slightly moving for about 15 minutes. In Aneurism, both the negative and positive needle are introduced into the sac at about 2 inches distance from each other. 5 — 20 cells are required, and the operation may last for one or two hours. The introduction of 3 or 4 positive needles has been lately recommended. Varicose Veins of the legs are said to disappear sometimes altogether under the Faradic treatment. 423. Extra-uterine Pregnancy has been treated suc- cessfully by the Faradic current from a strong inductive coil, one electrode being pressed against the tumor in the vagina and the other to the abdomen. The destruction of the foetus by electrolysis is applicable during the first four months, and the operation, which should not exceed one hour, has generally to be repeated 3 or 4 times at intervals of about 3 days. 224. Artificial Respiration. After having passed a needle into the Trapezius, or beneath the skin, imme- diately over the JPomum Adami, the moist sponge electrode is applied a little below the Sternum. The contractions of the diaphragm and chest muscles is now sustained just long enough until one leisurely may count three, when the sponge is removed, to be reapplied after a similar interval. See page 1. HPPENDIX. 3. Table of Weights and Measures, etc, 2. Analysis of Urine. 152 Table of Metrical and METRICAL WEIGHTS. 0.001 (Milligram) _ 0.015 gr. (&) 0.01 (Centigram) _ _ 0.154 " (J) 0.1 (Decigram) 1.543" (If) 1.0 (Gram=l C.C. of water at 4° Celsius).. 15. 432 " (15) 10.0 (Decagram) —%% drachms 100.0 (Hectogram) ; 3 ounces 1000.0 (Kilogram) _ 32 " Table for Converting Apothecaries' Weight into Metric. Troy Weight. Grams. 1-60 of a Grain O.001 Troy Weight. Grams. 36 Grains.. 2.33 1-30 " 1-20 " ..O.002 . .O.003 _ .0.004 .. .O.005 ..O.006 .-O.008 -O.011 ..O.016 ..O.022 . .0.032 ..O.05 ..O.065 -0.13 .-0.19 -0.26 -0.32 .-0.39 ..0.52 .0.65 .0.78 .0.97 -1.04 -1.17 ..1.30 -1.55 ..1.95 40 50 60 80 90 96 100 2 21 3 4 6 1 1* 2 21 3 4 5 6 7 8 9 10 12 16 a a a tt a a Drac! tt t% u tt Ounc a Ounc tt u a tt a a tt u a tt a (3ij)~ — 2.60 ... 3.24 1-16 1-12 1-10 1-8 " (30- Ojv)- ( 3 jss) ... 3.90 ... 5.18 — 5.83 ... 6.22 1-6 1-4 1-3 " (3v)„. lms ... 6.48 ... 7.75 ... 9.72 1-2 " ... 11.66 3-4 " ... 15.55 1 Grain ... 23.3 2 Grains 3 " e .. 31.1 .. 46.6 4 " es ... 62.2 5 " ... 77.7 i CO oc • _. 93. ..124. 10 " ..155. 12 " -186. 15 " ..217. 16 " 18 " 20 " O'j) 24 " 30 " (3ss)„. ..248. „279. -311. ..372. ..500. Apothecaries' Measures, etc. 153 APPROXIMATE EQUIVALENTS OF CUBIC CENTIMETERS. 0.001 C. C.= it Minim. I 0.1 C. C.=.— H Mmim. 0.01 u = I " I 1. " = 15 [The weight of 1.0 water at its maximum density— 39.2° Fahrenheit — see preceding page.] 4 C. C. — f . 3 j Cochleare parvum (Teaspoonf ul). 8 " =f. 3 ij Cochl. medium (Dessertspoonful). 16 " =f. 5 ss Cochl. magnum (Tablespoonful). 48 " =f. 5jss Cya thus vinosus (Wineglassful). 160 " =f. §v Vasculum pro thea (Teacupful). 320 " =f. §x — Cyathus (Tumblerful). 500 " =Oj Octarius (Pint). 1000 " =Oij Litre (a little more than a Quart). 4000 " =Cj Congius (Gallon). Table for Converting Apothecaries' Measure into Metric Weight. *0Q GRAMS FOR LIQUIDS. *0D H . M M M ga GRAMS FOR LIQUIDS. DP si Pi < ^3 OS u .8 « -t-J «3 MINIMS. 1 .055 .10 .16 .22 .28 .32 .38 .45 .50 .55 .65 .76 .80 .90 1.12 1.40 1.70 .06 .12 .18 .24 .30 .36 .42 .50 .55 .60 .72 .85 .90 1.00 1.25 1.55 1.90 .08 .15 .24 .32 .40 .48 .55 .65 .73 .80 .96 1.12 1.20 1.32 1.60 2.00 2.50 MINIMS. 35 40 50 60(f3j)- 72 80-.-™. 90 (f 5jss). 96 100 120(f3ij)- 150 (f 3 ijss) 160 180 (f 3iij)- 210(f 3 iijss) 240(f3jv). f§i f §jv 2.00 2.25 2.80 3.40 4.05 4.50 5.10 5.40 5.60 6.75 8.50 9.00 10.10 11.80 13.50 27.0 108.0 2.20 2.50 3.12 3.75 4.50 5.00 5.60 6.00 6.25 7.50 9.50 10.00 11.25 13.00 15.00 30.0 120.0 2.90 2 3.30 3 4.15 4 5 00 5 6,00 6 6 65 7 7 50 8 8 00 9 10 8.30 10.00 12 14 12.50 13.30 15 15.00 16 ._ 17.50 20 25 20.00 40.0 30 160.0 Age. 1 to 3 months 4 to 12 " 1 to 3 years 4 to 5 " 6 to 8 " Dose. 1-16 1-10 1-6 1-4 1-3 1-2 Age. 13 to 16 years 17 to 20 " 21 to 50 " 51 to 60 " 61 to 70 " Dose. ... 2-3 3-4 1 3-4 2-3 9 to 12 " 80 to 90 " 1-2 A FEW OBSERVATIONS ON URINE AND HOW TO TEST IT. The quantity of urine passed by a healthy person in 24 hours varies from 30 — 40 ounces, and its color will likewise vary very much, being like the quantity, in intimate relation with the ingesta. Though usually of a light amber or straw color, it may take all possible shades between water and porter. Among drugs that have a decided coloring influence on the urine, which, in some instances, might be taken for blood, may be mentioned Curcuma, Rheum, Frangula, Senna and Santonin. — A few drops of hydrochloric acid will settle the question, in as much bloody urine undergoes no change. Very pale urine, if not the consequence of much drinking, may be due to Ancemia, Chlorosis, Hysteria, Diabetes, etc., etc. High colored urine indicates generally an excess of acid, and unless the result of good living, is symtomatic of febrile diseases. A smoky tint is diagnostic of the presence of blood. Deep yellow or greenish brown indicates bile due to hepatic disorders. Dark brown or black urine is generally due to rapid morbid changes in the blood and tissues, and occurs in infectious and other severe diseases. Cloudy or filmy urine is generally alkaline and indi- cates the presence of mucus; white opaque and viscid — (154) Analysis. 155 mucus or pus or earthy salts, singly or jointly. Turbid urine of a creamy yellow color at the bottom is mostly acid and contains pus. Froth on healthy urine readily disappears, but if it be permanent the presence of albumen or the constitu- ents of bile may be suspected. The odor of urine is also of much importance. A smell of Ammonia indicates catarrhal inflammation of the bladder; that of Sulfurated Hydrogen occurs in Typhoid and Cholera, and is a bad omen. (The admin- istration of 01. terebinth, produces a smell of violets). The specific gravity of urine averages about 1020. If higher, sugar or uric acid are most likely to be present: a low spec, gravity is frequently observed in Hysteria and ancemic conditions; in chronic Bright' $ disease and in Diuresis from any cause. Blood and fibi*in may be detected by the microscope, and the presence of serum is ascertained by the discovery of its albumen, on account of which serous urine is commonly called albuminous urine. The urine to be examined should be always a portion of the lohole quantity passed in 24 hours, because that passed in the morning frequently contains no albumen, whilst that voided later, does. Urine, not distinctly acid, should be rendered so before testing for albumen, by adding a drop or two of nitric or acetic acid; and if it be permanently turbid from any cause, it should be filtered before boiling. In that case the presence of mucus or pus may be suspected, whilst a turbid urine becoming clear by boiling contains urates. (If the urine has not been acidulated before boiling, the cloud or 156 A Few Observations On Urine opacity, which may appear might be due to the presence of Earthy Phosphates, which, of course, will be redis- solved on the addition of the acid). Renal casts should always be sought for, if albumen is detected: Allow the urine to settle for a few hours in a tall glass, then, after having poured off all the top, place a drop of the residuum under the microscope,where the fibrin will readily be distinguished. Sugar. Unless the spec, gravity of the urine rise above 1030, it is of no practical value to examine on sugar, in as much, 15 grs. of it are excreted daily through the kidneys by a healthy person. Put a few drachms of urine in a test-tube, add the same quantity of Liq. Potassce, and heat to boiling-point over a spirit lamp, when, according to the quantity of sugar present in the urine, it will assume a dark-brown, even black color. It is, however, necessary to remove any albumen before testing for sugar, by boiling the urine in question with a drop of acid, and subsequent filtration. If there be no albumen, and a few drops of nitric acid be added, the dark color will disappear, the urine exhaling a smell of molasses. (Aside from albuminous urine, a urine high colored or containing an excess of Phosphates, will considerably darken on boiling with caustic alkalies). To estimate the amount of sugar, put two 12 oz. bottles, each containing 4 ounces of the urine to be tested, for 24 hours in a warm place, the one tightly corked and the other with a piece of yeast, the size of a chestnut, thrown into the urine and not corked. The difference in the spec, gravity will give the number of grains of sugar contained in the fluid ounce. And How To Test It. 157 Mucus and Pus. Pus produces a thick sediment at the bottom of the urine, which is rendered viscid and gelatinous by the addition of about half its quantity of Liq. Potassce; whilst urine containing mucus, which is stringy and floating rope-like within it, becomes more fluid and limpid under these circumstances. (Pus from the bladder will probably be mixed with mucus consti- tuting muco-purulent matter.) Bile-pigment may be detected by shaking the sus- pected urine with a small quantity of Chloroform. If bile be present, a yellow sediment will form, consisting of bilirubin crystals.* Spermatozoce. Allow about a quart of the urine to be tested to settle for a few hours in a tall glass, decant, and divide the rest of about 8 ounces in two pointed champagne glasses to settle for another 5 or 6 hours, after having added to the one a little Picric acid. Decant again and place a drop of the urine remaining in the two glasses under the microscope. To detect Spermatozoce in linen, a few threads of the stained piece should be moistened with a drop of Gallic acid, dissolved in water, to which must be added after about 10 min. a drop of Sol. Ferri chlor. dil. A few threads may now be prepared in the usual man- ner for microscopical examination, by means of a needle in a drop of glycerine. *Boiling of the acidulated urine in a test-tube, will in most cases suffice. Originally turbid urine, remaining so when boil- ing, contains Mucus or Pus— clearing up: Urates; whilst ori- ginally clear urine becoming turbid by heat, contains either Albumen or Phosphates, the latter if it clears up by the addition of an acid. Compare Urinary Deposits, part II.) THE SECOND AND THIRD VOLUME The General Practitioner (see contents of this volume), Will respectively appear in December, 1889 and February, 1890. The order, accompanied by $1X0, or for the whole work (3 volumes) $3.00, should be registered and addressed to DR. STREHZ, 380 Wells Street, CHICAGO, Ilii* M U.S.A. PART II. An Alphabetical Arrangement of the Diseases, 'with their several definitions, symptoms (whenever pos- sible pathognomic), and causes, together with diagnostic hints, and the remedies usually employed in their treat- ment. Abortion — Expulsion of the contents of the gravid uterus, before the seventh month of utero-gestation, i. e. before the viability of the foetus; attended by pain, which is marked by distinct intervals, like those in labor, and more or less hemorrhage, which, unlike that from delayed menstruation, usually precedes the pains, the os being at the same time more open — see Labor. Aside from blows, falls, or acute disease of the mother, and morbid conditions of the foetus, it may be caused by strong emotions; irritation of nerves — of the trifacial, from the extraction of a tooth; — excessive sexual ex- citement; violent purgation; anaemia; tumor in utero, ulceration of cervix, etc., etc. Treatment — Until dila- tation of the os, or the partial extrusion of the ovum is obvious, abortion may be prevented sometimes by complete rest; Morph. with Brom. (51) internally, and Bell., Opium, etc., as suppository, or enema (375 & 81). If there be plethora or feverishness, Nitre (123). In threatening or habitual abortion, Viburnum (p. 39); if want of nausea be suspected as cause, Ipecac, (p. 100). Proper attention should be paid to the uterus, for, if that (159) 160 Abscess. organ be fleeted to such a degree as to produce incarcera- tion of the fundus below the promontory of the sacrum, abortion is sure to follow. In case where prevention is impossible, the expulsion of the ovum, which in the first three months generally escapes entire, must be facilitated, though as a rule, the less we interfere th<* better. Should the ovum project, one may try to shell it out by means of two fingers which have been well greased, carried up to the os, while the right hand is applied externally to press down the womb and assist the operation. If unsuccessful, one drachm of Tr. Ergotae every 15 min. ex aqua. After three months, if the foetus has been extruded, we may leave the placenta alone, as nature is sure to expel it; though we may have to wait for more than a week, and Ergot would be of no use. Only in case of flooding, which in reality is the danger, it will be advisable — see Hemorrhage. To prevent sep- ticaemia Aconite or Veratrum may be given with Sa/icin (pp. 22 and 39), according to the strength of the pulse. Abrasion of Cervix. See Uterus (Granular degen- eration of cervix). Abscess — A cavity filled with pus in consequence of disintegration of the substance of an inflamed organ — compare Tumors and Ulcers. Treatment — Aside from due attention to the general state of health, ice or cold water compresses to check the formation of pus; or fo- mentations and poultices (400) to hasten maturation; and the knife. After evacuation of the pus, antiseptic dress- ings: Phenol (327 & 398); Phenof~lod. (402); Mangan (334 & 403); Bor (260); Iodoform (269 & 401); Salicin (399); Resorcin (335 & 396); etc. Internally Sulfides (p. 19) and perhaps Tonics (p. 69). F 'or fecal abscess see Alcoholism. 161 Typhlitis; Mammary — Breast; Pelvic — Uterus (Cellu- litis); Retropharyngeal — Pharynx; Vulvar — Vulva, etc. Aciditv of Stomach. See Dyspepsia. Acne. See Skin. Adipositas. [Fettsucht of the Germans.)— Obesity is mostly the consequence of excessive ingestion of food, especially of fat and carbohydrates — the latter by pre- venting oxidation — under certain circumstances and constitutional peculiarities, as, e. g. is sometimes the case in the climacteric period of females, when the ovaries get into a state of atrophy; or in males, from defective action or development of the testes. Treat- ment — Alkalies (p. 53); Fucus? (p. 12), with appropriate diet and plenty of exercise. An excessive accumulation of fat connected with menstrual aberration to be met with in young women, will frequently disappear, if the latter can be corrected. Ague. See Fever (Intermittens). Akinesis. See Paralysis. Albuminuria. See Kidney. Alcoholism — A toxical condition produced by abuse of alcoholic drinks, and culminating in delirium tre- mens — Mania a potu, — which is both, either the direct consequence of the long, continued action of alcohol on the brain, or due to the sudden withdrawal of. alco- holic stimulants in an habitual drinker. It is charac- terized by mental aberration, the mind wandering from one subject to another, and incessant talking, accompa- nied by a wild expression, the eyes being either vacant or staring. The mental disorder is preceded for a few days by the horrors: Muscular tremor, mental depres- sion and insomnia, attended by complete anorexia. A 1 62 Amenorrhea. form of acute mania, due to active cerebral congestion, and produced rather by a protracted paroxysm of drink- ing, than by the habitual use of alcohol (Delir. Ebrios.), is characterized by great hilarity, even violence and fury, which may, of course, eventuate as well in Delir. tremens. Treatment — In kater, Amman, (p. 44); Acid; hydrochlor. (p. 42). In debility and craving for drink [Dipsomania), Antimony (39); Acid. sulf. (155); Ammonia ( 159). In vomiting, Gelsem. (p. S3), see Vomiting. In anorexia, Capsicum (165); Quinine (16V); Zinc (p. 86). In coma — dead-drunk — Cold douche or Tablesa/t (p. 101); Croton (225); see Coma. In delirium ebrios., Cold douche and Croton ; Brom and Cannabis (pp. 21 & 28); Catechu. (135). In insomnia preceding delir. trem., Brom (49-53); Chloral (pp. 30 & 109). In delirium tremens, Antimony, Brom, Digitalis (p. 79); Cocaine (pp. 11 & 109); 4 doses of Capsic. pulv. 3 ss taken hourly, are said to have induced sleep, followed by profuse perspiration and urination. Alimentation. See Inanition. Amaurosis and Amblyopia. See Eye (Vision). Amenorrhcea — The absence — Retentio — or stoppage, — Suppressio—oi the menstrual flow. The former due to general debility; absence, or imperfect development of the ovaries; imperforate os tincae, etc., the latter mostly a consequence of disease; cold; fright; etc., etc. Resulting from pregnancy or menopause, which latter may occur even before the thirtieth year of age, it is, of course physiological. Treatment — Above all, removal of cause: If stricture of cervix, or uterine engorgement, see Uterus; ovarian dropsy — Ovaries; hemorrhage from any organ not connected with ovulation — -Menstruatio Anaemia. 163 vicaria, etc. In functional inactivity of the ovaries, Ars. (p. 10); tod. (pp. 14 & 15); Cantharis (p. 47); San- guin.(p. 41); Sabina(p. 86); Ergot (172); Mangan (182); Electricity; Hipbath and Pediluvia. If anaemia, Ferr. (174 & 197); 4c/V. s*///. (155); Guagac. (p. 12). If sud- denly checked; Aconite (p. 23); 4/0gs (p. 89). In con- stipation or palpitation, Salines (219); if pulse strong, Croton (225). If from cold or fright, Calomel (p. 93), with Mustard Bath (419), a few nights preceding the expected period; and Aloes c. Myrrha (p. 89), every second night. If plethora, eight ounces of blood from the arm. Mercury is the best deobstruant in suppression of long standing, as there is always more or less con- gestion of the uterus; when it has to be given until ptyalism, Calom. (12) at first; afterward at intervals of four or five days, as circumstances may require, to keep the mercurial action up for at least three or four months. A scrophulous diathesis, inflammatory affections, accom- panied with exhaustion, nervous irritability, etc., which prohibit its use, demand Iodine (p, 15); Quinine (pp. 75 £ 76); Strychnine (p. 89), etc. Anaemia — A condition mostly dependent on a dim- inuition in the mass of the blood, the number of the red corpuscles and in the amount of haemoglobin in the latter — the Liquor Sanguinis being poorer in albumen and containing an excess of salts. See Chlorosis, Leu- cocythaemia, and Heart (Valvular lesions). Treatment — Aside from good nourishment, plenty of exercise in the open air, bathing and sponging with cold water, Chalybeate Waters, and Cod-Liver Oil. Ferr. (197); or if it disagrees, Ars. (p. 9); Quinine (166); Mangan, Strychn. (pp. 82 & 83); Asa foetida (41). If spinal or cerebral, 164 Anasarca. Cocaine (p. 11). If constipation, Tonic Purgatives (p. 95). If monorrhagia, Acids (129, 154), etc. Anaesthesia and Analgesia. See Neuritis reap. Paralysis. Anasarca [Subcutaneous Oedema) — A serous transu- dation into the interstices o £ connective tissue, extend- ing over the greater part of the body. See Dropsy. Treatment — Quinine (166), if anaemia; if from gestation, Calomel (210). Aneurisma — -A circumscribed dilatation of an artery, dependent on a lesion of its coats. Treatment — lod. c. Ferro (p. 14); or Veratr. (p. 39); and compression of the artery between the affected part and the heart, if not contra-indicated by inflammation, to retard circulation, and thus cause deposits of fibrin. (Injections of Tinct. Ferri chlor. or Ergot into the sac, to cause coagulation of the blood, are always more or less dangerous.) Elec- tricity (p. 150), is sometimes of service. Angina Ludovici — Acute suppurative inflammation of the connective tissue around the submaxillary gland — always dangerous. Treatment — Poultices or fomen- tations, and when there is the least sign of fluctuation, an incision and cleansing the wound with Antiseptics. Phenol (327). See Abscess. Angina Maligna and Membranacea. See Diph- theria resp. Laryngitis exudativa. Angina Pectoris — A neuralgic affection, character- ized by a severe constricting pain, emanating from the praecordia, and radiating thence upward in different directions, accompanied by feelings of extreme anguish. The paroxysms are sudden, and mostly of a few minutes duration; however they may last for hours, and if asso- Anus. 165 eiated with heart disease, may prove fatal. Treatment — Aside from swallowing pieces of ice, revulsives to chest and extremities (408 to 411), or brandy (p. 73); Lobelia (p. 34); Cocaine (168); Morphia hypoderm. (255); Amyl as inhalation ( 3t)8 ). Arsenic (p. 9), is said to lessen the severity of the attacks and prevent them by degrees. In gouty habits, Colchicum (105). Angioma. For the simple and the cavernous variety see Naevus; for the villous form, Urethra. Anteflexion and Anteversion. See Uterus. Dis- placements). Anthrax. See Carbuncle. Anus — Fissura Ani — A small chap, crack or ulcer,, giving intense pain during the passage of a motion, and even for hours after. Treatment — Free purgation (pp. 95 to 97); and locally, Tannin (360); Iodoform (373); Cocaine, Plumbum, Salicin, (396 to 399), etc. Fistula in Ano — A fistulous track by the side of the rectum, through the fibres of the sphincter ani, in con- sequence of ulceration of the mucous membrane. Treat- ment — Copaiva (106), and tonics (p. 69); and locally, astringent and stimulating injections (361, 364 and 378); or the ligature. The only effective cure, however, is the knife: division of the sphincter, etc. Prolapsus Ani — An eversion of the lower portion of the rectum, and its protrusion through the anus. Treatment — Catechu or Ferrum, as injection (378). See Rectal diseases. Pruritus Ani — A violent itching of the anus, gen- erally complicated with a fissured state of the surround- ing skin. Treatment — Sublimate (339); Caustic (343); Atropine, Creosot, Phenol (350, 352 & 372). At the same 166 Aphonia. time alkalies or perhaps a tonic treatment (pp. 54 & 69). Atresia Ani — A congenital closure of the rectum. Treatment — The infant having been placed on its back, and the thighs elevated by an assistant, so as to expose the occlusion, an incision is made with a bistoury. A small pledget of lint, greased with some ointment, is then introduced and kept there for two days. Afterward an injection of a little warm water should be given to pro- duce a free evacution. Aphonia — Loss of voice, due to paralysis of the spinal accessory — unless it be the result of laryngitis — and frequently associated with hysteria. It may occur from pressure on the recurrent laryngeal by some tumor; or he a consequence of cerebral embolism and thrombosis. If purely a functional affection, the whisper is soft, but clear, whilst if due to inflammation, it is husky and labored. Treatment — Aside from shower-baths and pro- per attention to general health, counter-irritants (408 & 11); Belladonna plaster or electricity, (p. 148), provided it be simply neurotic, without involving lesions in the nervous centers, nor pressure on either, the par vagum or the recurrent laryngeal. Aphthae. (Stomatitis simplex.) See mouth. Apoplexy — A sudden loss, more or less complete, of sensation and motion in consequence of some kind of pressure on the brain. See Brain (Hyperaemia). Treat- ment — The head should be moderately raised, the cloth- ing round the neck loosened and stimulating applica- tions (409 & 11) to extremities if cold. If from active congestion, cold compresses to the head; Calomel (p. 92); Croton (225 & 385); Belladonna (p. 23); or Atropin hy- podermically (241); Aconite (p. 22); bleeding, etc. If Asphyxia. 167 from passive hyperaemia or embolism, brandy (p. 73), to prevent paralysis of the heart. Arthritis — A specific inflammation dependent on lithaemia, and accompanied by the deposition of urate of soda in and about the joints, especially of the feet and hands. Aside from a considerable redness of these joints, gout is characterized by severe nocturnal pains in the first joint of the great toe; and generally asso- ciated with digestive disturbance. Treatment — The limb should be kept in an elevated position, and after having painted the joint with lodof. (401), covered well with cotton. For the relief of pain, Opium, Bell, or Hyoscyamus (pp. 23, 33 & 35); if feverishness, Aconite (p. 22); salines (p. 96); Aloes (200); Lithium (110), Salicin (27&30); Guajac (11). The diet must be light. In the chronic form, Iodine (p. 14 and no. 402); salines (220), and alkalies (pp. 53 & 97); if flatulency Ammon. (93). In rheumatic gout, alkalies; Salicin ; Colch. (pp. 48 & 90); Benz. (p. 46); Arsenic (2). In Arthritis nodosa, Salicin (p. 18); Lith. (412), as application to the gouty concretions. Ascarides. See Helminthiasis. Ascites. See Hydro-Peritoneum. Asphyxia Neonatorum — An infant at birth appar- ently lifeless. Treatment — If a child be born in an apoplectic condition, as shown by swelling and lividity of countenance, the cord should be divided at once, and about two teaspoonsful of blood allowed to escape. Any mucus or clot must be removed from the mouth; the face exposed to the air and sprinkled with cold water; or the child may be dipped alternately into a cold and a warm bath; or artificial respiration. For Asphyxia from drowning, hanging, etc., see page 1. 168 Asthma, Asthma bronchiale s. nervosum — A paroxysmal difficulty in breathing, which is of a wheezing char- acter, and associated with a distressing cough, depend- ent on a spasm of the muscular fibres of the smaller bronchi, bronchitis or emphysema frequently co-exist- ing. (A peculiar combination of asthma with coryza and bronchitis, occurring in summer in persons with a peculiar idiosyncrasy, is called Hay- asthma.) The paroxysm is characterized by a sense of constriction, coupled with a feeling of great anxiety, the patient not being able to recline. Treatment — During the fit strong coffee may be tried; inhalations of Chlorof. (304); Asa foBtida (311), or Nitre (325); Brom (50); Chloral (60); Cyan (66); Grindelia (72); Lactucar. (74); Lobelia (75); Colch. (105); Bell. (p. 24); Cannab. (p. 28); Gels. (p. 33); Ipecac, (pp. 82 & 100); Jod. (pp. 14 & 15); Conium or Stramon. hypod.,(248 &9); etc. If bronchitis present, Arsenic per os, hypodermically, or inhaled (pp. 9, 107 & 120). In A. pituitosum, Apomorphina (96). In hay- fever, if catarrh predominates, Cocaine (285). Astigmatismtts. See Eye (Vision). Ataxia locomotor {Tabes dorsualis) — Unsteady and disordered movements of the extremities on account of impairment or loss of the ability to combine and direct muscular movements by the will, and dependent chiefly on sclerosis of the posterior columns of the spinal cord. Treatment — Aurum (p. 10); Argentum (p. 74); Phosphor, Zinc (pp. 85 & 87); or dry stimulation, see Electricity, page 149; eventually an antisyphilitic treatment. Atelectasis (Apneumatosis) — Collapse of pulmonary lobules. See Broncho-pneumonitis. Congenital atelect- asis in the newly-born is characterized by rapid and Bladder. 169 weak breathing, a feeble cry and cyanosis. See Asphyxia. Atresia Ani et Vaginae. See Anus, resp. Vagina. Atrophy. Progressive muscular ( Wasting or Creep- ing Palsy) — A spinal amyotrophic affection, character- ized by a wasting of some muscles, whilst adjacent ones remain intact, thus producing many deformities. The claw-like hand — la main en griffe — due to paralysis of the interossei, is a frequent, and therefore characteristic deformity. Treatment — Next to a judicious diet, Potass (31); Calomel (pp. 92 & 93); stimulating embrocations (409 & 11), and electricity (p. 148). Balanitis. See Gonorrhoea externa. Baldness (Calvities) and Barber's Itch [Tinea Sy- cosis). See Head. Barreness. See Sterility. Basedow's disease. See Bronchocele. Basilar Meningitis. See Meningitis (tubercular). Bedsores. See Decubitus. Biliousness. See Dyspepsy (acute). Bites and Stings of insects, etc., maybe treated with Caustic, Ammonia (407), etc.; of poisonous snakes, Alco- hol, Ammonii Carbonas (pp. 72 & 73). See page 6. Bladder — Irritable bladder, unless due to inflamma. tion or organic disease, may be caused by irritation of adjacent organs; an irritating state of urine; nervous- ness (as not uncommon in elderly people); general debility, and cold. It is characterized by frequent in- clination to pass water with or without spasm. Treatment —Above all, removal of cause, as piles, ascarides, etc. Attention should be paid to the urethra, as stricture will produce occasionally a form of incontinence, which is amenable to cure only by the sound. Soothing medi- 1*70 Bladder. oines, as Bell. (p. 24), may be of use in nervous cases. In cases with alkaline urine, mineral acids (152 & 153); for debility, Nux Vomica and Ferrum (pp. 19 & 83), etc. Enuresis JVocturna(NaechtlichesjBettnaessen)- Nocturnal incontinence, which arises from such causes as enumer- ated, and which is common in delicate children, is to be treated on the same principles. Aside from the remedies mentioned, Ferr.jod. (p. 15), may be tried, or Capse/la (p. 134). If from irritating urine, Chloral (p. 30), etc., and perhaps a blister (408), to sacrum; if the urine is not irritating, Canth. (p. 47), in minute doses. If there be hyperesthesia of the organ, the child should be made to sleep on its side, so that the urine may not be kept upon the over-sensitive surface of the trigone. Cystitis — Catarrhal inflammation of the mucous mem- brane lining the bladder is generally a consequence of irritation — ill-treated gonorrhoea, gout, stone, etc. It is characteiized by severe pain about the perineum, groins and sacrum; frequent micturition, with tenesmus — sometimes retention of urine — and fever. The urine at first bloody, contains afterward mucus or a muco- purulent sediment. Treatment — Fomentations and, if necessary, leeches with Calomel (p. 92), or Nitre (122), or alkalies (pp. 53 & 93). To relieve pain and tenes- mus, Opium per os, per anura or hypod. (pp. 56, 110, 135 & 36); Bell., Chloral, Hyoscyamus, etc. (pp. 24, 30 & 33). In the chronic form, which is mostly a consequence of irritation from stone (see Calculi), diseased prostate, stricture, or gout, there is less pain and no fever; but the urine is, as a rule, alkaline, and sometimes so viscid as to cause retention by blocking the urethra. Treatment — Removal of cause as far as possible. For pain, Opium Bladder. 171 supposit. (375); in strangury, Brom, Camphora, Canna- bis (PP- 2 ^ & 28). Of special value are, barring Pareira (114), Arctostaphyl. and Buchu, or Chian turpentine (101 & 151); Benzoin, Lith. and Copaiva (98, 106 & 110) are also much employed. Lycopod. (76) is occasionally of use. If the urine is very ammoniacal, warm water, pure or acidulated with Acid, nitric, injected by means of a catheter with double passage, is highly useful. Resorcin (335) is likewise recommended. Paralysis Vesicae — If the Detrusor itrinae alone is paralyzed, there will be retention of urine {Ischuria paralytica)', if the Sphincter vesicae, incontinence (En- uresis paralytica). In the first case there is complete anaes- thesia, the patient not feeling the want of emptying the bladder, which will be seen as a hard rounded tumor, reaching sometimes nearly to the navel; in the latter,* the water is dribbling away; though mostly both, in- continence and dribbling, exist, not because the water cannot be retained, but because it cannot be voided: the bladder will never be quite empty. Paralysis, unless due to injuries or disease of the head or spine, opera- tions about the perineum, etc., is generally a consequence of prostatic disease or stricture (see these affections); but it may also occur to nervous people, who allow the bladder to become over-distended. Treatment — In re- tention, or when, in spite of incontinence, the bladder is found distended, the catheter (330), is required. In pure palsy Ergot and Ferrum (pp. 6b & 67), will generally meet the case; Strychnine or Cantharides (pp. 83 & 75), are sometimes of service; also Buchu or Arctostaphy/um; sometimes Benzoin (p. 46), Cubebce, or electricity from the pubes to the sacrum. Dribbling in 172 Bladder. old people is occasionally benefited by Erigeron or Rhus (141 & 149). Spasmus Vesicae (Cystospasmus) — If the Detrusor alone is affected, there will be continued dribbling of urine [Enuresis spastica); if the Sphincter ', either com- plete retention [Ischuria spastica) or difficult micturi- tion (Dysuria spastica) ; and if both muscles are impli- cated, there will be tenesmus with retention. Cramp of the bladder is sometimes caused by irritation of adjacent organs, but generally it is due to nervous excitement — fright, etc.— -and cold. The fits, which usually last but a few minutes — at the end of which a great quantity of urine may be passed — are characterized by an excruciat- ing pain about the perineum, shooting toward the point of the urethra and testicles, followed often by vomiting, sometimes by syncope. Treatment — Fomen- tations to the perineum, or a warm bath — a cold douche against the perineum will frequently cut the fit — in con- junction with sedatives— Camphora, Hyoscyamus, Lupul., Lycopod., etc. ( 54 & 76). Retention of urine, caused by spasmodic stricture, requires, if the symptoms be urgent, the catheter under Chloroform or with Cocaine (330). [Retention should not be confounded with suppression — see Ischuria renalis]. Hot applications and a little Chloroform or Dover's powder (79), followed, if necessary, by Castor oil, will frequently suffice; sometimes Soda (p. 55) is of benefit; or & suppository (375); Tinct.Ferri chlor., 10 drops about every ten minutes, acts often like a charm, if the spasm arises from dietetic errors. If pro- duced by cantharides, Camph. with Hyoscyam.; and in case of inflammation of the urethra, leeches must be applied. Sometimes aspiration (p. 123) is the only Bladder. 173 remedy left. In hysterical retention, where it is due to want of will rather than to want of power, one introduc- tion of the catheter effects often the cure; else an anti- hysterical treatment — Pulsatilla (p. 16), etc., would be indicated. Retention from pressure of the prolapsed uterus on the neck of the bladder, or of the gravid uterus during the last months of pregnancy, requires catheterization (p. 125). Retention of urine in infants is generally relieved by Hyoscyamus or Spir. nitrico- cethereus (p. 33). For treatment of Hoematuria see Hemorrhage from the bladder. Prolapsus Vesicae — Barring a frequent desire to pass water, especially at night, prolapse is characterized by a dragging pain about the umbilicus. This pain, which is also a symptom of procidentia uteri, and which is worse before micturition, depends on the tension of the super- lor ligament of the bladder (formed by the remains of the two umbilical arteries), which passes from the fun- dus of this organ to the navel. After having passed a catheter into the bladder, the instrument may, by rais- ing its free extremity, be pushed oictivard and downward, so that its point can be felt against the protruding bladder. Treatment — Aside from the regulation of bowels, the restoration of the organ to its position, and keeping it in situ by means of an india-rubber ball or a sponge, an astringent wash (359 & 61) should be injected twice daily into the vagina, whilst a catheter is con- stantly kept in the bladder. Bleeding Wounds. See Hemorrhage. Blennorrhoea. See Vaginitis. Blepharism. See Eye (Lids). Boil. See Furuncle. 174 Brain. Brain — Anaemia — K deficiency of blood in the brain, due to congestion of other organs, vasomotor spasms, heart disease, and above all, to much loss of blood. If the hemorrhage is sudden, there will be fainting. Chronic anaemia is, aside from occasional faints, fits of vertigo and blindness, characterized by a weak pulse, pain in the forehead, tinnitus aurium, sleeplessness and frequent dreams. Treatment according to cause. Zinc and Phos- phor (pp. 85 & 86) are good tonics. During the fit, 6ra/7(//, Camphora, Valeriana (pp. 27 & 28), etc. See Syncope. Hypevaemia — A congestion of the brain, active or passive — the former, consisting in an excess of arterial blood, is due to the increased force of the heart's action, paralysis of vasomotor nerves, etc.; the latter an excess of venous blood, produced by an impediment to the re- turn of blood from the head, as pressure of the jugularis in goitre; of the vena cava by aneurism, and other tumors, etc. The acute form is characterized by head- ache, with a sense of fullness or weight and heat; flushed face, intolerance of light or scintillations; vertigo, tin- nitus aurium, and sleeplessness. In more severe cases there w T ill be strong pulsation of the carotids, mental confusion, delirium or convulsions. [In apoplexy from oerebral hemorrhage or embolism there is hemiplegic paralysis]. Treatment similar to that of apoplexy. Dry cups to neck; stimulating pediluvia (419); Brom, Chloral, Gelsemium (pp. 27 &33); or Ergot (pp. 65 & 78); after- ward salines or Colchicum (pp. 48, 90 & 96), with regula- tion of diet. In the passive form, which is characterized by more or less cyanosis, turgid veins of the head, somnolency and dullness of mind, the obstruction must be removed as far as possible. Brain. 175 Encephalitis — Inflammation of the substance of the brain is always limited, the foci varying in size from a pea to a walnut, and eventuating either in softening and abscess, or sclerosis. The former, unless traumatic, is generally a sequel to caries from disease of the ear, nose, or orbit, etc. Acute Cerebritis may begin with an apo- plectic fit, which, however, will have been preceded by mental aberrations for sometime; sudden and complete hemiplegia; or simply with a stage of irritation. (See Meningitis). If chronic, it is like induration, attended by cephalalgia, vertigo, vomiting and tremor, in conjunc- tion with mental dullness, failure of memory, and some- times aphasia — the latter if the morbid change is in the left anterior lobe of the cerebrum, near the island of Reil. Pathognomic of sclerosis are successive psralytical manifestations of an hemiplegic nature, according to the seat of the lesion, and the jog-trot gait {.festination) of the patient, whose body, when standing, appears more or less stooped. Treatment of acute encephalitis re- quires the remedies indicated in hyperemia: Cold to head; blisters to scalp, and cathartics, according to the severity of the case. In the chronic form, next to rest of body and mind, tonics with mild revulsives — Brom, Chloral, Phosphor, etc., according to circumstances. In sclerosis (a hyperplasia of the neuroglia, the analogon of the connective tissue in other situations), which may affect an entire hemisphere: Barium (5); Phosphor (154 & 194); Sublimate (p. 13), etc. Tumors within the cranium will, aside from their quality and situation — which may produce special effects — sooner or later occasion symptoms dependent on soft- ening, inasmuch by pressure they either excite cerebritis, 11 6 Brain. thereby inducing softening; or interfere with nutrition, thus leading to non- inflammatory softening. Both kinds are generally followed by hemorrhagic extravasations. ( Softening from suspended nutrition — necrobiosis — is also caused by embolism, thrombosis, atheroma, etc., and can therefore not be treated as a special disease). Treat- ment — Arsenic, Mercury and Jodine (pp. 9, 13 & 14), may be tried, even if the tumor be non-syphilitic. The diagnosis of locating a disease within the cranium, has its difficulties. Thus, lesions of the cerebellum may remain entirely latent, though, as a rule there are dis- turbances of co-ordination {cerebellar ataxia, and dizzi- ness, which may be superadded by vomiting and ambly- opia.; even amaurosis may result. Lesions of the pons Varolii- — especially hemorrhage — may be diagnosticated, if there exists crossed paralysis: Facial on one side, and paralysis of the extremitiescon the other. Lesions of the medulla oblongata are the only central lesions, which can cause aphonia — see Paralysis (bulbar). Hemorrhage into the medulla proves fatal, either instantaneously or within a few hours. Lesions of the cms cerebri produce a crossed paralysis: On the one side of the ocidomotorii/s, characterized by ptosis, dilatation of pupil, external strabismus, combined sometimes with double vision, and vertigo; on the other side there is loss of motion or hemianesthesia. Lesions of the corpora quadrigemina lead always to blindness. Characteristic of lesions of the motor cortical zone — the anterior and posterior cent- ral convolutions with the paracentral lobules — are the localized paralyses known as monoplegia and dissociated hemiplegia, etc., etc. Breajk>bone fever. See Scarlatina rheumatica. Breast. 177 Breast — Mastitis — Inflammation of the breast should be treated with fomentations and poultices; or, if very severe and the pulse good, a purgative or leeches. As soon as suppuration is evident, an incision, radiating from the nipple (to avoid cutting the lactiferous ducts, as far as possible) must be made; and a small tent of lint may be inserted between the lips of the opening, which should be removed several times a day, whilst the fomentations are continued. When the inflammation has subsided, antiseptic dressings may be employed, after having supported the breast properly by straps of adhesive plaster — see Abscess. Tonics (166) to invigor- ate the system will generally be found useful. In simple engorgement the application of the infant or of a pup will suffice to remove distension and prevent an abscess. If the nipple is so flattened that the child cannot grasp it, an empty, previously with hot water heated bottle, may be turned over it, and the nipple will elongate, whilst the milk is spurting out. If the milk should be too abundant, solid food in conjunction with salines (p. 96) to keep the bowels open, will be indicated. Engorgement after weaning, or when there is already pain, demands at the same time Antimony (p. 23); Pulv. Doveri (pp. 37 & 38), and locally Oleum Camphorce. In cases, where after delivery the secretion of milk is tardy, plenty of gruel is the remedy. A poultice of FoL Ricini to breast, and steam of a decoction of same to vulva are sometimes used — the latter, by making the patient sit over it, ricinus being supposed to be both emmenagogue and galactogogue. Sore Nipples may be washed with brandy and water, each time, after the child has been removed. If they 178 Breast, are very sore, Tannin or Cocaine (396 & 415), etc., etc. (Sore nipples may be altogether avoided by washing them with cold w T ater, and pulling at them daily for several months before confinement. Mastod/ynia — Neuralgia of the breast is characterized by an excessive sensibility or piercing pain in the breast, passing on to the shoulder, sometimes to the elbow and even fingers. It is generally associated with undue irri- tability of the constitution, especially an abnormal state of the menstruation; and frequently accompanied by an irritable tumor, sometimes not larger than a j>e&, movable, and often very sensitive, which may be discriminated from scirrhus, by the latter being of great hardness, the skin, covering it, becoming adherent and of a tubercul- ated character; whilst the pain, though lancinating, is usually limited to the breast. Treatment must be anti- neuralgic, with attention to the general state of health (p. 91). See Neuralgia. Breath, Foul. See Mouth. Bright's Disease. See Kidney (Nephritis). Bronchitis {Cold in the chest) — An inflammation of the large bronchial tubes, with or without fever, mostly preceded by a catarrh of the nose and upper air pas- sages; and unless a complication of other diseases, as measles, variola, typhus, emphysem, etc., due to cold or an atmospheric influence of some kind — see Catarrh. Bronchitis is characterized by an obtuse, substernal pain, together with a peculiar sore or raw feeling, especially on coughing. Dry or moist rSles are generally present; but the results of percussion are negative. Treatment — Pu/vis Doveri (79) at night, followed by stiff grog and a pediluvium, at the commencement will generally cut the Bronchitis. 179 disease. Quinine and Salicin (pp. 11 & 18) are said to abort the disease too. Locally, Mustard or some stimu- lating liniment (409); but no blister. Nor should ex- pectorants be given in the first stage, as they tend only to increase the inflammation; but water may be kept boiling on a stove, as the inhalation of steam will always afford relief. At the same time one of the following remedies is sure to meet the case: Ammonium or Apomorph, (94 & 96); Potass. (119 & 122); Veratrum (84); Opium 1 7 8 & 113) — this is contra-indicated if the efforts of expectoration are inadequate to prevent the accumula- tion in the bronchi, in which case Potassii Jod/dum. If feverishness, Aconite or Antimony (pp. 22 & 23). In a child, occasionally a mild emetic (p. 101). The chronic form, unless associated with emphysem, tuberculosis or cardiac disease, involves the same causes as the acute; often it depends on climatic causes, occur- ring every winter, to disappear again in the warm season. Treatment — Most remedies employed in acute catarrh; though Pot. Jod. (p. 14 & 15) is perhaps the most reli- able. Copaiva (pp. 48 & 49) is sometimes of value; and a glass of S el terser with hot milk every morning is of great benefit in cases of old standing, especially in con- junction with tonics (pp. 75 & 76). If cough trouble- some, Cyan (67) or Opium — see Cough. In hypertrophy of the mucosa ( Bronchoblennorrhcea or Phthisis pituitosd) , characterized by abundant expectoration, sometimes fetid, and easily brought up, antiseptic inhalations (302, 324 & 334). If emphysem {Catarrhus siccus), charac- terized by wheezing, shortness of breath and asthmatic paroxysms, inhalations of tablesalt, Ammonia or Iodine (306 & 321); Arsenic (pp. 9 & 120), is occasionally the 180 Bronchitis. remedy. If atrophy {Bronchorrhoea serosa), combined with asthma or valv. lesions, and characterized by short breath and abundant watery expectoration, especially in the morning, Tannin, Creosot, Uva Ursi or Tar (pp. 52 to68); wiihastr/ngent or soothing inhalations (3 15 & 323). For HJpidemic Bronchitis see Influenza. Bronchitis oapillaris — An extension of the inflam- mation of the larger bronchi to the smaller tubes — very liable in children and old people. This affection never gives rise to acute lobar pneumonitis, though there may supervene inflammation and collapse of pulmonary lobu- les in consequence of the accumulation of mucus, con- stituting broncho-pneumonitis. It is attended by accele- rated breathing with dilatation of the aloe nasi {Nasen- fluegelathmeit), dyspnoea, more or less lividity, an extreme- ly painful cough, short and jerking speech, etc. The disease being bilateral, moist rales, coarse, fine and finest (subcrepitant) — gross t klein und mittelblasiges Basseln — according to the size of the tubes, exist on both sides, and may be heard best at the back. Diagnostic are the sputa, which, consisting of mucus from both the larger and smaller bronchi, will float on water, the mucus of the latter, on account of its greater specific gravity — not being mixed with air, like the former — hanging rope- like into it. A rise of temperature to 103 or 104 de- grees and dull percussion are signs of complications — see Broncho-pneumonitis. Treatment as indicated for bronchitis of the larger tubes; especially inhalation of warm vapor by keeping the atmosphere of the room charged with steam. To excite deep inspirations and prevent atelectasis the child may have cold affusions directed toward the nuca, after having been placed in Bronchocele. 