■ ' " ■ «, m0 " i n LIBRARY OF CONGRESS. Shelf. "P^ UNITED STATES OF iERICA. THE PRE SCRIBER'S MEMORANDA '•+ V NEW YORK WILLIAM WOOD & COMPANY 1881 T o..\ Copyright by WILLIAM WOOD & CO. 1881. Trow's Printing and Bookbinding Company 201-213 East 1.1th Street NEW YORK PRESCRIBED MEMORANDA. ABORTION. Dr. Wm. T. Lusk gives the following rules for the treatment of abortion : 1. In the first two months an abortion needs no special treatment. The hemorrhages of early date are amenable to the same principles of treatment as those from a non-pregnant uterus. 2. In the third month no treatment is re- quired when the ovum is expelled with intact membranes. When the membranes rupture previous to ex- pulsion, and hemorrhage takes place, immediate removal should be attempted, provided the cer- vix be sufficiently dilated to admit the index finger. When the cervix is closed the tampon should be tried for twenty-four hours. If the tampon proves ineffective, the cervix should then be dilated with a sponge-tent, and the ovum removed with the finger. The finger 2 PRESCRIBES S MEMORANDA. should pass up along the side of the uterus, across the fundus, and complete the circuit of the uterine cavity. 3. In cases of neglected abortion, retained portions should be removed by the finger or the curette. When the ovum is decomposed, no dilation of the os is usually necessary. When the ovum is fresh, the preliminary use of sponge- tents is usually demanded if manual delivery is resorted to. 4. In immature deliveries, hemorrhage can usually be controlled without the tampon, by compression of the uterus, and in cases of de- lay, by the manual extraction of the placenta. Dr. Fordyce Barker says : Abortions occurring within the second month ordinarily require but little treatment. But I have seen patients who were perfectly exsanguinated by a hemorrhage which occurred within the eighth week of preg- nancy. Yet these cases are rare. I saw one patient who had passed only one menstrual period when she suddenly found herself flowing, and soon became so completely exsanguinated that it seemed almost hopeless to attempt to save her life. In early embryonic abortions, manipulations within the uterine cavity, for the removal of the ovum, are not practicable, be- cause the uterus is not yet sufficiently devel- prescreber's memoranda. 3 oped. In early abortions attended by profuse hemorrhage, I am accustomed to place the pa- tient crosswise in bed, with the hips drawn well over the edge of the bed, the legs flexed, and the thighs held at right angles to the body ; then place a rubber sheet under the patient, so as to protect the clothing and the bed perfectly, and conduct the water to run into a pail below, and then inject into the vagina a large quantity of very hot water, from 104° F. to 110° F. I be- lieve that one may always be sure that this will positively, absolutely, and efficiently arrest the hemorrhage. In all the cases where I have re- sorted to this method I have never found it ne- cessary afterward to subject the patient to manipulations for removal of the ovum. It has always come away spontaneously — sometimes the next day, or the next day but one — and absolutely without hemorrhage. In cases of abortion, when I find it necessary to tampon, I never trust to any kind of vaginal tampon, but always tampon the cervix uteri with a compressed sponge of proper size, and then fill the vagina only just sufficient to keep the sponge in place. This, if properly done, is certain to arrest the hemorrhage, and, in from eight to twelve hours, during which the patient rallies from the dangerous exhaustion following 4 PRESCRIBES S MEMORANDA. the loss of blood, the cervix is sufficiently dilated to permit the safe removal of the entire ovum with the finger. ALCOHOLISM. Br. F. P. Atkinson says : There are three different stages in the disease : 1st. Sleeplessness, accompanied by a hard, quick pulse ; loss of appetite in the morning, and morning sickness. ^ . Tinct. rhei Tft x. Tinct. card, co 3 ss. Tinct. hyoscyami 3 ss. Acid, hydrocyanic, dil 1TI_ iij. Spts. chlorof ormi TT\_ xv. Aquse ad. § j. S. — To be taken every four hours. The prussic acid acts as a sedative to the stomach, heart, and brain. The hyoscyamus has also to a certain extent the same effect. Abstinence from stimulants in this, as in the other stages, is strictly enjoined ; but, when I find it difficult to get this carried out, I allow a glass of claret three times a day. It is essen- tial that the patient have plenty of light and easily digestible food, and with this object I or- PRESCRIBES S MEMORANDA. O der essence of beef, milk and eggs beaten up to- gether and barley-water. This diet is suitable to each stage. The only thing to be said is, the more the depression the more the nourishment. 2d. Drowsiness, accompanied by a slow, some- what comprehensible and excitable pulse, com- plete loss of appetite, and constant sickness. The blood has in it an excessive amount of hydrocarbon. The treatment should be the same as just described, only it is as well to omit the prus- sic acid, as there is not the same excitement present. 3d. Delirium, accompanied by complete ab- sence of sleep and the presence of horrible appa- ritions, especially at night. The pulse is small, quick, easily excitable, and compressible. The blood is deficient in red corpuscles. Hydrocar- bons are present in poisonous quantities ; the brain undergoes little or no repair. The vaso- motor nerve-influence is almost entirely lost. The treatment I have found beneficial in each stage is the following : Chloral should be given in thirty-grain doses every four hours, till sleep comes on, and then be repeated as often as necessary. The nourish- ment should by no means be forgotten, and stimulants should be strictly forbidden. 6 pkescbibee's memokanda. If chloral is continued beyond a certain time, a sleepless condition recurs, when nux vomica and gentian should be given as follows : I£ . Tinct. nucis vomicae Tft x. Tinct. gent, co 3 ss. Ess. limonis Tf^ j. Spts. chlorof ormi KI^ xv. Aquse ad. § j. S. — To be taken three or four times a day. This rarely fails to reindu.ce sleep, but, if per- sisted in long after it has produced its effects, sleeplessness returns. When this is the case, the tincture of gentian, columbo, or chiretta, should be given alone. Dr. G. D. Griffith says that an entirely new series of symptoms result from the prolonged use of chloral for alcoholism. His observations would indicate that the drug may produce a condition akin to that for the cure of which it is given. Dr. Luton is strongly in favor of a more gen- eral use of strychnine in alcoholism, and believes it is given, at present, with too much timidity. In delirium tremens, hypodermic injections of strychnine may be continued almost to the com- mencement of tetanic action. In imminent alcoholism a few drops of the tincture of nux prescriber's memoranda. 7 vomica