181 a warm baih. I use, whenever practicable, the wet pack (420), with Priesnitz' compress (298). A nutritious diet with brandy (f 3), and to/7 /cs are of the greatest importance. BR0NCH0-PNEUM0XITIs(^071cA0J^n6l/7?^7?iaik/an^/r>l) — Lobular Pneumonitis is a lobular inflammation of the lung tissue, superadded to the bronchial affection, and incident chiefly to childhood. Being characterized by the symptoms of bronchitis capillaris, it cannot be differ- entiated from it, unless a high temperature, but above all, dullness can be demonstrated — a vesiculotympanitic sound on percussion at the upper lobes indicates emphy- sematous lobules. As the pyrexia is proportionate to the acuteness of the bronchial inflammation and to the extent of lung involved, the affection, which will also occur in the course of pertussis, and be a sequel of other diseases, especially of eruptive fevers, may «be of great severity, or comparatively devoid of danger. In very young children it is usually preceded and accompanied by ^pneumatosis. The most frequent termination of the lobular inflammation is as in lobar pneumonitis in resolution, the inflammatory product undergoing fatty degeneration, which, after having been emulsified with the transuded serum, is absorbed. The caseous meta- morphosis leads to the development of phthisis. Treat- ment is that of bronch. capill., as there are no other means but the cold affusions for the prevention of atelectasis. Bronchocele (^Basedoitfs Disease — Hypertrophy of thyroid Body and Prominence of the Eyeballs) — Exoph- thalmic Goitre is associated with functional disease of the heart, throbbing of the arteries, loud whirring — ancemic purr — during the systole, and in the arteries and veins; and consequent great nervous excitement. 182 Bubo. Treatment should be anti-hysterical — Valeriana & Ferrum (pp. 29 & 79); Brom or Con/urn (pp. 24 & 31); Barium or «/otf (pp, 10 & 14); with purgatives (p. 89); or Aconite (p. 22). Locally, «/o and warm enemaia. In case of inflammation, a warm bath, fomentations or ice with sedatives (p. 20); if the inflammation very severe, leeches or cupping. The pass- age of the stone through the ureter causes sudden and severe pain in the loins and groin, subsequently in the testicles and inside the thigh, with spasmodic contractions of the former, accompanied by violent vomiting, faint- ness and collapse, and may last from two to three days. Treatment consists of plenty of diluents; the warm bath, and emollient enemata (386), with large doses of Opium and Chloral (pp. 30 & 35), or Chloroform inhalations (304). Calculi. Vesical — Stone in the bladder is either from the urine or from the mucus of the bladder, dependent on prostatic disease; or if foreign bodies are introduced into the bladder to serve as nuclei, in which case they consist of phosphates. The symptoms are: Irritability of the bladder, with frequent desire to make water; occasional sudden stoppage of the stream; occasional passage of blood; occasional pain at the neck of the bladder, always most severe after micturition; and a pain in the glans penis. Sooner or later the urine becomes alkaline, and loaded with viscid mucus and phosphate of lime. Treatment — After the existence of the stone has been ascertained by means of a sound, litholysis: Acid. 184 Carbuncle. nitric, d. injected as in chronic cystitis, will reduce the size of phosphatic calculi, or dissolve them sometimes altogether. The continued use of Vichy water, or a solu- tion of Sodii Bicarbonas, saturated with carbonic acid, will also disintegrate lithic calculi. See Urinary De- posits. In obstinate cases recourse must be taken to /ithotrity or /it ho to my. Calvities (Baldness). See Head. Cancer. See Carcinoma. Cancrum Oris (Stomatitis gangrenosa). See Mouth. Carbuncle (Anthrax) — An exaggerated boil of a gan- grenous nature, sometimes attended with fever, and always dependent on a vitiated state of the blood. Treatment — Fomentations and a brisk purgative (p. 92). Afterward Ungt. Belladonnas or Phonol-lod (400 & 402), if very painful; or Iodine (20) to produce vesication; and if necessary, free radiating incisions at early stage. In- ternally, sulfides (pp. 18 & 19); Opium (p. 35), and tonics (pp. 71 & 76), in conjunction with a generous diet, in- cluding wine and brandy. See Abscess. For Carbuncle of genitals see Vulva (Vulvitis gangrenosa). Carcinoma — A peculiar malignant growth, making constant progress, destroying and causing absorption of the invaded tissue, tending towards suppuration and infection of the lymphatic glands, thus reproducing itself at distant parts, and even recurring after extirpation. Cancerous tumors are characterized by a stony hardness and severe pain of an intermittent and neuralgic kind, felt in the tumor itself as a sharp stabbing or burning sensation, and followed sooner or later by general cachectic symptoms. Treatment — Injections of Arg. nitr., Phenol and Pepsin (327, 98 & 403), or Ozonewater Carcinoma. 185 (0.1:500.0) may be tried; but if they fail to arrest the growth, extirpation before the corresponding lymphatics become affected is the safest plan. If not practicable, Opium (p. 35) and tonics (p. 76), with Belladonna plaster or Chloroform liniment (411), for the relief of the neu- ralgia. After ulceration, according to circumstances, either soothing applications, Opium (358, 65 & 400); Bell., Chloroform, Iodoform (350, 51 & 75); Bism. (351 & 93), etc.; or stimulating ones — blackwash (4=00); yeast poultice; astringents — Tannin, Zinc or Iron (338, 41, 45 & 77); or antiseptics — Phenol, Creosote (337 & 52), etc. A small bag of charcoal, dry and wrapped in flannel, may be laid over the wound to absorb the effluvia. (Poultices should not be applied too warm for fear of excoriating the surrounding skin; though it may be remedied by dusting the part with bismuth or tannin. Carcinoma Ventriculi — Cancer of the stomach is at- tended by pain of a burning and lancinating character, which increases upon pressure; by vomiting of sarcina and blood; and often by a peculiar green is h-yellow com- plexion, the so-called cancerous cachexia. Treatment — Above all, a nourishing diet, as eggs, buttermilk, etc.; if necessary, Pepton (p. 84) and rectai alimentation (387). Cathartics should be avoided. If pain or vomiting, Arsenic or Bismuth (pp. 10 & 46). Chian Turpentine is recommended. (There are four varieties of Carcinoma: the medullary, the most malignant and vascular; the colloid, which is the least vascular and malignant; the epithelial; and scirrhus, which latter is of a stony hard- ness, slow growth, and consists principally of a dense fibrous tissue). Carcinoma Uteri is most frequently medullary cancer, 186 Carcinoma, presenting the features of fungus hcematodes. The epithelioma, which attacks the mucous membrane of the os, may present itself either in ulceration of this mem- brane, or in the development of cauliflower excrescences. In the incipient stage, where the only symptom may be menorrhagia, the os having a nodulated and hard surface^ cauterization with Argentum nitricum or Potassa c. Calce at intervals of five or six days, without paying attention to the discharge of blood, may avert still the disease, as they will improve the condition of those parts and pro- mote a slough of the cancerous mass. If, however, more advanced — the womb enlarged, immovable, the lips everted and ragged with deep ulceration, much hardness in the surrounding tissue, the vagina and rectum both being involved in the induration, attended by profuse loss of blood (see Hemorrhage); mucous, mucopurulent or serous, sometimes very fetid discharges; by pains in the hips, thighs and uterus; with increased weight, ex- treme prostration, frequent vertigo and sick stomach — Treatment can be but palliative. Cauterization for temp- orary "relief, with Iodine (20); Chrom, Benzol, lUangan (402 & 3); Cuprum, Liq. Hydr. nitr. (344 & 47), etc. But the speculum must not be unnecessarily introduced, as it will aggravate the pain and may cause flooding. To alleviate pain, Arsenic, Silicium or Hyoscyamus (pp. 10, 19 & 27); and locally Opium (365 & 75); Belladonna or Chloral (350 & 65); Iodoform and Conium (373 & 75); if nothing of avail, /ce'(3l2), or a blister to sacrum, dressed with about two grains of Morphia, and repeated according to the emergency. In mucous or serous dis- charges, Acid, nitric, Alum, Creosote (362 & 63). Consti- pation should be relieved by the use of enemata (386). Catarrh. 187 Cardiac Disease. See Heart. Cardialgia. See Dyspepsia. Caries — Ulceration of the soft part of a bone, de- pendent on some constitutional disorder (scrophulosis, syphilis, etc.), requires appropriate Treatment of cause, and locally injections of Acidum nitricum v. phosphoricum dil., after having removed the diseased part by forceps or gauge. See Necrosis. Carphologia. See Subsultus tendinum. Caruncle urethral. See Urethra. Catalepsy — A form of hysterical coma, the sensory functions, volition and consciousness being suspended; with the addition of a peculiar wax-like rigidity of the voluntary muscles, retaining the limbs or the different parts of the body, in any position, in which they may have been placed by the hands of others. Treatment as in hysterical coma. If the paroxysm should last for weeks or months, forcible alimentation must be resorted to; afterward any derangement of the organs of genera- tion should be attended to. Catarrh or Cold par excellence (Schnupfen) is a catarrhal inflammation, which extends over more ox less of the mucous membrane that lines the tract, leading from the nose to the lungs, its distinctive name being derived from the particular part affected, as cold in the head, cold in the throat, cold in the chest, etc. Treatment as indicated in bronchitis, coryza, pharyngitis, etc — Pulsatilla and Antimony (pp. 16 & 23); Ferrum, Cocaine or Phenol (285, 89 & 99); Alum, Iodine (299 & 321, etc. For Cervical and Intestinal Catarrh see Uterus (En- dometritis), resp. Enteritis. Cellulitis, periuterine. See Uterus. 188 Cephalalgia. Cephalalgia — Headache is a neuralgic affection, sup- posed to depend upon either spasm or paralysis of the muscular fibres of the arteries within the skull, which is produced by a vaso-motor influence of some toxical agent, acting on the sympathetic nerves. Treatment according to cause: If from constipation, cathartics (p, 88); if congestion, Aconite or Ergot (pp. 22 & 65); if syphilitic, Iodine (pp. 14 & 15); if from defective menstruation, Brom (50 & 53); Veratrum (p. 39). In sick headache, Caffein, Guarana (1*78, 163 & 242); if periodic, Sa/icin (29); if throbbing pain in brow, Arsenic (p. 10). In migraine, Brom, Caffein, Cyan, Cypripedium {66 & 69); Arnica (p. 74); Chloral (pp. 30 & 109); Camphora (54, 243 & 314); Cannabis (p. 28)-; Valeriana or Zine (193 & 96); Chloroform or Amyl (37, 246 & 308); Aconite or Veratrum externally (410), etc. See Neuralgia (trifacial). Cephalhematoma — A tumor consisting of an extra- vasation of blood under the scalp, caused by pressure on the head during parturition, which is soft, painless and slightly compressible. Treatment— Evaporating lotions and gentle pressure by the cross-wise application of strips of Emplastrum adhcesivum, to assist absorption. Cerebral Disease. See Brain. Cerebro spinal Meningitis. See Meningitis. Cervicodynia. See Myalgia. Cervix Uteri. See Uterus. Cessation of Menses. See Menopause. Chancre. See Syphilis. Chancroid — Soft chancre is a highly contagious, suppurating ulcer of venereal origin; and though, when- ever oculated, it may be followed by suppuration of the nearest lymphatic gland (see Bubo); it is but a local Cholera. 189 disease, independent of syphilis, and, therefore, without secondary symptoms, which, however, does not exclude the co-existence of a chancre. Treatment — If the sore should not be a week old, it may be cauterized with Acidum nitricum (329); if older, Mercury (347). Other applications are: Cuprum, Mangan, Tannin, Phenol (327 & 340); Iodoform, Jodol or Ferrum (269 & 331). The latter three are of special benefit in phagedena. If syphilis is suspected, Mercury and Iodine (pp. 13 & 15). Chicken-pox ( Varicelli). See Eruptive fevers. Chilblains. See Perniones. Chlorosis — Green Sickness is a neuropathic affection, occurring in girls at or near the period of puberty, and dependent on an anaemic state of the blood in conjunc- tion with a faulty evolution of the sexual organs. It is generally characterized by a greenish complexion and perversion of appetite, as a craving for chalk, slate and the like. See Anaemia. Treatment — Aside from a gen- erous diet with out-of-door life and mental hygiene according to indications: Pancreatin, Aloes, Calomel (185, 97 & 208); Ferrum and Quinine (166, 75 & 253); Acidum su/furicum (129 & 55); lod and Strychnine (pp. 15, 82 & 83); Arsenic (p. 10); Cocaine (168 & 247), etc. Artificial suppression of the menses for a few times by injections of cold or warm water, with absolute rest in bed, has been recommended in cases where hysteria is a prominent symptom. Cholera morbus (Cholera nostras) — Sporadic cholera is a functional affection of the alimentary canal, pro- duced mostly by indigestion. Its chief characteristics are : Violerit vomiting, speedily followed by purging, and accompanied by colic pains, anxiety, restlessness and 190 Cholera. exhaustion. In severe cases there may be aphonia? cramps of the legs, etc.; but the attacks seldom prove fatal. Generally the various symptoms soon diminish, and after a few hours disappear altogether, even without remedial interference. Treatment— Opium (77,255 & 381); Brom or Camp ho ra (pp. 27 & 28); Ipecacuanha (p. 100), if necessary. A small piece of ice or a tablespoonfid of water and no more may be allowed at short intervals, to appease a little the intense thirst. Brandy (p. 73), if much prostration. Of other remedies may be mentioned Chloroform (p. 31); Veratrum, Phenol (22, 84 & 382), etc. Cholera Infantum [Summer Complaint) — This name embraces different distinct affections, occurring in child- ren under two years of age during the hot season, especi- ally from June to September: Sporadic cholera, diar- rhoea from indigestion, enteritis, colo- enteritis and dysen- tery. See these. The development of hydrocephaloid during any of these affections is, at least to the young child, almost always fatal. Treatment — Bismuth, Creta, Catechu (99, 107 & 135); Cinchonidin, Brom or Chloro- form (pp. 12, 27 & 31); Camphora, Opium (55 & 77); Argenium, Cotoin, Pepsin (133, 37 & 87); Phenol as enema (382). Sometimes an emetic is required (p. 100). If much thirst, Nitre (p. 57); if much prostration, brandy (p. 73); if vomiting, Creosote (138) and Mustard to epigastrium, etc. Cholera Asiatica — Epidemic cholera is a miasmatic contagious disease of the alimentary canal, dependent on some specific germ, which finds its way into it, and pre- ceded generally by a simple diarrhoea. It is characterized by violent purging — copious liquid discharges, the so- called rice-water stools — and vomiting, conjoined with Chorea. 191 great prostration, coolness of skin or cold perspiration, and sometimes cramps of the muscles; and, if not arrest- ed, followed speedily by collapse — the algid or cyanosed stage. Treatment — Prophylactically it will be well to avoid over-fatigue and undue excitement from whatever source; no unnecessary exposure to night air, and par- ticular attention to diet: Lobster, oysters and pork, with cabbage, peas and beans, especially green corn, cucum- bers, melons and the like, should be banished from the table for the time being. Premonitory diarrhoea (which is considered by some a salutary process to eliminate the poison), unless already of some duration, may some- times be stopped by Calomel (208), followed by Castor oil; Camphora and Ammonia (bo & 1 5 7), are often of use. The best remedy is perhaps Morphium (pp. 37, 38 & 110), Phenol (22), and Cocaine (168 & 247) are also recom- mended. To control vomiting, ice and brandy (p. 73), in collapse the latter per rectum (380), with external warmth — blankets, hot stones, etc. Iodine (p. 15) is said to promptly check vomiting. To arrest cramp, a warm enema of salt (386) is sometimes beneficial. In my hands has invariably proved successful the modified pack (420), w r ith lemonade: 20 drops of Acidum sulfuricum dilutum in sugar water (p. 61), ad libitum. Chordee. See Gonorrhoea. Chorea — St. Vitus Dance is aneurose, characterized by irregular clonic contractions of more or less of the voluntary muscles, especially of the face and extremities, giving rise to movements which are either involuntary or not under the control of the will. Treatment — Next to removal of cause, as anaemia, worms, etc., invigorat- ing measures in conjunction with tonics — Arsenic alone 192 Colic. (pp. 9 & 107), or if jactitations prevent sleep, combined with Chloral (60); Ferrum (167), etc; Argentum and Zinc (pp. 74, 86 & 87); Cuprum (170); Strychn. (p. 83); />Ay- sostigm (270); Cocaine (p. 109); 4/7/7 (38); 4«a fcetida and fltffa (41 & 81); Cimicifuga (104); Aconite and Con turn (pp. 22 & 31); 0/e*//w Jecoris (185), etc. Clergyman's Sore Throat. SeePharyngitis (chronic). Coccyodynia. See Myalgia. Coitus. Painful. See Dyspareunia. Cold. See Catarrh. Colica Intestinalis — An affection of the alimentary canal, characterized by paroxysmal spasmodic pains in the umbilical region, accompanied occasionally by vomit- ing, and dependent on a weak and irritable state of the digestive system. Treatment — If from indigestion — cra- pulous, Opium (pp. 35 & 38); if from constipation, Brom (pp. 24-27); if from hepatic derangement — bilious, fomentations, etc.; if tympanitic, Dioscorea, Valeriana, VaniI.(10, 82 & 83) ; Opium, Chloroform or Asa fat/da (7 7, 61 & 41). In children, Aqua Calcis, etc. See Enteralgia. Colic. Hepatic — A paroxysm of pain about the right hypochondriu.n or epigastrium, often extending into the chest and right shoulder, due to the passage of a gall-stone. It is always accompanied by vomiting. See Calculi. Treatment — For the relief of pain, Morphine (77 & 225); Atrop. and Chloroform (241 & 304), with ice or fomentations locally; alkalies (pp. 53, 57 & 97). Of special benefit are said to be Macis, Oleum Olivarum and Oleum Therebinthince (146, 150 & 213). For Renal and Urinary-, Saturniiie-(Pamter > s) and Uterine Colic, see Calculi, resp. Enteralgia from lead or Dysmenorr- hea (obstructive). Combustio. 193 Coma — A lethargic state, lasting from a few hours to several days, and dependent among other causes, on cerebral congestion and insufficient supply of arterial blood to the brain; internal and external toxical agents, etc, etc. (It is also a pathological element in some neuroses, as hysteria, epilepsy and catalepsy.) Treatment — If from cerebral exhaustion, nerve tonics and brandy (pp. 70 & 72); if from alcoholism (dead drunk), the cold douche. In semi-coma or somnolency, due to ner- vous exhaustion, strong coffee. In coma of typhoid, sinapism or blister (408) to back of neck. If dependent on uraemia, saline hydragogues (p. 96), or Tiglium (225), unless contraindicated, in which case Pilocarp. hypod. (pp. 50 & 110). In hysterical coma — characterized by profound but tranquil sleep, without stertor, the pupils readily responding to light — aside from the douche, enemata of 01. Tereb. or Asa faet. (385). In unknown cases of sudden coma, if uraemia be suspected, though there should be no dropsy or other symptoms of it pre- sent, a little urine should be drawn off and examined with reference to albumen, casts and specific gravity. Combustio (Burns and Scalds) — Lesions produced by the application of heat have to be treated according to the damage done. Cotton to exclude the air; Copaiva, Glycerin .Collodion or Cocaine (405 & 15). Avery popular application is Aqua Calcis cum Oleo Lini; if extensive, Phenol or Iodoform (405); from phosphor, Caustic. Very severe burns (of second degree) should, after having been bathed with warm turpentine, he dressed with Ungt. ResincB or Linim. Therebinth on lint, and the whole cov- ered with cotton. The dressing should remain as long as possible — any loose portions of it should be replaced by 194 Constipation. fresh ointment, the old having been clipped off — and not be removed unless there is profuse discharge or bad smell from the wound. Burns in the granulating stage may be touched with the alcoholic extract of Quebracho, until it forms a scab, under which healing is said to rapidly take place. Collapse must be treated with brandy and beef tea; pain with Opium (p. 37). Remaining ulcers have to be managed according to their nature — see Ulcers. Proper attention should be paid to the cicatrix, on account of its liability to become excessively hard and cartilaginous, and to contract in such a way as to occasion most serious deformities. In such cases it may be necessary to dissect it up from the parts beneath, and then filling up the gap by transplanting a portion of sound skin from the neighborhood. Condylomata. See Syphilis. Confinement. See Labor. Congestion of Brain and Uterus. See Brain (Hy, peraemia) resp. Uterus (Hyperplasia). Conjunctivitis. See Eye. Constipation (Costiveness, Obstipation) — A func- tional disorder of the large intestine, unless dependent on some lesion of the alimentary canal, characterized by a faulty defecation, as regards the intervals between the single acts, the sufficiency in, and quality of the evacua- tions, due partly to a diminished secretion of the bowels, partly to an impaired contractile power by distention — as in habitual constipation — or to both ; or to mechanical obstruction — as in females during gestation, etc. It pro- duces generally a feeling of pressure and weight in the perineum, combined with flatulency, diarrhoea or colic pains; sometimes it gives rise to headache, palpitations Convulsions. 1 95 siid general malaise, and very often it is the cause of hemorrhoids. Treatment according to cause. If torpor or retained feces, especially in full or gouty habits, Aloes and Colchicum (pp. 88-90); Potass. (220); Senna (pp. 91 & 98). If habitual, Fruit (pp. 88 & 95); Glycerin (207); Aloes, c. N. Vom. (199); Podoph. (p. 93); Lobelia (p. 34). If urine red, Sod. Phosph. (p. 97); if flatulency, Colocynthis (203); if very obstinate, Croton (p. 98), or enemata (385); if deficient secretion, Ammon, (223). In chronic disease, if weakness or general malaise, ionic salines, R h am n us or Rheum (215, 216 & 19), etc. For the use of women during pregnancy there might, aside from fruit, glycerin, salines, senna and the popular castor oil, be enumerated still a host of cathar- tics, as Mercury (pp. 92 & 93); Gamboge, Magnesia cum Rheo (218), etc., etc., to chose from; but for the welfare of the patient it will, as a rule, be better to confine the treatment as far as possible to massage and simple ene- mata (385), which, in connection with a proper diet, will answer in most cases. In order to derive from massage the desired effect, the rubbing should be commenced in the ileo-ccecal region and follow the course of the colon. In habitual constipation of children the operation is best performed in the morning. Consumption (Phthisis). See Lung. Convulsions. Epileptiform — Automatic movements of various parts of the body, marked usually by clonic spasm, dependent on irritation of the spinal cord from a multitude of causes, and occurring frequently in child- ren and pregnant women. Treatment — If from uraemia, Brom (pp. 25 & 27); Chloral and Chloroform (60, 304 & 379); or Morph. (255)> until the elimination of urea 196 Cough. by hydragogues or suporifics. See Kidney (Bright's Disease). Hysterical convulsions, which are always more or less voluntary, require the cold douche or Opium. See Hysteria. In Eclampsia Gravidarum et Parturleri- tium, Verairum (258), or Conium (248), with ice to head if indicated, may be tried, irrespective of the sedatives above mentioned. In Eclampsia Infantum, Mercury (212), if from teething; Vinegar (376), per rectum, and a warm bath. Brom, Chloral or Hyoscyamus (p. 34), may be tried; or Vanilin (83). In gastric irritation — worms, Santonin (p. 103). If due to suppression of eruption in scarlatina, Ammon. Acetas (92); oi Ipecacuanha (p. 82), with Mustard bath (419); if from loss of blood or exhaus- tion, Opium with brandy (p. 37), or Iodine (p. 15). Corn. See Skin. Cornea. See Eye. Coryza. See Nose. Cough — Short, abrupt and sounding expirations, forced through a more or less contracted glottis, some- times of a purely nervous nature; but generally incident to some inflammatory state of one or the other of the organs of respiration. The neuropathic affection — tiussis hysterica — is characterized by a dry, peculiar, sometimes spasmodic sound. Treatment — The remedies are seda- tives and expectorants; Ammon., Apomorphine (93 & 96) ; Nitre, Scilla (122 & 126); Lactucarium, Opium (74, 78 & 113); Cyan, Chloral, Cerium (67, 60 & 59); inhalations oi Belladonna, Conium and Hyoscyamus (312, 15 & 19); or of Tar or Turpentine (323 & 24). In the nervous form, Hyoscyam. c. N. V. (183); Ipecac, Colchic, Lobelia (181, 105 & 75); if due to anaemia, Ferrum c. Chin.; if from gastric irritation caused by worms, Santonin (230). Decubitus, 197 Cramp. See Spasm. Craving for Drink. See Alcoholism. Croup — Membr. or True, and Spasmodic or False, See Larynx (Laryngitis exudativa, respect. Spasmus Glottidis). Crusta Lactea [Tinea Capitis). See Head. Cyanosis. See Dyspnoea. Cynanche Maligna. See Diphtheria. Cyst. Sebaceous, which consists of an organized bag, containing sebaceous matter. Excision (396). For Ovarian and Vulvar Cyst, see Ovaries, resp. Vulva. Cystitis. See Bladder. Cystocele. See Hernia. (Vesico-vaginal). Deafness. See Ear. Debility — A want of strength, both physically and mentally. Treatment — Next to a dietetic regimen, re - storatives — if after illness, Acid. sulf. with or without Strychn. (152-55 & 184); Few. c. Chin. (166 & 173); Bebeer. (161); Pancreatin and Pepton (185, 188 & 38 7), etc.; if from excessive loss of blood, Opium in large doses. See Hemorrhage (post partum) and Hematocele (pelvic). In old persons with troubled breathing and loss of memory, Arsenic or Digitalis (pp. 10 & 79) are sometimes of use. In drunkards, Ammon. (159). In nervous exhaustion, without apparent cause, we may try also Phosphor (pp. 85 & 87); or Cocaine and Hex Para- guay en sis (pp. 77 & 84). Decubitus [Bed-sores) — A gangrenous affection of integument covering projecting bony parts, as the sac- rum, brim of ileum or great trochanter, and due to arrested circulation from pressure during protracted con- finement to the bed, especially in tedious and debilitate 198 Delirium. ing diseases, conjoined with want of cleanliness. Treat- ment — Next to an occasional change of position to avoid continued pressure, washing the back and hips with brandy is the best preventive. If there is already a prickly sensation (just as lying on crumbs or salt might produce)^ the parts may be covered with Emplastrum saponatum or Zincum tannicum or Albumen (393). Some- times a bread and milk poultice will do good. If there are already sores, antiseptic applications. See Gangrene. Degeneration. Cervical and of Chorion. See Uterus. Delirium — An agitated condition of the mind, shown by a fitful rambling way of talking and usually sympto- matic. Treatment — If dependent on trauma, Brom (pp. 25-7); Chloral (pp. 30 & 109), or Opium (77, 255 & 381); in fevers, Antimony (p. 23), Hyoscyamus, Digitalis (pp. 33 which may be partial or com- plete, on one side only, or on both, is characterized by the protrusion of the chin forward or a little sideways, the mouth being fixedly open. The condyle may be felt to project unnaturally under the zygomatic process, whilst there is felt a hollow in the upper part of the parotid space. Treatment — After having fixed the head against the wall or the back of a high chair, the sur- geon should place his thumbs, wrapped in some cloth, at the roots of the coronoid process behind and outside of the molar teeth, and press these downward and backward, elevating the chin at the same time with his fingers. After reduction the chin must be supported for a, few days by a four-tailed bandage, to prevent accidental redisplacement from involuntary yawning. Dislocations of the wrist may readily be recognized by the altered position of the hand, which is thrown eitker backward or forward, or twisted on its axis with an outward or inward projection, and by the alteration in the relative position of the styloid processes of radius and ulna with the carpal bones. They are reduced toy simple extension. Dislocations of the hand — If the os magnum a&ib os 204 Dislocation. cuneiforme are partially dislocated, they form projections at the back of the hand, which must not be mistaken for ganglia. The os pisiforme is sometimes dislocated by the action of the flexor carpi ulnaris. Tre a tmeni ^con- sists of pressure, mechanical support and cold affusions, Dislocations of the thumb, fingers and toes, which are difficult of reduction, aro best managed by taking a firm hold of the joint by means of a piece of tape, spread with adhesive piaster where it is m contact with the skin, fastened with the clove-hitch. It is a good plan to place a part of the tape round the head of the dislocated bone, so as to pull it into its place. Extension should be made toward the palm, so as to relax the flexor muscles. Displacements of Uterus (Prolapse, Flexions, Ver- sions, etc.). See Uterus. Dorsodynia. See Myalgia. Dropsy. General — A transudation into the serous sacs with anasarca, dependent either on obstructions — produced by diseases of the heart and lungs, which impede the return flow of blood from the vena cava, or by certain affections of the liver, which cause portal obstruction, — or on a morbid condition of the blood, as in Bright's disease, and the cancerous and tuberculous cachexy: the hydremic dropsy, attending the two latter diseases is usually less in degree than that in kidney dis- ease. General dropsy arising from mitral lesions, occurs after enlargement by dilatation of the right side of the heart has taken place, and the dusky hue, combined with oedema, gives to the face an appearance as distinctive of cardiac disease as the pallid aspect, which characterizes general dropsy from renal disease. Treatment — Diu- retics, diaphoretics and hydragogues, followed by tonics, Dysmenorrhea. 205 are the remedies, in conjunction with paracentesis (p. 144 — note), and multiple punctures to allow the escape of fluid, where much oedema. Potassa (pp. 53 & 96); Jaborandi (pp. 51 & 110); Blatta and Scilla (pp. 47 & 58), etc. Elaterium, Gamboge, Jalap (pp. 91 & 92). Aside from these there may be mentioned Cole hi cum and Colo- cynthis (pp. 47 & 91), which are often employed in dropsy from heart and liver disease; the former com- bined with Digitalis (p. 50), the best heart tonic. Copaiva (pp. 48 & 49) in B right's disease; Ammonum (p. 43) if dysentery be the cause), and Nitre or Calomel (pp. 57 & 92) if from scarlatina. Scilla, Iodine or Iodoform (401 & 413) externally, or Juniper inhalations (322), especially where the state of the stomach precludes the use of diuretics. See Hydro-peritoneum and Anasarca. For Ovarian Dropsy see Ovaries. Dysentery — A specific inflammatory disease of the large intestines, occurring in all possible forms— from the simple catarrhal and sporadic to the diptheritic and epidemic — all of them characterized by mucous and bloody stools, accompanied by griping pains and ten- esmus of more or less severity. Treatment — In the acute form, aside from hot fomentations to the abdomen, Opium (pp. 36 & 136); Bismuth, Plumbum (99 & 147); Creta, Catechu (i07 & 135); or Calomel (12), according to circumstances. If chronic, Creosote, Cuprum (138 & 39); Alum, Ergot (pp. 62-65); Arsenic (p. 9); Ipeca- cuanha (p. 82), etc. — Nitre (p. 57), as drink; and brandy (p. 72), as support. See Diarrhoea. Dysmenorrhea — Difficult menstruation, attended by more or less pain, and dependent on one or more of the following factors: A depreciated condition of the con- 206 Dysrn enorrh oea . stitution, beginning usually either in the nervous system or blood, which creates a tendency to neuralgia; an- abnormal state of the uterus, or diseased ovaries. Neuralgic Dysmenorrhea may be caused by a neural- gic diathesis; chlorosis or plethora; malaria and rheu- matism; luxurious and enervating habits, as onanism or excessive venery, etc., and is characterized by simple neuralgic pains, with an occasional spasmodic element. Treatment — Aside from attention to cause — tents, or a galvanic pessary locally; or the occasional passage of a sound to the fundus uteri may do good (pp. 129-31). Internally, sedatives — Asa fodtida, Brom, Chloral, Canna- bis, Hyoscyamus, etc. (pp. 23-33); Aurum or Guagac (pp. 9 & 12), are sometimes of service; or Amy I as in- halation (308), and if the pain is of a spasmodic nature, enemata of Asa fcetida or Belladonna (365 & 381) or, suppositoria (3*50, 374 & Id). Parturition will in most cases cure this form entirely. Congestive Dysmenorrhoea, which may be caused by general plethora; sluggishness of the portal circulation, exposure to cold; sudden mental disturbances, displace- ments (perhaps the most frequent cause), and womb diseases, is characterized by severe pelvic pains, accom- panied by diminuition or cessation of discharge and con- siderable constitutional disturbance — pyrexia, headache, nervousness, restlessness, and sometimes rectal and vesical tenesmus or diarrhoea. In the inflammatory kind there will be pain also during the inter-menstrual periods, difficult locomotion; leucorrhcea, fatigue and similar symptoms. Treatment — Removal of cause if possible; and local inflammation, if it exist, should be treated first. If due to plethora or sluggish portal cir- Dysmenorrhea. 20*7 eolation, next to exercise, cathartics — Colocynthis (203); Calomel (ip. 93); salines (2 19), according to circumstances, and a pediluvium (419) at the menstrual period. Some- times the lancet may be necessary; or from two to four ounces of blood may be taken from the sacrum by cup- ping, to be repeated within a fortnight if required. See Amenorrhoea. Difficult menstruation, due to cold, de- mands diaphoretics, especially Ammonii Acetas (p. 43), with sedatives — Brom, Morphium (51 & 255), etc. Obstructive Dysmenorrhoea,wh\ch, barring a contracted cervix, or flexions and versions, may be caused by polyps in utero, or fibroid in the parenchyma of the neck; vagi- nal stricture or obturator hymen, is characterized by severe spasmodic pain [uterine colic), which comes on a few hours after menstruation has continued, and suffi- cient blood been collected in the uterus to distend it, and which passes rapidly into a violent expulsive effort like the co?itractions in miscarriage, accompanied by the passage of some blood. If the obstruction exist in the cervical canal, the efforts of the uterus will generally expel first a small clot, w r hich is followed by a gush of liquid blood. Treatment relates to the obstruction. Membranous Dysmenorrhea ;, being due to an exuda- tion of coagulable lymph, like that in croup, is char- acterized by steady pains, which, w T ith the progress of the menstrual flow, become violent and expulsive, like those of abortion, and end only with the discharge of the exfoliated mucous membrane of the uterus, either in shreds or entire — a false mole. Treatment — Ammonium (p. 43), with Morphium or Ether (255 & 304) to relieve pain. Alterative applications may be tried — Argentum nitricum, Jod, Chiom, Phenol, Ferrum (343, 41, 48, 51 208 Dyspareunia. & 6*7); or, if the patient be married, she may be put under the full effect of Mercury. See Amenorrhoea. Ovarian Dysmenorrhea, caused by chronic oophor- itis, is characterized by great pain in the affected ovary, the pain generally preceding the bloody flow several days, and diminishing as it is established; sometimes appearing even in the inter-menstrual period; and often accompanied by mental depression. Frequently the breasts will sympathize, becoming painful and tender. Treatment — Aside from replacing the ovary, in case it be prolapsed, a warm sitz bath or pediluvium (419),with warm soothing injections (358), and leeches to each groin if necessary. Sedatives in conjunction with suppositoria of Iodoform, etc. (350, 374 & 75), may be indicated. J)ysmenorrhoea consisting of more or less of the ele- ments of the various forms jointly, as usually is the case y demands, if severe, recumbency in bed, Brom and Chloral, with or without enemata or suppositoria (3 75 & 381). At the same time, according to indications, Aloes, Calomel (pp. 89 & 93); or Borax (p. 55); Berb., Viburnum (44, 85 & 162); or Phosphor (154), etc. Dyspareunia — Painful coition, which may, aside from being the consequence of too frequent, too impetuous, or too protracted coition, be due to a number of causes, as chronic poritonitis or cellulitis, endometritis, displace- ment of uterus, requires the treatment of these diseases. If there is a hypersensitive condition of the carunculm after laceration of the hymen (vaginismus — see Vagina) or erosions in the vaginal orifice produced by leueorrhoea, Argent.nitr.(3i3). Sometimes vaginal suppositories (3 5 6) are of benefit — rectal ones will be preferable if, at the same time, a constitutional effect should be required. Dyspepsia, 209 Dyspepsia [Indigestion) — Functional disorders of the stomach or small intestines, or both; mostly chronic, and characterized by imperfect digestion — indigestion proper — or perfect but difficult digestion, dependent, among othercauses, on dietetic excesses, sedentary habits, mental anxiety, anaemia, hysteria, etc. Whilst difficult digestion is attended by a sensation of fullness in the region of the stomach, with a general feeling of heaviness and dis- comfort, indigestion will produce regurgitation, cardial- gia, tympanitis or vomiting; but either may be asso- ciated with more or less languor or incapacity for work after a meal, which feelings sometimes will last for hours. In many cases the urine deposits a lateritious sediment, which generally contains oxalate of lime in abundance. Treatment — Acute Dyspepsia, popularly called a bilious attack, with or without headache, and, among other causes, due to over-repletion of the stom- ach, the ingestion of indigestible food, or an arrest of digestion by strong emotions, etc., rarely requires medi- cation. Blue pill (p. 92), followed by a cathartic (p. 97), and afterward Quinine (p. 76), or some other tonic will at any rate suffice. In the chronic form, which is some- times very obstinate, the diet should, above all, be regu- lated; if gastric, farinaceous and fatty articles as food; if intestinal, albuminoid substances and meat. Medica- tion according to circumstances. In atonic indigestion — of sedentaries — Hydrastis, Absinth, and Alcohol (pp. 72 & 82); if constipation, Aloes, Podophyll., Rheum (pp. 89-94), and other tonic aperients; if dependent on the liver, alteratives (p. 7); if due to fermentation and putre- faction in the alimentary canal, Naphthol (21); or Saiicin (25 & 29), etc. In heart-burn (cardialgia) : a burning 210 Dyspnoea. pain over the pit of the stomach, and shooting upward into the throat, alkalies (pp. 53-5) — taken before meals they increase the flow of gastric juice — ,Berberis, Guar- ana (pp. 24 & 81), etc. In waterbrash (pyrosis) : regur- gitation of insipid, saltish or acid liquid in the morning when the stomach is empty, Bismuth or Soda (p. 46); acids or Pepsin (pp. 71 & 84). If foul taste, Nitro-mur. acid (153). If morbid sensibility of stomach (pain and distress after eating, or diarrhoea excited by food), Arsenic, Creosote, Argentum (pp. 9, 64 & 74) ; Brom (p. 25). If tympanitis, alkalies, Bismuth, Ammon., Carbo (93, 103 & 159), or Benzin, Creosote (97), etc.; (a little brandy is sometimes of service). In hysterical flatulency, Asa fcetida and Valeriana (41); Strychn., Ferr. (pp. 80 & 81); Glycerin and Pancreatin (pp. 8 1 & 84). If ansomia, acids; Ferr. c. Chin. (p. 76). In dyspepsia of drunkards, Ammon. (159); or Capsicum (pp. 75 & 82). If vomiting. Cyan, Cerium (67 & 59); sulfites (33). See Vomiting. Dyspnoea — A difficulty of breathing, dependent on deficiency of oxygen in the blood. Treatment according to cause — Ammon. (158); Amy/ (37 & 308). See Lungs. Dysphagia. See (Esophagus. Dysuria. See Bladder (Spasmus vesicae). Ear — Foreign bodies in the meatus should be removed as quickly as possible, when it can be done by gently syr- inging the ear with warm water, which procedure may even be repeated at short intervals, if required; else the substance had better be left alone, as foreign bodies are known to have remained in the ear without permanent injury for years. Except in the case of soft or fibrous substances lying just at the entrance of the passage, other instruments should not be used, as they will only Ear. 211 do harm. (To get a proper view of the inside, in exam- ining the ear by speculum, the auricle must be drawn outward and backward). Deafness, if organic, depending on concussion or rup- ture of the auditory, is incurable. See sub-acute and chronic inflammation of tympanic cavity. If functional and dependent on debility, Rmmon. (p. 73) may be tried; or Arnica, Valeriana (pp. 74 & 29), etc.), with Glycerin, Phenol or Camphora (274 & 78) locally. If caused by an accumulation of wax, the syringe. (Glycerin dropped into the meatus, and retained by a tampon of cotton for twenty-four hours, will facilitate the removal). Catarrhal or Throat Deafness, which depends on a morbid state of the mucosa lining the Eustachian tubes, generally associated with swelled tonsils and relaxed throat, is characterized by ringing and crackling noises in the ear. It is easily diagnosed by means of the oto- scope. When the patient, with firmly closed mouth and nose, makes an 'effort, as in blowing the nose or swallow- ing, the shock of air against the membrana tympani may be heard, if the tubes are pervious, or a gurgling - : ind, if they contain fluid; whilst, if they are imperv- ious, there will be no sound at all. Treatment — Aside from tonics (p. 70), to brace the system, astringent garg- les (321), inhalations of Creosote or Iodine (336); abridg- ing of the tonsils if necessary, and catheterism of the Eustachian tubes. As the latter operation requires much skill, the following procedure may answer as well: The mounted end of a short flexible tube attached to Politzer's india-rubber bottle is introduced into one nostril, which is then closed by the surgeon. The patient is now told to swallow — having taken some 212 Ear. water into his mouth for the purpose — and during the act the surgeon squeezes the bottle, so forcing the air through the nasal cavity into the tubes. Tinnitus Aurium — Noises in the ear, accompanied with more or less deafness, a symptom which may be due to anaemia, grief, anxiety, and a general weakened state of the system. (When occurring in the decline of life it is seldom amenable to a cure). Treatment con- sists of a generous diet and out of door life, with Ferrum, Zinc, Valeriana (174 & 196), etc. Otalgia — Earache, unless inflammatory, is neuralgic, and usually due to carious teeth. It is characterized by fits of excruciating pain, shooting over the head and face. (Inflammatory pain is throbbing and accompanied by fever). Treatment — Locally may be tried Atropia, Camphora, Chloral, Phenol or Cocaine (174-9); internally cathartics (p. 88), with tonics (p. 69), if necessary. Otitis externa — Catarrhal inflammation of the lining membrane of the meatus, occurring chiefly in delicate children whilst cutting their teeth, or as a sequel of the exanthemata, and frequently associated with strumous ophthalmia. It is characterized by more or less fever- ishness, swelling of the meatus, soon followed by a thin yellowish discharge, and ear-ache. Aside from a con- stitutional treatment, purgatives (p. 88), with foment a- tions or poultices (p. 114), locally; and if the discharge continue, astringent injections (p. 114), with counter- irritation. Should the discharge stop suddenly, and an attack of acute pain and fever come on, the injections must be discontinued, and purgatives, with fomentations — if necessary, leeches — must be again resorted to. Otitis interna — Acute inflammation of the membrana Ear. 213 tympani and the tympanal cavity, which is frequently connected with measles, scarlatina, rheumatism, gout and scrofula; but which may be due also to cold, sea- bathing, violent syringing and otherwise irritating an inflamed ear, is characterized by swelling, tenderness and dryness of the meatus. Suppuration within the tympanum and mastoid cells, with, occasionally, facial paralysis, may follow; and the membrane finally ulcerate and burst. Whilst in neglected cases inflammation or suppuration within the cranium may occur and prove fatal, in less severe ones, the membrane may be left thickened and opaque; and the cavity blocked up by adhesions; or there may remain an obstinate discharge with caries of the bone, and mischief within the cranium, hereafter. The inflammation is attended with sudden and intense pain (often so excruciating as to produce delirium), which is increased by coughing, sneezing and swallowing— always worse at night — in conjunction with tinnitus aurium, more or less deafness and violent fever. Leeches should be repeatedly applied to the mas- toid prominence and in the depression immediatelybelow the auricle, and by means of a leech-glass to the orifice of the meatus itself. Should the acute symptoms not be mitigated, and there be any sense of fullness, swelling or fluctuation over the mastoid process, an incision, an inch long, should be made with a stout scalpel down to the bone, parallel to, and half an inch from the attach- ment of the auricle. When the acute stage is subsiding, a portion of the incision may be converted into an issue, or blisters may be employed. Neuralgic pain, accomp- anying otitis, may be allayed by applications of anodynes behind the auricle, Aconite, Belladonna with Opium, Co- 214 Ear. caine (263 & 350), etc. If the membrane should bulge outward on account of the pus within the cavity not being able to escape through the Eustachian tube, it may be perforated at its lower and posterior portion (to avoid the ossicula), by means of a sharp-pointed steel probe. In the sub-acute and chronic form, where the changes, wrought in the tympanic cavity give rise to the majority of cases of deafness, though the symptoms are but slight — a woolly sensation, 'occasional noises with variable obtuseness of hearing and slight aching, — and which most frequently is associated with a rheumatic or gouty diathesis, a constitutional treatment is imperative. Iodine, Sublimate (pp. 13 & 14); sometimes Hydrargyrum c. Creta, gr. j bis die, is of service. At the same time counter- irritants in the shape of Iodine (20), or small blisters (408), over the mastoideus, with occasional leeches, if they give relief to pain, noises and headache. In child- ren of weakly habit this form may exist still more in- siduously: they may cry when it is washed; or they may like to have it tickled; or they may put their hands to it, or roll their heads on their pillows; but no real com- plaint is made. Aside from counter-irritants and tonics, Ferr. jod. (p. 15), especially if the tympanum is bulging. Perforation of the Membrana Tympani, which, if large, will cause considerable deafness, may be the con- sequence of injury— blows on the head, or a box on the ear, etc., — but it is mostly a result of otitis and suppura- tion within the cavity, or ulceration of the membrane itself. If the opening be small, Argenti Nitras applied by means of a fine probe coated with it, may cause the aperture to heal; but if the loss of substance is great, a substitute for the membrane is the only remedy. JEchinococcus. 215 Otorrhoea is either the result of catarrhal inflamma- tion of the meatus — see Otitis externa — or the conse- quence of otitis interna. In purulent discharge follow- ing the latter, the ear should be twice daily very gently syringed with warm water, and immediately afterward a tepid lotion of Alum, Zinc or Plumbum (277 & 81) be dropped into the meatus till it is filled, to remain there for about two minutes. If the discharge is very fetid, Phenol, Salicin, Mangan (274, 75 & 81); and if very obstinate, the interior of the meatus may be pencilled twice a week with So/utio Argenti nitrici (gr. v: § j). If the fetid discharge is caused by caries of the petrous or mastoid bones as consequence of suppuration within the tympanum or mastoid cells — in which case palsy of the side of the face will be present — the dead bone may be felt with the probe. (An early incision down to the mastoid bone may prevent caries). Polyps in the ear may be extracted; but perhaps equally effective, and less liable to set up irritation, is the application of Alumen pulveratum by means of an insufflator, in connection with astringent lotions, with which the meatus should be regularly injected. Fungous Granulations, which cover sometimes the membrana tympani, may be treated with Argentum nitricum and astringent lotions; Alum or Tannin. As all inflammatory affections of the external meatus may implicate the brain, care should be taken to have always a free exit for the discharge- Echhstococcus (Hydatid) — The scolex or larval stage of Tcenia echinococcus, a small tapeworm of about five mm. in length, which infests the dog, mostly in the liver; but the cyst may exist in any part of the body. 216 Elephantiasis. Treatment — Puncturing the tumor with a fine hollow needle or trocar, and withdrawing a portion of the liquid from the sac by aspiration, will generally suffice to effect a cure; but electrolysis (p. 150) is preferable. Eclampsia. See Convulsions. Ecthyma and Eczema. See Skin. Ectopic Gestation. See Pregnancy (extra-uterine). Elephantiasis Arabum — A disease of warm climates, consisting in a slow hypertrophy of skin, areolar tissue and bones; and affecting generally the leg or the scro- tum, resp. the labia. Amputation of the diseased part is the only remedy as yet known. Embolus. See Brain, resp. Lung. Emissions. Seminal. See Spermatorrhoea. Emphysema vesiculare — An abnormal accumula- tion of air within the alveoli, whereby they become distended, and their walls often atrophied, produced mainly by forcible efforts of expiration, and generally preceded by or associated with bronchitis or asthma. It is characterized by the barrel-shaped chest, with an abnormal intense resonance on percussion; and leads invariably to hypertrophy and dilatation of the right ventricle with venous congestion— £Ag cyanosed hue of the face being most markable during paroxysms of couglu ing — on account of the obliteration of pulmonary capil- laries, causing obstruction to the flow of blood through the lungs. In slight cases want of breath will be appar- ent in speaking, singing, especially in laughing or walk- ing fast; more severe ones are characterized by habitual labored breathing, consisting of a prolonged expiration and a remarkable short inspiration. In JE. senile the air el, and the contents squeezed out. Eczema Palpebrarum {Ophthalmia Tarsi) — A usually chronic eczematous inflammation of the palpebral con- junctiva and the edge of the eyelids, with a morbid secre- tion of the Maibomian glands (so that the lids will stick together and become encrusted with dried secretion during sleep), leading frequently to ulceration of the lids, disease of the hair follicles, and loss of the eye- lashes; even to thickening and subsequent inversion of the edge of the lids. It mostly occurs to weakly persons with disordered digestion. Treatment — The lashes should be cut off, the eyes bathed with warm water several times daily, and at night the edges of the lids be smeared with lard or Ungt. Hydr. nitr. (26(5). At the same time aperients (p. 88); alteratives and tonics (pp. 8 & 69), and if possible, change of air. Trichiasis — A growing inward of the eyelashes, lead- ing to inflammation or ulceration of the cornea, and depending on some changes in the fibro-cellular tissue, in which the ciliary follicles lie. Treatment — If pluck- ing of the offending ciliae will not answer, roots and bulbs must be extirpated with the knife. Ectropion — E version of the eyelid, caused by a thick- ening of the conjunctiva, owing to chronic inflammation or to a cicatrix on the cheek; often it is a consequence of the cicatrization resulting from the healing of abs- ea at the edge of the orbit. Entropion — Inversion of the lid, produced by the unnatural action of that por- tion of the orbicularis palpebrarum which covers the edges of the tarsal cartilage. Operation is the remedy. Lagophthalmos — Hare-eye is called the inability of 228 Eye. closing the palpebrae, and depends either on cicatrices or upon inaction of the orbicularis through palsy of the portio dura. In the latter case fomentations, a blister behind the ear, and aperients (p. 88), may suffice, unless it be due to some specific disease. Ptosis — A falling of the upper eyelid, whereby the eye is more or less closed, and depending on inaction of the levator palpebrce, in consequence of paralysis of the third nerve or on senile loss of power of the muscle; or it follows injury to the eyelid, whereby the nerve supply is more or less destroyed. In the first case, if it is at- tended with headache, giddiness and other signs of brain disturbance, the treatment should consist of rest, with purgatives, and locally, cold compresses; if caused by exposure to draught, tonics may be employed. In cases where general measures fail, a surgical operation. Symblepharon — Union of the eyelid to the ball, produced by ulceration of the lid and the surface of the globe in consequence of some accident, is generally irremediable. i Pediculi — -These parasites lodge sometimes about the roots of the eyelashes, and produce obstinate itching. Unguentum mercuriale is the remedy. Epiphora — An over- secretion of tears, so that they run over the cheeks from irritability of the lachrymal gland or a hypersemic state of the conjunctiva, common in scrophulous children. Aside from warm local appli- cations, purgatives, alteratives and tonics. Xerophthalmos — Dryness of the eye from deficiency of the mucous secretion of the conjunctiva in conse- quence of severe inflammation or too much cauteriza- tion, and may be relieved by applying milk or Glycerin. Lachrymal Apparatus. 229 Stilliciclium lachrymamm — Watering of the eye is caused by an over-flow of tears in consequence of an obstruction somewhere in the lachrymal apparatus. If the punta lachrymalia be closed in consequence of in- flammation in their neighborhood, it is only temporary: if congenita], it is incurable. In other cases a caniculus is generally obstructed as well, which should hes/it open at once, and prevented from closing again, by passing for a few days occasionally a probe into it. Sometimes there is obstruction of the nasal duct in consequence of a thickening of its lining membrane, not uncommon in scrophulous persons, attended with a perpetual watering of one eye and dryness of the corresponding nostril. This is characterized by a small tumor by the side of the nose, which consists of the lachrymal sac distended with tears and pus, and the contents of which can be squeezed upward through the punta, and down ward into the nose if the obstruction is not quite com- plete. The best plan is to s/it open a caniculus and pass from there twice a week a style into the nasal duct (to be kept there half an hour) until the stricture is overcome. Dacryocystitis — Inflammation of the sac is known by redness, swelling and pain at the side of the nose, im- plicating the conjunctiva and eyelids, and attended with fever and headache. Treatment — If acute, leeches, co/cf compresses and cathartics (p. 88); if the pain becomes throbbing, the sac more and more distended, and its contents cannot be pressed down into the nose, the impediment within the nasal duct must be removed by catheterization as indicated. In the chronic form, an astringent (273) may be applied twice a day to the inner angle of the eye, to be transmitted to the sac by strong and 230 Eye. repeated inspirations, with mouth and nose well closed. Fistula lachrymalis signifies a fistular opening at the inner corner of the eye, communicating with the lachry- mal sac, the ordinary consequence of an obstruction of the nasal duct, if not in time relieved. Synechia anterior et posterior consists of an adhesion of the iris to the cornea or capsule in consequence of organization of lymph from protracted iritis. Artificial pupil by iridectomy. In Atresia iridis, which is dependent on the same cause, iridectomy is also the only remedy. Myosis — Inability of pupil to dilate, attended with great obscurity in vision, and sometimes with injury to the sympathetic of the neck. Attention to general health and rest to the eye — Atropin does harm. Mydriasis — A preternatural dilatation of the pupil, which does not contract on exposure to light, caused by any injury of the brain affecting the tubercula quadri- gemina, as in apoplexy and compression, or on a derange- ment of the nerves supplying the iris, in which case it may be attended with ptosis — from paralysis of the third nerve; — or it may even depend on gastric irritation and general debility. It is often an attendant of confirmed amaurosis. Ergot or Strychn. (pp. 18 & 83), in conjunc- tion with blisters to the temples, are sometimes of use. Cataract (Grauer Staar of the Germans)— Opacity of the lens or of the capsule, or of both. Operation. Glaucoma — Choroiditis with diffuse imbibition by the vitreous body, which latter increases the intraocular pressure, terminating in disorganization and total blind- ness, is characterized by a stony hardness of the eyeball, a steamy looking cornea, and a dilated and fixed pupil. In the acute form — glaucoma fulminans — which occurs Vision. 23 L generally in feeble constitutions of elderly people, there is at the same time a violent neuralgic pain in the eye and throughout the ophthalmic branches of the fifth nerve. Treatment- -Next to rest, cold compresses, leeches and tapping of the anterior chamber. Iridectomy if chronic. Asthenopia or weakness of sight (muscce volitantes) r if dependent on hypermetropia, may be ameliorated by spectacles. If associated with intolerance of light, it is usually an accompaniment of short sight, easily recog- nized by the contracted brow and half closed, continu- ally winking eyelids. Amaurosis and Amblyopia— Blindness is often asso- ciated with some disease of the brain or spinal marrow — embolism of the central artery of the retina is a com- mon cause of blindness. Treatment — Pulsatilla (23), or Nux Vomica (p. 83) may be tried, and Strychn. or Veratrin (271 & 72) locally. Impaired vision, which may be a consequence of atrophy of the optic nerve, detached retina, retinitis, displacement of the lens, etc., is sejdom amenable to amelioration. Myopia — Short sight dependent on the fact that par- allel rays are brought to a focus before they reach the retina on account of either the refracting power of the eye being too great, or its antero-posterior axis too long. Use of carefully adjusted spectacles. Presbyopia or far- sightedness is called a narrowing of the range of accomo- dation, owing to changes in the lens and ciliary muscle. Hypermetropia is the converse of myopia: Parallel rays of light are not brought to a focus on the retina, but behind it, owing to the refracting power of the eye being too low, or the optic axis too short. It being one of the most common causes of asthenopia or impaired msion y 232 Eye. and of convergent strabismus, it should be corrected by well selected convex spectacles. Astigmatismus (irre- gular refraction) — When different meridians of the same eye have different powers of refraction, characterized by the fact that whilst some lines or objects are seen clear, the neighboring ones look blurred. It may be owing to original conformation, cicatrized ulcers, or a conical condition of the cornea; or to disease or displacement of the lens. In Keratoconus, where the abnormal bulg- ing of the cornea causes first shortsightedness, but by degrees inability to see anything at all on account of too great refracting power, a concave glass or a perfor- ated diaphragm, or the two combined, will sometimes remedy the faulty refraction; but an artificial pupil by Jridodesis will be more satisfactory. Strabismus — ^Squinting signifies a want of parallelism in the position and motion of the two eyeballs. It is called convergent, when the affected eye is turned in- ward, which form occurs generally in young people, and is frequently due to hyperopia. When the eye is turned outward, as chiefly met with in elderly people (being due to a myopic condition or to partial paralysis of the internal rectus), it is called divergent. Moreover, squinting may result from congenital imperfection; it may be induced by using one eye constantly, or by imitating squinting persons. Sometimes it is a sequel of fever; and a disordered digestion, teething, worms, fright and fits of passion are known to give rise to it. Frequently it is caused by some disturbance in the brain, being often the precursor of acute hydrocephalus and convul- sions in children; and when it is accompanied by drop- ping of the eyelids, sleepiness, torpor of the intellect, or a Febrile Diseases. 233 staggering gait, some mischief within the head may fairly be anticipated. Treatment — Squinting of not more than a few weeks duration may often be removed by a judicious management of the case, having for object the strengthening of the weak eye by exercise: Shutting up the sound one; wearing gogqles; placing black patches on the nose, etc. If the squinting is of long standing, the internal resp. external rectus must be divided to in- sure a cure, provided the antagonist be not paralyzed — if the disparity in vision is too great this operation will j t either be of lasting benefit. Fainting. See Syncope. Falling of Womb (Prolapsus uteri). See Uterus (Displacements). Ffbricula — An ephemeral form of simple or essent- ial fever, being not secondary to a local affection, but primary or idiopathic. It is associated with anorexia, constipation, headache, and more or less pain in the limbs, and lasts generally from one to three, seldom more, days. Treatment embraces refrigerants (p. 57); saline laxatives (p. 97); and, perhaps, anodynes (p. 20). Febrile Diseases — Local affections, attended with elevation of temperature and increased frequency of the heart's action — the so-called symp>toinatic fever. Treat- ment — Aconite or Veratrum (35 &S4); Nitre (pp. 55-57); Cinchonidin (p. 12), etc. Feet, sweating. See Ephidrosis. Fetor oris (Stomatodysodia). See Mouth. Fever. Bilious. See Fever (remittent). Fever. Continued. See Typhoid, Typhus, Relaps- ing and Erysipelatous fever Fever. Eruptive or Exanthematous. See Scar- 234 • Fever, latina, Morbilli, Rubeola, Roseola, Varicelli and Variola — the latter for differential diagnosis. Fever. Essential — An idiopathic fever, character- ized by continuity or periodicity; or by specific erup- tions of the skin, constituting those general diseases known as continued, periodical and exanthemetous fevers. Fever. Gastric. See Gastritis. Fever. Hay. See Asthma. Fever. Hectic. An insidious fever, which accom- panies chronic disease, especially suppuration, and characterized by daily paroxysms of chills, followed by dry heat and sour perspiration, and a marked tendency to diarrhoea, leading sooner or later to emaciation. Treat- ment relates to the cause. Salicin (p. 18); Phosphor (154) ? land other tonics. Fever. Intermittent [Fever and Ague,, Swamp fever, the Snakes, etc.) — A periodical fever, due to a special morbific agent, known as malaria, and charact- erized by febrile paroxysms, which occur at definite in- tervals, thus constituting various types of the disease: The quotidian, if the paroxysm occurs every day — the tertian, if every other day — quartan, if every fourth day; and consisting generally of three distinct periods, a cold ? a hot, and a sweating stage, followed always by a per- fectly apyrexial interval. It is called pernicious, if it is associated with symptoms dangerous in themselves: In- tense jaundice — Icteric Iatennittents y hematuria or hemorrhage in other situations— IIe?norrhagic J. / vomit- ing and purging- Choleraic I.; cold extremities— Algid 7; restlessness and prostration — Asthenic I In the com- atose or apoplectic form the coma is sometimes preceded by delirium or convulsions. Treatment — Quinine (p. 11) Relapsing, 235 directly after the paroxysm; if irritability of stomach, the tasteless tannate, especially in children — gr. v ter die to child of 3 years. Or it may be administered per anum or hypodermically (384 & 244). For rectal injections, the bisulfate, muriate or bromide are preferable to the sulfate on account of their greater solubility. In the hot stage, sponging (420). Of other remedies may be mentioned Acidum nitricum,Cedron (pp. 9 & 10); Salicin, Resorcin (pp. 1 4 & 1 6) ; Ammon.andTablesaltfpp. 44 & 96) ; Bebeeria, Cocaine, Cuprum (pp. 74-78); Phenol or Pilocar- pin hypoderm. (pp. 51, 107 & 110) — the latter injected before the paroxysm is said to prevent the same. In chronic intermittens, Arsenic (p. 10) is perhaps the best remedy — 0.C005 or one drop of Fowler's solution ter die may be safely given to a child of 3 years — but it must be used for some time. The pernicious form has to be treated symptomatically. Opium (p. 35) in restlessness, convulsions, diarrhoea, etc.; Chloroform (p. 81) to induce sleep; Camphora externally (409) in cold stage; brandy (p. 72), and other stimulants as support, if necessary. As the 'pernicious paroxysm is always preceded by at (east one devoid of danger, it is of importance to present another. Anaemia and general dropsy as sequel requires Ferrum (pp. 76 & 79). In enlargement of spleeii — ague cake, Quinine (pp. 1 1 & 76); Brom and Ergot (pp. 24 & 65, with Belladonna plaster (411), etc. Fever. Periodical. See Fever (Intermit lent, He- mittent, Typho-malarial and Yellow fever). Fever. Puerperal. See Puerperal fever. Fever. Relapsing (Typfais recurrens, Uunyer- / pe,st) A form of continued fever, contagious, and without a prodromic stage, characterized by sudden paroxysmg, 236 Fever. which are ushered in by a chill, and may last from two to ten days, being separated by a thorough apyrexial period of a similar duration; frequently attended by nausea and vomiting, and above all, by muscular pains, which will continue during the intermission. The paroxysms are supposed to be due to broods of ' spirillce, as they terminate with their existence, and reappear with a fresh brood. Treatment — Aside from a milk diet, and, in asthenic cases, brandy (p. 72), sponging or the wet sheet (420), with salines (p. 96), and if neces- sary anodynes (p. 20). Afterward tonics (p. 76). Fever. Remittent — A periodical fever, dependent like intermittens on malaria, and characterized by dis- tinct remissions, which may take place at intervals cor- responding to those of apyrexia in the various types of the latter, and associated with gastric symptoms: nausea and vomiting, with some tenderness over the epigas- trium. Treatment essentially that of intermittens — sponging or the wet sheet (420), as in typhoid, if the skin is very hot and dry. The malignant form — Jangle fever — standing in the same relation to pernicious inter- mittens as the simple forms to each other, claims the treatment of that disease. Fever. Scarlet. See Scarlatina. Fever. Typho-malarial — Being as the name sug- gests, produced by the combined action of malaria poi- son and the especial cause of typhoid, it is also charact- erized by the symptoms of both of these diseases: Periodicity of fever, diarrhoea, tympanitis and iliac tenderness, connected with abdominal lesions, in con- junction with the ataxic series, as delirium, subsultus tendinum, etc., according to the proportions in which Fractures. 237 they may stand to each other in the different cases. The treatment is, of course, anti-periodic and anti-typhoid. Fever. Yellow — An essential fever of a miasmatic- infectious nature, and peculiar to warm climates, where it occurs sporadically and epidemically. It is of more or less intensity, without a particular distinctive char- acter, generally ushered in abruptly by a chill, and last- ing from a few hours to three days — when, in mild cases, reconvalescence may take place —followed after a short time of comparative ease by black vomit, yellowness of skin, especially of the conjunctiva, hemorrhage, a notable fall of the pulse (sometimes to 30 p. minute), and all signs of collapse. The treatment is symptomatically: Aside from a milk with lime-water diet, sponging (420). In gastric irritability and vomiting, ice per os; sinapism to epigastrium, and internally Creosot (p. 64); Cyan or Chloroform (pp. 30-32), or Pilocarpin (pp. 51 & 110). Restlessness requires Opium (p. 35); hemorrhage, Ergot (p. 65); and prostration, brandy (p. 73) per anum, if not retained by the stomach. Fibroid. See Uterus. Final cessation of menses. See Menopause. Fissure of anus. See Anus. Ftstula. Fecal, urin ary and vaginal. See Vagina. Fit. See Convulsions. Flatulency. See Tympanitis. Flexions. See Uterus (displacements). Fluor albus. See Leucorrhcea. Fractures are solutions of continuity of a bone, as wounds are of the soft parts. A fracture is called simple when there is no wound communicating with it; com- pound, when there is such a wound; and complicated, 238 Fractures. where there is laceration of an artery or joint, or other additional injury. Comminuted it is said to be if the bone is broken into more than two pieces at one place, multiple, if broken at different places, or more than one bone in the same limb. It is characterized by deformity, preternatural mobility and crepitus in conjunction with more or less pain, swelling and helplessness of the in- jured part, spasm of the muscles, and sometimes con- siderable subcutaneous ecchymosis. However, deform- ity may be absent in fracture of the ribs, pelvis and scapula, and the other signs are sometimes wanting in impacted fracture, or when the bones are held firmly by muscular spasm. Treatment — While the upper end of the limb is held steadily by one assistant, the lower is extended, i. e., firmly, gradually and gently drawn in such a direction as to restore the limb to the proper length and shape; the surgeon meanwhile manipulating with his fingers, and placing the fragments in their correct position. Chloroform (304) may, if necessary, be ad- ministered to prevent pain and spasm. Under con- tinued extension the whole of the fractured limb should then be bandaged from its extremity, for the purpose of preventing contraction of the muscles and swelling* Now, layers of wadding or old linen to fill up ail hollows may be applied, a strip of stout tape laid lengthwise on the limb, and the whole evenly covered with layers of bandages of old linen, well soaked in starch or dextrine. If the apparatus has to be got off or loosened (as in case of swelling), it may be lifted with the tape and easily ripped up by means of scissors as a complete mould, and without wounding the skin— if dampened with boiling water it can be softened and put on again more com- Gangrene. 239 fortably, but sufficiently tight to keep the parts steadily in their place. (Plaster of Paris is also a good material). Wounds and doubtful bruises should be left uncovered, and every newly-set fracture, especially if done up in a circular bandage, should be examined after six hours: If the fingers or toes are blue or benumbed, there would he a possibility of gangrene. The remaining treatment must be conducted on general principles. Cordials (p, 72) to restore the patient from the shock of the in- jury; the- catheter — usually required after fracture of the leg; aperients (p. 88), cold lotions and leeches must " e employed at the discretion of the practitioner. Opium in grain doses 1-3 times a day, and if need be, with Colocynthis, may be given to allay pain and irritation. (For consolidation fractures require from 30-40 days. Freckles. See Skin. Fright. See Excitement. Frostbites. See Perniones. Furunculus (Boil) — A circumscribed, round and hard swelling from inflammation of true skin, attended with pain and tenderness, and ending in suppuration. It is caused by unwholesome food and depressing influences generally. For treatment see Carbuncle — Poultices wdth purgatives (p. 88); Napthol (21), and, perhaps, the knife. If indolent, Creosote, Opium, Iodine (398, *00 & 402). Gallstones. See Calculi (biliary). Gangrene — A mortification of tissue in consequence of inflammatory action or obstruction in the circulation, etc., accompanied by putrefaction ; or dependent on some constitutional cause, and the result of deficient supply of blood, etc., the dead part becoming dry and hard: This constitutes dry gangrene, whilst the former is called 240 Gastralgia. humid or moist, the decomposed effusion being known as slough. Treatment according to causation, with local applications of Phenol, Brom (398); Chrom or Salicin (344 & 99); in hospital gangrene, 01. Terebinth, Creosote or Acidum nitricum (352 & 72). See Phagedena. For Pulmonary Gangrene see Lung. Gastralgia (Gastrodynia) — A neuralgic affection of the stomach, frequently associated with spasmodic con- tractions, so as to give the pains a griping character {colic), and accompanied sometimes by vomiting and dyspeptic symptoms. In the chronic form the pain occurs either in more or less frequent paroxysms; or it is continuous with occasional exacerbations. Treatment — Fomentations or a sinapism to epigastrium; and inter- nally, Belladonna, Brom or Hyoscyamus (pp. 22 & 23); Cyan (66) — Morphine is objectionable — Bismuth in large doses (p. 46); Spir. cethereus or brandy; Nux Vomica or Pepsin (pp. 83 & 84); Alum (p. 63); Arsenic and Quinine (pp. 9 & 11); A rgentum (p. 74), etc. SeeColicaintestinalis. Gastritis — Gastric Catarrh, if accompanied with considerable pyrexia, Gastric Fever is called an inflam. mation of the stomach, caused mostly by abuse of alco- hol and dietetic excesses, and characterized by distress- ing pain in the epigastric region, which is increased on pressure; nausea and vomiting; intense thirst; and, unless the consequence of irritant poison, constipation. In acrid poisoning there is generally diarrhoea, vomiting of bloody matter, and burning pain in mouth, fauces and oesophagus. Treatment — Aside from fomentations, tur- pentine stupes or sinapisms to epigastrium, Morphine at once (77 & 255); ice to allay the thirst, and milk with Aq. Calcis as diet. Emetics and cathartics are contra- Gastritis. 241 indicated; instead of the latter, enemata (385 & 86), if necessary. In the toxical form emetics or the stomach- pump to commence with; then, to neutralize the poison, the appropriate antidote. In poisoning from an acid emetics are of no use. In subacute gastritis (bilious attack) there exists sometimes irresistible desire to provoke vomiting by voluntary efforts on account of a secretion in the otherwise empty stomach, very much like that known as tenesmus, and produced by the particular form of inflammation. In the chronic form, nausea and vom- iting, with anorexia and habitual thirst is more likely to occur than in functional disease; but still more char- acteristic is the tenderness in the epigastric region, which is here continuous, and not only during digestion as in dyspepsia. Chronic gastritis moreover results frequently from long continued nervous congestion of the stomach, caused by obstacles to the circulation in the liver, lungs and heart; and it is also present in certain cases of renal disease, because the carb. of ammonia, which is formed from the decomposition of urea, acts as a local irritant, when eliminated by the gastric mucosa. Treatment — Aside from a diet consisting of articles which are digested in the small intestines — neither meat nor stimu- li nts must he allowed — Cyan or Opium may be given (p. 35); or Hyoscyamus, Arsenic, Argentum,Ammon. (p. 44); Tannin or Creosote (pp. 62 & 64); if vomiting of glazing matter. Alum, Hydrastis (p. 82), if from drink; and in atony or debility after the acute symptoms have passed, Nux Vomica and acids (pp. 61 & 71). See Dyspepsia. Gastric Ulcer. See Stomach. Gastro-intestinal Catarrh. See Enteritis. Gastrodynia. See Gastralgia. 243 Globus hystericus. Gastrorrkagia (Gastrorrhoea). See Hemorrhage (from stomach). Gestation. See Pregnancy. Gingivitis parenchymatosa [Stomatitis ulcerosa). See Mouth. Glands. See Lymphatics. Gleet. See Gonorrhoea. Globus hystericus — The result of primary irritation of the uterine nerves, which is transmitted through the whole chain of ganglia to the nerves of the oesophagus and trachea, producing here spasm. See Hysteria. Glossitis. See Mouth. Glottis. (Edema. See Larynx. Goitre. See Bronchocele. Gonorrhoea (Urethritis) — A suppurative inflamma- tion of the mucosa of the genitals, produced occasion- ally by gout — if attended with acid and irritating urine) — and several other irritants; but generally it is due to contagion from matter of a mucous mem- brane in a similar condition, and characterized by a purulent discharge, scalding urine, and sometimes chordee (a painful crooked state of the penis during erection). It may be complicated with balanitis (a sup- purative inflammation of the mucosa covering the glans), hemorrhage from the urethra, bubo, phimosis, orchitis, etc., and in severe cases the inflammation may reach the bladder, and cause even irritation of the kidneys. Treat- ment according to cause. In the acute stage, saline cathartics (p. 69); Aconite or Nitre (35 & 122); if ardo urinm, Potass, (p. 54). Afterward Copaiva (106) in con- junction with injections of Zinc, Plumbum, etc (32 7, 333-36). If chordee, Camphora or Cocaine (54 & 330). If balan- Hematocele. • 243 itis,ra/7/7/7;,etc.(396). A catheter dipped in carbolic 0/7(39 8) and passed into the urethra about one inch a-half every hour for five hours, is said to abort incipient gonorrhoea. In the chronic form — gleet, tonics (pp. 69 & 10); Col- chicum, Uva Ursi (105 & 151), and injections of Bismuth r Zinc (326 & 336); if complicated with spermatorrhoea, Ferrum (143). Gonorrhoea in females requires a similar treatment. See Vaginitis. Gout. See Arthritis. Gravel. See Urinary Deposits. Growths. See Tumors and Carcinoma; Polypus in '0 — Hemorrhage (from the uterus); other uterine growths — Uterus. Gumboil (Parulis) and spongy gums. See Mouth. ILematemesis. See Hemorrhage (from the stomach). Hematocele. Retro-uterine — An extravasation of )d in thefossa^between the uterus and intestines, accom- | nied by a severe pain in the back passage, and frequent desire to defecate. (It must be discriminated from a retroverted or prolapsed uterus). Treatment — Aside from an enema of Aqua tepida (Oj) every night, to keep the bowels in a soluble state, the absorption of the blood may be assisted by occasionally puncturing the tumor, to allow the escape of a little blood, with a needle per vaginam. For the relief of pain Morphine (255). Pudendal Hematocele, which is generally con- nected with pregnancy or parturition, and which con- sists in a mass of blood, effused into the tissue of a labium, or the areolar tissue, surrounding the wall of the vagina, associated with a throbbing pain and difficulty of walking, may be treated with a cooling lotion (337). This, in conjunction with rest, will frequently suffice to 244 Hcematocele. produce absorption of the thrombus; but if there is evi- dence of plegmonous inflammation, suppuration should be encouraged by poultices (see Vulva). If the tumor be large, an incision by means of a bistoury should be made upon the mucous surface of the labium, the clot turned out of its nidus, and the cavity washed with phenol- water (398), to prevent phlegmonous inflammation or septicaemia. In case of hemorrhage the cavity must be washed with Fern, persulf. (366 & 67), or pledgets of lint soaked in this astringent may be pressed into the sac, and if necessary counter- pressure per vaginam, by means of a cotton tampon. Pelvic Hcematocele or Periuterine Hematoma consists of an accumulation of blood in the pelvic cavity, either above or below the peritoneum, in consequence of sudden stoppage of the molimia; obstruction of the cervical canal or Fallopian tubes; excessive coition; violent efforts; blows or falls, and the like, and is accompanied by great prostration : Pallor and faintness, nausea and vomiting, coldness of extremities, metrorrhagia with uterine tenesmus, in conjunction with a severe pain and a sensation as if a large and heavy body existed in the pelvis, which the patient instinctively strives to expel through the vagina. The reaction, which occurs within 4 8 hours, according to the degree of inflammation set up by the sanguinous accummulation, is marked usually by a tendency to chilliness, suppression of urine, and constipation, tympanitis, heat of body, and small but rapid pulse, pointing both to a sudden and excessive loss of blood, and to the existence of some substance in the pelvis, which mechanically interferes with the viscera. Vaginal touch will reveal a soft tumor, mostly posterior Haemoglobin uria* 2 4 5 to uterus and vagina, and generally partially closing the latter, and according to the quantity of the effused blood, or whether it has collected in the peritoneum or in the areolar tissue beneath it, an abdominal tumor may be felt as high up as the navel, or may not be discovered at all ; but care should be taken not to confound it with pelvic cellulitis or abscess. Treatment — Aside from cold com- presses or an ice bladder to hypogastrium* Acid. sulf. arom. or Acid. gall. (p. 61) in free doses, with cold drinks, especially iced champagne or brandy and water. In great nervous prostration Opium (255), this being a more re- liable stimulant than alcohol,- having moreover the ad van t- eige of relieving pain — see Hemorrhage from abortion. As long as nature seems to be causing the absorption of the tumor, it should be left alone; however, if there are signs of septicaemia — chills, febrile action and profuse sweating — the softening mass should be discharged by incision. After evacuation, the patient should not rise from bed, even for calls of nature, the bladder being emptied by the catheter — the bowels have to be kept constipated by Opium. Besides poultices to hypogas- trium, and after abatement of acute symptoms, a blister, if necessary. Perfect rest is imperative. Hematuria. See Hemorrhage (from the urethra). Hemoglobinuria (Hmraatinuria) — Intermittent or paroxysmal hematuria is a hemic affection, characterized by an attack of chilliness, followed by more or less fever, and associated with the elimination of hemoglobin by the kidneys, the blood-corpuscles having previously undergone a kind of dissolution. The affection is sup- posed to be due to exposure to cold. Treatment — Brandy and tonics (p. 69), in conjunction with warmth. 246 Haemorrhoids . ILemometra. See Uterus (Imperforate Os). Haemoptysis. See Hemorrhage (from the lungs). Haemorrhoids — Piles are small, indolent or inflamed tumors, near or within the anus, and consist of en- larged and knotted veins, covered with mucous mem- brane in various stages of congestion, and generally connected with a sluggish circulation in the abdominal veins and torpor of the bowels. They cause much dis- comfort, and more or less pain in defecation; frequent- ly irritation of the bladder; and in women uterine irri- tation with mucous discharge, when inflamed, they will not only produce violent straining and prolapse, but oc- casionally much hemorrhage. Treatment — Hot fomen- tations, or cold lotions, leeches if necessary. After- wards Opium, Iodoform or Hyoscyamus (337 & 373), in conjunction with cathartics (pp. 89 & 97). If bleeding, Alum (p. 63). Within the anus, they may be destroyed by cauterization with Acid, nitric, v. carbol. (372), unless they are actual tumors or a large tract of mucous mem- brane, when the ligature is the proper remedy, as excision is of external piles. Hair— Of the many remedies which are recommend- ed for its growth, may be mentioned Bals. peruvian. and brandy (388 & 89) — see Head. To remove superfluous hair, Cafe. (338) maybe used, but electrolysis (p. 149) is preferable, (It is of importance that a strong light be directed on the surface to be operated upon, and that the latter be on a level with the operator's eyes). Hayasthma. See Asthma. Head — Pityriasis is a local disease, confined to the head, which consists of irregular patches of a furfura- ceous or scaly nature. Treatment is local: Citrine oint- Head. 247 ment, Borax (390) etc.. That form occurring in phthis- ical subjects seldom requires treatment, For Pityriasis versicolor see Skin (Parasitic Moles). Tinea Capitis or Porrigo is an eczema affecting the scalp and frequently the face (in the latter case it is called crusta laciea). Cuprum, Zinc, or Mercury (391). Tinea Favns — Scaldhead also known as Porrigo is a parasitic head disease consisting of cup-shaped scales, which requires the same remedies, after having removed the scab by softening it with poultices and fat. Tinea tonsurans , Porrigo s. Herpes tonsurans consists in an erythematous inflammation of a circular form, ac- companied by itching, and soon followed by a white, powderlike fungus (Trichophyton) , which covers the epidermis between the single hairs, making them dry and brittle, so as easily to break. (If the same parasite forms on parts covered by lanugo, the disease is called Dermatomy costs seu Trichophytosis tonsurans (Ring- worm), and if it forms under a nail, making it knotty or brittle, the disease is called Onychomycosis tonsu- rans. Treatment — Iodine (p. 15) or Mercury (390 & 92) with or without epilation. Tinea pelada or Area Celsi is a form of alopecia, where lotions of Ferrum and Jaborandi (3S8) may be of service. In baldness [Alo- pecia acquisita or calviti'es) a whig will be the remedy. Tinea Mycosis or Mentagra — The so-called Barber's Itch, is a simple inflammation of the hair follicles char- acterized by papules and vesicles. When due to a fun- gus, it is called trichomycosis. Treatment -The loose hairs should be removed by means of the epilating for- ceps (as long as they are firm in the follicles, epilation does no good), afterwards Mercury or Phenol (392 &98)* 248 Heart. Headache. See Cephalalgia. Heart. Pericarditis — Inflammation of the serous cover of the heart, unless due to trauma, is mostly de- veloped in articular rheumatism, pleurisy, and Bright' s disease. It is characterized by increased action of the heart: quick, vibrating pulse, with pyrexia and its concomitants — anorexia, debility, etc., more or less pain in the prsecordia, and a dry irritable cough, in con- junction with those symptoms arising from the co-ex- isting affection. Almost pathognomic is the cardiac friction murmur — an adventitious sound, caused by friction of the pericardial surfaces in the movements of the heart — which may be heard at an early period, as exudation usually takes place within a few hours af- ter the commencement of inflammation. It is of a grating or creaking nature^ generally double and not propagated beyond the borders of the heart; it may even be limited to a portion of the precordial space. The existence of effusion maj be determined by per- cussion, and the size and shape of the area of abnorm- al dulness, within which vocal resonance and fremitus are diminished or lost, will be in proportion to the amount of the liquid. Moreover the apex-beat of the heart is weakened or suppressed, and its situation may be altered as well. Treatment — Poultices or cold com- presses to prsecordia, with Aconite (p. 22) internally, and due attention to the causative disease. Opium (p. 35) to relieve pain; Digitalis (pp. 50 & 96), if effu- sion; and in second stage brandy (p. 72), as support. In the chronic form, salines (p. 96) and tonics (p. 69), with Iodine (413) or blisters locally. Endocarditis — Inflammation of the membrane, lining Valvular Lesions. 249 the cavities of the heart, is like pericarditis mostly con- nected with articular rheumatism and Bright'* disease; and as endo-pericarditis it occurs occasionally in erup- tive and continued fevers. It is characterized by pal- pitation, the heart's action being frequently out of pro- portion to the force of the pulse; and the precordial pain, if present, is but dull, not sharp and lancinating like that in pericarditis and pleuritis. The endocar- dial or belloics murmur is systolic and consequently more regular in rhythm than the pericardial murmur. (As this murmur may proceed from valv. lesions, its existence or non-existence should be ascertained prior to the rheumatic attack). Treatment — Aside from sina- pisms and stimulating liniments to pnecordia (409), alkalies (p. 54) internally — to prevent fibrinous depos- its in rheumatism. If restlessness, Chloral (60) etc. Myocarditis — Inflammation of the muscular struct- ure is either interstitial and chronic, or suppurative. As it is impossible to diagnosticate the different myocard ial lesions the treatment can be but symptomatic. Yalmdar Lesions, unless congenital, affect nearly always the mitral and aortic orifice; and though some- times syphilis may be traced as a remote cause, they are generally due to chronic endocarditis, whether they be of an obstructive nature — contraction or stenosis of the ostia; or regurgitant — insufficiency of the valves; or both. Sooner or later they lead to hypertrophy and dilatation, which generally coexist, followed ultimately by general dropsy, beginning with anasarca of the lower limbs. Mitral lesions, before having led to hypertrophy, do not occasion inconvenience, then deficiency of breath xercise is the first symptom, and increases in pro- 250 Heart. portion as the obstruction to the pulmonary circulation increases, until dyspnoea becomes habitual, culminating in orthopnoea, the patient being unable to lie down. Aortic lesions are attended more by palpitation, espec- ially on mental emotions or exercise, and a precordial pain, irrespective of angina pectoris. Whilst mitral lesions are characterized by a systolic or presystolic mur- mur, to be heard best near the apex-beat, the systolic murmur produced by aortic lesions (generally propaga- ted with the carotids), is most distinct at the base of the heart. The latter must not be confounded with the anaemic or hcemic murmur, which is inorganic, be- ing due to anaemia, and known by its varying intens- ity — sometimes it even disappears altogether/ though mostly it is connected with the venous hum ofthejugu- laris. The tricuspid murmur is best heard at the right inferior border of the heart, near the ensiform cartilage; and the pulmonic murmur, indicating pulmonic les- ions (iinless ancemic) at the base of the heart, over the pulmonary artery, in the second intercostal space, near the left margin of the sternum. The extent and grav- ity of the lesion may be ascertained by comparing the diastolic murmurs as produced separately at the aortic and pulmonary orifice — in the second intercostal space right and left to the sternum, and by the degree of hy- pertrophy, which is proportionate to the amount and duration of the obstruction and regurgitation caused by the lesion. Treatment — Aside from good nourishment to retard the progress of dilatation, Digitalis (1 Vl), if the heart's action is irregular and feeble from dilatation —not where hypertrophy predominates; it is especially useful in hypertrophy from mitral regurgitant lesions. Hypertrophy, 251 Aconite (p. 22), if the action of the heart is rapid, but not weakened by dilatation; and in cases where func- tional disorder is superadded, a brisk hydragogue (205) from time to time for the relief of dyspnoea; or Ether (304) or Ammonia', or dry cups to chest. Ammonium with Senega (pp. 43 & 73) in aortic regurgitation and Iodine, or a Belladonna plaster to praecordia (411 & 13). Sedatives (pp. 23-33) are sometimes of service. Lobelia (75) is occasionally used. Nux Vomica (p. 83), or Cof- feine (p. 75) may also be tried; or brandy (p. 72) as stim- ulant, if required. Ancemia should be treated, since irreg- ular or excessive action of the heart, dyspnoea, and even dropsy may be due to the superadded functional disorder. Hypertrophy and Dilatation — The former is an abnor- mal increase of the muscular substance, being called simple, if the capacity of the cavities is of normal size; and eccentric, if it is enlarged, i. e. dilated. The lat- ter is an abnormal enlargement of the cavities, called simple, if the muscular wall is of normal thickness; and hypertrophic or atrophic, if it is thicker or thinner than normal. Hypertrophy and dilatation, if primary, may be produced by habitual over-exertion of the muscular system, and by repeated nervous excitement of the heart; but mostly they are due to some mechanical ob- stacle to the circulation, which may be situated in the heart itself — valvul. lesions, etc., in the pulmonic — em- physema, pleuritic effusions, etc.; or in the- systemic circulation — atheroma, small, granular kidney, etc. In proportion as the apex is removed without the left nip- ple, and lowered, is the amount of enlargement: The left border of the heart is found by percussion to fall from one to three inches without the left nipple, the sit- 252 Heart. nation of the right border and the base of the heart be- ing generally but little changed. If the first sound is loud, prolonged and booming, the apex-beat be felt by the hand to be abnormally strong, especially if there be a heaving elevation of the prsecordia with the vertricu- lar systole, hypertrophy predominates ; but if the first sound is weak, short and valvular, and the beating, if felt at all, feeble, dilatation is in excess. Treatment is not required in hypertrophy when compensatory; other- wise the excessive action of the heart must be modera- ted by aperients {p. 96), Aconite (35); Bell., Cyan (43 & 68), etc. Dilatation has to be treated as in connec- tion with valv. lesions. Digitalis, Ergot, Ferrum (pp. 78 & 79); Cimicifuga (p. 47); Am/1 (37); etc. Fatty Degeneration or Obesity — The metamorphosis of the muscular substance into fibrinous particles and fat, which in most cases is due to immoderate use of spirits and indolent habits, is characterized by more or less feebleness of the circulation, the pulse being irreg- ular and intermittent (its number falling sometimes as low as 20 p. minute), with dyspnoea, occasional fits of syncope or angina pectoris. Treatment — Aside from •-animal food as diet, with the exclusion of fat, mineral acids, Ferrum c. Chinino (p. 71); Cyan; and in irregu- lar action of the heart, Digitalis. Alcoholic stimulants /p. 72) in syncope or pseudo-apoplexy. Palpitation — A disturbed action of the heart, which, unless connected with organic disease, may be due to good living, excessive venery, dyspepsia, etc., but it is more frequently produced by anaemia and generally char- acterized by a higher degree of mental depression and anxiety than that caused by lesions. Treatment according Helminthiasis. 253 to cause — In full habit or constipation, Aloes, Rhamnus 7 & 215); or Mercury (p. 93); if there is amenor- rhcea, Acidum sulfuricum (136 & 155), etc. During the paroxysm, aside from ice bag, Belladonna plaster ', sin- apisms, or stimulating embrocations (409 & 1 1) to prsecor- dia, ethereal stimulants and antispasmodics — a mouthful of undiluted brandy; Camphora, Brom, Bell., Chloroform (pp. 24-30); Cyan or Zinc (68 & 195); or Cocaine (p. 77), Aconite (35), if action strong; Digitalis (68 & 171), if feeble or irregular. Heartburn (Cardial gia). See Dyspepsia. Hectic Fever. See Fever. Helminthiasis — The name embraces a variety of diseases, produced by certain entozoa, which infest the human body, the larger number of these parasites be- ing developed in the intestines. Asearides lumbricoides — Round worms, which re- semble common earth-worms, inhabit the small intes- tines, emigrate sometimes into the stomach, and will even ascend the oesophagus. They are occasionally present in immense numbers; but the symptoms they produce are often so obscure, that their appearance is the only pathognomic sign of their existence. Impaii- ment of the digestive organs, together with a general cachexy are among the most frequent causes; and they, on the other hand, may occasion no disturbance what- ever, or they may give rise to the most extraordinary symptoms, especially of a nervous nature, as aphony, catalepsy, epilepsy, even paralysis. Treatment — The chief remedies are Santonin and Spigelia (p. 103). Oxywis vermicular is — Pin or thread worms which in- fest the rectum, and sometimes are voided in large masses, 254 Helm hit It iasis . agglomorated by mucus, produce generally pruritus aoi, and in girls pruritus vulvae with leucorrhcea from mi- gration into the vagina. Excitation of the sexual organs leading to masturbation is frequently a sequel; but general debility, even in adults, is by no means rare. Treatment — Enemata of Acetum or Ferrum; or suppos- itories of Ungt. Hydr. nitr. (376 & 77). Toenia solium— The tapeworm is a flattened animal, composed of numerous segments, and attaining to such a length, that it will often occupy the intestinum crassum, for want of room in the small intestines, which are its real habitat. (T. mediocanellata, and T. lata, are also tapeworms, met with in the human body; however their discrimination is of no practical value). The symptoms tapeworms produce, are as obscure as those of the round worms — sometimes of no significance whatever, some- times as severe, as they are varied. Aside from colic- pains, emaciation, and other disorders of the digestive system, a tapeworm is supposed to cause the most seri- ous disturbances of a nervous nature, as vertigo, tinni- tus aurium, temporary amaurosis, epilepsy, etc., etc, Treatment — Aspidium, Phenol, Thymol, etc. (pp. 103-5). Cuprum has been recommended as a specific. . People who do not like to fast, may have pumpkin pie for 24 hours as diet, to facilitate the removal. Hemiplegia — Loss of motion, with or without loss of sensation, affecting one or more muscles on one side of the body. Unless due to cerebral lesions, it is a func- tional disease of the nerves, following sometimes diph- theria, epilepsy, and chorea; but most frequently con- nected with hysteria — see Paraplegia. Hemiplegia fa- cialis, if peripheral, is generally produced by injury to Hemorrhage. 255 the seventh pair of nerves; occasionally it is due to cold. Treatment — Nux Vomica, Phosphor (pp. 83 & 86), or elec- tricity (p. 148) are the chief remedies. If from undue pressure of the forceps in infants, Linimentum vel Oleum camphoratum as embrocation. Hemorrhage, if active, is the escape of blood through the walls of the vessels or the heart, and mostly due to inflammation or excitement — if passive, it is caused by the obstruction to the return of venous blood, or it may be owing to structural weakness of the blood ves- sels, etc., etc. Aside from a treatment having refer- ence to the disease, with which the hemorrhage is con- nected as a symptom, the indications for its arrest are in all forms essentially the same. Irrespective of bleed- ing from any part of the surface of the body, as pro- duced by injury (see wounds), leech bites, and similar cases where pressure, Boletus igniarius, Alum, Vinegar or cobweb will suffice, the indications are: Rest in the re- cumbent position, with ice or cold water compresses locally; and internally, besides Opium (p. 35), haemosta- tics — Acid urn gallicum, tannicum, or sulfuricum ; Alum; Ergot; Ferrum and Plumbum (pp. 61-67). Epistaxis — Hemorrhage from the nose may be due to simple determination of blood to the head; but it is most frequently incidental to some general disease, as to obstruction to the circulation in cases of heart and liver affections; it may be even vicarious of menstrua- tion like haemoptysis. Treatment — Astringents or cold water by irrigation or atomizer. In urgent cases, plugg - ing: A curved catheter (if the proper intrument be not at band) may be used for the purpose of plugging the posterior orifice of the nostril; in the anterior nares 256 Hemorrhage. a fold of lint may easily be inserted by means of a probe. The plug has to be left for three days. Ucernoptysis — Hemorrhage from the lungs, which is called Pneumorrhagia, if the blood proceeds from the parenchym of the lungs, and JBronc/iorrhoea, if the affected part is the bronchial mucous membrane, is incidental to various diseases of the lungs and heart, aneurisms, etc.; though it is often vicarious of menstru- ation, and may occur even idiopathically. In addition to the treatment indicated above, inhalations of Alum or Ferrum (305 & 20); Tablesalt in half drachm doses or in solution, by spoonsful, occasionally, until nausea, is sometimes of service; or temporary ligation to the ex- tremities for the purpose of retarding the flow of blood to the heart. Gastrorrhagia and Enter orrhagia — Hemorrhage from the stomach and bowels, the former if vomited, being called IIwmatemesis\ though the blood may also be evacuated by the bowels, like the latter, which has its origin in the intestines. Both, intestinal and gastric hemorrhage, are generally connected with morbid con- ditions, though they may arise from portal congestion, or be vicarious of menstruation. Treatment — Besides the indicated remedies, Creosote or Terebinth, (pp. 64 & 67) may be tried. Opium may also be given to quieten the nerves and prevent peristalsis, and food and drink should be taken cold. — Hemorrhage from the rectum is generally caused by bleeding piles within, and may be treated with astringent lotions, etc., unless a radical cure by operation be preferred. Hematuria — Hemorrhage from the urethra may have its origin, either in the urethra, bladder, ureters, or kid- Metrorrhagia . 26 7 neys. In urethral hemorrhage, the blood escapes with- out any effort at micturition. In cystic, there is gener- ally obstruction to the free passage of urine, and the blood follows as a rule the discharge of the latter. It is caused by a disordered state of the bladder, but may be also produced by the pressure of a calculus, a wound, and by injury. In hemorrhage from the ureter, which may be distinguished by the presence of fibrinous casts in the urine, a calculus is always the cause; and renal hemorrhage is either a symptom of kidney disease, or it occurs like cystic hemorrhage alone or conjointly in diseases of a hemorrhagicdiathesis, as scorbut, yellow f ev er, etc. (For Paroxysmal or Intermittent Hmmaturia see Hemoglobinuria). Treatment — Aside from Acid, gallic, Ergot and Terebinth.; Lith. benz. (p.50), is recommended. Pudendal hemorrhage is the consequence of a rupture of the bulbi vestibuli, a reticulated plexus of large veins beneath the labia, provided there be rupture of the skin at the same time (see Hematocele), which, irrespective of injury, may be caused by great muscular efforts, if the veins are in a varicose condition, especially during , pregnancy. Treatment— If the flow of blood cannot be controlled by cold and astringents (341 & 367), the vagina should be filled with a firm tampon of cot- ton, a folded towel applied as a compress over the vulva, and a T shaped bandage made to press this forcibly against the body. Metrorrhagia — Hemorrhage from the uterus, if occurr- ing at the menstrual period, called Menorrhagia, is caused by any condition, which induces a state of active or passive congestion of the uterus, as areolar hyperpla- sia, subinvolution, displacements, etc.; it may be due 258 Hemorrhage. however to granular degeneration, and whatever pro- duces a solution of continuity of the mucous membrane; or to some growth, which has a vascular connection with the uterine vessels, as polyps; or to a dyscrasia of the blood, as chlorosis; even general plethora may be the cause. Treatment — The immediate indications, as a rule are: Recumbent position in a bedstead (the foot of which might be elevated about ten inches); and cold compresses over abdomen, vulva and thighs, with ice, genera/ haemostatics and Opium internally. In severe cases the speculum must be introduced and the vagina filled with a tampon of cotton (369), medicated or no; and if danger imminent, injections into the cavity of the uterus have to be made after dilatation of the cervix, with Iron or Iodine (367). An examination during syncope is not admissible, because the flooding, tohich generally stops during that time, would be sure to be brought on again. The curative treatment will be according to the cause. If due to fecal impaction or active congestion and ple- thora, aside from acids with Ergot, Tannin or Ratanha, salines (p. 95) every morning; Calomel (p. 93); or a ni- tric acid issue either in the arm or on the side of the spine. If from debility, as caused e. g. by undue lac- tation; mental depression (grief); or from chronic en- gorgement at menopause (passive congestion), an enema of half a pint of cold water bis die, commencing after men- struation has begun; or Calomel followed by tonics — Quinine (165), as the case may be, and irrespective of acids, Ergot, Cannabis or Erigeron (pp. 28 & 61-66). In spasmodic menorrhagia, with or without chronic ovaritis, Brom (50); Ipecacuanha (140); Sabina (192); or Viburn- um (p. 39). If there be anaemia or nervousness, barring Uterine. 259 Opium with enemata of cold water at night, Sabina or Cantharis (164); followed by Quinine and Phosphor (194). In hyperplasia, styled vegetations, or in fungoid degen- :!on — a consequence of a complication of subinvolu- tion or as a result of chronic engorgement of the mucous lining of the womb, the whole organ should be scraped with a wire -curette, after having dilated the cervical I with a tent, if necessary (p. 130). (After labor, especially after abortion, little growths, w r hich probably arise from minute particles of placenta having become organized, are sometimes found to be attached just above the os internum — with their removal by the curette the hemorrhage will cease at once). In simple subinvolu- tion Ergot alone will generally effect a cure. The same drug acts also curative after removal of hydatids or polyps, if they have been the cause. If the hemorrhage, produced by the former, be profuse, and the os uteri and dilatable, they may be extracted with the hand, taking care to remove the whole mass, else Tinct. Er~ gotce 3 j every 15 min.; or a piece of ice may be intro- d into the vagina and carried up to the cervix — an iciection of cold water against the mouth of the womb, or into the rectum will sometimes answer the same pur- pose. Whilst in the first case the stimulus of the hand will produce contractions of the uterus, and stop the bleeding, the stimulus of the action of cold will cause the motor nerves of the womb to contract, having been transferred from the excitor nerves of the vagina to the spinal cord — see Uterus). Should the hemorrhage be alarming, a tampon-, and internally Acid. sulf. etc. In carcinoma, the same treatment — Acid. gall, with local ap- nions of Alum, Tannin, Zinc, or Iron. (341 & 66); 260 Hemorrhage. JPost-partum hemorrhage, whether the placenta be wholly or only partially detached, the hand should be introduced into the womb without delay, and with the dorsum of the fingers uniformly but gently pressed against its bleed- ing surface, whilst tvith the other hand counter-pressure is made on the abdominal wall. Should the womb not con- tract at once, recourse may be had to the cold douche. Throw a pitcher or two of ice water from a height of about two feet suddenly npon the abdomen, and the womb is sure to contract. Afterwards warmth to the patient should be restored by applying bottles with hot water, warm flannel, etc., without however removing her, as the slightest exertion on her part might produce syn- cope. Or hot water (110°-120°) with Phenol (228) — to prevent septicemia — may be injected into the uterus, and tape-ligatures placed round arms and legs, just tight enough to prevent venous circulation. Besides Ergot (109), which, with ice water as drink, and put- ting the child to the breast may in slight cases already suffice. If there be already great prostration — no pulse, cold extremities, etc., one drachm of Laudanum every 10 to 15 min. until the pulse reappears at the radial ar- tery, together with warmth to the body and extremi- ties. If much thirst quick pulse, difficulty in breathing, etc., which indicate internal hemorrhage, also Opium in large doses with brandy. Post-partum secondary hemorrhage, if slight, requires Ergot in small doses; in severe cases, Sol. Ferri persulf. vel perch/or., just strong enough to produce a styptic im- pression upon the tongue, may be injected warm, by means of a flexible gum catheter attached to a syringe; or hot water with Phenol as above indicated. Hernia. 261 Ante-partum accidental hemorrhage may be treated with Ergot in small doses, and Bell, or Brom (pp. 53 & 26), if bearing down pains. Injections of iron and hot water as in secondary post-partum hemorrhage if necessary; and if the os be fully dilated, rupture of the membrane. In unavoidable ante-partum hemorrhage, if the bleed- ing is but slight, and occurs rather early before the term, aside from the recumbent position, cold compresses to abdomen and vulva, Plumbum c. Opio (147). If the bleeding persist or grow alarming, recourse must be had to the tampon, which will not only stop for the time the hemorrhage, but will also serve to dilate the Osp when, after twelve hours — longer it should not remain — premature labor must be induced. See Placenta previa. In Abolition, recumbent position, cool room, cold drinks, with enemata of cold water or ice to os, and Ergot, acids, etc. If alarming, and in advanced stage of pregnancy. the cold douche or hot water injections as in post-partum hemorrhage; or the styptic solution of iron as in second- ary post-partum hemorrhage. In the earlier stage, a tarn - pon, moistened, if possible with a weak solution of Phe- nol, which may remain there for 6 to 12 hours; or a piece of soft sponge, large enough to fill the vagina without inconvenience, and wrung out of pretty sharp vinegar, should be carried up to the os, and renewed if necessary. During or after abortion, rest for at least a week is neces- sary; as retained fragments of placenta may again and again occasion hemorrhage. Hepatic Diseases. See Liver. Hernia — A protrusion of any viscus from its natural cavity, the formed tumor being hmooth, rounded and elastic, if the hernial sac contains only intestines, (entero- 26*2 Hernia. cele); but flat, flabby and inelastic, if it contains only omentum (epiplocele), the latter requiring however more continued pressure for its disappearance. In most cases the sac contains both intestines and omentum. Hernia maybe reducible or returnable into the abdomen; it may be irreducible, i. e. not returnable into the abdomen, yet without constriction; and it may be strangulated, that is, subject to constriction, which not only prevents its reposition, but also interferes with the passage of its contents. Reducible hernia presents a soft, compressi- ble swelling, which increases in size, when the patient is standing, and diminishes or disappears when in the recumbent position; and if grasped, it is found to dilate on coughing. In irreducible hernia there are dragging pains in the abdomen, or perhaps attacks of vomiting, which comes on after food, or when patient assumes the erect posture, because the protruded omentum or intes- tines being fixed, resist the distention or upward move- ment of the stomach. (As the patient may not be aware of having a rupture, he should in cases of vomiting and constipation, especially if the face looks anxious and pinched, be examined for it ; first the ordinary seats of hernia, such as the inguinal and femoral rings, and the umbilicus; then the extraordinary, such as the linea alba and the ischiatic foramina, etc., etc.). The symptoms of strangulated hernia are those of obstruction of the bowels — flatulency and coliky pains, succeeded by vom- iting, first of the contents of the stomach, then of mucus and bile, and lastly of feculent matter — which, unless promptly relieved, will be followed very soon by those of inflammation — more or less tenderness, pain and swelling locally, with a small, hard and wiry pulse, etc. Hernia. 263 The treatment consists in returning as much of the rup- ture as may be reducible by taxis, and if necessary to divide any constricting part. As 1^8 hours of complete obstruction by strangulation usually results in mortifica- tion of the bowels, the operation for dividing the stricture should be performed at once, if taxis, aided by Chloro- form or Opium (pp. 35 & 119) does not prove successful. The most effective way of reducing rupture at the lower part of the abdomen is taxis with inversion, which may be done, by raising the pelvis on a chair, placed under the lower part of the mattress of the bed, so that the patient's head and shoulders rest upon the bed itself; care being taken that the legs are bent up to the body and the trunk itself be bent forward, so as to relax completely the aponeurotic structures in the groin. In ordinary cases or if there be no strangulation, simple taxis generally will suffice: x\fter having emptied the. bladder, the pa- tient should he down in an attitude of complete repose, if Chloroform is to be used; or he may be made to lie in a warm bath , with his thighs raised towards the belly, close to each other, so that every muscle and ligament connected with the abdomen may be relaxed. Now the surgeon grasps the fundus of the tumor, gently com- presses it, so as to squeeze out a little flatus and venous blood, and with the fingers of the other hand gently kneads the parts at the neck of the tumor, occasionally drawing them a little downwards, in order, if possible, to dislodge them; whilst.the patient, during this opera- tion, which may be continued for half an hour, if the tumor is not painful, endeavors to 'keep his breath, making only from time to time a deep inspiration. Sometimes pressure on the abdomen a little above the ring, so ow to i 2G4 Heryiia. press back the intestines from the ring, will materially facilitate the reduction. Scrotal hernia, even if stran- gulated, may often be reduced by boring the* index fin- ger of the right hand into the inguinal canal in the di- rection of the horizontal ramus of the pubes, whilst the tumor is compressed and bent slightly towards the ab- dominal wall. In strangulated hernia lical etherization has been strongly recommended, where simple taxis fails: A tablespoonful of Ether is repeatedly poured over tumor and inguinal ring (having previously guarded the mucous surfaces, as anus, labia, etc., with some grease) so as to produce contraction, when in less than ■half an hour, reduction may be accomplished with ease. In acute strangulation, especially if the pain and vomit- ing are violent, a large dose of Opium is most useful, if for any reason Chloroform cannot be given. Cathartics — Colocynthis or Aloes (p. 90), or enemata — gruel with some olive oil, though mischievous in sudden acute strangulation, are beneficial in the incarcerated variety, if the patient is aged, the hernia large and long irreduci- ble, and the attack caused by constipation. After re- duction a compress with a bandage, and if necessary a full opiate; at all events no purgative. Oleum Ricini c. Laudano maybe given after 12 — 24 hours. Inguinal Hernia — The protrusion is through one or both abdominal rings; the direct or internal form push- ing before it the conjoined tendon of the internal oblique and transversalis muscles, Just behind the external ring, the oblique or external (which is the most common) taking the same route as the testicle in its passage from the abdomen into the scrotum — H. scrotalis. In women it passes down one of those canals on the side of the Enter ocele. 265 round ligament into the labium — H. labii pudendi ex- terni — since the labia majora are the analoga of the scro- tum in the male, and the round ligaments correspond to the spermatic cord. If hernia exists already at, or soon after birth, it is called congenital, and may then be en- cysted. Whilst in man the diagnosis is not difficult, if care be taken, not to confound it with hydrocele (which however may co-exist — see same), in women where a sense of discomfort upon bending the body, or even up- on walking may draw the attention of the patient to the affected part, unless there be strangulation at the same time, a peculiar gaseous or airy sensation to the touch may be felt by absence of all signs of inflammation or cedema. Treatment — After reduction the hernia must be kept up with a truss, care being taken, that the pad do not press against the spinous process of the pubes or upon the spermatic cord — in women, a truss should be adjusted with a perineal strap, so as to keep the com- press of the instrument sufficiently low down to effectu- ally close the point of exit. If irreducible, it must be supported by a bag truss. A radical cure can only be effected by an operation. Vulvar Euterocele, a variety of pudendal hernia, which descending between the vagina and ramus of the ischium to form a tumor in one of the labia, may be dis- tinguished from an inguinal hernia, which has descend- ed into the labium, by the absence of swelling at the ab- dominal rings. In carrying the finger along the vagina, the tumor can be traced on its internal wall as far back as the neck of the uterus, and the other hand applied to the external surface of the labium, the protruding mass can be felt between the two hands. Treatment — After 266 Hernia. having placed the patient on her back, with her hips ele- vated by a cushion, or still better by having raised the foot of the bed, the index finger is introduced into the vagina, and the tumor pressed with it against the side of the vagina, whilst the lower portion of the tumor ir the labium is seized with the fingers of the other hand and pushed cautiously back and upward, in a direction parallel to the vagina. After reduction a cylindrical pessary may be introduced with its base upward, to ex- ert pressure on that portion of the vagina, where the in- testine made its way between its external wall and the ramus ischii. To retain the pessary a T shaped bandage will be necessary; and occasionally PiL Gambog. co. with some ionic (pp. 71 & 91) to keep the bowels in a solu- ble state. Here may be mentioned perineal hernia, which descends between bladder and rectum, forcing its way through the pelvic fascia and levator ani, and forming a tumor in the perineum; and the vaginal her- nia, a variety of the former, in which the tumor pro- jects into, and blocks up the vagina, instead of descend- ing to the perineum. These two, with the pudendal last mentioned, must be replaced by pressure with the fingers, and be kept up by pads made to bear against the perineum, or by caoutchouc pessaries worn in the vagina. In slight cases of vaginal prolapse and hernise, as vesico- vaginal H. (Cystocele), rectovaginal EL (Hectocele), en- tero-vaginal H. {Enter ocele), prolapse of the ovary or intestine into the triangular fossa between rectum and uterus, etc., etc., local astringents, Alum, Zinc or Tannin (359) with copious injections of cold water bis die, as- sisted by tonics (p. 70) internally, may be of use. Con- stipation must be guarded against by enemata and occa- Exomphalos. 267 sionally one ounce of Castor oil. Great relief may be effected by abdominal supporters with perineal band, and by the use of a proper pessary: The double lever of Hodge or Smith; Meig's ring; the stem of Cutter, or the globe pessary of glass or silver, or the air pessary of Gariel. The latter two will be of special benefit if the bladder or rectum participates in the prolapse. A piece of soft sponge, wrapped in oiled silk, carefully in- troduced into the vagina, and kept in place by a bandage will answer sometimes; but whether sponge or pessary, it must be daily withdrawn for the purpose of ablution. The curative treatment consists in the removal of the relaxed portion of the mucous membrane of the vagina by perineorrhaphy. Hernia cruralis— Femoral hernia escapes close be- hind and below Poupart's ligament, passing first through the crural ring, and attains rarely a large size. It is to be distinguished from the inguinal by observing that Poupart's ligament can be traced over the neck of the sack, and that the spinous process of the pubes lies internal to and above it. whereas it is the reverse in the inguinal hernia. If reducible it should be supported by a truss, the pad of which would tell against the hollow, which is just inferior and external to the spinous pro- cess of the pubes; if irreducible and omental, a common pad may be borne, else the pad must be hollow. Hernia, umbilicalis — Exomphcdos is most frequent in children, soon after birth, and in women who have been frequently pregnant. For children, a ten-cent piece, cov- ered with adhesive plaster with the sticking side outer- most, is the best pad. An adult should wear an elastic belt; if irreducible, a large hollow pad. 268 Hydrocele. Ventral Hernia, which protrudes either through th%5 linea alba or the linem serni-lunares, requires uniform support by a properly adjusted bandage. The separa- tion of the two recti (abdomino-rectal H.) is frequently a result of gestation. Herpes. See Skin and Head. Hiccough. See Singultus. Hives (Urticaria). See Skin. Hoarseness. See Laryngitis. Hodgkin's Disease. See Leucocythaemia. Hooping Cough. See Pertussis. Hydatids. See Echinococci; II in utero — Uterus (Degeneration of Chorion). Hydrocele — A pear-shaped tumor, formed by the collection of serum in the tunica vaginalis or spermatic cord, commencing in the lower part of the scrotum, and growing upwards. It is sometimes a sequel of syphilis or of inflammation of the testis; but generally it is the consequence of straining of the loins and belly. It is painless, causing only an uneasy sensation by its weight, and may be distinguished from hernia by being translu- cent and fluctuating ; by surrounding the testicle in such a way, that the latter cannot he clearly felt— on\y the cord can be felt lying above it — ; and by not dilating on coughing. In the congenital form a cylindrical tumor extends up to or through the deep abdominal rings, so that if raised and compressed the fluid is slowly squeezed into the abdomen. Encysted Hernia is extraperitoneal, whilst in the com- mon or congenital form the effusion is poured down from the peritoneum, and is usually situated between the epididymis and tunica; seldom between the latter Hydro-Peritoneum. 269 and the testis or in some part of the spermatic cord. In women the fluid collects in the inguinal canal, around the round ligaments, which passing downwards, enter the labia majora, and distribute their filaments within the dartoid sacs, which extend like glove fingers down- wards towards the four chette. The gradual and painless development of the tumor, with a sense of flue uation without inflammation; and a resonance upon percussion make the diagnosis easy. Treatment — Evacuation of the fluid (in women by means of an aspirator) followed, if necessary, by an injection of Iodine (332). Punctures with a needle, though for children sufficient, are for adults only palliative. The radical cure with Tod is not admissible, if the tunica communicates freely with the abdomen, or if there is hernia, or some disease of the part. Hydrocephaloid — An infantile affection, dependent on exhaustion from diarrhoea and similar diseases, of which it forms in fact the closing stage. It is charac- terized by re^tlessnes with more or less fever, soon fol- lowed by drowsiness, stupor and convulsions, and ter- minating generally in death. Treatment — Brandy with Opium (pp. 3*7 & 72), in conjunction with due attention to the causative disease. Hydrocephalus — Unless congenital, an affection of early childhood, consisting of an excessive accumulation of serous fluid into the ventricles of the brain, giving rise to an enormous enlargement of the cranium. Treat- ment — Aside from a light diet, aperients (p. 88). For Hydrocephalus acutus see Meningitis (tuberculous). Hydronephrosis. See Kidney. Hydro-Peritoneum — Ascites may be local, or part of general dropsy. As local affection it is dependent on 2 7 Hypoch ondriasis. obstruction in the main trunk of the portal vein or its branches within the liver, unless it be the result of dis- ease of the peritoneum, in which case however the af- fection is inflammatory. Treatment as indicated in dropsy. Whenever the effusion has been distending the abdomen to such an extent as to cause much incon- venience, tapping is the remedy par excellence (413), as aside from being a perfectly harmless operation, it* is sure to give instantaneous relief. Hydrophobia — Rabies is a disease caused by inocu- lation with the saliva of a rabid animal, and character- ized by intermittent laryngeal spasms and an increased flow of saliva. Treatment — In many cases Curare (65 & 259) has been of benefit. Xanthium, Ammonium and Cocaine (86, 94 & 168) are also recommended, Hydrotkorax — A dropsical effusion into the pleural cavities, sometimes due to affections of the pleura, but mostly to cardiac lesions, producing obstruction of the mitral orifice after having led to dilatation of the right cavities of the heart. Treatment — Digitalis or Elaterium (108 & 205); or aspiration. Hyperesthesia. Mental, and Mental and Physic- al. See Hypochondriasis, resp. Hysteria. Hyperesthesia or Vulva. See Vulva. Hyperplasia. Areolar of Uterus. See Uterus. Hypertrophy of Cervix. See Uterus (Hyperplasia); of Nymphje — Vulva; of Heart — Heart. Hypochondriasis (Hypercesthesia psychica) is some- times classed as a neurosis, sometimes as a psychosis, the characteristic feature of which consists in a morbid attention, which the patient devotes to the study of his own physical condition and the unwarrantable degree of Hysteria. *^7l anxiety which he exhibits regarding it. Sexual Hypo- chondriasis and Syphiliphobia — where he believes him- self impotent, resp. a victim to syphilis — may be men- tioned as forms of the disease. The intelligence may become greatly enfeebled and in many cases the separa- tion between pathophobia and insanity cannot be distinct- ly made. The form of mental aberration resulting most commonly, is of the melancholic type, and evidenced by delusions connected with the patient's symptoms (he may fancy the presence of some animal in his stomach, or he may suppose himself persecuted, etc). Next to heredity, excesses of all sorts, and depressing sur- roundings, overwork in conjunction with chronic abdom- inal disease, syphilis or some disorder of the sexual or- gans may have a part in it, though frequently the causes, mental and physical are alike obscure. Treatment — Change of air, combined with judicious management of a moral nature will be of benefit. Regular habits must be insisted upon, and constipation, piles, etc., should be attended to. In case of dyspepsia or anaemia, Nux Vomica resp. Ferrum (pp. 71 & 79-81). Arsenic, Brom or Co- caine (pp. 9, 24 & 77) may be tried; or Morphine and Valeriana (80 & 82), See Insanity. Hysteralgia. See Neuralgia. Hysteria — An abnormal condition of the mind and nervous system, dependent on a variety of affections, all of which are connected more or less with the organs of generation. While convulsions, coma and delirium of a peculiar kind, occurring in paroxysms, constitute the severe grades of hysteria (for their treatment see those affections), the milder forms are characterized by fre- quent neuralgic pains and headache — clavus hystericus 21 2 Icterus. is supposed to be pathognomic-; hyperesthesia and an- aesthesia — the former sometimes simulating articular rheumatism, sometimes giving rise to a sensation as if a round body was sticking in the throat: the not less patho- gnomic globus hystericus- — ; cough; retention or incon- tinence of urine, etc. The relation between hysteria and insanity is about the same as that of hypochondria- sis to the latter, but the insane manifestations of hysteria involve mainly the maniacal element, the melancholic type is less frequent, and a condition of dementia, the terminal state of mania and melancholia will be met with but rarely. (See Mania). Treatment — Removal of cause if possible. Anaemia requires acids ( 1 54) ; Fer- rum c. Chinino (pp. 76 & 79); or artificial suppression of menses — see Chlorosis—; uterine irritation, Cannabis, Chloroform (57 & 61) with Iodoform or Belladonna local- ly (356, 374 & 75); perhaps Cocaine (p. 77), etc. In meteor- ismus, Aloes and Colocynthis (199 & 203); or Ferrum c. Strychn. (pp. 79-82); if neuralgia, Aconite or Camphora internally and externally (35, 56, 409 & 410); or Zinc, (196); globus hystericus, Cyan, Ammonium (68, 159); or Cypripedium (p. 32). In palpitation, Aconite, if action strong — Digitalis (171), if feeble and irregular. Of oth- er remedies may be mentioned Pulsatilla, Ether, Brom (23, 36, 47); Castoreum and Helonias (58 & 179); Arsen., Lithium and Lactucarium (pp. 9, 27 & 34). In many cases Valeriana and Asa foetida (41) are very effective — Opiates are of not much use. Icterus {Jaundice) — A yellowness of skin and the con- junctiva, produced sometimes by changes in the blood itself (hematogenous)'^ but generally by absorption of bile by the blood (hejiatogenous), and arising among Impotent. 213 other causes from low blood pressure in the portal sys- tem, on obstruction to the passage of bile into the in- testine; and occurring chiefly in duodenal catarrh, cer- tain hepatic affections, and in connection with several general diseases. (The yellow tint of the surface seen in some cases of cancer, intermittent fever and chloro- sis is readily discriminated from slight jaundice by the dbsence of yellowness of the conjunctiva). As icterus may persist still for several months after the disappear- ance of bile-pigment in the urine, the latter alone is the criterion of a successful cure. In cases, where jaun- dice is the consequence of some serious affection of the liver, and more especially of scirrhus in that region, it w T ill prove fatal, death usually ensuing from coma, the result of the action of the biliary poison on the cerebral mass; — if death be preceded by convulsions, the poison acts on the medulla spinalis and its continuation in the en~ cephalan. See Liver (Hepatitis parenchymatosa). Treat- ment according to cause: Acid, nitro-mur., Ammonium Soda, Hydrastis (153, 158, 120 & 180), with laxatives for the relief of constipation, Sodii Phosphas (p. 97); etc.; or cholagogues — Calomel, PodophilL (pp. 92 & 93) to re- store the biliary secretion to its legitimate channel. This may be followed by Mercury in alterative doses (13); or Belladonna, Hyoscyamus, Conium (pp. 23, 31 &33), especially the latter in conjunction w r ith vegetable diu- retics (p. 40) and warm baths to eliminate the bile. If malarial, Arsenic or Quinine (pp. 9 & 11); if due to ob- struction by gallstone; duodenitis, etc.; these affections must be treated. In Icterus Neonatorum, Soda (p. 96). Impetigo. See Skin. Impotenz — Inability to perform the act of coition, 274 Inanition. may, aside from malformation and from lesion of ner- vous centers, produced by blows on the head or spine — where impotenz is usually permanent — be due to gener- al debility; mental perturbation, as timidity; or wasting diseases, as diabetes, renal affections and dyspepsia — here frequently combined with loss of sexual desire. Involuntary seminal emissions, that is, the ejaculation of semen and venereal orgasm without any voluntary ef- fort, either natural or unnatural, from morbid erethism; and spermatorrhoea (a discharge of semen without the occurrence of the orgasm), both of which are brought on by premature and excessive venery or self-pollution — masturbation, onanism — are sure to lead to impotenz. Treatment — Strychnine (pp. 71 & 83); Chinin. c. Ferro, Mangan (pp. 82 & 85); if morbid erethism, C amphora, Cannabis (pp. 27 & 28), ovSalicin (p. 17); if loss of sex- ual desire, Aurum, Barium, Lycopodium (3, 5, 76); or Phosphor (189 & 194). In spermatorrhoea, alkalies, Co- caine (pp. 54 & 77); Ferr. c. Phosph., Cantharis (143, 54 & 64); or Camphora. In nocturnal emissions, besides Camph., Bell., or Zinc (pp. 24 & 8 7); Apis, or Ergot (95 & 172); &nd icebag or stimulants (411) to spine or perineum. Inanition — Starvation is a pathological condition of all diseases, which interfere with alimentation and the immediate cause of death in many cases of disease which prove fatal by asthenia. The diet is, in any case of sickness, a most important factor in a successful treat- ment, as a judicious alimentation will do much toward shortening the disease. Sometimes rectal alimentation will have to be resorted to. About 24 years ago, dur- ing a voyage of nearly two months, I kept alive with chicken-broth, administered mostly jjer rectum a woman Insanity, -75 in her sixth month of pregnancy, who, on account of seasickness, which lasted the whole time, from the day she embarked in Sydney to the day we landed in San Francisco. The irritability of her stomach was such, that, with the exception of water given by mouthfuls, it rejected everything, and the distressing efforts to vomit, which in her state were particularly dangerous, could be controlled only by absolute rest and the continu- ed exhibition of hydrocyanic acid and other sedatives. After a week on terra firma she felt as strong as ever. Incontinence of Urine. See Bladder (Paralysis). Induration of Cervix and Infarctus Uteri. See Uterus (Hyperplasia). Influexza — Epidemic Lroncldtis {La Grippe of the French) is an essential fever, associated with the bron- chial affection, commencing generally with lassitude, fron- tal headache and coryza, followed by chills, pyrexia, etc., and depending on some atmospheric influence. The treatment is symptomatic, embracing aperients (p.- 88) and diaphoretics (p. 40) with Opium (78 & 113), and if necessary tonics (p. 69). Insanity is the general term of the many varieties of unsound mind, man is subject to, and which from two distinct points of view — first as regards their physical origin, and second with respect to their mental form — are arranged in a somato-etiological and a psycho sympfo- matological group. In the former, the source of the di- visions is found in general organic arrest of growth (> . g. idiocy)', in perversions and defects of development (pjrimary monomania); in general neuropathic states, that may assume the shape of major neuroses (epilej}- tie — ); or of mental disorder at the time of the physio- 2 76 Insanity, logical crises {senile insanity) ; in general cachexias, toxic [morphinism)', and systemic morbid conditions (mala- rious insanity)) and in distinct pathological lesions of the higher nervous centres (general paresis, syphilitic and sympathetic insanity, etc). In thepsycho-sympto- matological group the divisions correspond with the psychical features and outward manifestations of the disease, as depression (melancholia) said exaltation (ma- nia) in the sphere of feeling; weakness and stupor {pri- mary ?nental enfeeblement and acute primary dementia) in the sphere of intellect; and states marked by impair- ed volition (abulic insanity) , and of suspended will (som- nambulistic insanity) in the domain of will. The relative curability of the various types can only be stated approximately. Mania and melancholia (see these) are the most curable, while general paresis, termi- nal dementia, and that class of hereditary cases in which all the psychical and somatic symptoms of degeneracy are present,may be put down as utterly hopeless; though of hereditary cases in general, it may be said, that their chances for recovery from a first attack are as good as in the non-hereditary types — only that relapses have to be looked for. The prognosis is as bad in mental alien- ation- originating in trauma capitis and insolation, or that, resulting from the gradual transformation of the major neuroses (hypochondriacal and hysterical insanity , etc.); or from prolonged moral causes, such as anxiety and business worry — mental disorder occasioned by sud- den violent emotions is often amenable to cure. Insan- ity in connection with the scrophulous and tubercular dia- thesis does not often admit of a cure; and if produced by alcoholic excesses and venery, it is scarcely more Fnsolatio. '2 77 favorable, even before organic changes in the nervous centres have taken place. The therapeutic principles of psychiatry are not dif- ferent from those of general medicine, and since insan- ity, in its widest relation, is a disorder, not only of the whole nervous system, but of the whole organism, the alienist will have to treat each case according to its etio- logy. Next to due attention to the relief of urgent symptoms, such as obstinate constipation, prolonged in- somnia, cardiac failure, precordial panic, inanition and exhaustion, is the moral management under medical supervision of the highest importance. Regular habits as to meals, sleep and exercise, must be insisted upon. Sometimes separation is one of the most effective means; if necessary, asylum care. Derangement of intellect, if threatening maybe treated with electricity (p. 148) or Cocaine (p. 109), preceded by Aloes (198). Arsenic (p. 10), especially Zinc (195) are sometimes of great benefit. The cold douche and Tiglium in maniacal delirium. Insolatio — Sunstroke is a congestive apoplexy, pro- duced by exposure to great heat or the direct rays of the sun, and associated with more or less exhaustion; occasionally the latter without the former — here the vital powers are protracted, the forces carrying on circulation give way, and death takes place by syncope. Hence in some cases, the attack is characterized by a strong and quick pulse, hot and dry skin, contracted pupils, even cramps, in fact all the signs of apoplexy — loss of con- sciousness; followed frequently by stertor and convul- sions, with not seldom, a fatal termination; in others the skin will be pale, the pulse weak and pupils dilated; vertigo, headache and listlessness being the chief symp 278 Insomnia. toms. Treatment — The apoplectic form requires the wet sheet or sponging (420) and enemata (385); and Brom (p. 24) perhaps internally, whilst in simple faint- ing stimulants are indicated — Brandy (p. 73); Opium (p. 73); Ammonium, Digitalis (158 & 250), etc. Insomnia — In inability to sleep sedatives are the prin- cipal remedies — Opium, Hyoscyamus (71, 79, 195); or Brom and Chloral (48 & 60); if stomach irritable, Hy- drastis (180). In old people Digitalis (p. 79) is sometimes of value. In sleeplessness of typhoid Antimony (p. 23). Intermittens. See Fever (intermittent). Intertrigo. See Skin. Intestinal Catarrh. See Enteritis. Intussusception — Invagination is an accidental inser- tion or protrusion of an upper into a lower segment of intestine, occurring mostly in infancy, and causing bloody stools with tenesmus and perhaps vomiting. Treatment— Enemata to irrigate the bowels and Opium p. os (p. 37). A solution of Sod. Bicarb, followed direct- ly by one of Acid. tart, may be tried. See Rectal diseases. Inversion of Urethra and Uterus. See Urethra, resp. Uterus. Iritis. See Eye. Irritation. Spinal, See Spine. Irchias. See Neuralgia (cruralis). Ischuria renalis is only of diagnostic value in reten tion of urine (by the catheter), since the kidneys having ceased to secrete it on account of disease, its suppres- sion is invariably fatal. For Ischuria paralytica see Bladder (Suppression of urine). Itch. See Skin (Scabies). Jaundice. See Icterus. Joints, 279 Joints — Synovitis or Inflammation of the synovial membrane, produced, aside from injury and other local causes, by the rheumatic, gouty, syphilitic and gonor- rhoeal poison, the exciting cause being frequently expos- ure to cold, is characterized by a rapid effusion of fluid into the synovial cavity, accompanied by severe pain, great swelling and violent fever. (A chronic form, af- fecting the knee — Tumor albus genu — is called by Ger- mans Gelenkschwamm). Treatment — After having fas- tened a wooden splint, properly padded, at some distance above and below the affected joint, to render it motion- less, leeches should be applied to the joint, or cups near it, with hot fomentations and evaporating lotions (337). Internally Calomel (p. 92), or some other brisk aperient; and at night Opium (p. 35) to insure rest. In chronic cases, & piece of pasteboard, which admits of easily be- ing adapted to the surface of the joint, when softened in warm water, will be more convenient — moreover a swing, if the knee or anclejoint, should be affected, will greatly add to the comfort of the patient. At the same time an appropriate constitutional treatment: If a red sediment in the urine present, alkalies (p. 54) with Colch- icum; Iodine (pp. 14 & 48), etc. In the chronic form, blisters and other stimulating liniments (402, 408 & 9) may be used irrespective of the general treatment. If in either form, symptoms denoting suppuration — rigors, quick pulse, etc. — should appear, aspiration will be nec- essary. In the case of tumor albus, no pressure must be made over the patella, therefore instead of the wooden splint,a long but light splint of leather should be mould- ed on each side of the limb, after having been steeped in hot water. 280 Kidneys. Keratitis. See Eye. Kidneys — Acute congestion, unless produced by vaso- motor influences, incident to diabetes insipidus, certain diseases of the brain and emotional or hysterical dis- turbances — when the urine is abundant and not albumin- ous—is inflammatory, and due to irritation, as the abuse of cantharides, nitre, copaiva, etc., and characterized by albuminous or bloody urine, which is diminished in quantity, and may be even suppressed. If passive it is symptomatic of certain pulmonary and cardiac diseases, without, however, causing tcrcemia; though the dim- inished secretion of urine, which is dark, albuminous and bloody, containing a few hyaline casts, and after some time throwing down an abundant sediment of urates, is sure to increase the general dropsy, which usually co-exists. Treatment of the active form, if in- flammatory: Camphora (p. 28), with Opium (411) locally. In venous congestion, barring the appropriate treat- ment of the causative affection, Benzoin (p. 46) is fre- quently used; Digitalis (p. 78), to strengthen the force of the heart, thereby increasing arterial tension and relieving the venous stasis. For Renal Colic and Hoe- maturia see Calculi resp. Hemorrhage from the kidneys. Diffuse Nephritis — Acute Bright's disease is the col- lective name of the various inflammations of all or part of the constituents of the kidneys — the interstitial tissue, the uriniferous tubes, and the blood vessels — thus comprising the various forms, known as catarrhal croupous, parenchymatous, desquamative and tubal nephritis, accompanied by dropsical symptoms — the separation of serum from the blood and its presence in the urine, connective tissue and cavities of the body — , Bright' s Disease. 281 commencing nearly always with oedema round the eyes, or in the lower extremities and the characteristic urine, which is secreted in congestion: Granular and fatty casts indicate a more advanced stage of degeneration than generally belongs to acute Bright's disease. As primary affection, being due to extensive burns, the effects of cold, blows and other injuries, it is secondarily frequently incident to general diseases, suppurative pro- cesses and toxic agents. The treatment of acute neph- ritis from blows on the loins, or the irritation of calculi, which is characterized by pains in loins and abdomen, fever and vomiting, w T ith tenesmus vesicae and scanty high colored urine, requires leeches or dry cupping, with warm fomentations, and 01. Ricini or Calomel (p. 92). Aconite (35) and Opium (p. 37) if necessary. Painful and frequent micturition may be relieved by Coccus (62). In the other forms, aside from rest, warmth, a bland diet and plenty of water to drink, the treatment em- braces saline laxatives (p. 96), in conjunction with dry cupping over the loins as revulsives, or counter-irritation and fomentations over the region of the kidneys. If much dropsy, Elaterium or Pilocarpin (pp. 91 & 51); or perhaps Digitalis (108). After scarlatina, Aconite (35). In unemic coma and convulsions, hydragogues and sudori- fics in alternation (see Coma); while, until elimination by these means has been effected, Chloral p. os v. p. anum (60 & 365), or inhalations of Chloroform (304) may be employed to arrest the convulsions for the time. Chronic Bright's Disease, comprising like the acute, several diseases, which culminate in structural lesions of the kidney, constitutes three distinct forms — the large mottled, the small granular, and the waxy kidney. The 282 Kidneys. first is generally developed in connection with syphilis, chronic suppuration, phthisis and other wasting diseases, whilst the small atrophic kidney is mostly associated with cardiac hypertrophy; and with the waxy form there co-exists frequently waxy degeneration of the liver or spleen. Treatment is essentially the same as that of acute nephritis: Elaterium, etc.; though sometimes diu- retics will suffice, Digitalis internally and externals y (pp. 50 & 143); Broom, Petrosel, Blatta, Juniper (100 & 322), etc. Sudorifics, however, must be relied upon, if hydragogues are not borne and diuretics have no effect — laborandi (p. 51). A warm water bath will generally produce diaphoresis; if not, the hot-air bath (417) may be tried. If the genitals and lower limbs are very much distended, superficial punctures with a pin will afford relief. To diminish the albumen in the urine, Acid, gallicum (p. 61) is the remedy; Aurum and Cuprum (pp. 10 & 77) are also used. Opium (p. 36) may be given for the relief of headache and neuralgia. Diarrhoea, if moderate, should not be interfered with, (as the vomiting and purging is here due to a vicarious elimination of urea) ; if excessive, Acid. sulf. (pp. 61 & 72) to neutralize the ammonia; or Cyan, Bismuth, Creosot (pp. 31, 46, 64), etc. Skim or buttermilk is said to be curative. Interstitial or Suppurative Nephritis — The surgical kidney is called Pyelitis, if the mucous membrane of the renal pelvis is only inflamed; but, if there are at the same time small abscesses, it is known as Pyelo- Nephritis. The surgical kidney is, aside from opera- tions, mostly due to pyaemia, impaction of a calculus in the ureter, or diseases of the bladder, and the like, which, on account of causing obstruction, lead to an Labor. 283 accumulation of urine in the pelvis and calices, where it decomposes and acts as a local irritant. Treatment — Removal of cause — Buchu, Arctostaphylum (pp. 47 &68); Benzoin (pp. 4(3 & 51); Cantharis (102), etc. Suppura- tive nephritis as a primary disease or produced trau- matically, claims an antiphlogistic treatment: Cold applications or counter- irritation with rest, etc. If en- docardial ulceration and other affections present, which furnish the infectious emboli and general symptoms, they have to be treated. A renal abscess, if large, should be evacuated by aspiration. Hydronephrosis is a dilatation of the pelvis and calices of the kidney on account of an accumulation of urine in consequence of some obstruction in the urinary passages, which may be congenital or acquired. In some cases the dilatation constitutes a sac filling out most of the ab- dominal cavity, containing several gallons of fluid, and the dilated ureter may reach the size of a coil of small intestine. Treatment — Next to the evacuation of the fluid by aspiration, the cause must be removed, if possible. Hydatids— A cyst may attain in the kidney the size of a tumor, perceptible to palpitation. See Echinococ- cus. Treatment — A large cyst will generally be de- stroyed by simple aspiration; small ones may be dis- lodged by Terebinthina (p. 68) in diuretic doses. Labia majoea. See Vulva. Labor — Parturition is the expulsion of the contents of the gravid uterus, when the foetus has attained maturity for extra uterine life — generally at or near the tenth catamenial period, counting from the one last before conception. Labor is called premature, if deliv- ery takes place before the full term, but not before the 284 Labor. seventh month of gestation, it being considered the time to correspond with the viability of the foetus. If not induced intentionally, premature labor, like abortion, is a consequence of disease or due to some accident. In cases of confinement, the following points may be worth to be borne in mind: "The cord should not be severed be- fore pulsation has entirely ceased, unless the child has been expelled in an asphyxiated state- See Asphyxia. 2. Traction on the cord should never be made before the afterbirth is really detached from the uterine sur- face; for, aside from the many accidents which may happen through its sudden separation at the time, it may blight the life of the young mother for ever after. An- other source of much unhappiness in married life is the unnecessary use of the forceps. To justify their em- ployment, the following conditions must be present: 1, no deformity, either of the pelvis or of the soft parts; 2, os uteri dilatable; 3, one of the obstetrical extremities must present; and 4, inertia of the uterus. Irregularities during labor may be often avoided, or at least more or less rectified: If there be rigidity of os. Chloral (p. 30); Antimony (p. 100); inhalations of Chloroform (304 & 16); or injections of warm water. In feeble contractions, Ergot, though contra-indicated in obstetriccd doses, may be given by drops — four of the fluid extract every 15 min. ex aqua; or Cimcifuga (p. 49); if they are feeble from too great an amount of Liquor Amnii — known by the large size and extreme tightness of the abdomen — the membrane should be ruptured, pro- vided the os be dilatable. For procuring sleep in pro- tracted labor, or in afterpains, Opium (11 & 79); Chloral or Gelsemium (p. 32). To prevent septicaemia, Occlusion Larynx. 285 pad (371); Aconite c. Salicin. (p. 22). For flooding, see Hemorrhage in Labor. Premature Labor is conducted on the same principles. The induction is indicated in deformity of pelvis, ob- struction from large tumors, certain cases of placenta previa, diseases, etc. After having dilated the os by the introduction of a tent, made in suitable form of slippery elm bark, an oiled bougie is pushed merely so far as to r the os, and then a tickling motion performed. If by this titillation the uterus should not begin to con- tract, the instrument may be introduced again after about 12 hours, and pushed a few inches between the uterus and the membrane, without, however, rupturing the latter, and left there for a few hours until the pains come on. Before rupturing the membrane a binder may be applied to the abdomen and gradually tighten- ed, so as to keep the head in close apposition to the os, which will prevent the cord from being washed down i»v the rush of the water. For the prevention of pre- mature labor, see Abortion. LachPwVmal Apparatus. See Eye. Larynx — Fhreign Bodies in the larynx and trachea. If the symptoms urgent and surgical assistance in time, the patient should be putunler Chloroform (394 & 16), as to relax the muscles, which guard the aperture of the glottis, and then be turned upside down — a child may be held with its head downwards and slapped on the back without ceremony. In less urgent cases Opium, Chloral or Hyoscyamus (pp. 20, 33 & 3 7), the patient being con- fined to the bed, when the substance may become coated with mucous and be expectorated during coughing or vomiting. If however by these means removal cannot be 286 Larynx. effected, laryngo — or tracheotomy (295) will be required. Laryngismus stridulus. See Spasmus Glottid is (p. 288). Laryngitis acuta — Catarrhal Laryngitis is generally- preceded by the subacute inflammation or a common cold, accompanied by more or less spasm of the glottis, and characterized by a husky stridulous cough (in child- ren, false croup — see Spasm (p. 288), loss of voice and fever. As a primary affection it is mostly due to expo- sure to cold. Treatment — Hot fomentations; co/d com- presses, or Acid. acet. (294 & 98) to throat; and Opium or Belladonna (43, 78 & 79) to allay spasm and cough, will as a rule, be sufficient. Sometimes, however, the disease is much more severe in adults than in children; therefore tracheotomy (295) should be performed as soon as the obstruction in the larynx occasions retrac- tion of the lower part of the chest in inspiration and be- 'fore the occurrence of lividity. The subacute form, which is but mild, characterizing certain cases of a common cold, hoarseness or aphonia, in connection with a cough and a viscid expectoration being the most prominent symptoms, claims a similar treatment, Chronic Laryngitis on the other hand is a constant companion of more or less ulceration of the larynx, which, if not the result of syphilis, is mostly due to pul- monary phthisis. In addition to the usual symptoms of acute or subacute laryngitis, it is characterized by dif- ficult deglutition, occasionally spasms of the glottis with dyspnoea. The treatment relates to the causal disease and complications. To alleviate the cough, Opium, Bell,, Hyoscyam. (23,43, 78 or 113 &l2!2); or Cyan (68 &307), Pimpinella (116) is sometimes very effective in aphonia or hoarseness, but above all inhalations of Acid, nitric. (Edema Glottidis. 28Y Phenol,Tannin and Ammon. Chlor. (298-309 & 323), with occasional applications of Argentum ox Iodine (288 & 293). Laryngitis exudativa — Membranous or true croup is a local disease, characterized by fibrinous exudation in the form of a false membrane in the larynx, trachea, and frequently the larger bronchi, involving as a rule the pharynx, tonsils and adjacent parts, accompanied by a peculiar shrill, barking cough and difficulty of breathing. The treatment consists, aside from cold compresses (298) to throat at intervals of a few minutes, or Acid. acet. (294), in emetics, Ipecacuanha or Turpeth ter v. quater die (pp. 100 & 101); or Apomorphine (p. 107) to compensate for the want of voluntary expectoration and the lime- steam bath (418). Ferrum (1 74) in conjunction with inhalations of Brom (313) are recommended. As a last resource laryngotomy (295). Oedema Glottidis — The serous or sero-purulent effu- sion in the submucous tissue above —seldom below — the vocal cords, especially in the ary-epiglottic folds about the ventricle of Morgagni and the base of the epiglottis, constitute tumors, which, as they project on each side, impeding more or less the inspiration, may readily be felt with the finger. Aside from being caused by injury, the swallowing of irritant poison or hot water, oedema of the glottis is chiefly due to inflammation of the neighboring parts, and occurs frequently in the course of general diseases, as typhoid, phthisis, Bright's disease, variola, etc. In kidney diseases it is sometimes the first and only dropsical symptom. Treatment — Leeches; in- halations of steam, medicated or no (303 & 9); applica- tions of Arg. nitr. (288), and shallow scarifications, with free purgation (p. 92) in acute, whether occurring during 288 Larynx. simple sore throat or in connection with erysipelas, scar- latina, etc. If dyspnoea intense and suffocation immi- nent, laryngotomy (295). Sometimes pressure with the finger or fingernail will suffice to open the tumors. Spasmus Glottidis — A morbid susceptibility to spasm in the laryngeal muscles, dependent on irritation of the vagus, the motor fibres of which are distributed in this locality, is, aside from being incidental to various in- flammations of the larynx, and sometimes associated with hysteria, peculiar to infantile life under two years: Laryngismus stridulus, popularly known as^s of hold- ing the breath, is a primary affection, and characterized by a shrill, whistling respiration, culminating in the suspension of breath, until the face becomes congested and livid, and often accompanied by carpo-pedal spasms or convulsions. Treatment — During the paroxysm, cold water dashed in the face, or, what is still better, the touching of the glottis with the finger, or the intro- duction of a catheter (296). At the same time Brom or Hyoscyamus (pp. 25 & 33); or enemata of brandy or Phenol (179 & 80); or the wet pack (420). In case of constipation, or irritation from teething, Mercury (p. 93); if gums swollen and hot, lancing. The presence of worms requires Santonine, etc., with proper attention to the general health. Spasm of the Glottis, occurring in children over two years and accompanied by more or less laryngeal irritation, is known as spasmodic or false croup (pseudo-cro'icp). It is characterized by a shrill sounding cough, with difficulty of breathing, which usually quite suddenly interrupts the sleep in the middle of the night, and may be easily discriminated from true croup by the abruptness of the fit and the Leucocythcbmia . 289 absence of fever ', as well as any buskin ess or hoarseness of voice. Treatment — Fomentations or cold compresses to throat (208), and, perhaps, a hot foot-bath. If the stomach be overloaded, a mild emetic — Ipecac, Alum or Cuprum (p. LOO), followed by Aconite or Brom (35 & 49). Spasm of the Glottis in adults, which is characterized by intermittens of the dyspnoea, requires simple anodynes and antispasmodics, Cocaine, etc. (p. 20). Lateroflexion. See Uterus (Displacements). Lead Colic and Lead Palsy. See Enteralgia resp. Paralysis from lead. Lentigo. See Skin. Lepra — Leprosy, which does not prove fatal by it- self, but predisposes, like other incurables, to diarrhoea, phthisis or renal disease begins with an eruption of the skin, to which is superadded disease of the nerves, char- acterized by numbness, distortion and mutilation of the extremities; or a crop of tubercles in the face; or both. It must not be confounded with psoriasis scutel- lata, which is sometimes called lepra vulgaris; nor with lepra syphilitica, sax aggravated variety of syphilit- ic psoriasis. Treatment — Aside from a nutritious diet and cleanliness, Acid, nitro-mur. (153) to improve diges- tion; and locally Copaiva. Arsenic (p. 9) is also much used. Leptomeningitis. See Meningitis. Lei:cocytil/Emia or Leukaemia is a chronic disease, characterized by a superabundance of white corpuscles in the blood, supposed to be owing to their increased formation in the lymphatic glands, spleen and marrow of the bones, and attended by swelling of the glands those of the neck and axilla being mostly first affected — , enlargement of spleen, a hemorrhagic diathesis and 290 Leucorrhcea. general anaemic symptoms. Without an increase of the white corpuscles in the blood, but with the same ana- tomical changes, as hyperplasia of the glands, enlarge- ment of spleen and alterations in the marrow of the bones, it constitutes Pseudo-leucocythmmia. known as LTodgkin's disease, Lymphatic Anaemia or Malignant Lymphoma, Treatment — In addition to good nourish- ment, sea bathing, and other hygienic measures, tonics — Arson. ,Ferr. 9 Phosph. (pp. 9,79 &87); 01. Jecor.(\o. 84), etc. Leucorrhcea is the collective name of a variety, of discharges from the female genital apparatus, secreted by the different parts of its mucous surface, when in- flamed or morbidly irritated. Thus it may be caused either by congestion — subinvolution of uterus or vagina; suppressed menstruation, fibroids; polyps; or fungous vegetations; prolonged lactation; gestation or parturi- tion; excessive coition; displacements; or by inflamma- tion — endometritis; granular degeneration; syphilitic ulceration; vaginitis, etc. The discharges may be either mucous, purulent, muco-purulent or watery; and the vaginal form, which is acid, consists of abraded epithelium and pus; whilst vulvar leucorrhcea has, owing to the numerous glands in that part, a more or less rancid odor. But there exists no test to distinguish gonorrhoea — the discharge due to contagion — from that arising idiopathically, and the diagnosis must be chiefly a matter of inference. True leucorrhcea, popularly called the whites ox female weakness, however, is a tena- ceous alkaline mucus, being sometimes transparent like raw white of an egg, or having the appearance of the white boiled — if greenish, it is mixed with pus — , and is secreted from the surface of the cervix uteri. A Liver. 291 discharge of clear viscid mucus from the vagina is not infrequent in feeble women, the parts of generation being patulous and relaxed. Vulvar and vaginal leucorrhoea is common to all ages of woman's life; but the uterine form is rare in childhood, yet frequently met with in chlorotic girls, where it will precede or follow menstruation. The leucorrhoea, which accompanies pregnancy, and which is >ecreted by the follicles of the lips of the os, is intended to prepare the parts for their ultimate distension, and ..onsequently must not be interfered with; and whites, which are observed sometimes at menopause, may here act as a wastegate, and should neither be rashly arrested. Treatment according to cause (see Vaginitis, Vulvitis, Carcinoma, etc.) Excercise, bathing, and a good diet; with tonics, Quinine (p. 70), etc. Locally Argentum (343) <»nce a week, with copious astringent and soothing vaginal injections (358-60), to be used twice a day. In cases of chronic vaginitis astringents do sometimes harm when Inf. Lini vel Ulmi may be employed; though in chronic endometritis astringents will prove beneficial, since they tend to harden the mucous lining of the vagina, and thus prevent vaginitis. Lichen. See Skin. Lithiasis. See Urinary deposits. Liver — Congestion of the liver (Hypercemia Hepa- tis), if acute, is but transient and produced by excessive eating and drinking. It is characterized by a sense of weight in the right hypochondrium, bitter taste with loss of appetite and headache; sometimes nausea and vom- iting; and the rapid reduction to the normal size of the swelled organ, after removal of the cause, which maybe 292 Liver. effected by saline cathartics (p. 95). In torpor of the liver — a functional affection dependent on deficiency of bile, Potass, (p. 50), — a morbid excess of bile is supposed to enter into the etiology of diarrhoea, colic, etc., whilst the greenish color of the stools often observed in in- fants, is believed to be due to acrid (vitiated) bile. Passive Congestion is always chronic, and produced either by uncompensated valvular lesions, or obstruction in the pulmonary circulation, as emphysema, chronic bronchitis and pleuritis. The increased size of the pe- culiarly mottled organ — nutmeg liver — , a slight degree of icterus, in which as contradistinction from common jaundice, the stools remain bilious, and a more or less cyanotic face, followed by ascites and oedema of the ex- tremeties, as soon as the liver begins to atrophy are the most prominent symptoms. Treatment can be but symp- tomatic. Salines. Abscess— When the existence of an abscess is conject- ured by a fluctuating tumor over the liver, it may be explored, eventually evacuated by aspiration, as there is no risk of pus escaping into the peritoneal cavity, even if there is no adhesion. When the abscess discharges through the bronchial tubes or the alimentary canal, the treatment will be limited to tonics (p. 69) and appropri- ate remedies for the relief of undue irritation. Hyda- tids in the liver are characterized by the absence of all symptoms, unless the tumor be large enough to cause pressure upon the adjacent parts. If the tumor does not open externally, nor discharge, by expectoration or dejections, it may be aspirated like an abscess. Gall- bladder distended by liquid will form a tumor, character- ized by jaundice and absence of bile in the stools if the Hepatitis -fibrosa. 293 ductus communis choledochus be obstructed; by serous or purulent fluid and absence of jaundice, if the ob- struction is in the cystic duct. Aspiration. Perihepatitis — Inflammation of the covering of the liver and Glisson's capsule may be caused primarily by trauma; but is mostly secondary to carcinoma or syphi- lis; sometimes it may follow inflammation of the peri- toneum or the liver itself. It is characterized by severe pains in the region of the liver, with vomiting of bile; a violent fever, ushered in by chills; and a most painful cough with dyspnoea. The absence of swelling of the liver, distinguishes it from parenchymatous hepatitis. Treatment according to cause. Hepatitis fibrosa interstitialis or Cirrhosis of the liver is the diffuse form of chronic interstitial inflamma- tion, which leads to more or less contraction of the organ, accompanied by the various symptoms of passive congestions in the portal system — ascites, icterus and enlargement of spleen. Ascites is generally the first symptom suggesting the existence of the affection, which is confirmed by the diminished size of the liver (the previous gradual enlargement, though attended with more or less tenderness, being neither taken notice of), the high colored urine from the abundance of blood pigment and a large deposit of urates, though albumin- uria is usually rare, — in some cases there is profuse hem- orrhage without dropsy. It is due principally to the abuse of alcohol (hence its popular name of gin or whisky liver); sometimes to malaria, syphilis and other causes. Cardiac and renal diseases are occasional complications. The treatment is symptomatic, see Hydro-peritoneum and Hemorrhage. 294 Liver. Hypertrophic Cirrhosis is called the affection, when the liver remains large. In this form jaundice is more persistent than in ordinary alcoholic cirrhosis, and if it is due to syphilis, gummata may be felt sometimes as hard nodules on the surface of the liver. Treatment— Arsenic (p. 9); Acid, nitro-muriat. (153); Ammonium and Soda (120 & 158), etc. See Icterus. Portal Thrombosis may be secondary to cirrhosis; but generally it is due to pressure from without, impacted gallstones, portal phlebitis, etc., and though not standing in any relation to spirit drinking, it has the symptoms of cirrhosis; only the accumulation of the dropsical effusion is more rapid, which claims, however, the same treatment. Hepatitis parenchymatosa (Malignant or hemorrhagic jaundice) — Acute yellow atrophy is a diffuse parenchy- matous inflammation of the liver, which rapidly dim- inishes in size (whilst the spleen enlarges), attended by hemorrhage and ureemic symptoms — headache and de- lirium, soon eventuating in convulsions and coma. Oc- curring especially in pregnants and parturients in conse- quence of violent emotions, this grave disease is either developed abruptly or preceded by a prodromic stage, during which the highly acid urine will, when cool, de- posit a greenish yellow sediment, showing the presence of leucin and tyrosin — supposed to be diagnostic — with a diminuition of urea. Treatment — In the prodromic stage Quinine in full doses (p. 11), or Calomel, etc. — see Icterus. Coma, convulsions and hemorrhage require appropriate remedies. Afterward mineral acids (p. 71). Hepatitis suppurativa — A circumscribed inflamma- tion of the liver leading to suppuration may, aside from trauma, or from obstruction by gallstones, be secondary Lochials. 295 to dysentery and similar diseases, when emboli from ulcerative processes should find their way into the liver, and is characterized by pain and swelling in the region of the organ, accompanied by an enlargement of the spleen; if matter should form, there will be in addition repeated chills. JBepar adiposum — Fatty liver, dependent either on excessive introduction or production of fat in the organ, or ondiminuition of oxydation, is characterized only by an increase in size, without induration or any subjective symptoms. The enlargement, which in drunkards is followed by cirrhosis, may be so great that the liver- sound will reach as far as the navel. Generally no treat- ment required. See Adipositas. If abuse of alcohol the cause: Regulation of diet. In co-existing phthisis Cocf- liver oil may be taken without fear. Conium (p. 31). Waxy liver is also enlargement without any other symptoms, therefore only of diagnostic interest, the treatment being directed to the disease, with which it is connected — syph- ilitic, scrophulous and tubercular cachexia?. Calomel '(208). Lochials are called the physiological product of in- volution of the uterus after labor, consisting of a vaginal discharge, which the first few days is sanguinous [Lochia rubra) ; after about four days serous (X. serosa)] and after a week, milky (X. lactea). Suppression of the lochials may be due to cold, inflammation of the womb, or some febrile excitement, and is generally attended by headache and vertigo. Treatment- A linseed poul- tice with a tablespoonful of Camphora over the vulva; steam of a decoction of Leonurus cardiaca or Ricinus communis, (see p. 1 T 7 ) ; or a pediluvium (419); with salines (p. 96); or Calomel (p. 92), if much plethora. 296 Lungs. Lockjaw. See Tetanus. Locomotor Ataxia. See Ataxia. Loss of Memory. See Debility. Loss of Voice. See Aphonia. Lumbago (Lnmbodynia). See Myalgia. Lungs. Hypercemia Pulmonum — Active congestion may be due to increased action of the heart, arising from inha'ation of irritating vapors, spirit drinking and mental emotions; if partial, to emphysema and other diseases, which cause the unobstructed flow of blood in the not affected parts to be more or less vehement; and is characterized by a feeling of oppression, and a want of air, or increased frequency of respirations and dyspnoea in proportion to the degree and extent of the congestion, together with a quick pulse. Sometimes there is palpitation and a short cough, followed by a scanty expectoration, more or less streaked with blood. If the congestion increases so as to eventuate into (edema, which consists of a transudation of serum into the interlobular tissue, the alveolar walls and air cells, and is always dependent on other pathological condi- tions, dyspnoea will become extreme, expectoration serous and frothy, followed soon by the symptoms of poisoning by carbonic acid: small and intermittent pulse, the skin covered with a clammy perspiration; moist bronchial rales, etc., etc., and death. Whilst in simple hypercemia percussion and auscultation give negative results, pulmonary oedema will produce dul- ness on percussion, associated with the moist bronchial rales. Passive Congestion is a consequence of heart disease, especially valvular lesions, dilatation and fatty degeneration. If occurring in the dependent portions of Hoemoptysis, 297 the lungs, it is called hypostatic congestion , which is in- cidental to protracted and debilitating, and acute infec- tious diseases, and may also result in a transudation of bloody serum, known by dulness of that part of the thorax. Treatment — In active congestion: Cardiac seda- tives (p. 20); Nitre (p. 56); saline cathartics (p. 95), etc.. with revulsives locally — dry cups, sinapism, etc. In the passive form, stimulants: Alcohol (p. 73); Digitalis (p. 78), etc. In pulmonary oedema, if connected with dilatation of the heart, or when accompanied by feeble pulse and cyanosis, alcoholic stimulants with revulsives, footbath (419), etc. Occurring in kidney disease, the treatment is directed to the dropsical affection. If adynamia, tonics (p. 69). In oedema occurring so sud- denly as to endanger life, venisection. The hypostatic form may be prevented by frequent changes of the po- sition of the body. JTcemoptysis is aside from being the result of an aneu- rismal tumor, etc., bursting into a bronchus, due either to bronchorrhagia or pneumorrhagia. In the former, it is owing to rupture of capillaries and other minute ves- sels of the small bronchi, which may be produced by violent muscular exertion or great mental excitement; or it is a consequence of the increased blood pressure in the pulmonic system from not compensated heart dis- ease; or collateral congestion in connection with suppress- ed menstruation, etc.; or from a morbid susceptibility of the vessels to break — a premonitory sign of phthisis. The expectoration of the blood which is generally pure, frothy, of a bright red color and a sweetish taste, is mostly preceded by a sensation of the presence of a warm liquid in the chest, with or without oppression, and verti- 298 I/ungs. go, etc. Pneumorrhagia in the circumscribed form ma}" be conjectured, when in cardiac disease, connected with dilatation of the right cavities — demonstrable by in- creased dulness towards the right with increased second pulmonic sound — there is a fit of great dyspnoea with cough and an expectoration of dark blood with mucus y but without fever. Hemorrhagic infarction, with or without haemoptysis, is due either to thrombosis or em- bolism of branches of the pulmonary artery; and as here the blood is in the air-cells and interstitial tissue, without laceration of the pulmonary parenchyma, it may, unless absorbed or expectorated lead to gangrene, to embolic pneumonia, or, if the emboli contain infectious matter metastatic abscesses. Diffuse pneumorrhagia or pul- monary apoplexy consisting of extravasation of blood with destruction of lung-tissue and resulting usually from trauma (stab-and gunshot wounds) is easily recogniz- ed, the patient lies cold and pale and death will some- times take place before the blood appears. For the treat- ment of haemoptysis see Hemorrhage (from the lungs). Pulmonary Gangrene — A necrosis of lung-tissue, at- tended by decomposition, may be either diffused or circumscribed and occurs, aside from trauma — penetra- ting wounds, etc. — in infectious diseases, and various af- fections of the lungs. It is characterized by accelerated breathing, pain and cough, followed by sjmta more or less discolored, according to the amount of pus and blood present, in which, in contra-distinction from fetid bronchitis, or decomposition of the contents of the pul. monary cavities, may be visible shreds of lung-tissue to the naked eye, and of a more penetrating odor than that which is peculiar to pulmonary abscess. Treatment — A Pneumonia. 209 nutritious diet with tonics, Quinine (p. 76); Ferrum or Potass (pp. 55 & SO); disinfectant inhalations, Phenol, Pix, etc. (302, 323 & 24): and to alleviate the cough, 0/W//77 (p. 37). Pneumonia crouposa s. Jibrinosa — Acute lobar pneu- monitis or pneumonic fever is an acute inflammation of the lung-tissue, running, when idiopathic, a definite course, characterized by three distinct stages: Active congestion {engorgement)- -solidification {hepatization) — and resolution, or, if the inflammatory products in- stead of being absorbed, become a cheesy mass, purulent infiltration (suppuration), in which latter case it maybe followed by chronic catarrhal pneumonitis, cirrhosis, gangrene, or abscess. Secondary pulmonic fever is -fre- quently complicated with typhoid, dysentery and other affections. (In typhoid pneumonitis the typhoid state does not involve the essential fever, as in typhoid com- plicated with pneumonitis). There are cases in whioh lobar pneumonitis if perfectly latent, so that only an exploration of the chest will reveal the existence of the disease; but generally it produces more or less distinc- tive symptoms. The fever, which is preceded by a chill, if severe, is usually accompanied by headache, delirium, vigilance, etc., etc. Pain and cough, unless wanting, may be very harassing. The pain is lancinat- ing, as in pleuritis (which disease in the dry or circum- scribed form always co-exists — constituting, if effusion should take place, pleuropneumonia) ; it will, however, diminish in the second stage. The cough in this stage is also less troublesome than in the first, the expectora- tion becoming more easy: The rusty sputa are patho- gnomic, as is the hectic flush on one or both cheeks, jot 300 Lungs. herpes labialis, if present. The respiration, on the other hand, will be even more hurried, in consequence of the .solidified portion of the lung not participating in the respiratory function; but it will improve like the other symptoms, when resolution begins — their aggravation would indicate suppuration. Whenever lobar pneumon- itis is suspected, both sides of the back, below the scapula, should be examined at once, since, if the inflammation be primary, a lower lobe of the lung is mostly affected first: More or less dulness on percussion with fine dry {crepitant) rales — Zellenknistern, tohich are limited to the inspiration and pathognomic, characterize the first stage. In the second stage the dulness is more pronounced, and in addition there are moist (subcrepitant) rales — Knisterrasseln, the finest kind of moist rales, in sound similar to that, produced by passing the hand lightly over a new piece of taffeta, and to be heard also during expiration — , broncho-vesicular and bronchial or tubular re ■ spiration with bronchophony, which indicate solidification. In children under 5 years the disease is sometimes ushered in by convulsions; or it may be masked by a violent fever, associated with cerebral symptoms, or those of acute gastro-enteritis; it may even remain latent, as it often does in the adult — in which case a moaning or grunting sound accompanying the expiratory act is of frequent occurrence and diagnostic — ; however generally an increased frequency of respiration, which ^mounts often to 60 p. m., and causes the alee nasi to dilate; and the characteristic flush on the cheek are co- existing with the high pyrexia and a pulse of from 150 —200 p. m. As pneumonitis is unilateral, there is, as a rule, no difficulty in differentiating it from capillary Phthisis. 301 bronchitis, since that disease is bilateral — saber epitant rules consequently to be distinguishable on both sides; moreover, bronchial respiration or bronchophony never exist in the latter. Treatment — Quinine (7) at the be- ginning may arrest the disease; else it is not indicated, unless the axillary temp, be above 102 degrees, in which case sponging or the wet pack are important auxiliaries (420). If the fever not severe, Nitre (122); Aconite; Antimony (p. 23); or saline purgatives (p. 96). Warm fomentations or cold compresses over the affected part — the former as revulsives, the latter as painkiller, by diminishing the determination of blood to the part. If restlessness, cough, etc., Opium (p. 36); if delirium and headache, Brom (p. 27); or vigilance, Digitalis (pp. 50, 56 & 73). In the second stage, Ammonium (p. 73) as stimulant, especially if much dyspnoea, with dry cups or Iodine locally. Brandy (p. 72) as support at any time if required, especially if weakness with a frequent, vibratory or thrilling pulse. As regards the adminis- tration of Alcohol and Opium to children, see pp. 35 & 73. For Pneumonia catarrhalis sen notha (Lobular Pneu- monitis) see Broncho-pneumonia Infantum. Phthisis — Tuberculosis or Pulmonary Consumption, essentially a chronic catarrhal or interstitial pneumonia, superadded to a formation of tubercles, the product of a constitutional dyscrasia, and invariably accompanied by a dry pleuritis, is, aside from a congenital or heredi- tary diathesis, chiefly due to acute pulmonary or bron- chial inflammations, and often complicated with tuber- culous disease of the intestines, tuberculous laryngitis, pleuritis with pneumothorax, etc., etc., even kidney dis- ease may co-exist. It is attended in the first stage by 302 Lungs. a slight hacking cough, which, though dry at the be- ginning, is soon accompanied by a scanty expectoration of frothy mucus, sometimes streaked with blood. Haemoptysis generally follows next, and whilst the sputa grow more abundant and opaque, feverish symp- toms with frequent chills will set in, and a shooting pain may be felt occasionally under the scapula. As the disease mostly begins at the apex of one lung, there will be on that side the characteristic depression of the supraclavicular region. Crepitant and subcrepitantrafes, the former due to pneumonitis, the latter to bronchitis — the secondary, circumscribed form — with pleural fric- tion and other crumpling and crackling sounds, each and all, if present, will be significant, provided they are limited to the summit of the chest, in conjunction with dulness on percussion of that part, and if broncho- vesicular respiration with exaggerated vocal fremitus co-exists. (During percussion the patient should not incline his head sideways, since the stretched muscles of the neck might produce a dulness). When the dis- ease is progressing towards the second stage— -the for- mation of cavities — , the cough becomes more trouble- some, and the expectoration, generally of a muco-puru- lent character, will be in proportion to the number and size of the cavities. Diagnostic are the nummular sputa, which are round and flat, like a coin, when falling upon the bottom of a vessel. Not less significant is the fever, which becomes continuous, with evening exacerbations; the hectic flush and the burning sensation of the soles and palms; the copious nightsweats and the progressive emaciation. Colliquative diarrhoea, dependent on tuber- culous enteritis, may occur, and sooner or later oedema Lupus. 303 of the feet and ancles — which will disappear again when in the recumbent position — mostly due to thrombosis of the crural vein. Exclusive the dulness, which amounts sometimes to flatness, the bronchial and broncho-vesicu- lar respiration — indicative of solidification — and the correlative vocal signs, as bronchophony and pectori- loqui, there will be heard a tympanitic resonance or one of its variations — the cracked and metal — which change in /tight, if during percussion patient alternately opens and closes his mouth (indicating the existence of a cavity), with cavernous and amphoric respiration. Treat- ment — Alcoholic and fermented liquors, if they be borne, with tonics, Quinine, Ferrum, Strychnine (pp. 75, 80 & 83), and an invigorating diet, including "milk cures," in conjunction with out-of-door life and daily sponge baths (04-68 degrees) are of prime importance. Glycerin ; 01. Jeco r is (pp. 81 & 84); Benzoin and Cocaine (pp. 46, 58 A 77); Arsenic (p. 9); Potass (p. 55). Hypophosphites are said to be curative. If cough troublesome, sedatives (pp. 23-33); Ammonum (pp. 43 & 44), with soothing in- halations (319 & 324); if pain, revulsives or Belladonna plaster. Nightsweats require acids (129), Agaricin (131) or Airopia (p. 23); diarrhoea, Opium or Bismuth (pp. 36 uch an attack of apoplectic coma may occur more than once, and may last for days. The limitation of the haematoma to one side may produce facial paralysis or hemiplegia, muscular contractions or convulsions, or only contraction of the pupils. The disease, which occurs mostly in old age — drunkards being particularly liable to it — is, aside from trauma, incident to chronic lesions of the brain, especially to those belonging to general cerebral paralysis. The treatment consists in cold compresses to the head; stimulating pediluvia (419); counter-irritation to the neck, and cathartics (p. 88). Brom (p. 25), or Ergot (pp. 65 & 78) may be tried, and to promote absorption, Iodine (p. 14). Leptomeningitis — Simple acute cerebral meningitis, exclusive of its occurrence in the course of eruptive fevers, pneumonia, etc., developes sometimes with in- flammation of the dura mater, in connection with dis- e of the middle ear; though, in cases of otitis interna, it may be developed without either, pachymeningitis or caries. It is characterized by great excitement, eventuating even in hilarious or maniacal delirium; in- tense headache; intolerance of light and sound; flushed countenance; strongly pulsating carotids; vomiting, and 308 Meningitis. more or less fever. These symptoms are followed by the stage of oppression: Drowsiness; rapid and feeble pulse; Cheyne- Stokes respiration^ spasmodic twiteh- ings and paralysis facialis or hemiplegia, passing (in fatal cases) into coma. Strabismus, hemiplegia and convulsions are not absolutely of bad omen. Treatment similar to that of the preceding disease, the ice -cap or cold douche to head; sinapisms to neck; and Calomel and Jalap, or Croton (pp. 92 & 98); or Aconite (pp. 22 & 55). To diminish the cerebral excitement, Brom, with or with- out Morphia, In the second stage, Iodine as sorbefacient, and a blister to nuca, if required. Attention to bladder and supporting measures are other important items. Meningitis tuberculosa — Basilar Meningitis or Acute Hydrocephalus (for the chronic form see Hydrocephalus) occurs chiefly in children of, from 2 — 7 years of age. It is characterized by the presence of miliary tubercles in the pia mater, conjoined with meningeal inflammation and a serous effusion in the ventricles. Unless super- vening upon tubercular disease of the lungs, it is usual- ly preceded by general indisposition, muscular debil- ity, pallor and irritability of temper. The disease be- gins mostly with frontal headache, fever and vomiting, in fact all the symptoms of simple meningitis; and a lancinating pain, causing infants to utter from time to time a sudden, sharp cry, known as the cephalic cry. The second stage is marked by somnolency, with occa- sional delirium; the pupils dilate; the eyelids are but partially closed; and sometimes there is strabismus. Subsultus, carphologia and paralysis or convulsions gen- erally close the scene. The treatment is similar to that of simple meningitis, though without much hope for success. PART II. CONTINUATION. Meningitis cerebro-spinalis is an essential fever of an infectious nature, the inflammation of the meninges be- ing a local manifestation of a general morbid condition. It is characterized by severe headache with spinal pain and hyperesthesia of the whole body, to a degree that renders the slightest touch unsupportable, in conjunc- tion with contractions of the muscles of the neck and re- traction of the head. In addition there are chills, nau- sea and vomiting; paroxysms of delirium, especially at night, and accompanied by hallucinations; finally great prostration, followed by coma. Deafness and blindness are occasional sequels, if the disease does not end fa- tally — the latter from purulent choroiditis, the former a result from purulent inflammation of the labyrinth of the ear. Treatment according to the severity of the disease — wet cups to the neck; or leeches behind the ear; andcoA/ applications with Quinine (7); or Aconite (pp. 22 (309) 310 Menopause. & 55); Pulsatilla (p. 16); Ergot (p. 78); Brom, Chloral, G else mi urn or Opium (pp. 25-38) or Morphine hypoder- mically (p. 110). As support, brandy (p. 73). Menopause — The final cessation of menses where the ovaries get into a state of atrophy, and women fre- quently grow in flesh, represents the so-called critical time of female life, inasmuch, aside from any tendency to cancer (either of the breast or of the womb, which will have been held in check by the catamenia); or any predisposition to apoplexy; or engorgement of some or- gan, all of which are more liable to be developed at this time, where the derivative effect of the monthly loss of blood necessarily stops, we usually meet with disturb- ances in the economy, which are of more or less import- ance, and in the treatment of which we have always to bear in mind this cause. Exclusive from irregularities of the molimia, which may be extremely profuse or very scanty; suspected to reappear after several months, or replaced by a leucorrhceal discharge; in connection with uterine disease or no, we will find at the climacteric period the most varied affections, all standing in some relation with the organs of generation — asthma, palpi- tation of the heart, haemoptysis, etc.; often the nervous system is imminently excited, producing paralysis of all grades and convulsions of all shades — catalepsy, epilep- sy, chorea, hysteria, even mania. The treatmenthas ref- erence to the causative disease, amenorrhoea, metrorrha- gia, uterine disease, etc. Compare Menstruatio vicaria. Menorrhagia (Profuse menstruation). See Hemor- rhage from the uterus ; for Difficult Menstruation, and Re- tention or Suppression of Menses see Dysmenorrhea resp. Amenorrhoea. Menstruatio. 311 Menstruatio yicaria is the hemorrhage from any organ, taking the place of the physiological discharge of blood from the uterus. The bleeding may come from the bowels, stomach or bladder; from the nose, mouth or bronchial tubes; even from the umbilicus or from hemorrhoids or ulcers. Sometimes the molimia are re- placed by abundant salivation, leucorrhoea or periodical eruptions; but the intestinal mucous membrane is the one which most frequently affords the vicarious discharge as diarrhoea. For a time, women are protected against the effects of suppressed menstruation by the increased deposit of fat in the various tissues, thereby preventing local engorgement, especially at the climacteric period. The treatment consists in breaking up, if possible, the faulty determination and stimulating at the same time the uterus: Aloes cum Myrrha (p. 89) every 2d or 3d night and a saline draught (p. 95) in the morning in case of constipation; together with styptic pediluvia (419), etc. Some blood, (about 2 ounces) may betaken from the arm at the period of menstruation and if required to be re- peated for several months in succession. Mentagra (Tinea Sycosis). See Head. Mental depression. See Melancholia and Hypo- chondriosis. Mental Diseases — Insanity. Meteorismus. See Tympanites. Metritis interna and parenchymatosa. See Uterus. (Endometritis resp. Hyperplasia.) Metrorrhagia. See Hemorrhage from the Uterus. Micturition, painful (Strangury). See Bladder, resp- Kidney, (Cystitis, Spasmus Vesicae and Nephritis acuta)* Migraine. See Cephalalgia. Milk leg. See Phlegmasia alba dolens. 312 Mole. Miscarriage. See Labor (premature). Mole (Mothermark), See Nsevus. Mole, uterine — True moles, the vesicular or hydati- form are clue to an alteration in the envelops of the ovum, together with an irregular enlargement of the cho- rial villosities. The false mole is not necessarily con- nected with pregnancy, and is often represented by po- lypoid and fibrous growths, or membranes of conges- tive dysmenorrhea. In connection with pregnancy, the whole or part of the frontal shell, or of the placenta is retained and more or less organized within the uterus, after the life of the foetus has been destroyed by ad- verse influences, without being expelled properly. It is characterized by cessation of the signs of pregnancy, he- morrhage w T ith uterine tenesmus and a feeling of weight. Treatment— After full dilatation (by tents if necessary) of the cervix, uterine action should be roused by the persistent use of Ergot (p. 65). Or the mass may be re- moved by a large uterine scoop, or by traction with the placental forceps. Morbilli (Measles) — A contagious fever chiefly oc- curring in childhood of mostly a mild form; but sometimes associated with grave complications, as capillary bronchi- tis, croup, diphtheria, etc., or followed by no less serious diseases. It is characterized by an eruption, preceded sometimes by an eclamptic fit, but generally by more or less catarrh of the air passages, coryza and conjunctivitis with feverishness constituting the most prominent symptoms. The rash appears first on the forehead, in- vades face and neck, and spreads within two days over nearly every part of the body, the slowness of the ex- tension being distinctive from scarlatina and variola; Mouth. 313 though the papules into which the spots soon are trans- formed, resemble those of the latter disease prior to their turning into vesicles. After four days the erup- tion, which is sometimes uniformly diffused over the whole body, and which may be accompanied with pruri- tus, begins to fade again. In severe forms the phenom- ena of purpura supervene, and if there be hemorrhage from nose and mouth, or from the bowels, it takes the name of hemorrhagic measles. Treatment is symptomat- ic: According to the degree of pyrexia sponging with cold or tepid water, or the wet sheet (420); else Aconite (p. 22) Nitre or Soda (pp. 54 &56); for cough, Opium (p. 52) and in suppression of rash, Ammonium (p. 43) with Mustard bath (419). Morbus Bebidorum {Kater). See Alcoholism. Morbus maculosus Werlhofii. See Purpura. Morbus nauticus — Seasickness occurring in other- wise perfectly healthy people when on the water and pro- duced sometimes already by the slight motion of a boat is characterized by general malaise, nausea with or with- out vomiting; hyperesthesia of some nerves especially of the olfactory and occasionally by extreme prostra- tion. Treatment — Aside from spirits, oranges and apples, which are the usual remedies employed on board ship, Cocaine (p. 11) or Chloroform (61 & 246) may be tried. Mortification. See Necrosis. Mouth. Stomatitis simplex — A circumscribed in- flammation of the mucous membrane in form of small white specks, which are slightly elevated and surround- ed by a dark red zone, terminating in white sloughs. (The follicles are not involved). Aphthae accompany frequently indigestion, and in women menstruation; 314 Mouth. sometimes they are due to smoking and chewing of to- bacco; mostly however they occur in children, during dentition, from want of cleanliness. Treatment accord- ing to cause — In children, Magnesia (112) to correct the acidity of the stomach and Borax (284) locally. Muguet or Soor (Stomatomycosis) is very similar in appearance, being characterized by a whitish exudation in shape of min- ute points; they are produced by a fungus — Oidium albi- cans — -which is developed in the follicles. Thrush occurs chiefly in infants duringihe first few weeks if the mouth has not been washed after feeding; in adults it is a sign of a cachectic state of the blood. Treatment as in stom- atitis simplex; if obstinate, caustic with attention to the constitution: Potass (31). Stomatitis ulcerosa, Stomacace or Gingivitis paren- cliymatosa occurs seldom primary (from bad air and food, etc.); usually it is secondary. The most severe form, being generally due to the abuse of mercury, is characterized by swelling and inflammation of the sali- vary glands, cheeks, tongue and fauces, with bleeding and sloughing of the gums, accompanied by a flow of pe- culiar fetid saliva. Treatment — The best local applica- tions are gargles of brandy and water; Phenol, Potassii Chloras, Myrrha or Tannin (283, 98 & 300) and Iodine with bark (p. 14) internally with occasionally & purgative. Stomatitis gangrenosa s. Cancrum Oris — Noma, oc- curring chiefly in illfed children, and after infectious diseases, begins sometimes as a black spot of gangrene on the lip, or inside the mouth, without any inflamma- tion, the parts around being pale and wax-like; general- ly, however, it commences with a shallow circumscribed ulcer, accompanied by swelling of the face, saliva mix- Ranula. 315 ed with blood, and fetid breath. Soon it becomes gan- grenous, destroying cheek and gums; the teeth drop out and typhoid symptoms supervene, terminating in death. Treatment — A purgative (p. 88), followed by tonics, Quinine, mineral acids (p. 76), etc; Potassii Chloras (p. 56). As lotion, Creosote, Phenol or Zinc (337 & 08); or Acid, nitric. (372). The application of Sublim. (1 :5000) after having cut the sloughs away, as far as possible, with scissors, is said to have been successfully employ- ed. The dressing should be renewed every twelve hours, until the surfaces are clear and healthy, when it has to be discontinued. Glossitis — Inflammation of the tongue accompanied by great swelling, tenderness and difficulty in speaking and deglutition, is generally caused by profuse saliva- tion. Treatment as in stomatitis ulcerosa: A purgative and gargles; if necessary leeches or incisions. Parulis — Gum-boil, a small abscess, forming in the socket of a tooth, and bursting through the alveolus and gum, sometimes through the cheek, is caused usually by the irritation of a decayed tooth. Treatment — Removal of the tooth if much decayed, and fomentations; as soon as matter is detected, an incision. If the gum next to a decayed tooth becomes spongy, swelled and sensitive, the incision should be made too. Aperients (p. 88) and an astringent mouth-wash (299) will be of service. Hamda, an encysted tumor under the tongue, may, if the cyst be loosely attached, be dissected out; or a piece of the eac may be cut out ; or simply a free incision may be made, and the interior touched with caustic. Epulis is a fibrous or myeloid tumor, flat, prominent or pendu- lous, and painless, growing from the internal or exter- 316 Mouth. nal surface of the gum; or from the periosteum, covering the alveoli between two teeth, which latter ultimately will be displaced. It should be extirpated at once, even if the tooth on either side has to be extracted. Cancer commences with a nodule, which is nearly always situa- ted on the edge of the tongue — Free and early extirpation. Tongue-tie is a congenital shortening of the frcenum linguce, confining the apex of the organ to the lower jaw. The fraenum must be divided with a blunt-pointed pair of scissors, taking care to direct their points downwards close to the jaw, so as to avoid the ranine artery. Fetor Oris seu Stomatodysodia — Offensive breath is either due to catarrhal affections of the respiratory or- gans, chronic pulmonary disease, digestive derangement; or to caries of teeth and want of cleanliness. Removal of cause, if possible, and disinfecting gargles (283 & 298). For Salivation (a morbidly increased secretion of sali- va) see Stomatitis ulcerosa, page 314. Muguet (Stomatomycosis). Seepage 314. Mumps. See Parotitis. Myalgia — Muscular Rheumatism is a neuralgia, af- fecting sensory nerves in muscular organs, characterized by more or less tenderness, extending over the whole sur- face of the affected muscle, and not limited to certain points as in ordinary neuralgia; and by the fact that par- oxysms of pain are more or less cramp-like and excited exclusively by movements of the affected muscle — A dia- gnostic feature of abdominal myalgia is, that firm pres- sure with the palm of the hand can be well borne. (My- algia in the exlremeties must not be confounded with neuralgia affecting the nervous trunks, or with syphili- tic rheumatism). If the muscles of the anterolateral Ncevus. 317 part of the neck are affected, it is called rheumatic tor- ticollis, if of the posterior part, cermcodynia\ if of the back, dorsodynia; if of the loins, lumbodynia or lumba- go', if of the thoracic muscles, pleurodynia^ shoulders, scapidodynia; coccyx, cocciodynia. This last affection, which is characterized by severe pain upon sitting down or rising, especially from a low chair, and defecation; and which is to be discriminated from painful hemor- rhoids, fissure of anus, and a spasmodic condition about the muscles of this part, due to worms in the rectum, aris- es frequently from uterine disease. Treatment — In acute cases, next to rest sinapisms and soothing embrocations, Belladonna, Aconite, Chloroform (350, 410 & 11) etc.; or Phenol or Morphium hypodermically (pp. 107 & 1 10). In- ternally Am mon. Chlor. in one-half drachm doses (p. 44); Salicin (p. 18); Quinine (p. 11) in full doses; with an- odynes, Brom, Gelsemium, Morphium, Lithium (pp. 26, 33, 37 & 51). In the chronic form aside from the above treatment stimulating liniments (409); or Lugol's paint (p. 15). Small blisters (408) do sometimes good. Elec- tricity or the pack (420 & 21) may be tried; Ferrum (p 79) if anaemia. In coccyodynia extirpation of the bone, if nothing should effect a cure. Myelitis. See Spine. Myopia. See Eye. Njevtjs — A mole or mother's-mark is a simple angio- ma of a red color, if arterial; dark or bluish if venous. It is generally congenital and harmless. Galvanopunc- tiure (p. 149). The cavernous angioma is an erectile tu- mor, and the villous variety is a vascular growth most- ly to be found at the neck of the bladder. See Ure- thral Tumor. 318 Nails. Nails — A very common and troublesome affection, which usually occurs by the side of the great toe, is in- growth of the nail. The contiguous soft parts are first swelled and inflamed by constant pressure against the edge of the nail from the use of tight shoes, and soon an ulcer is formed, with fungous and exquisitely sensi- tive granulations, in which the edge of the nail is em- bedded, often producing so much pain as to prevent walking. Treatment— In most cases, if the nail having been well softened by soaking in warm water, is shaved as thin as possible with a sharp knife, and the pain and irritation allayed by rest, with fomentations; any ulcer that has formed will heal with the aid of black-wash (329) on lint, or a touch of lunar caustic. Afterward it is useful to cut out of the middle of its free edge a V-shaped piece, reaching down to the quick, but not in- to it, so as to permit the nail to be bent up vertically from the sides, and thus yield to the lateral pressure. Or the interstices between the nail and the granulations may be brushed several times a day with a solution of Gutta percha in Chloroform (1 : 8), until the nail is lift- ed from the underlying parts; when it can easily be cut off with scissors. The gutta percha of the anaesthetic menstruum is said to force its way between the granu- lations and the nail, thus liberating it from its abnor- mal position. Exostosis — A fibrous tumor (which sooner or later os- sifies), on the dorsal surface of the last phalanx of the great toe. To cut away a sufficient portion of the nail, and dissect the tumor out, separating it deeply from the phalanx by means of bone forceps, or amputation of the toe, is the only effective treatment. For knotty and Neuralgia, 319 brittle nails ( Onychomycosis) see Tinea tonsurans, page 247; and for inflammation at the root of the finger- nail — Onychia. Nausea. See vomiting. Necrosis — Death or mortification of bone, especially the shaft of a cylindrical one which is inclosed in a case of new bone, is due to injury or violent inflammation. Necrosis of the superficial layer of bone is called exfo- liation. Treatment — As soon as the diseased part (se- questrum) is sufficiently loose, it has to be removed. See Gangrene. Neoplasma. See Skin (Hypertrophy), Nephritis. See Kidney. Nervousness. See Hysteria. Nervous Exhaustion or Prostration (Neurasthe- nia). See Debility. Nettlerash. See Skin. Neuralgia — A functional affection of nerve-trunks or their branches, characterized by morbid sensibility, and shifting excruciating pain, which occurs in parox- ysms, or marked exacerbations, accompanied by tender- ness in certain circumscribed spaces of the skin, and due among other causes to anaemia, malaria, gouty and rheu- matic dyscrasiae. Trifacial Neuralgia or Prosopalgia is characterized by pain situated in the sensory fibres of the quintus and is generally unilateral: If the supra-or- bitalis is affected, there will be moreover intolerence of light with redness of the eye and increase of tears (mi- graine, hemicrania or brow-ague); in neuralgia of the 2d branch (N. maxillaris superior)^ there is increased se- cretion of one nostril, accompanied by heat; and if the 3d be affected, there will probably be more or less saliva- 320 Neuralgia. tion. A very obstinate form of facial neuralgia is char- acterized by spasmodic contraction of the muscles of the face, hence the French name tic douloureux. Cer- vico- Occipital Neuralgia is characterized by shooting pains, starting from the cervical vertebrae just below the occiput and extending thence over the posterior and su- perior portion of the cranium as far as the ear. Cervi- co-Brachial Neuralgia is generally limited to either the ulnar, radial, median or musculo-cutaneous. In Crural Neuralgia there is a shooting pain along the anterior cru- ral nerve and its branches. In Sciatica, the neuralgia is of a rheumatic nature (see Myalgia), and sometimes associated with muscular twitchings and cramps. The most painful parts of the sciatic nerve are generally at the sacroiliac junction, behind the trochanter major, at the head of the fibula, and the external malleolus. Hys- terical Neuralgia is in most cases easily diagnosticated on account of its anomalous character: A woman may complain of an unsupportable pain in the chest or side, yet she will expand her ribs freely \ or of the severest pain in any part of her body, yet she will easily bear pressure. For Visceral Neuralgia see the organ which is the seat of the disease. Treatment — Aside from due attention to the causative disease, a generous diet, and proper hygienic measures, anodynes will be of most im- portance: Aconite, Belladonna, Brom (35, 43 & 50); Chlo- ral, Chloroform and Hyoscyamus (60, 64 & IS) Conium or Morphium hypoderm. (245 — 255). Locally, Aconite, Ver- atrin or Camphora (409 & 10); Opium, Bell., or Chloroform (350 & 52); small blisters successively applied to the ten- der points (408); the actual cautery or electricity, espec- ially cutaneous Faradization (p. 149). Weak nerve irri- Neuritis. 321 tation of any part in the body, but particularly, if caus- ed by slight urinary affections as lithiasis, grit or con- gestion of the kidneys, is said to be easily subdued by a few drops of Cocaine (20#) 3 injected into the urethra — in severe neuralgia, as the pain produced by stone, in- flammatory diseases, or cancer, it is of no value what- ever. One or the other of the following remedies will also sometimes afford relief: Arsenic, Quinine, Rhus (pp. 9, 10 consisting in an enlargement of the muscular structure, and incidentally of the glandular ele- ments, is almost peculiar to advanced life, and charac- terized by difficulty in making water, sense of weight in the perineum and tenesmus as from internal piles, with occasional fits of complete retention of urine, which may be brought on by cold or excess in venery. In proportion as the obstacle increases, the bladder re- mains distended, whilst the urine continually dribbles away, and chronic cystitis is the consequence, which sooner or later is followed by disorganization of the kidneys. Aside from the introduction of a catheter at regular intervals, in order to get rid of the residual urine and the prevention of constipation, the irritation of the bladder must be alleviated (see same); whilst occasional fits of pain or congestion must be treated by leeches and hot baths in conjunction with proper diet. Prostration. See Debility. Prurigo. See Skin. Pruritus Ant, see Anus; Pruritus pudendi — Yulva; Pruritus of shin — Skin. Pseudo-Leucocyth^emia. See Leucocythaemia. Psoriasis. See Skin. Pterigium. See Eye. Ptosis. See Paralysis of third nerve. Ptyalism (Salivation, Sialorrhoea) — An excessive secretion of saliva may be due to a variety of causes, especially to catarrhal affections of mouth and fauces, or of the alimentary canal, even of the organs of gener- Puerperal Fever. 355 ation. Sometimes pregnancy is the cause, and some- times influences of a purely psychical nature will give rise to it. The most violent form of salivation is gen- erally a consequence of the use or abuse of mercury. For the treatment see Mouth (Stomatitis ulcerosa). Puerperal Fever is an infectious and contagious disease, produced, for the most part, by micrococci, which result from infection of the uterus and abraded vagina in consequence of parturition, and usually com- plicating or complicated by inflammatory lesions within the pelvis or abdomen, thus constituting the many varie- ties of this affection. The lesions referred to as gener- ally co-existent with the blood-poisoning, manifest them- selves primarily as vaginitis, metritis, pelvic peritonitis and cellulitis, phlebitis and lymphangitis; and of second- ary origin, may be mentioned in addition to pleuritis and meningitis, purulent inflammation of the joints, pyaemia and circumscribed inflammation of the subcu- tanous areolar tissue. The ^fever makes its appear- ance in, from two to nine days, following confinement; and pursues frequently a favorable course, terminating after several days; but even under most discouraging circumstances hope of recovery should not be abandon- ed, though there are cases, which will prove fatal in less than a week. Nevertheless, prevention is better than cure, and since we know that infection arises, either from wounds or rents in the genital tract, or by absorp- tion from surfaces not wounded, but laid bare by the process of parturition, we know also, that puerperal fe- ver can be very often prevented by the liberal use of nail brush, soap and water: Keep hands and instruments surgically clean (see note on page 139), whenever you 356 Puerperal. are called to assist a puerpera, and if, in a suspicious case, you properly guard against direct infection, puer- peral fever will be next to an impossibility, with the exception of those extremely rare cases, where it can be traced to colonies of bacteria, which, in the shape of purulent deposits (the result of old inflammations) will probably be present somewhere in the pelvic tissue or Fallopian tubes. From what has been said it is evident that the symp- toms will vary as much in character as in degree of severity. Barring fever and pain, there will be consid- erable sensitiveness on pressure over the womb, with partial suppression of lochia, if Metritis develop. If M. suppurativa ensues, the fever increases, chills are more frequent, and a fetid diarrhoea is generally the precursor of death; whilst simple inflammation of the womb may in, from 5 — 8 weeks end in recovery. M. gangrenosa, where vagina and vulva become involved, runs also usu- ally a fatal course. In Peritonitis, there will be tympa- nites, vomiting and coliky pains in conjunction with co- pious perspiration; the face will grow dark and flushed, and the temperature often reach 105°. Marked consti- pation is sometimes present, which may be followed by a critical or colliquative diarrhoea. In Putrid Infection, which is supposed to be an auto-genetic lesion, due to retention of any material in the sexual organs, which may have decomposed, there is in addition to repeated chills, fever and high temperature, a fetid and per- sistent diarrhoea frequently in conjunction with a foul discharge from the uterus, terminating as a rule in death. Pycemia, which appears seldom before the eighth day after confinement (very often much later) and which is Fever. % 357 identical with the surgical lesion, begins invariably with an intense chill, the pulse rising rapidly to 130 and the temperature to 106° or 107% followed by profuse sweat- ing, localized inflammation and abscesses. As purulent collections may occur in any part of the body, in the liver and spleen (pyaemic abscesses in the lungs and kid- neys result frequently from emboli, formed by disinte- gration of an infected venous thrombus), or in any of the synovial membranes of the joints, a fatal termination is also here the rule. Phlegmasia dolens, which appears generally during the second or third week after labor, oc- curring mostly in the leg, is characterized by great swell- ing, the veins being felt sometimes like hard, knotted cords; and a shining whiteness of the skin coupled with pain and great tenderness. The exudation may be ab- sorbed in five or six weeks; however sometimes suppura- tive phlebitis will develop, abscesses form, and occasion- ally a thrombus, having undergone purulent softening, will give rise to infected emboli, which may, in turn, orig- inate metastatic abscesses in different parts of the body. Treatment — When after parturition, fever, chill, foul lochia, and other symptoms of sepsis make their appear- ance, the uterus should be searched at once for any se- condines, even if lesions exist, to account for them; and it should like the vagina, be thoroughly washed with phenol, mangan or sublimate water (334, 368 & 397). Poultices and fomentations (337) may be required; or Zinc, chlor. (340) and an occlusion pad (371). At the same time according to circumstances Aconite with Sa- licin (p. 22); Quinine and Opium (pp. 11 & 35); and above all stimulants (p. 72). As alcohol, in puerperal fever, is not only well tolerated, but reduces also the temper- 358 • Puerperal Fever. ature, some practitioners rely, after the appearance of constitutional symptoms, solely upon its employment in conjunction with lukewarm baths. Brandy or cognac may be given with the yolk of an egg in doses of 1 to 2 teaspoonfuls every hour. The baths are indicated by failure of nutrition, incipient somnolence, delirium and cardiac weakness (small and quick pulse). One or two baths a day, with or without cold affusions, and last- ing for 5 to 10 minutes are sufficient. Contraindica- tions are collapse, fresh metastases, and venous (femor- al) thromboses. Milk, eggs, broth and meat in small quantities ought to constitute the sole diet. Obstipation, even if peritonitis should set in, is to be relieved by 01. Ricini ; violent abdominal pains require the ice -bag and opiates; and to allay nausea ice per os or sinapisms to epigastrium. See the heads of the complicating diseases. Pulmonary Disease. See Lungs; Pulmonary Hemor- rhage — Hemorrhage. Pulse, if quick and strong, indicates fever, inflamma tion,etc; if quick and weak — depression; quick, small and thready — great prostration, especially from loss of blood; variable in rapidity and force — nervous irritation; jerk- ing — valvular lesions; double — continued fevers; inter- mittent—obstructed circulation; irregular — disturbances of circulation and respiration, or functions of the brain, puerperal diseases, etc. The pulse of infants is best to be ascertained, when the child is sleeping, though there can be much more learned from the expression of the face, breathing, heart-beat, etc. See Tem- perature. Purpura simplex {Purples) — This cutaneous disease is characterized by small spots on the skin from minute Pyaemia. 359 extravasations of blood, and attended mostly by lan- guor and debility with general malaise. If accompan- ied by hemorrhage, especially from mucous surfaces, it is called P. hcemorrhagica or Morbus moculosus Werl- hojii. The treatment of the idiopathic form is similar to that of scurvy, and consists aside from an appropri- ate diet,of hcemostatics and tonics: Chininum cum Ferro (p. 76); Acidum sulfur/cum v. gallicum (p. 61); Terebin- thina (p. 67) etc. Pyjemia — A condition of blood-poisoning, which in- duces fever, accompanied either by severe gastroente- ritis and visceral congestions, or by certain local lesions, which are chiefly venous thrombosis, embolic abscesses in the viscera, acute suppurations of the serous mem- branes and joints, multiple abscesses in the connective tissue, and cutaneous eruptions. The fever, ushered in by shiverings,is characterized by a very high temperature — it may exceed 107.5° — accompanied by offensive per- spiration in conjunction with the usual symptoms of septicaemia. Suppuration is profuse and may take the shape of carbuncles, pustules or erysipelas. The first onset of pyaemia may be difficult to distinguish from severe ague; and sometimes the joint inflammation causes it to be mistaken for acute rheumatism. The predisposing causes are those, that produce a low state of constitution, and render the blood incapable of form- ing a firm clot; such as profuse loss of blood, depriva- tion of food, unhealthy air, organic disease of the kid- neys and other viscera; even mental anxiety. The im- mediate cause may, aside from infection and contagion, be disturbance of the coagulum in a vein; as by exer- cise of an arm after venesection, or imprudent move- 360 Pycemia. ments after parturition; the presence of septic fluids near orifices of veins, unhealthy suppuration in the neighborhood of the urethra, or of the mastoid cells. However, it may follow mere bruises without wounds, exanthemata, cholera or diarrhoea. Treatment— Quinine should be given at once, with or without Iron (p. 11). If suppuration is established, Acid, sulf.w\t\\ bark (p. 71). Alcohol (p. 72) as support. Pyrexia requires the ice-cap and sponging (420). Sleep must be procured by Mor- phia. Locally leeches and fomentations or poultices if much pain and tenderness; and whenever suppuration or a puriform deposit takes place, incisions are neces- sary, on the same plan as in phlegmonous erysipelas. See Septicaemia. Pyelitis (Suppurative Nephritis). See Kidney. Pyothorax. See Pleuritis suppurativa. Pyrosis. See Dyspepsia. Quinsy. See Tonsillitis. Rabies carina. See Hydrophobia. Ranula. See Mouth (TongueV Rectum — Foreign bodies in the shape of small bones, apple cores, etc., that have passed the alimentary canal, or pins and other things, which have been introduced into the anus, may be removed by proper forceps, after having previously dilated the rectum, by passing into the anus several fingers coated with lard, or by means of a speculum. Ulcers within the rectum, if influenced by the sphinc- ter ani are seldom cured without the knife; if however out of its reach, soothing enemata (381); Phenol (382); Borax (290) and applications of Argentum nitricum (343) may be resorted to, after having administered a purga- Rectum. 361 tive (p. 96), which latter may be followed by Acid, nitro- mur. (p. 71) and other tonics, to bring the secretions into a healthy state. For Piles see Haemorrhoids and Hemorrhage. Invagination of the rectum, either due to protracted constipation or the abuse of warm eneniata, is charac- terized by the upper part of the bowel lying within the lower, so that the passage on examination with the fin- ger is found obstructed by a tumor having in its centre the natural opening of the bowel. This state is attend- ed with great distress, a constant feeling of weight and desire to pass motions without being able to do so. Treatment consists in aperients with Nux Vomica (219); and astringent injections (378). See Intussusception. Stricture — A chronic thickening and contraction of the mucous lining, so as to form a ring encroaching on the rectal canal is generally situated at from 2 — 4 inches from the anus, and unless of a cancerous nature is a consequence of contracting ulcers from dysentery, etc. If unrelieved it may lead to ulceration of the rectum above the stricture with aggravation of all the symp- toms, as pain, straining and difficulty in defecation, more or less associated with pains in the back and loins, to- gether with irritation of bladder, anus and uterus, Treat- ment — Aside from aperients (p. 88) and injections to in- sure soft stools, a bougie capable of being passed comfort- ably through the stricture, should be introduced once in three days, and allowed to remain for 15 — 20 minutes. The size of the bougie has to be gradually increased. Spasmodic Stricture, which is characterized by spasmo- dic pains and great difficulty in evacuating the bowels, will generally yield to antispasmodics (p. 27) combined 362 Regurgitation. with soothing injections (365 & 381) and a proper diet. For Hectocele see Hernia (recto-vaginal); and for other rectal affections — Anus. Regurgitation is mostly a symptom of indigestion, though it very much varies in its character. The liquid thrown up by the stomach may be entirely sour if there be present an organic acid, as~acetic, butyric, or lactic; it may be acrid, appearing to scald the throat; it may be insipid, pasty or foul, having the odor and taste of rotten eggs, the latter denoting putrefactive changes. If the regurgitation occur during the progress of stomach-di- gestion, the acidity is usually due to chemical changes of the ingesta; but if it occur when the stomach con- tains no food, it may come from the gastric glands. For the treatment see Dyspepsia (Pyrosis). The acidity of the stomach during digestion may be prevented some- times by a few drops of Acidum hydrochloratum. Relapsing Fever. See Fever (relapsing). Renal Diseases. See Kidneys. Respiration — The^abdominal form occurs whenever there is great pain in using the thorax (pleuritis, etc.); or if the brain gets an insufficient supply of blood (croup, etc). Cervical respiration predominates when there is considerable exertion of the upper ribs, the sterno-cleido mastiodeus and other muscles of the neck, as in advanced stages of pulmonary and cardiac affections, obstruc tion or disease of the larynx, etc. The thoracic form again is called into play when there is obstruction to the action of the diaphragm, as in abdominal enlarge- ments, by dropsy, etc., etc. Stertorous breathing, oc- curring in cerebral oppression, depends on relaxation of the velum palati; whilst the so-called Cheyne- Stokes re- Rhachitis. 363 spiration, which may be observed sometimes in fatty de- generation of the heart, is nearly always due to cerebral anaemia: It consists of a period of apparently perfect absence of breath, succeeded by feeble and short inspi- rations, which gradually increase in strength and depth, until the respiratory act is carried to the highest pitch of which it seems capable, when the respirations, pursu- ing a descending scale, regularly diminish until the com- mencement of another apnceal period. Respiration proves a valuable remembrancer when using large doses of Opium (p. 36). Yawning and Sighing immoderately is frequently hys- terical; after an attack of hemiplegia, they are unfavor- able signs. Retention of Menses. See Amenorrhoea. Retention of Urine (see Ischuria) may arise from causes functional or organic: Want of power of the muscular coat of the bladder, diseases of the prostate, calculi or foreign bodies blocking up the urethra, pres- sure from without, spasmodic or permanent stricture, hysteria, etc. For treatment see Bladder. Retroflexion and Retroversion. See Uterus. RiiACiiiTis is a constitutional disease of early child- hood, frequently connected with scrophula, and arising from hereditary taint, or from improper food, or by be- ing too long and exclusively confined to breast-milk (phosphate of lime should be mixed daily into the food of pregnant women and nurses). Rickets are character- ized by an imperfect development, atrophy and distor- tion of the bones, becoming very manifest in the bend- ing of the shafts of the long bones and a thickening of their articular extremities, a narrow prominent chest 364 Rheumatism. (pigeon-breasted), and a variously curved spine. The treatment is similar to that of scrophula: Aside from animal food, cold sponging and fresh air, Calcii v. Sodii Phosphas (125 & 222); Potassa (31 so in "common par- lance," their description with treatment will be found elsewhere, T. albus — Joints; encysted, vaginal — Vagi- na; vulvar and pelvic bloody — Hematocele; vascular of Tympanites. 399 meatus (urethral caruncle) — Urethra; fecal (retained fe- ces) — Constipation, etc. Treatment according to the nature of the growth; in some cases parenchymatous in- jections of Phenol (239) are recommended. In malig- nant forms, Argentum nitricum (403) or an injection of an acidulated solution of Pepsin? For ovarian tumors see Ovaries; for malignant tumors — Carcinoma. Tympanites (Meteorismus) — An accumulation of gas in the stomach, small intestines or peritoneum. If in the latter, it constitutes sometimes a most distressing symptom of peritonitis, which may easily be distinguish- ed from the other forms by the disappearance of the liver sound, on percussion, the tympanitic resonance hav- ing extended over that organ, so as to change at once into the full lung-tone. Barring this, and those forms which develop occasionally in other acute diseases, tym- panites occurs mostly in dyspeptic disorders, and in connection with some uterine diseases. If indigestion be the cause, the gas is derived from either, putrefac- tive or fermentative changes in the ingesta; if irrita- tion of the uterine nerves, the abdominal ganglia, to- gether with the solar and semi-lunar plexus may be sec- ondarily affected, in consequence of which the diges- tive functions suffer, leading to sudden secretions of gas. (The disability to expel the gas is the consequence of a paralytic state of the muscular fibres of the intestines due to over-distention or defective nerve-power, see Hysteria). Treatment according to cause — Vegetables and other articles of diet, which easily ferment, must be avoided. If hysterical, tonics, especially Iron and Qui- nine (pp. 76 & 79). Sometimes a tumblerful of cold water by its tonic impression on the intestinal canal will 400 Typhlitis. be of service. Or Aloes, Colocynthis and Jalap (pp. 89, 90 & 96). In very troublesome cases, an elastic tube may be introduced into the rectum and carried up the bowels for several inches above the promontory of the sacrum, which will give immediate relief, unless there is excrementitious matter in the intestines, which must be removed by Terebinthina (217 & 385). See Dyspepsia. Typhlitis ( Typhlo-Enteritis, Ccecitis) — Inflamma- tion of the ccecum is characterized by pain and tender- ness corresponding to the situation, attended by vomit- ing, diarrhoea, and more or less fever. It is generally associated with inflammation of that portion of the pe- ritoneum, which covers the ccecum, with the additional symptom of circumscribed tympanites in consequence of paralysis of the muscular tunic; and chiefly due to detention of feces and the presence of irritating sub- stances. Sometimes it leads to fecal abscess (Perity- phlitis). Treatment — Rest; poultices and mild laxatives — 01. Ricini or small doses of Salts; or what is still bet- ter three times daily an enema, given through a long flexible tube, which is carried upward to the sigmoid flexure. For pain, Opium (p. 35); if an abscess is form- ed, aspiration as soon as fluctuation is felt. Typhoid (Typhus abdominalis—Ileo-typhus) — Con- tinued or enteric fever is an infectious disease, mostly due to drinking of polluted water, with lesions of the intestinal lymphatic structures, which are specific and always associated with enlargement of the mesenter- ic glands, especially those in immediate relation to the Peyerian patches and solitary follicles, and charac- terized by a long prodromic stage: Chills, irregularly recurring, and followed sometimes by perspirations; Typhoid. 401 loss of appetite, mental irritability, frontal headache, with pains in the loins and limbs; looseness of bowels, and frequently epistaxis. In the first days of the fever wakefulness is a prominent symptom; this is soon fol- lowed by a pseudo-somnolent state (coma-vigil) and a kind of muttering delirium (typho-mania), with car- phologia and subsultus tendinum, terminating occasional- ly in true coma. About the 7th day from the time of taking to the bed, there appear usually on the chest iso- lated papules of a pink color, whilst in the latter part of the disease miliary vesicles (sudamina) are common. A gradual rise from dag to day of the thermometer, with its oscillations of about one degree and a half be- tweeen morning and evening temperature for the first week is diagnostic; and so is tympanites, tenderness or pain and a gurgling noise, on pressure in the ileo-coe- cal region with the diarrhoea, which looks not unlike pea soup. There may be however constipation and sometimes hemorrhage from the bowels. Walking cases of typhoid (Typhus ambulatorius) are those, in which the symptoms are so slight, that the patient need not take to the bed. Barring complications, which are many and various, the treatment is the same as employ- ed in all essential fevers — Aside from Quinine (p. 11); Saficin (27 &29); Baptisia (4); Veratrum (p. 39); etc., Sponging, or the wet sheet with sprinkling, or the pack (420), whenever the axillary temp, reaches 103°, or that of rectum 102^°. At the same time supporting meas- ures: Brandy (p. 72) and food at intervals of from 2-4 hours — milk, eggs, broth, etc. If headache, the ice- cap, if insomnia or delirium, Opium, Brom or Hyoscyamus (pp. 27, 33 & 35); Antimony or Digitalis (pp. 23 & 50). 402 Typhoid. Constipation requires enemata (385); diarrhoea, Alum or Bismuth (pp. 46 & 62); tympanites, which depends on a paralytic condition as result from enteritis or peritoni- tis, may be relieved by Terebinthina (pp. 68, 95 & 137); and externally with hot fomentations. Hemorrhage de- mands astringents — Ergot, Creosote or Plumbum cum Opio (pp. 64-67), or Terebinthina and cold compresses to abdomen; coma, blisters (408) or sinapisms to nuka — if dependent on uraemia, saline hydragogues (p. 96) un- less contra-indicated by abdominal symptoms, in which case Pilocarpin (p. 50). In children and infants a warm bath will generally answer better than a cold one or the pack; but very of- ten cold applications to the heart are quite sufficient to reduce the temperature. Quinine should only be em- ployed in persistent enlargement of the spleen, as it is liable to produce diarrhoea or tenesmus. Antipyrin may be given instead, but in conjunction with a cardiac stimulant, in order to avoid any debilitating effect on the heart: gr. v ter v. quater die to child of three years. In tympanites, cold applications or enemata of cold wa- ter are sometimes serviceable, though as a general rule 01. Terebinth. (385) will do more good. In diarrhoea Naph- tha! in gr. ss-j bihorio] or Saiol gr. j-iij at the same in- tervals, will generally improve the stools and diminish their number. Constipation should, as a rule, not be in- terfered with, at any rate, if peritonitis present; other- wise enemata of warm water, perhaps with 01. Terebinth. will usually suffice in the most obstinate cases. Or 01. Ricini 3 ss-j every few hours; or small doses of Calo- mel (gr. ss-j). Perforations require aside from cold compresses to abdomen and hot applications to feet, Ulcer. 403 Opium in conjunction with stimulants; hemorrhage should be treated with ice to the right hypochondrium, and in- ternally, Alum or Plumbum with Opium and Digitalis (p. 50). Half a minim of Tinct. Opii every hour or two, will act both as a cardiac-stimulant and astringent. When there is the slightest brain complication not de- pending on the infection itself or anaemia, neither opium nor alcohol must be given, though it may appear indi- cated by the condition of the heart; however the for- mer is well tolerated, and relieves sleeplessness and the general irritability, if the cerebral symptoms belong to anaemia or to the infection alone. Before the tenth day after the fever has disappeared no solid food should be allowed. Raw fruit must not be given under any cir- cumstances; and the little patient should be kept still in bed for at least a fortnight after the disappearance of the fever. Typhus {Typhus exanthematicus — Ship fever, etc.), is a continued fever, usually due to contagion in conjunc- tion with broken health from deprivations and hard- ship incident to poverty. The symptoms during the de- velopment of the disease are essentially those of ty- phoid, with the exception of the pathognomics of that disease. Moreover the prodromic stage is very short or wanting; and a copious persisting eruption (if present) of dark red macular appears already in the first few days of this fever, the skin assuming nearly all over a dusky hue. Treatment similar to that of typhoid; Sali- cin (p. 18) is particularly recommended. Ulcer — An open sore from softening and disinteg- ration of structure in consequence of a wound, bruise, abscess, injury or disease. Treatment — Cleanliness, 404 Ulcer. rest, bandaging or strapping and exclusion of air, with purgatives, and if necessary anodynes for the relief of pain in conjunction with proper attention to the gener- al health, are the chief points. The healing ulcer or common sore should be covered with dry lint, if there be much discharge; else a dressing with simple oint- ment or Ungt. Zinci, which should not be changed oft- ener than every three days. If the granulations should be too luxuriant, it may be touched with lunar caustic; or it may be treated with lotions {Zinc or Phenol, etc). Inflamed and irritable ulcers require poultices, with or without Poppy, Opium or Conium; afterwards Liquor Plumbi or Blackwash (400). The foul or sloughing ul- cer is best treated with Bismuth, Creosote, Mercury, Re- sorcin, Phenol or Salicin (393-399). The indolent sore requires similar applications, after having applied strips of adhesive plaster two-thirds round the limb, from one inch below the ulcer to one inch above it. A thick lay- er of phenol-gauze should be put over the dressing, af- ter which the limb has to be bandaged from the toes to the knee. Varicose ulcers of the leg must be band- aged. In syphilitic and scrofulous ulcers Iodoform (401) is usually employed. For ulceration of bladder, see Bladder; for ulceration of cervix — Uterus (Degenera- tion); of cornea — Eye; etc. Ulcus ventriculi (Gastric ulcer). See Stomach. Umbilicus (Prolapse and Bleeding). See Hernia um- bilicalis, resp. Menstruatio vicaria. In the new-born the navel will sometimes suppurate, even before the stump has dropped off, which, unless arising from want of cleanliness, is generally due to a leucorrhceal discharge from the vagina of the mother. Urethra. 405 In syphilitic infants the navelstump, inteadof mummi- fying on the fourth or fifth day, as is normal, will remain soft and attached for perhaps more than a fortnight, thus exposing them to navel inflammation and septic infection. To prevent such a gangrenous or putrid con- dition, not only the cord should be tied with an aseptic ligature (416), and cut with scissors, which have been made aseptic by passing them through a flame; but also the stump should be wrapped in a piece of burnt linen (with a hole for its passage), after having been washed with bor water (260), and cautiously dried. If in spite of these precautions the navel should ulcerate, or proud flesh sprout from its side, the part must be dusted twice a day with Calomel (400). Argenium nitricum 2%, as used for the prevention of gonorrhoea! ophthalmia, is also recommended. Urjemia — Uremic poisoning is characterized by coma, epileptiform convulsions and sometimes delirium, even amaurosis, preceded generally by headache, vom- iting and diarrhoea. It is due to an accumulation of ex- crementitious substances, especially urea, in the blood, in consequence of impaired or interrupted functions of the kidneys. The urine contains albumen and as a rule dropsy is present. For treatment see Coma. Urethra (Male). See Gonorrhoea resp. Stricture. Urethra (Female) — Urethritis in women occurs mostly after hard labor; but it may be also a conse- quence of a faulty introduction of the catheter during pregnancy, and is characterized by great tenderness on passing the finger along the course of the urethra; more or less discharge, and frequent micturition. Treatment consists in saline purgatives (p. 95); diluents — Nitrum 406 Urethra. gr. x ter die in Decocto Lini; Aconite (35) and perhaps Buchu (p. 47). Locally Argenium nitricum (364), espe- cially if there should be some ulceration at the border of the meatus. Prolapsus Vrethrce known also as procidentia and eversio urethrce consists of prolapse of the mucous mem- brane, which encircles the meatus like a roseate projec- tion, and unless the result of hard labor, depends on a relaxation of the part in connection with a broken-down health. It is characterized by much sensitiveness, great liability to bleed, and difficult and painful mic- turition. Sooner or later it may cause pruritus vulvas, with a leucorrhoeal discharge and even ulceration from the parts being exposed to friction of the dress, etc. From caruncle, polypus or angioma it may be easily differentiated by its entirely surrounding the meatus. Treatment — The patient being anaesthetized, the pro- lapsed tissue should be drawn down with tooth-forceps and removed by encircling it with the galvano-caustic wire, placing for some days a catheter in the bladder if necessary. Existing ulceration should be treated first with caustic. Sometimes astringent injections (359 et seq.) with attention to the general health will effect a cure — Magnesia (218); Ferrum (175); etc. Urethral Caruncle — A vascular tumor, soft and frag- ile, varying in size from that of a pea to that of a pul- let's egg, situated on the border of the meatus, some- times extending up the canal. It is almost always ac- companied by a mucous discharge, excessive pain in sexual intercourse, in walking and micturition; and will sooner or later affect the general health by causing ner- vousness and depression of spirits. Treatment — After Urine. 407 having covered the adjacent parts with hardened lard, so as simply to expose the tumor, it is freely touched with Acid, nitric. (329), which may be repeated after a few days if necessary; or it may be cut off, and Potassa fusa, or solid Cloride of Zinc, applied to the surface, to prevent its reproduction. If Potass has been employed the parts should, after its use, be washed with diluted vinegar; if Zinc, they should be well oiled. If it is necessary to introduce the caustic within the urethra, it must be by means of a porte-caustic. The best opera- tion is however with the galvano-cautery, since by this means the hemorrhage, which is sometimes very pro- fuse, is not only stayed, but a relapse is also prevented. Before the operation the patient should be thoroughly anaesthetized, and the labia well separated by an assistant on each side. When the urethra has been invaded, it should be thoroughly stretched by small retractors, held by assistants, and the growths thus exposed be cut off with scissors, or scraped from their attachment by a steel curette. After removal they should be touched with Arg. nitr. y Acid, nitric, fumans, or the actual cautery. Angioma, which affects the urethro-vaginal tubercle or anterior half of the urethro-vaginal septum, attaining sometimes a large size, so as to project between the la- bia, requires the same treatment. It can easily be dif- ferentiated from caruncle by its want of sensitiveness. Stricture, which is characterized by difficult mictu- rition, pain upon pressure along the urethra, and some- times a mucous discharge, is best treated by mechanical dilatation with graduated bougies. Urine (see page 154) — Incontinence occurs in most inflammatory affections of the urinary organs, nervous 408 Urine. diseases, paralysis, etc., see Bladder; for Retention, (inability of expelling the urine, though the bladder is filled), being due to deficiency of contractile power of the bladder, stricture of the urethra, etc., see Reten- tion; for Suppression from inaction of the kidneys, the bladder being empty, see Ischuria; and for Hcematuria (the passage of blood with the urine), see Hemorrhage from the kidneys. Urinary Deposits, if precipitated from the urine, af- ter it has been voided, are called sediments; if how- ever already formed in the bladder or kidneys, they are known as gravel. Red gravel, consisting of lithic or uric acid crystals, tinged with coloring matter, indicates generally a highly acid state of the urine, and forms the sediment observed in fevers, gout and chronic diseases of the liver. It may exist with highly plethoric condi- tions, and may, on the other hand, be a sign of debility and malassimilation. The amorphous lithates of ammo- nia, soda, and lime, form a very common sediment, vary- ing in color from nearly white or yellow to dark red. Oxalate of lime, presenting letter-envelope-like crys- tals, which are easily recognized under the microscope, is generally deposited from acid urine containing lith- ates, and indicates feeble assimilation and exhaustion of the nervous system. The phosphatic deposits, aside from being a result of irritate bladder w T ith excessive secre- tion of mucus, caused by a primarily over-acid urine, which on account of its urea being decomposed into carbonate of ammonia, has turned alkaline, are due to a primarily alkaline, or insufficiently acid state of the urine, mostly dependent on excessive acidity of the stomach. Unless arising from changes in the bladder, the Uterus. 409 phosphates usually indicate anaemic dyspepsia or undue wear-and-tear of the brain from overwork. A fit of gravel is generally accompanied by pains in loins and hips; aching of the testicles; and frequent micturition. Sometimes there is languor, fits of headache, sour perspiration and nettle-rash, with despondency and other symptoms of indigestion, or a disordered state of the constitution; especially in Oxaluria. Treatment ac- cording to causation — In red gravel of robust and strong persons, aside from a bland diet, Liquor Potasso (119); or Benzoin (pp. 45 & 46 & 58) with occasionally a purga- tive (p. 97). In feeble persons a nutritious diet with tonics (p. 69), especially Acid, nitro-mur. (pp. 42 & 43), which is also indicated in oxaluria and phosphuria, in fact in all cases, where taste is foul or flabby, denoting impaired digestion. If there are sour eructations, flat- ulency, etc., whether the urine be alkaline or not, alkalies in small doses (p. 53). Chloral (p. 29) as hyp- notic; and in oxalic and phosphatic cases, Conium or Bell. suppositories (375), to allay local irritation; or Co- caine (see Neuralgia). Of other remedies may be men- tioned, for lithiasis, Lithium and Arctostaphylum (pp. 51 & 6S); for phosphuria, Acid. sulf. (pp. 61 & 72); for oxa- luria, Ferrum (pp. 79-81); Quinine (p. 76); Zinc and Strychnos (pp. 83 & 86). Urticaria. See Skin. Uterus — In the majority of cases, a diseased uterus, which has been for a long time in an abnormal condi- tion, will be found enlarged and displaced; there will be most likely catarrh of the lining membrane, a granu- lar condition of cervix; and probably, slightly enlarged and sensitive ovaries. A proper examination (p. 126) 410 Uterus. of the womb has to be made, whenever existing symp- toms of a female disease cannot be explained otherwise. Disjolacements — In anteversion, there are sometimes no symptoms whatever; generally, however, the pres- sure of the os against the posterior vaginal wall will in- duce dysmenorrhea and sterility; whilst the pressure of the fundus against the bladder and the cervix against the rectum will cause there irritation. In the former there will be a state, bordering upon cystitis; and in the latter, tenesmus and pain; besides neuralgia in con- sequence of compression of the nerves, and more or less difficulty in locomotion. Anteversion is generally com- bined with flexion, and if it is complete, the uterus will be found lying at an angle of 90° to the normal — the axis being taken to be a line passing from the umbilicus to the point of os coccygis; if partial, the angle may not exceed 45°. Treatment — The patient should be placed upon her back on a table, after having previously emp- tied the bladder by a catheter and removed all tight clothing from the abdomen. Then two fingers, well oiled, should be passed into the vagina so as to reach with their tips the body of the uterus, which will have forced the walls of the bladder down before it, and the patient directed to take a deep breath. Now, while the latter expels the air gently by a prolonged expiration, the operator presses up the body of the uterus with the fingers in the vagina, and the abdominal viscera and fundus with the other hand on the abdomen. After the fundus is lifted, the hand on the abdomen must keep it up until the cervix has been pulled forward towards the symphysis with the fingers in the vagina. The reten- tion of the uterus in position is generally effected by an D isplacements . 411 internal pessary; but if we have no skill in its use, it is better to employ one with a stem arching over the perineum, or going over the symphysis and anterior ab- dominal walls. A still safer plan for the inexperienced is to merely lift the displaced organ without rectifying the anterior displacement and keeping it in that posi- tion by the ordinary ring- or GarieVs air pessary in conjunction with the abdominal pad of wood or cork. Retroversion sometimes gives neither rise to any symptoms, though a fixed, gnawing pain in the back, discomfort in walking, and pain in defecation with te- nesmus of rectum and bladder are common. Very se- vere symptoms are sure to follow sudden retroversion, the result of succussion: The patient falls to the ground, and is unable to rise, suffers from suppression of urine and feces; and is often in such agony that the face is bathed with perspiration, and the pulse becomes weak and fluttering. Like anteversion, it may produce con- gestion, areolar hyperplasia, dysmenorrhoea, sterility, etc; and the pressure of the fundus on the sacral plexus causes at times complete paraplegia. Retroversion has three degrees: The uterine axis lying to that of the superior straight at an angle of 45°; 90°, (thus lying across the pelvis); and 138°, the cervix being thrown up, and the fundus descending. Treatment — Standing at the back of the patient, who is placed in Sim's position (p. 127), we introduce index and middle finger of the right hand to the fundus, their palmar surfaces being directed to the rectum: The uterus is now lifted upon the inner surface of the fingers, until it becomes erect, then their dorsal surfaces (the back of the nails) are made to push the organ over into the normal position. 412 Uterus. Or a sponge, fixed in a sponge-holder may be introduc- ed and pressed into \he fornix vagince — this latter pro- cedure may be made still more effective by carrying an- other sponge-staff up the rectum. If it can't be reduc- ed in this way, the patient is made to kneel upon a table, with the chest resting on it. Two fingers of the right hand are now carried against the fundus, elevating it forcibly, whilst the patient, after having taken a deep breath makes a profound expiration. Should this plan fail too, the buttocks should be still more raised by placing cushions under the knees, and the attempt re- peated with two fingers in the rectum. In cases, requir- ing no particular force, Sim's repositor may be employ- ed, or, if not handy, the uterine sound: Having intro- duced it, the handle should be held with the left hand, and while the tips of the fingers of the other hand press upon the staff near its middle, thus making of the sound a lever; it must be pushed back gently to the perineum. This movement will lift the uterus and partially restore it. Now the tip of the sound is made to revolve very gently, and the uterus carried into a condition of ante- version. For its retention in situ a tampon of carbol- ized cotton, or a sponge, saturated with carbo/ized gly- cerine, either of the size of a small hen's egg, may be carefully pushed as far as possible into the fornix va- gince, the uterus being held in a state of complete an- teversion by means of a repositor or sound. Then the sound being removed, a large roll of aseptic cotton should be placed below the cervix and a little anterior to it, so as to lift this part up into the hollow of the sa- crum against the roll in the fornix. The tampon (369) may be retained for 48 hours without inconvenience. Af- Displacements. 413 terwards, when a pessary is employed, care should be taken, that it create no discomfort, as in such a case a most violent cellulitis may result. In f act, p essa ries should be always controlled, as besides cellulitis or peri- tonitis they may produce not only vesico, recto and utero-vaginal fistulas, but even pass out of the vagina into the rectum or bladder. While a pessary is kept in the vagina, daily vaginal injections should be made (358 et seq.). Flexion is quite frequent, in slight degrees, in nulli- parous women, without constituting a disease; during childhood it is even the rule. As at the point of any flexion the cervical canal is always more or less closed, the ingress of fluids is prevented, and sterility com- monly results; at the same time is the egress so much interfered with, as to produce dysmenorrhoea, haemato- metra, hydrometra, and accumulations of mucus, which latter again results in endometritis, and even hemato- cele by regurgitation. A consequence of venous hyper- emia, arising from hindered reflux of blood at the point of flexion is oedema with tumefaction and genuine hy- pertrophy of the body of the uterus. In fact, neck and body will become tumid, tender and painful, the mucous lining so congested as to secrete excessive amounts of mucus and blood; and the tissues of the organ, excited to excessive growth by prolonged blood stasis, undergo in time marked hypergenesis. Besides these consequen- ces there may be a tendency to abortion, menorrhagia, ovaritis and salpingitis, granular degeneration, uterine neuralgia, pelvic peritonitis, cystitis and rectitis. With regard to Anteflexion , a certain degree of it may exist for years, without the development of symptoms. Sooner 414 Titer us. or later there will be, however, pain over the hypogas- trium, in groins and back, increased by locomotion and sexual intercourse; with irritable bladder, leucorrhoea, dysmenorrhoea, neuralgia, and all kinds of nervous dis- turbances. In Retroflexion there will be in addition, severe backache, weight in the rectum with tenesmus; uterine colic or tenesmus, and gastric disorders. Treatment of reducible flexion — body bent forward, axis of neck normal. The bowels having been evacuat- ed, pelvic and vaginal irritation removed by warm in- jections and rest in the dorsal decubitus, the uterus sound is introduced to the fundus as straight as it can be made to pass, and then the handle, being held in one hand, is carried to the symphysis, whilst the tips of the fingers of the other are pressed against the shaft of the sound near the middle, so as to make a fulcrum, by which manoeuvre the flexed uterus is elevated and brought towards the hollow of the sacrum. Now the sound' should be very gently rotated so as to complete retro- version with partial retroflexion. The patient should remain in bed for a few days, Cutter's pessary (modi- fied) may be applied, and the abdomen pressed inwards by means of an ordinary obstetric bandage with a fold- ed towel under it as a compress. In case of pain the bulb of the pessary should be replaced by a soft sponge, which is however to be removed every 24 hours. In Flexion with neck bent forward, the axis of body being normal, the sound, slightly bent forward, should be car- ried to the fundus, and the body thrown backwards, where it must be held for several minutes, in order to straighten the uterine canal. Now Hurd^s pessary, which must exactly fit and fill the vagina, may be in- Displacements. 415 troduced to keep the cervix backward; care being taken that it does not get incarcerated, which will sometimes happen, especially if the pessary is too small. After- wards Meig's ring should be worn for some time, to pre- vent the upward and forward pressure of the vagina. As in any form of flexion there is generally more or less con- traction of the cervical canal, it is well to finish the cure by dilating it with graduated sounds. Irreducible flexions , which mostly are congenital and one wall of the uterus well developed by excessive growth whilst the other is atrophied, may be corrected with the intra-uterine stem, provided the patient can bear it; or the knife. Before the introduction of the stem, the cervix, if found to be too contracted, should be dilated by one or more sea- tangle tents (p. 130), which for the time will straighten the uterus and dilate the canal. After introduction the patient should be kept in bed for several days, and upon leaving it, should be very careful in her movements for some time. Daring menstruation the instrument must be removed; likewise when there is pain, chilliness or feeling of general languor and discomfort. In Retroflexion the patient is placed on her left side, with the left hand drawn behind the body. The oper- ator stands now behind her, his face looking towards her occiput, and the line of the anterior surface of his body being about on a level with one passing through the patients body at the base of the sacrum. He now passes two fingers of his right hand, after having lubri- cated them, with their palmar surfaces towards the pos- terior wall of the vagina up to the fundus. Then, bend- ing forwards, he, by the tips of his fingers, pushes the fundus upwards, while, by their bases he retracts the 416 Uterus. perineum, elevates the posterior vaginal wall, and ad- mits air freely to the vagina. If this method should fail, the knee-chest position may be tried. Should the sound be used, it must be introduced but slightly bent to the uterus: Holding the handle in the left, the tips of the fingers of the other hand should be placed on the shaft to carry it towards the perineum as far as possible. The uterus being now to a certain degree straightened and elevated, the sound should be rotated so as to throw the fundus forward, at the same time the handle of the in- strument held in one hand has to be carried towards the patient's back, so as to advance the tip as far as possible towards the abdominal wall. For its reten- tion, any pessary will be of use, provided the fundus be light and easily reducible; but if it be heavy or rebell- ious, Cutter's will be preferable — the stem pessary will only be indicated, if the vagina unites so low to the cer- vix as not to leave a post-cervical space. If there be much tenderness, a sponge or the inflated soft rubber pessary may be advisable; or still better the fornix may be packed with medicated cotton or sponge to elevate the whole uterus as in retroversion. Irreducible flexions, Awe to old false membranous at- tachments are better left alone, unless the patient is very much suffering from the displacement, as in treat- ing it, we always incur the risk of peritonitis. In case the flexion be due to parenchymatous alteration, all that can be done, is 'to bend the body cautiously forward once or twice a week, by means of the sound or reposi- tor and then keep it in anterior inclination with a retro- flexion pessary or Cutter's modification. Sometimes the fornix should be filled with a soft moist sponge and Displacements. 417 the body sustained by a tampon of cotton in the vagina. In these cases the patient should be kept very quiet, and all pain should be soothed by the free use of Opium to prevent peritonitis. Latere flexion of the uterus, which is either a conse- quence of disease of its proper tissue or of direct pres- sure, requires generally the intra -uterine stem. Proleqjsus Uteri may even in the third degree remain without marked symptoms; but generally congestion, areolar hyperplasia and granular degeneration occur, which render it sensitive and intolerant of pressure or friction. In the first degree, the fingers passed up the vagina, will meet the os low down in the pelvis, yiressing upon the floor; in the second degree — the patient being examined standing — the os will be found at the ostium vagince, prevented from extruding only by the resist- ance of the sphincter muscles. As congestion and hy- perplasia affect not only the parenchyma of the uterus, but also the mucous membrane and submucous tissue, endometritis is invariably a consequence of prolapsus. The vagina, which as the uterus descends is inverted, makes constant traction upon the os externum by its cer- vical attachment, until the canal becomes completely everted, turning the os internum literally into the exter- nal and only os uteri, the real os externum having disap- peared by expansion. Dislocation of the bladder, which by uterine descent may happen to such extent, that, if a catheter be introduced, it will pass downwards and backwards, is also a grave complication, since traction and dislocation not only tend to the production of cys- titis, but this is further induced by reflex irritation and by decomposition of urine, retained in the pocket, 418 Uterus. formed by the inverted wall of the bladder. By a similar process prolapse of the anterior wall of the rec- tum occurs, and results in fecal impaction at this point. Sudden or acute falling of the womb may come on from any great effort, a fall, or violent contraction of the abdominal muscles, acting upon a womb which is en- larged by hyperplasia, subinvolution, pregnancy or tu- mor. It may even occur to a uterus normal in size and constituency: In an instant the patient feels that some- thing has given way within her, becomes prostrate and much alarmed, suffering pain of an expulsive charac- ter. Should in these cases reduction not be effected at once, violent pain will be felt over the sacrum and groins and the degree of traction exerted upon the pel- vic peritoneum may result in dangerous inflammation. Treatment — The patient, after thorough evacuation of the rectum and bladder, if this be possible, should be placed upon her knees and chest, in order to cause grav- itation of the pelvic and abdominal viscera towards the diaphragm. She should kneel upon the floor or a table and ten or fifteen minutes should be allowed to elapse before any efforts are made at reduction, in which time the existing congestion of the viscera will greatly di- minish. The operator then taking the cervix into the grasp of his index, middle and ring-fingers, pushes the uterus firmly upwards in coincidence with the axis of the inferior strait, steadying at the same time the pa- tient by placing the left hand upon her back. The pres- sure has to be kept up for fifteen minutes and longer until the uterus is restored to its place. It remains now to adopt proper measures in order to sustain the organ in situ, which, as a rule, is no easy matter. If for in- Displacements. 4 1 stance, the prolapse is associated with subinvolution, prolapse of the vagina, and rupture of the perineum, a most frequent combination, the three factors — increased weight, feeble supports^ and traction — have to be taken into account. To prevent pressure from above, it will be imperative to avoid the accumulation of urine or fe- ces, and to shun tight clothing; the use of skirt-support- ers will be of more or less advantage. Means for di- minishing the uterine weight are, treatment of inflam- mation, hypertrophy or congestion; removal of growths and perhaps amputation of the cervix. Means for strengthening or supplementing uterine supports are, aside from douches, cold hip baths, and recumbent pos- ture, local astringents — Tannin, Alum or Iron (359-61) in conjunction with an invigorating diet, sea bathing and general tonics — Ergot, Ferrum, Strichnos (pp. 78- 83); and a pessary , provided a morbid condition of the part does not forbid its use. Sometimes an india-rubber ball is preferable, as it is soft and unresisting. Care, however should be taken, that the air is squeezed out, and that the hole is looking towards the vulva, so that it may again become distended, as soon as it is prop- erly lodged in the vagina. Moreover a string should be attached to it, that the patient may be able to re- move it daily to have it cleaned. If the uterus thus has been fixed, a cold hip-bath and morning and night an injection of cold water or Alum and Zinc in connec- tion with a cathartic — Rheum cum Aloes (197 & 216) will do a great deal of good. Before resorting to a pessary the patient should be kept in the recumbent posture for a few days with the feet of the bedstead elevated about six inches, for the purpose of allowing congestion to 420 Uterus. pass off. At the same time mild cathartics (p. 91) to remove fecal matter and stimulate circulation, may be given with astringent vagina/ injections to harden the tissues for the reception of the pessary, and to cause contraction of the distended superficial blood vessels of the vagina. If the weight of the uterus be but moder- ate, an internal pessary will do— Meig's elastic ring, Hodge's, Smith's, etc. — provided it does not distend the vagina, and can be worn without discomfort. It should however be kept clean by irrigation with an astringeut at least once a day, and should be examined from time to time, to make sure that it is not cutting into the tis- sue. If the uterus be too heavy or the prolapse of the 3d degree (procidentia, uteri), Cutter's pessary with a stem curbing over the perineum, will be preferable. The cup at its extremity receives the cervix, and the in- strument can easily be removed at night, and replaced in the morning by the patient herself. As regards the means for preventing traction by the vagina, partial re- lief may sometimes be obtained by applying to the weak part a pad or cushion filled with cotton, hair, or air, com- bined with an abdominal supporter, to which it may be attached. In Procidentia, especially during pregnancy, a soft compress with a T bandage, for the support, to- gether with a mild aperient to keep up a soluble state of the bowels. The proper remedy is, of course, the res- toration of the perineal body (perineorrhaphy), and the narrowing of the vagina (elytrorrhaphy). Simple Prolapse may sometimes be cured in from six to eight weeks, by the daily performance of a process of massage and uterine elevation in conjunction with cer- tain gymnastics. The elevation of the uterus cannot be Displacements. 48 1 carried out without the aid of an assistant, who, with one hand, has to push up the uterus in the vagina, keep- ing it in a state of anteflexion, while he puts his other hand on the abdomen, exactly over the uterus. The operator, standing at the foot of the table, on which the patient is lying, lays now his two hands, strongly supinated, flat on the abdomen, the fingers being point- ed towards the pubes, and grasping the fundus between them, raises the uterus gently but steadily upwards, in the pelvic axis. When the organ has been elevated as far as is possible (which may be as much over its normal level, as it had been prolapsed), it is allowed to slip from between the hands, and sink slowly until its de- scent is arrested by the assistant's finger, which has re- mained in the vagina to fix, and keep it in a condition of anteflexion. This movement of elevation is repeated two or three times at each sitting, a few minutes inter- val being allowed between each, during which time the assistant massages the fundus in order to stimulate it to contract. To carry out the second or gymnastic move- ment, the patient should be placed in the exaggerated stone position, and closing the knees and thighs, she should elevate the sacrum, so that the body rests on the elbows and feet only. In this position, the operator forcibly separates the knees, whilst the patient resists him as much as possible. Having repeated this proced- ure about three times, a contrary movement -the pa- tient lying with the knees widely separated, and the oper- ator bringing them forcibly together — is now practiced for as many times; when the patient should turn over on the face and remain in that position for about ten minutes, which closes the sitting. 422 Uterus. Inversion is generally a cause of mismanagement in the removal of the placenta after childbirth. The uterus should be fixed with one hand near the symphysis pubis, whilst the tips of the fingers of the other hand are plac- ed in the middle of the projecting part and pushed up- wards, indenting the uterus until the point has passed through the os, when it will get into its place as easy as possible. When the uterus is again right, the hand must not be retracted too suddenly, as it might invert again. The bowels should be kept in a soluble state by salines (218). Uterine Colic. See Menstruation and Ovaries. Uterine irritation is mostly a consequence of de- fective menstruation, and liable to produce a host of nervous disorders — neuralgia, convulsions, paralysis, even epilepsy. At each menstrual crisis the peripheral extremities of the spinal nerves, which are distributed on the cervix uteri, as well as the extremities of the sym- pathetic, which pass to the upper portion of the womb, being subjected to unusal irritation, this irritation may be transmitted directly by the spinal nerves, and indi- rectly by the sympathetic filaments to the brain and spinal marrow. Treatment is directed to the causative disease — Potassa (p. 54); Brom (p. 26); Morphia (255); Arsenic (p. 10); Argentum (p. 74); etc. Locally suppos- itories of Iodoform or Belladonna (374 & 75). Endometritis acuta is characterized by a swollen and very sensitive cervix; a discharge clear and albu- minous-looking, or consisting of long tenacious shreds of cervical mucus, which comes from the gaping os uteri; accompanied by pain in the back, and groins; burning in the vagina, which sometimes is very dry and Inflammations. 423 hot; and vesical and rectal tenesmus. Occasionally there is tympanites or diarrhoea, due to reflex irritation of the rectal nerves. It is caused by direct injury; cold from exposure during menstruation or stoppage of same; ex- cessive venery; etc., etc.; and may be complicated with vaginitis, cystitis, pruritus vulvae and various eruptive disorders. When occurring in the non-puerperal state, it may without treatment go on to recovery; some- times it will eventuate in the chronic form of mucous inflammation, or in a slight hyperplasia; but if the in- flammation should extend, it may even prove fatal. Treatment — Complete rest; a warm linseed poultice cov- ered with oiled silk, over the hypogastrium; and for the relief of pain, Opium (p. 37). No cathartics unless con- stipation. As soon as the discharge becomes more co- pious, emollient injections (358) three times a day. Chronic Cervical Endometritis — Cervical Leucorrhoea is characterized by a glairy mucus, discharged by the glands of Naboth, which are especially involved in the morbid action, producing soon abrasion round the os. The hypertrophy, which by degrees develops in the villi, is called granular degeneration. The usual symp- toms are, dragging sensations about the pelvis, pain in back and loins and menstrual aberration. Sooner or la- ter nervousness will supervene and sometimes a disor- dered digestion, coupled with nausea and even vomit- ing. Occasionally the disease is complicated with an ever- sion of the os and lower portion of the canal to such an extent as to keep up inflammation there by the friction of the membrane thus exposed, against the floor of the pelvis. Other complications are a very troublesome va- ginitis, cystitis and a cervical hyperplasia, which will 424 Uterus. produce great pain during coition. Of the many causes, which give rise to this disease, may be named artificial abortion, excessive coition, vaginitis, obstructive dys- menorrhea, laceration of cervix, polypi, displacements, and pessaries. Though an alterative influence, which ex- erts a complete change in the economy, as parturition, a change of habits, and the like, may result in a cure, the disease is usually very obstinate — the mildest case last- ing about six months under the best treatment; and in multiparous women it generally passes into cervical hy- perplasia with its train of ailments, which will cause a •life of misery. Treatment — Saline cathartics combin- ed with tonics — Magnesia (219), to keep the bowels in a soluble state; Acid, nitro-mur. (p. 11) in enfeebled digestion; &n&Brom (p. 25 et seq.), if much nervousness; with emollient injections (358) twice a day as in endo- metritis. If the os be contracted, it must be above all dilated, which is best done by snipping the external fibres of the os with scissors for one-fourth of an inch, touching the raw surfaces with caustic, to prevent union, and keeping a plug of greased lint or cotton in the ca- nal for a week; or a tent (p. 130) or sponge may be used, as they, to a certain extent, are also free from danger, as long as they do not penetrate the os internum. After dilatation the mucus may be removed in the following manner: After having slipped upon the extremity of a long-piped hard-rubber syringe (of 1 oz. capacity), which can be worked with one hand, a bit of gutta-percha tubing, the free portion of which projects half an inch, it is introduced as far as the os internum, when the pis- ton is powerfully retracted. If the matter is purulent or starchy and not tenacious, a stream of water may be Inflammations. 425 projected from this syringe against the cervix, and the whole removed by suction; or this may be done by a small pledget of cotton, wrapped round a probe. The latter instrument will also answer for the application of the remedial agent to the canal — a strong solution of Zinc, Salicin or Iodine (343, 348, 354 & 55). A very good plan is to rub a probe, coated with caustic, against every part of the investing membrane, and dipping it carefully in its convolutions. After the application a stream of water should be projected against the cervix, after which some cotton saturated in Glycerine (369) may be placed over it. The cotton has to be removed in twelve hours (by means of a thread which has been attached to it for that purpose). Or the probe with the cotton, which has been soaked in the solution selected — zinc, copper, iron, lead or bismuth with opium, con- iura, or hyoscyamus, etc., etc. — is passed into the cervi- cal canal so as to engage within the os internum, when the cotton may be slid off by means of the slide and left within the canal. After twelve hours it has to be removed. In cases where a glairy and very tenacious plug of mucus is hanging from the os, the glands must be de- stroyed with Acid, nitric, fumans or chromicum (344). This has to be followed, like the other applications by an injection of water and a wad of cotton. In ten days or a fortnight a slough of the cervical mucosa will take place, after which the surface should be painted over twice a week with Argenti Nitras. If these means should prove ineffectual, the glands must be removed by Sini's curette. Chronic Corporeal Endometritis {Uterine Catarrh or 426 Uterus. Uterine Leucorrhced) — Internal Metritis lasts generally for years; and though it may confine itself to the mucous membrane, as arule it will gradually excite congestion and exuberant growth in the adjacentparenchyma — hyperpla- sia; sometimes a want of nutrition may take place, event- uating in distention. Barring the pain in the back, groins and hypogastrium, there is often tympanites, symptoms of pregnancy and nervous disorders — especially neural- gia confined to the crown of the head. The most prom- inent symptom however is a profuse leucorrhcea more or less tinged with blood, particularly for some time after menstruation, which latter is also faulty — either pro- fuse or too scanty. The most frequent complications are: Displacement, granular degeneration of cervix, vaginitis and pruritus vulvse. Treatment is similar to that of cervi- cal endometritis: Improvement of general health and lo- cal applications — Chrom, Zinc, Ferrum (344 & 48); and hot douches. Internally, Strychnos (172), but without Ferrum, if menorrhagia; and other tonics. As regards intra-uterine injections, they should never be made with- out securing an immediate reflux (by a double-canula sy- ringe), the os internum must be properly dilated, or a tent (p. 130) must be previously used. In fact, injections should never be used in a sharply flexed uterus before replacement, never just before or after a menstrual pe- riod; and never when pelvic peritonitis or periuterine cellulitis has recently existed. At the same time care should be taken never to inject with force, and to allow no air in the syringe. It is best to begin always with a weak alkaline injection of warm water (not below 85°) to test the tolerance of the uterus; and the organ should always be washed out before a stronger solution is used, Hyperplasia. ±21 which should be of the same temperature. The patient has then to lie down until all sense of discomfort has passed; if however there should be uterine colic or pain of some sort, Opium must be given freely. Intra-uterine scarification is another way of assisting the cure; but if there are fungoid granulations, mucous cysts or po- lypi, the little copper curette is preferable. Areolar Hyperplasia of the Uterus — Chronic paren- chymatous Metritis is no inflammatory process, but con- sists of a proliferation or hypertrophy of the areolar or connective tissue of the uterus, accompanied by con- gestion and nervous hyperesthesia. It is, as a rule, a consequence of subinvolution; but it may result from displacements, cervical endometritis, or sexual inter- course; from the latter, when excessively indulged in, shortly before or after the menstrual period, as the uterus, being an erectile organ, is subject to active phys- iological congestion. Sometimes cardiac diseases and abdominal tumors, which produce blood stasis and oedema in the feet, the labia majora and the parts about the vagina, will affect the uterus in the same way. Cer- vical Hyperplasia is characterized by a swollen and pain- ful cervix, which may be as large as a small orange and fill the vagina, compressing the rectum to such an ex- tent, as to interfere with its functions. On account of the displacement caused by the great weight, the con- gestion is still increased, and the patient suffers, until the menopause at least from endometritis, granulation and the ordinary symptoms of displacement — some- times however atrophy will take place. If the affection be general or corporeal, the symptoms attendant on the mentioned diseases are still of a graver nature: A dull, 428 Uterus. heavy, dragging pain through the pelvis, much increased by walking; pain in defecation and coitus, before and during menstruation; pressure on rectum with tenesmus and hemorrhoids; on bladder with vesical tenesmus; nausea and vomiting; darkening of the areolae of the breasts; great nervous disturbance and sterility. Neo- plasms and periuterine inflammation may be confounded with corporeal hyperplasia in its first stage; the latter however will fix the uterus, create hardness and swell- ings in the iliac fossae and pouch of Douglas; whilst in fibrous growth, conjoined manipulation and the sound will assist in the diagnosis. Internal metritis may be also suspected in comparative young women, though all the signs of early pregnancy are present, provided men- struation is not suspended. The second stage of areolar hyperplasia or sclerosis might be confounded with scir- rhus; but there is no cachexia, nor tendency to hemor- rhage; and a sponge-tent will soften the tissue and not leave the cervix hard. Treatment must be first directed towards the complications, which usually accompany hyperplasia (the more so, as in most cases nothing be- yond can be done) — displacements, fungoid growths, granular degeneration, laceration of cervix, and vagini- tis. Prolapse will be benefited, by means of Meig's pes- sary; retroversion by Hodge's double lever or one of its varieties. Fungoid growths, this source of congestion, metrorrhagia and leucorrhoea must be removed by gent- ly scraping the whole cavity with the wire-loop curette] and laceration of cervix, which aside from congestion, causes not only neuralgia but intense nervous irritation, both, immediate and reflex, and which is frequently over- looked, especially if the excoriated walls of the cervix Hyperplasia. 429 have been treated for some time by caustics, should be repaired by fixing in the parts of the severed lips tena- cula and then to approximate them as accurately as pos- sible. Before the suture is applied^ their inner surf toes have to be, of course, thoroughly pared. The complica- tions being removed, there remains a large, heavy uterus, the tissue of which is exuberant, the blood vessels en- larged and the nerves in a condition of hyperesthesia. This state requires, barring general treatment with rest, great discrimination with regard to local applications. If the uterus is very tender a few ounces of blood may be taken occasionally by puncture or scarification: A sharp and narrow bistoury or tenotomy knife is passed up to the os internum, and cutting through the mucous membrane and the superficial layer of muscular tissue, it is withdrawn through the external os. In cases of amenorrhoea, three or four leeches may be applied through a speculum of sufficient size to contain the en- tire vaginal portion of the cervix, after the latter hav- ing been thoroughly cleansed and the os been plugged with a pledget of cotton, to which is attached a thread for removal. Now a few punctures should be made in- to the cervix, the leeches thrown in and the speculum filled with some cotton, pushed towards the bleeding surface. When they have ceased sucking, all clots of blood should be removed by a sponge or some cotton, and after the withdrawal of the speculum, a large sponge, squeezed out of warm water, should be placed over the vulva. After this, in fact, after any kind of lo- cal depletion, the patient should be kept for some hours perfectly quiet. Once a week an alterative — Tinct. Jodi comp. or Iodoform (346)^ may be applied by means of a 430 Uterus. brush of pig's bristles to the os internum; or even to the fundus, should endometritis exist, and over the whole cervix, to be repeated as soon as it has dried, and then covered with a tampon (369), Should the hyper- aemiabe persistent,counter irritants — vesicating collodion, prepared with Acidum aceticum may be applied by means of a camel's hair brush to the whole vaginal cer- vix and os, followed a few minutes after by a stream of cold water, projected upon it to prevent any escape into the vagina. Afterwards the Glycerine-tampon should be applied for its hydragogue effect, whilst the patient is kept perfectly quiet for several days. The vagina must be cleansed with warm injections, and as soon as the discharge shows a tendency to cease, the blistering may be repeated. Vesication may be also produced by ap- plying Argentum nitricum, which after having destroyed the epithelial covering and sloughed off, leaves a gran- ulating surface, that may be dressed with glycerine or any of the alteratives. If injections (358) are used, they may be put in a tub, across which there is a board for the patient to sit on. Instead of Davidson's syringe, a fountain syringe is often preferable, as the patient may then lie on a lounge, with the buttocks projecting over its edge and the feet supported upon the floor, without tiring herself with the working of the instru- ment. If the cervix should be too bulky, a, part of its vaginal portion may be removed by encircling it with the galvano -caustic wire. As regards the general treat- ment, ferruginous and vegetable tonics — Potassa, Acid, sulf. (155 & 173-177) in case of spanaemia; and altera- tives to the bowels in conjunction with a nourishing diet may be tried. During the stage of enlargement Degeneration. 431 (before contraction of the exuberant tissue has occurred), Ergot (p. (So) will be of value, if kept up for some time. Chronic (soft) Engorgement from passive congestion with loss of tonicity in the blood vessels, which is always accompanied by profuse menstruation, and not uncom- mon in the climacteric period, requires cold injections into the rectum (about 8 oz.); internally Tinct. Ergotce ( 3 j bis die), and regulation of bowels. Sometimes Ruta or Borax (pp. 3S & 55) will answer very well — In chronic engorgement with amenorrhoea, a dozen of leeches ap- plied to vulva, and the bleeding to be promoted by fo- mentations, with Calomel (p. 92) at night, if necessary or salines (p. 96) as circumstances may indicate; and the whole procedure to be repeated at the time of the ex- pected menses, when there is much bearing-down pain. In induration or hard engorgement, revulsive bleedings from the arm every fortnight with saline aperients, or slight scarifications twice a week, if necessary; but the best remedy perhaps is Hydrargyrum jodatum flavum (12) if not contra-indicated by the general state of health. Granular Degeneration of Cervix presents various forms: In abrasion the epithelial covering is removed and the villi are destroyed; if the papillae increase in size and project like granulations, the looped capillaries, which they contain, become also hypertrophic and va- ricose and naturally bleed easily, constituting the vari- cose idcer. If the surface becomes coated with a false membrane, it is called the diphtheric ulcer. E version of the cervix with increase of the villous hypertrophy in the crested folds of the everted membrane represents the fungous ulcer or coxcomb granulation. The light forms may produce no symptoms whatever; however 432 Uterus. the severer ones will be characterized by more or less pain in back and loins; leucorrhcea, profuse menstrua- tion; sometimes hemorrhage after intercourse; tendency to anaemia; nervous disorders and perhaps hysteria. Bar- ring diseases which keep the villi of the cervix con- stantly bathed in an ichorous fluid, cervical degenera- tion will be caused by any influence producing conges- tion of the uterus, or anything, which keeps up friction against the cervix. On the other hand, the affection will keep up a hyperemia in the neighboring parts, and will even exert a reflex influence on the ovaries. Treat- ment — Aside from special attention to the general health, copious injections should be made daily — Zinc, Alum, Tannin, etc. (359); sometimes suppositories are of use (35V). Argenti Nitras (343) with a coating of styptic collodion (415) may be applied once a week. (The latter does not only protect the part from friction and dis- charges, but acts also as a direct alterative, and dimin- ishes congestion by compressing the excoriated villi with their increased vascularity). Other alteratives are: Cuprum, Ferrum, Iodine, Phenol and Chrom (344, 47, 48, 51 &67). In simple eversion the hemorrhoidal mucous membrane must be destroyed by touching it with Acid, nitric, fumans (329); or it may be cut off with scissors. If it be due to laceration, the edges of the cervical fis- sures should be accurately united by deep sutures of sil- ver wire, after having pared them with long scissors. In coxcomb granulation, the growths must first be snipp- ed as close as possible to the mucous membrane with a pair of long-handled scissors, or scraped off by means of a steel curette, before making the local application. If the congestion can not be mastered by means of the Subin volution. 433 various applications, a few superficial incisions in the sub mucous tissue of the cervix with a curved bistoury, as indicated in hyperplasia, may be tried. Well fitting pessaries, supporters, etc., will occasionally be of value. Cystic or Follicular Degeneration, called also Acne, Her- pes, or Aphthae, of the Uterus, is an inflammation of the mucous glands of the vaginal cervix, characterized by a number of vesicles of the size of a millet seed, which after bursting, leave depressions, where the papillae un- dergo hypertrophy and appear like red, elevated tuber- cles of the size of a hemp seed. The disease is gener- ally secondary to cervical endometritis, hyperplasia and granular degeneration. Treatment — The cysts should be opened with a bistoury and then thoroughly cauter ized with Arg. nitr., Chrom,ov Hydr. nitr. acid, (344). If this should be of no avail, the vaginal face of the cer- vix must be removed by means of the bistoury, scissors or still better by the ga/vano -caustic wire. Cystic Degeneration of the Chorion is called the pe- culiar metamorphosis of this membrane, which it may undergo, when, having remained attached to the uterine walls after expulsion or death of the embryo. See Hydatids. Subinvolution — The uterus is said to be in this state, if, after delivery, the retrograde evolution has been checked or retarded by certain influences, so that it re- mains flabby and large. About the fourth day after the birth of a child the muscular fibres of the uterus be- gin to undergo fatty degeneration, the fat thus formed, is absorbed and the organ usually has required its nor- mal size about the eighth week. Subinvolution consti- tutes the chief cause of all chronic uterine disorders. 434 Uterus, Treatment — Ergot (p. 65) with or without injections of hot water (358); Uva Ursi (151) is sometimes used, and Cacao locally (354). See Areolar Hyperplasia. Stricture of the Cervical Canal, which is one of the causes of dysmenorrhoea and sterility, maybe remedied by means of graduated bougies, tents (pp. 129 & 130), or expanding instruments; sometimes a superficial incision through the whole course of the canal (with a narrow- bladed bistoury, if a hysterotome be not at hand) may be necessary. A sound should be left in position for several minutes, and upon its removal, another may be inserted, until the distention deemed practicable at one sitting is attained, which ought to be done at least ten times at intervals of from 5-7 days. Or a small-sized metallic male catheter may be glided on the index finger of the left hand previously introduced into the vagina. On reaching the os the handle must be de- pressed in order to give an upward direction to the curved portion of the instrument corresponding to the axis of the uterus. After having entered the cervix, a few oscillatory movements may be given to the instru- ment, and then it may be withdrawn. If very painful, Chloral (365). See Dysmenorrhoea. Imperforate Os Uteri unless congenital, is the result of injury, as injudicious probing the womb, which is sometimes done by women in order to abort, and which may result in closure of the canal. It will soon cause enlargement of the womb from retained menstruation, (Haemometra), accompanied with symptoms of pregnan- cy, as morning sickness and tumefied breasts, which ha° to be borne in mind in cases of young girls whose repu- tation is criticized, Diagnostic is the closure, resp. Neuralgia. 435 entire absence of the two lips of the os, instead of which there may be found in the middle and lower portion of the uterus, corresponding with the os, a slight circular depression. Treatment — The index finger of the left hand being introduced into the vagina, up to the central and lower portion of the cervix, to serve as guide, a curved trocar is carried with the other hand and made to penetrate the womb from below upwards, parallel to the axis of that organ. In order to prevent the closure of the cut, a soft bougie must be kept there for a few da^s, whilst the patient remains in a recumbent position. Ilgdromctra is produced by the accumulation of the fluid (secreted as a consequence of chronic endometri- tis) due to some obstruction in the cervical canal, and occurring frequently in elderly women. Aside from the enlargement, there will be from time to time colic pains of a bearing-down character. Treatment— Jiz moval of the liquid by means of sounds, tents or trocar. Physometra signifies the accumulation of gas in the cav- ity, easily to be recognized by the tympanitic sound on percussion. Treatment — After removal of the gas, Mer- cury (p. 12) until ptyalism, followed by Acid, nitric, (p. 9) and tonics (p. 61). Neuralgia of the uterus is characterized by pain, in- creased by sexual intercourse, and accompanied gener- ally by a mucous discharge. Sometimes there is a pain in the back, sometimes in the lower portion of the ab- domen or in the loins, sometimes it is limited to the urethra; it may go and come; it maybe periodic; and it may be so severe as to make coition impossible — it may even produce convulsions or mania. This rheumatism of the womb or hysteralgia has an analogon in the 436 Uterus. specific pain of the testicles in the male, and in the neu- ralgia of the labia externa in the female; the former be- ing propagated through the ileo-scrotal, and the latter through the ileo-pudendal nerve from the lumbar region. The catarrh is here but the result of a peculiar state of the uterine nerves, like the increased secretion of saliva, s affected by a savory dish. Treatment — If sympto- matic of disease of the womb, this has to be attended to; otherwise powerful revulsives to the spine, as a ni- tric acid issue on the side of the lumbar vertebrae, with cauterization of the os uteri or even an incision of the cervix. Ungt. Belladonnce or injections of Opium (381) will occasionally relieve. If marked by periodicity, Quinine (p. 11). Rupture of the womb is accompanied by severe pain and a noise like a loud click, and the child will be felt high up near the umbilicus. Here is Ccesarian section indicated and prompt action necessary: A cut of six inches at least should be made, if necessary to the um- bilicus, but half an inch on the side of it. After remov- al of the child, with placenta, the blood, Liq. Amnii, etc., the uterus must be sown up again, as the stitches will not hurt in the peritoneal cavity. Moles are generally made up by polypoid and fibrous growths, blood clots, and the membrane of congestive dysmenorrhoea; but sometimes they are connected with pregnancy, when they consist of a part or the whole of the foetal shell or placenta. As a rule, the whole of the products of conception is swept away by uterine cop tractions, in case the life of the foetus has been destroy- ed by adverse influences; sometimes however the shell of membranes will cling to its attachment and become Hydatids. 43-, to a certain extent organized, to be expelled as an an- omalous substance, which resembles the product of con- ception at the second month. The condition may be suspected, when, aside from uterine enlargement there appear menorrhagia or metrorrhagia, hypogastric weight and uterine tenesmus with uneasiness; and in cases connected with pregnancy, cessation of the signs be- longing to that state. Treatment — After having prov- ed its existence by microscopical examination of a small piece of the mass, removed for that purpose (if necessa- ry), the cervix should be fully dilated by tents (p. 130), and uterine action caused by the persistent use of Ergot (p. 65). Should this fail, the mass must be removed with a large uterine scoop, or by traction with the pla- cental forceps. Hydatids consist of small, oblong sacs, which are pedi- culated and distended by a serous fluid, so as to appear like a bunch of grapes; and if due to the presence of the acephalocyst, very dangerous on account of the hemor- rhage, which generally is more profuse than that occur- ring at child-birth. See Cystic Degeneration of Chor- ion. Aside from the usual signs of pregnancy, as en- largement of the womb, nausea and vomiting, which are associated with this disease, there are at certain in- tervals bearing-down pains, accompanied by a discharge of a watery liquid, which constitutes the distinctive fea- ture; for, as the hydatids increase in volume, the most dependent ones will irritate the neck of the uterus, thus causing contraction and their rupture: hence the period- ical discharge of water. During the process of expul- sion of the hydatid masses, there is generally profuse hemorrhage. See the latter for treatment. 438 Uterus. Polypi^ which always give rise to irregularities in the menstruation, especially to much loss of blood, vary in size from that of a pea to that of a foetal head. In the mucous species, which is essentially vascular, there is more loss of blood, than in the fibrous type, though the hemorrhage is by no means in proportion to the size; on the other hand, the menses will invariably be more abun dantthan usual, since at that time the mucous membrane, which invests the tumor, becomes naturally congested. Aside from the hemorrhage there is frequently a mucous discharge — a result of the irritation, to which the mucous lining is subjected — and bearing-down pains, if its size and situation should be such as to cause contractions of the uterus. In addition there may be irritable bladder and in proportion to the existing anaemia, prostration, palpitation of the heart, etc., etc. Treatment — When the existence of the growth has been ascertained by means of a sound, Ergot (p. 65) should be given, to throw it into the vagina, where, guided by the index finger of the left hand, its pedicle may be seized with the smaU calculus forceps and twisted off. Afterwards vaginal injections of cold water twice a day with tonics (p. 76) internally. If the finger can be insinuated within the uterus, and a stalk be found, the ligature may be applied, and the pedicle will slough in about thirty-six hours. (If pain, the ligature has, of course, to be loosened again, as in that case, the polyp being insensible, the cervix would be implicated). If however the parts are very much relaxed, and the tumor small, it may be removed by torsion with the finger. If a polyp has been excised and there is much bleeding, the stump of the pedicle may be twisted once or twice by means of forceps. A Tumors. 439 polypus of the mucous species can be brought away but by fragments, as it is too soft and has no resistance. The removal should be followed by a cold injection daily for a few days. See Hemorrhage. The fibrous tumor, which develops within the uterus or on one of the lips of the os, is covered by mucous membrane; if it grows from the external surface of the womb, it is covered by peritoneum; and the insterstitial has its origin amid the muscular fibres of the organ. Whilst the ovarian tumor is situated in one of the iliac fos- sa?, the fibroid lies centrally; in the former the os uteri be- comes elevated, in the latter it is thrown downwards. The whole train of symptoms, indicating gestation, may be occasioned by the enlargement of the womb, produc- ed by its presence except the peculiar empJnjsematous con- dition of the areola of the breast, so characteristic of pregnancy — frequent desire to pass water; constipation with painful evacuation; swelling and feeling of numb- ness in the lower limbs, and suppression of menses. There may be hemorrhoids, prolapse of the mucous membrane of the rectum, and profuse hemorrhage with great emaciation. The bladder will sometimes become so much distended, that ureters and kidneys may be in- volved, so as to produce coma. Treatment — As the tu- mor is occasionally spontaneously absorbed, Iodine (p. 15) may be tried, with Unguentum mercuriale (353). Sometimes it may be expelled hy Ergot (p. 65). If the tu- mor projects into the vagina, or is within reach of the fin- ger in the cavity of the womb, it may be separated with the finger or knife, after having divided the mucous membrane. For Cancer of tlie Womb and JB foody Tutn&r of the pelvis see Carcinoma, resp. Hematocele. 440 Uterus. Parametritis — Periuterine Cellulitis or Periuterine Phlegmon, consists in an inflammation of the adipose and areolar tissue of the broad ligaments and of that im- mediately in contact with the uterus at its junction with the vagina and bladder; and is in severe cases general- ly associated with pelvic peritonitis, ovaritis and salpin- gitis. Exclusive from parturition and abortion, it may be caused by direct injury from coition, caustic applica- tions, pessaries, operations or blows; and it may be sec- ondary to metritis and ovaritis. Parametritis may re- sult in destruction or atrophy of the ovaries, and in a permanent displacement of the uterus in consequence of strong adhesions,the productof the inflammatory process. Cellulitis proper usually passes off in, from two to three weeks by resolution; but if suppuration sets in, it w^iil ran a most tedious course; and any one of its complica- tions may become chronic. In acute cases, following parturition, suppuration may take place in a few days; though generally it does not occur for two or three weeks. The symptoms depend as a rule, on the severi- ty of the disease; but though the acute form may show all the signs of inflammation, fever, chills and pain, combined perhaps with dysuria or metrorrhagia, there are cases, marked only by extreme weakness, some sense of pulsation with weight about the pelvis, and hectic in the evening. In the chronic form, there may be for months after delivery general weakness with fever towards evening, but without pain; only now and then a throbb- ing, especially tension and weight about the organ, which is increased by walking, defecation, and urination, will remind the mother of her past trouble. At the be- ginning of the disease, a very sensitive little swelling may Abscess. 441 be detected on one side of the uterus by conjoined ma- nipulation (p. 125), which, as effusion (the second stage) advances, and induration occurs in the areolar tissue af- fected, will form a tumor as large as a walnut or orange, situated in the tissue around the cervix, or in one of the broad ligaments. In the third stage the uterus will be found more or less displaced in the direction opposite to the accumulated pus. (In a chronic case, the effused matter may remain hard for months, withont showing signs of softening). Treatment — Before effusion, or at least before its complete organization, leeches should, in the case of a strong patient, be at once applied to the hypogastrium, followed by poultices every hour or two. Internally Salicin (p. IS), in conjunction with refriger- ants and sedatives- Nitre, Aconite, Veratrum or Gelsem- ium (pp. 56, 22, 33 & 39). Opium (pp. 37 & 110) through- out the acute stage to relieve pain and keep the bowels constipated. Afterwards Jod or Brom (pp. 15 & 27), and laxatives (p. 88), especially Mercurials (p. 92) to keep the bowels in a soluble state and to disgorge the veins of the pelvis by acting on the liver. A valuable auxiliary will be the warm douche for fifteen minutes twice a day, which in the latter part of the disease may be slightly medicated with common salt or Tinct. Jodi. The treatment of the suppurative stage is indicated in the next paragraph. Pelvic Abscess unless consisting of tuberculous ma- terial, deposited somewhere in the pelvic tissue, is either the result of a suppurative action in the walls of a cavi- ty formed by an ovarian cyst or hematocele; or, what is most frequent, it is an inflammatory suppuration in the areolar tissue, the ovaries, tubes, the pelvic peritoneum 442 Vaccination. or the parenchyma of the uterus. The formation of pus is characterized by the symptoms of abscess in other situations: Chills, followed by fever with profuse per- spirations, etc., etc. When left to themselves, these ab- scesses may open spontaneously and discharge through any part, viscus or foramen, and gradually heal (those, which result from puerperal cellulitis, usually discharge through the abdominal wall, whilst those, occurring in the non-puerperal form, open mostly into the vagina or rectum); or they may burrow into the tissue, to open by long fistulous tracts into some organ, as the large intes- tine or sigmoid flexure, or they may discharge into the peritoneum. Treatment — A generous diet, alcohol and tonics (p. 72). If it be decided to open the abscess, the patient should be placed on the left side, and Sim's specu- lum being introduced, the pus be drawn off by aspira- tion. If there is any doubt about the nature of the tu- mor, it should be previously explored by means of a hy- podermic syringe or an exploring needle. Whether the vagina, rectum or the abdominal wall be chosen for the operation, an anaesthetic to insure perfect quietude, will be essential to a safe cure. If the abdominal wall is to be opened by trocar or bistoury, adhesion of the layers of the serous membrane should be caused first by means of a nitric acid issue. After removal of the pus, the sac may be filled with Tinct. Jodi et Aqua 7, to be drawn off again at once; and to prevent closure of the opening, it may be touched with Arg. nitr. or Sol. Ferri persu/f.', or some rubber tubing may be left in it. Vaccination — The matter should be taken on the seventh or eighth day, before an inflamed areola is spread around the vesicle; and it should be lymph, clear Vagina. 443 and transparent, not purulent or discolored by blood. If it is desired to preserve the lymph, it may be taken on ivory paints or pointed quills; or, what is still better, it shouldbc withdrawn from the vesiclesin glass capillary tubes, which are to be sealed at once by means of a spir- it-lamp. The scab, which exfoliates, and falls off be- tween the eighteenth and twenty-fifth day, made into a paste with water, is also used; but the lymph is to be preferred to the crust, though inclosed in wax, and cov- ered with tin foil, the latter w T ill retain its activity for a considerable time. As regards the introduction of the virus, the situation for it should be on the outside of the left arm, near the insertion of the deltoid, and should be done by means of slight punctures or minute scarifica- tions, made with a common lancet, or by scraping away the epidermis with the ivory point, having before moist- ened the dried lymph by a momentary exposure to steam. It need scarcely be mentioned, that, whenever possible, the lymph should be applied directly from one arm to another. Vagina — Tv/^/^^^^^^^consistsinanexquisitesensibility of the vagina, due to a hyperoesthetic condition of thecar- unculse after laceration of the hymen during normal coi- tion, which whenever touched, causes irregular or spasmo- dic contractions of the organ, so that even a finger can- not be introduced. An attempt at intercourse is utterly impossible, on account of the agonizing pain the act produces. See Dyspareunia. Treatment — In the symp- tomatic spasm, which is continuous, and may be the result from disease of the uterus, vagina or rectum; even from hemorrhoids and prolapse of intestines, the cause must be removed. The idiopathic form, which is 444 Vagina. of an intermittent character, requires injections of warm water, medicated Or not (365); Belladonna or Iodoform (350 & 56); or Cocaine (330) and other soothing appli- cations. Sometimes it may be necessary to remove the hymen with scissors, or to incise the perineum. In most cases it will be sufficient to introduce into the vagina a large plug of cotton or a conical glass speculum to be re- tained there, by means of a T bandage, for about half an hour every day. Should the introduction of the plug or dilator be too painful, the patient must be anaesthe- tized, and the ostium vaginm distended by a trivalve or quadrivalve. Vaginal Discharges are either mucous, purulent, muco- purulent or watery, according to the part affected, and the disease, which gives rise to it. In addition to the causes enumerated under the head of leucorrhoea, there may be mentioned still a mucous discharge due to salpin- gitis, when the products of inflammation escape through uterus and vagina. In these cases a tumor generally marks the position of the Fallopian tube, resp. tubes, and considerable pain about the part, followed by a sud- den sensation of giving way usually precedes the dis- charge, which at these times is more or less profuse. In children a mucous discharge frequently accompanies scarlatina and other exhausting diseases; sometimes it is connected with dentition, if there be a scrofulous habit, and occasionally it may be traced to want of cleanliness; but the most common cause is without doubt local irritation, in consequence of the presence of thread-worms in the rectum or their migration into the vulva. Treatment — Aside from Zinc (338) locally, en- emata (377) with Calomel, followed by 01. Ricini every Vaginitis. 445 third night, if due to worms. In scrofulosis Mercury, Iodine or Potassa (pp. 13,15 & 18), preceded by a cathar- tic (p. 93). Vaginal discharges in adults are more fully discussed in the paragraph on leucorrhoea. If from nervous disturbance, it must be treated with applica- tions to the spine, blisters, cauterization, issues, or the red-hot iron. If it be due to excrescences in the vagi- na and vestibuhtm — a result from want of cleanliness, chronic inflammation of those parts, or sequels of ven- ereal disease — applications of Cuprum (340) will be of service; or the warts may be ejrc/se(/with a pair of curv- ed scissors, whilst they are grasped with a tenaculum or a pair of small forceps, and the cut surface cauterized with lunar caustic. Vaginitis catarrhalis, which may be produced by ex- posure to cold, injury from parturition, pessaries or coi- tus, disordered state of the blood and the like causes, is characterized by more or less swelling of labia and va- gina, throbbing heat and great tenderness on intro- duction of the finger, in conjunction with excoriations of the part around the vulva, profuse purulent leucor- rhoea, frequent desire to pass water, and violent pel- vic pains. Sometimes the inflammation extends to the cervix uteri, and the speculum will usually reveal the vagina much congested, its surface abraded, and in severe cases covered with follicular ulcerations. Urethritis, endometritis, salpingitis and pelvic peritonitis may be complications. The specific form, caused by infection, cannot be differ- entiated from a discharge arising from intrinsic sources; but may be suspected if the inflammation develops with great activity and violence especially in women, 446 Vagina, previously free from vaginal discharges; if it be accom- panied with marked urethritis and bubo; and if it has been trasmitted to the male by coition. The granular form is generally chronic, and without being necessari- ly specific, may produce in the male gonorrhoea. When occurring during pregnancy, accompanied by i^ruritus vulvce and lichenous eruptions about the pubes, this form will, after parturition, usually disappear without medication. Treatment — In the acute stage, a cathartic (pp. 92 & 96); or Mitre (p. 56) in conjunction with soothing injec- tions (358), and if necessary anodyne suppositories in rectum (375). To relieve ardor urince, akalies (p. 54). Later, Copaiva (p. 48), with astringent injections (336 & 361). In severe cases, whether specific or no, or chronic ones, if very obstinate, it may be required to paint the vagina twice a week with Argentum (343) — a bivalve will suffice for this procedure, if Sim's speculum should not be at hand — , and then to introduce a medicated tampon (359 & 60), just large enough, to prevent the sur- faces of the vagina from rubbing against each other. When the disease becomes less severe, the tampons, which should remain in the vagina for two days at a time, may be thoroughly covered with boracic acid in powder. During pregnancy, especially of very nervous women, only injections of tepid water, resp. frequent ablutions should be used. If complicated with endome- tritis, the cervix should thoroughly be dilated (not with tents, but under ether, if necessary), and, a strip of io- doform gauze passed into the uterus, so as to protrude from the os, for the purpose of establishing a free drainage. See Endometritis. Fistula. 447 Atresia Vagi nee — Imperforate vagina consists in a complete closure of the orifice of the vagina by the hy- men, which on account of its retaining the menstrual blood, will be found slightly bulging. Aside from per- cussion of the enlarged uterus, which may be felt some- times several inches above the superior strait, the dis- tension by fluid of the vagina can easily be ascertained by means of a finger in the rectum and a catheter in the bladder. Treatment — A crucial incision should be made with a bistoury to evacuate the blood, and septicaemia from putrid matter prevented by warm antiseptic injec- tions (368 & 397); then, after havingthe abdomen prop- erly bandaged, the patient should be confined to the bed for a few days. Cystic Tumor of the Vagina consists in the enlarge- ment of one or more follicles in consequence of obstruc- tion of the orifice, caused by inflammatory action. It is movable and painless, and if very small, will not cause any annoyance, if large, it will however not only in- terfere with defecation but also with coition and par- turition. Treatment — A free incision into the tumor, followed for a few days by injections with soap and water. For Vaginal Prolapse, Cgstocele, Iiectocele and Fnterocele, see Hernia. Fistula — Vesico-vaginal, signifies a communication be- tween the bladder and vagina, generally a result from sloughing of the parts after a tedious labor, and char- acterized by constant dribbling of urine. Treatment — As soon as it is discovered, the patient should be made to lie on her stomach, and the healing promoted by a wash of soap and water, or astringent injections (359-61). Sometimes it is expedient to apply the cautery at a black 448 Varicelli. heat to the edges of the fistula at intervals of, from ten to thirty days, so as to prevent sloughing; or in old cases, caustic to the thickened edges; and as a tempo- rary relief a sponge pessary to retain the dribbling. If these means fail, an operation must be resorted to. In recto-vaginal fistula there are in addition mild laxatives indicated (p. 95); but if after a time, the aperture does not close, it must be operated upon. Varicelli — A specific eruption of vesicles, which af- ter the fifth day begin to dry into little scabs. The eruption, which is generally preceded for twenty-four hours by a slight constitutional disturbance, is usually called chickenpox, if the size of the vesicles does not ex- ceed that of a lentil; they take the name of swinepox, if they are as big as a split cherry stone. Medication not required. Varicocele or Spermatocele signifies a varicose state of the spermatic cord, induced by weakness of ve- nous structure, combined with obtruction to the return of blood through corpulency, constipation and the like. If affecting both sides, it is like piles (varix of the hem- orrhoidal veins), an accompaniment of enlarged and dis- eased liver pressing upon the vena cava inferior. In women the enlargement of the veins of the labia forms a soft tumor, which on walking increases in size and causes pain; but which disappears in the recumbent po- sition. Treatment in males — A suspensory with cold and astringent lotions to scrotum (299); in females, aside from cold bathing, a truss or T bandage with a pad. Varicose Veins or Varix — Dilated veins, which pre- sent a tortuous, knotted and convoluted appearance, where valves are incapable of preventing the reflux of the Variola. 419 blood, and affecting, aside from the scrotum (varicocele) and rectum (hemorrhoids), usually the legs. They cause not only pain, weight and fatigue on taking exercise, but lead often to excoriations of the skin and even ulcers. Treatment — Firm pressure by means of a pad and band- age or elastic stockings, with cold and astringent lotions (Ferr. chlor.) will generally give relief, especially if con- stipation be avoided. As a radical cure, Faradization (p. 150); or subcutaneous acupressure, by which the in- clusion of skin in the ligature, and consequently much pain and soreness, are obviated, may be performed. Variola — Smallpox designates an eruptive fever, eminently contagious, which, when occurring in subjects who have been vaccinated, is called Varioloid or Modi- fied Smallpox, on account of the disease being rendered less violent by the vaccine. It is characterized by a re- mittent fever, followed in two or three days by an ex- anthem, which appears before, or at least simultaneously with the cutaneous eruption, in mouth and throat, as round and whitish spots, peculiar to eruptions on mu- cous membrane. The papules on the skin which gen- erally show first on the face, neck and wrists, whence they spread over the body, are to the touch granular, hard, and deep-seated. They turn soon into vesicles, which, presenting an umbilicated shape — the pathognom- ic central depression — form, after having become pus- tules, ultimately, a scab. Scarlatina and measles are easily differentiated; for, aside from the nasal catarrh, which precedes the one, and the throat affection, which accompanies the other, in neither is the fever remitting or ceasing with the appearance of the exanthem; and as regards varicelli, the eruption is from the first vesicular, 450 Vertigo. without taking into account the insignificance of the whole disease. Moreover a mustard plaster applied to any part of the body, will not only bring out the erup- tion 24-36 hours sooner than usual, so that a diagnosis may be made on the first day of the fever; but by this means the eruption may be also invited to a particular part — abdomen, etc. — and thus the pitting of the face avoided; or in malignant cases, a fatal termination. Treatment — Su/fo-carbol and sulfites (pp. 16 & 19), in conjunction with evaporating lotion s; or Iodine, Chloro- form, Collodion, etc. (413 & 414), and evacuation of the vesicles by means of a fine needle to prevent the dis- figuration caused by pitting. Iodoform (401) is said to prevent pustules. In hyperpyrexia, sponging or the wet sheet (420). Version. See Uterus (Displacements). Vertigo— Dizziness or swimming of the head is, un- less a symptom of some cerebral or womb disease, an individual functional affection (Meniere* 's disease), char- acterized by a sensation, similar to that, caused by con- tinued rotatory movements, so as to be unable to stand without support, combined with forgetfulness. It is incident, 6. g. to excessive venery, and smoking of too much or too strong tobacco. Treatment according to cause — Digital, (p. 78); in aural vertigo, Quinine (p. 76). Vision. See Eye. Vomiting and Nausea — A sick feeling combined or no, with a forcible ejection of the contents of the stom- ach through the mouth, may be due to cerebral or kid- ney disease, or to gastritis, gastric ulcer and other les- ions of the stomach; but it occurs also in cases of chron- ic dyspepsia, where the stomach seems to be intolerant Vulva. 451 of all forms of nourishment; sometimes rupture is the cause (see Hernia — p. 262); and in women, it is fre- quently a sign of pregnancy. Treatment — Belladonna, Camphora, Cyan or Chloroform (43, 56, 61 & 67), Creo- sote and Strychnos (138 & 184), all are employed, and will occasionally be of service; or Calomel v. Hydr. c. Creta in small doses; a small piece of ice swallowed, will act sometimes like a charm. Bismuth or Pepsin (pp. 46 & 84), see Dyspepsia; Aq. Calcis or Potass (119) if chronic; Alum (p. 62) in consumption from cough; if sarcina, sulfites (33), see Sarcina. In vomiting of pregnancy, in addition to those named, Brom, Ipecacuanha (46 & 181); Aq. Calcis c. Lacte or Acid, citric, (pp. 42 & 56); Cerium and Morphia (pp. 29 &37); if hysterical, Cocaine (pp. 11 & 115); if from alcoholism, Gelsemium, Capsicum (pp. 33 & 15); Sol. Fowl, half a drop in water half-hourly. Iodine (p. 15), is said to check the vomiting in cholera. Vomiting in infants, if from mother's milk, will stop upon weaning. Vulva — Hyperesthesia. Excessive sensibility may involve the whole surface of the vulva, or it may be confined to the vestibule, one labium {minus) , or to the meatus. In any case it makes sexual intercourse very painful, even with a large and otherwise healthy ostium vaginae. Unless due to an irritable caruncle (see Ure- thra), it is either idiopathic, or associated with chronic vulvitis. Treatment is essentially local — Alum, Borax, Tannin (340 & 46); Belladonna or Cocaine (350 & 396); though tonic cathartics (jp. 95) may be sometimes of service. Pruritus Vulvae — Itching of the part has a multitude of causes: Exclusive local inflammations, as vulvitis or vaginitis; or irritation produced by vaginal discharges^ 452 Vulva. eruptions, or parasites, it may be due to scrofula, sup- pression of menses, excessive heat of the season, indo- lent habits, and not seldom, to want of cleanliness. Pru- ritus pudendi is sometimes constant, sometimes inter- mittent, and may ultimately lead to complete nervous derangement and a general break-down of the constitu- tion. Treatment — Above all, removal of cause, if pos- sible. Calomel or salines (pp. 92 & 96), if plethora; So- da or Aloes (191 & 197) according to indications. Lo- cally, Alum, Borax, Plumbum, Phenol (337 & 46); Cam- phora, Bismuth, Zinc (339, 345 & 59); Chloroform and Cre- osote or A tropin (350, 51 & 56). In diabetes, the parts should be bathed and protected with some ointment after urination; and where bristly hairs are found on the mu- cous surface of the labia majora they should be remov- ed. A magnifying glass (263) may sometimes be nec- essary to discover them. Vulvitis — Inflammation of the vulva is characterized by swelling and heat of the parts, attended by burning and itching; and if the urethra be involved, scalding in micturition. In the purulent form this first stage will be followed by superficial ulcers, which may appear all over the surface of the vulva; whilst in the follicular form the increased, sometimes very offensive smelling secretion, is limited to the glands — if the muciparous follicles are chiefly affected, the mucosa of the vulva, especially on the edges of the lower vaginal rugce, the nymphce and carunculce, will be found intensely red in spots or patches, which bleed on the slightest irritation; and if the sebaceous and pilif erous glands are principal- ly involved, little red papillae will cover the surface of the labia majora et minora, and the base of the clitoris. Inflammations. 453 Both forms may result from vaginitis, exanthemata, want of cleanliness, friction and onanism, or excessive vene- ry, Treatment — Saline cathartics (p. 96) with cooling and emollient applications (837). Afterwards Argentum nitricum or Ferrum persulf. (343 & 45). The parts should be constantly kept dusted with Lycopodium, Bismuth or starch. The gangrenous form begins with a small patch or vesicle of a blackish hue, which leaves soon an ulcer. As the purplish oedematous state of the labia, in con- junction with the grave constitutional symptoms, show- ing its connection with puerperal and other continued fevers, renders the diagnosis perfectly easy — with diph- theria it cannot possibly be confounded on account of the absence of false membranes — there should be no delay for a prompt and energetic treatment. Aside from a nu- tritious diet, wine and other stimulants, a powerful caus- tic: The actual cautery or Acidum nitricum vel hydro- chloratum should be used at once for destroying the gan- grenous spots (the patient being anaesthetized), and then the whole covered with antiseptic poultices. Internally Chininum cum Ferro (p. 11). Noma affects sometimes the labia pudendi of young female children: After two or three days of low fever, the little patient is observed to suffer considerable while making water; and on ex- amination the labia present a livid, erysipelatous red- ness and vesications, that are rapidly followed by pha- gedenic ulcers. The disease, which, in its causes, na- ture and symptoms resembles cancrum oris, must be treated on the same principles as the latter affection. Phlegmonous Inflammation of (he labia major a com- mences like acute abscess elsewhere, with fever; throbb- 454 Vulva. ing pain; bright redness; and much swelling: firm in the center and cedematous around. The formation of pus is indicated by an abatement of the fever and pain, which latter is converted into a sense of weight and tension. Care must be taken to differentiate phlegmon from enterocele (see Hernia pudendi) or displacement of an ovary. Serous engorgement and bloody tumor (see Hydrocele resp. Hematocele), even oedema labio- rum and vulvitis have been mistaken for it. Treatment — Saline cathartics (p. 95) with cold compresses or lead and opium wash (337) at the beginning; afterwards poul- tices, and as soon as there are signs of fluctuation, the knife. Abscess of the vulvo-vaginal glands is characterized by a hard, painful, and perhaps fluctuating tumor about the size of a small egg, with a limited and distinct globular outline, which is easily distinguished from a cyst by the presence of inflammation. Treatment like that indicated for phlegmonous inflammation. If the abscess does not open of itself: the lancet. Hypertrophy of Nymphce unless congenital, is gener- ally due to excessive excitement, or syphilis. If they are so much changed as to interfere with sexual inter- course or walking, they must be excised with curved scissors, after having passed a number of threads through the roots, so that the borders of the wound may be brought together and united by first intention. As a rule, cauterization of the cut surface suffices to stop the bleeding; for though the labia interna are more vascu- lar than the externa, the vessels are too small to pro- duce much hemorrhage. Eruptive Diseases of the Vulva usually create sooner Wounds. 455 or later vulvitis, which has to be taken into account in the treatment of the latter, since they require the same remedies as they do in other parts of the body. Pruri- tus is one of the most constant signs, and the itching, which it produces often first attracts attention to their presence. In prurigo the vulva presents large, scattered papules, which are generally denuded at their points of cuticle. Lichen shows more numerous papules, which rest upon a thickened and somewhat indurated surface. Acne consists in engorgement of the sebaceous folli- cles, which stud the labial surfaces. Eczema, which in diabetes and vesicovaginal fistula often constitutes a very troublesome complication, presents vesicles, which, as an acute disorder, may rapidly heal again; but some- times there are successive crops of them, which will ex- haust the strength of the patient in consequence of the nervous excitement and irritability they occasion. Ery- sipelas and Erythema are always accompanied by graver symptoms, than when affecting other parts. Wakefulness. See Insomnia. Warts. See Skin (Neoplasms). Weakness. See Debility, resp. Impotenz. Whites. See Leucorrhoea. Whitlow. See Onychia. Worms. See Helminthiasis. Wounds — A solution of continuity or separation of continuous parts by violence, is usually directed from the cutaneous or mucous surfaces; but sometimes it is caused within the body by broken bones, etc. Incised wounds (those made by a clean-cutting instrument), which are usually produced with the least violence, gen- erally admit most easily of repair, while lacerated and 456 Wounds. contused ones are more prone to slough or suppurate, though they do not bleed much. Punctured wounds are dangerous from the possibility that deep-seated ex- travasation of blood or abscess may follow. Treat- ment consists in checking bleeding, which in most cases may be accomplished by a raised position, moderate pressure, cold compresses and styptic applications (415 & 16), see Hemorrhage; removal of foreign bodies (with forceps or sponge and water); bringing the divided parts into their natural position and keeping them in union — which may be obtained with strips of adhesive plaster, covered by a compress or bandage, with collo- dion or by sutures (interrupted, twisted, continuous or quill, as maybe required); and lastly by preventing sup- puration and fever — which is most effectually done by the antiseptic method (p. 139). If any small portion of the body (as finger, part of nose for instance), has been completely cut off, it may unite again, even after several hours, if it is reap- plied, retained with plaster or by sutures, and wrapped up, so as to preserve its temperature. Open wounds will heal best by forming a scab: Pledgets of lint, soaked in blood, friars balsam, or Quebracho are placed on the wound to there adhere; or by the use of simple water dressing with some antiseptic. If there be pain, rest- lessness and shivering, an incision may be necessary. Punctured wounds should be kept at perfect rest and bandaged sufficient firmly to prevent subcutaneous ooz- ing of the blood, which is the most likely cause of in- flammation. Gun-shot wounds of the thorax or abdo- men are always followed by more or less collapse, from which the patient should not be roused too soon, Wounds. 457 if large vessels are supposed to have been injured. He should be placed on a bed, with his head low, and care- fully watched in order to prevent the collapse from go- ing too far, by the judicious application of stimulants, warmth, etc. In case of hemorrhage, pressure and the l ; gature (if intermediary, which may occur after reac- tion has taken place, or secondary, which may take place up to the 25th day after the injury, the same treatment, see Hemorrhage). The exploration of the wound should be made, if possible, before swelling and oedema have come on. Sometimes the right forefinger, aided by counter-pressure of the other hand will suffice, espe- cially if the wound be dilated, to allow its entrance; but generally probes for this purpose have to be resorted to. The extraction of the ball is best accomplished by means of forceps; for small, loose fragments, a bullet- scoop may be of service. Gun-shot wounds of the scalp with fracture of the skull should be carefully examined with the finger, if there is a depression. In this case the depressed bone should be lifted by means of an ele- vator, especially if there are symptoms of compression; if not, the operation may be delayed until cerebral symptoms appear. In fracture of the skull without de- pression, cold compresses to the head, in conjunction with cathartics (p. 88), and rest. The formation of pus, which would be indicated by severe rigors with head symptoms, coming on from fifteen to thirty days after the injury, requires evacuation, after having removed a portion of bone with the trephine. Gun-shot icounds of the face are sometimes complicated with injury to the brain. Plastic surgery may be occasionally desirable, and ligature of the carotis necessary (416). All loose 45 S Wounds. spicula of bone should be removed, the parts by sutures adjusted, and covered with light antiseptic dressings. If the jaw be fractured, it should be maintained in posi- tion by means of the perforated wire or gutta-percha splint. Wounds of arteries require first of all, firm pressure to arrest the bleeding, by means of a finger on the vessel; in wide and deep wounds, by placing the fin- ger on the exact spots where the blood issues from; by tying a handkerchief with a stone round the limb and twisting it tightly with a stick in default of a tourni- quet. If the arteries are numerous and small, pressure by means of cold compresses in conjunction with styp- tics will suffice, Tinct. vel Liq. Ferri chlorati, Argantum nitricum, 01. Terabinthince, Creosote, A pinch or a pidl with the forceps will often cause small vessels to cease bleeding. Many obstinate hemorrhages from small ves- sels cease, when the wound is cleared of coagulum, and the bleeding part sluiced with cold water, and exposed to the air for some time, before it is bound up again. The actual cautery at black heat will be indicated for arteries, that either* cannot be tied, or are too diseased to hold the ligature. If the vessels are large, # the liga- ture (416), or still better, acupressure or torsion will be the proper thing. The method of employing acupressure is either, by passing a needle of, from three to six inches in length (according to the thickness of the wound) through one of the flaps of a wound over the vessel in the same way as we would fasten with a pin the stalk of a flower to our coat; or a sewing needle is passed behind the vessel, and a fine iron wire having been slipped over its point, is brought over the vessel tightly enough to close it, and Wounds. 459 secured with a slight twist round the eye-end. Torsion is performed by drawing out the vessel from its sheath by a pair of broad-pointed spring-forceps, and then twisting it round freely as far as its natural connections above will allow; or by fixing the vessel with one pair of forceps a quarter or half an inch from the end, and then twisting the end with another pair till it does not untwist itself. Arteries situated immediately over a bone may be closed with & graduated compress. A puncture or partial division of an artery is generally more troublesome than complete division, as neither contraction nor retraction of the vessel can take place; therefore small arteries should in these cases be completely divided. In cases of arterial hemorrhage, which there is dif- ficulty in restraining by ligature or otherwise, the pa- tient should be kept in the recumbent posture. The diet should consist of milk, broth, and such substances, which nourish without stimulating; and Opium (p. 35) may be given to tranquilize the heart's action. If life is endangered by the loss of blood, the head must be kept low; beef -tea with brandy (p. 72) be given frequent- ly by spoonfuls, and small doses of Opium every three or four hours. As a last resource, transfusion should be resorted to. Wounds of veins are as a rule easily closed by pres- sure in conjunction with a raised position; sometimes however they may require the ligature or acupressure. Wounds from stings and bites of insects must be cau- terized with Aqua Ammoniac, Acid, nitr. or Soda (407). A wound from a bite of a rabid animal should be well sucked, a ligature put above the bitten part, and as soon as possi- ble cut out and freely cauterized with Argenti Nitras. In 460 Wryneck. Snakebite, brandy may be exhibited freely; Ammonii Carbonas or Cedron (pp. 10 & 73); Mangan (403) has been recommended. Poisoned wounds {Ptomain) from dissection or from operation will cause blood poisoning: Inflammation of the glands, abscesses, erysipelas, etc., accompanied by constitutional symptoms. They claim aside from tonics (p. 7l) and cathartics (p. 71) an antisep tic treatment: Resorcin, Mercury or Phenol (396-98). Zinc or Benzol (403); Medicated cotton (416) etc., see Septicaemia. Wristdrop. See Paralysis from lead poison. Writer's Cramp. See Spasm. Wryneck (Caput obstipum) — A peculiar distortion, in which the head is bent down towards one shoulder, the face being turned to the opposite side; and unless congenital, dependent on some intra-cranial or spinal affection of the spinal accessory, or what is more usual, an inflammatory spasm of one of the sterno-cleido-mas- toidei, which feels hot and tender, and upon the slight- est motion, painful, (see Spasm and Myalgia — Torti- collis rheum aticus). Treatment — In fresh cases, next to perfect rest, poultices and fomentations, a generous diet in conjunction with cathartics (p. 88) and tonics, espe- cially Quinine and Zinc (pp. 77 & 87). The use of a ma- chine or gutta-percha collar with a chin and shoulder piece, to keep up extension in cases of no long duration. The congenital form will probably require division of the sternal origin of the muscles. Yellow Fever. See Fever. HRMGUR'S EXTRACTS ° F - BEEF FLTJID. ARMOUR'S EXTRACTS ARE FREE FROM ALL HARSH, BURNT OR MEDICATED TASTE OR ODOR, AND RETAIN A DELieieus Beef Flavor Particularly Grateful and Inviting to Children or Invalids. BEND FOB SAMPLES, TO THE MANTTEACTTJBEBS : ARMOUR & CO., CHICAGO. PHYSICIANS • ATTENTION A WORD TO THE WISE IS ENOUGH. OUR JARVIS-RIESING GRAPE - BRANDY, OUR OLD PORT WINE, . OUR • SHERRY . WINE, . ARE EQUAL IN ALL RESPECTS TO THE FINEST IMPORTED AND ARE GUARANTEED CHEMICALLY PURE. We have Brandy, Port and Sherry Wines from the vintage of 1869 up to the present time, equal in Strength, Brilliancy, Body, Bouquet Flavor, and all the distinguishing marks of excellence to any brandy and wine in the L'nited States. We make and age all our own goods so can attest to their purity. THE G. H. JARVIS COMPANY, SAN JOSE, CAL. Branch: 39 N. State Street, CHICAGO, ILL. Absolutely PURE UNSWEETENED 7VSIL-K, STERILIZED — AND— EVAPORATED —TO A— Creamy Consistence. 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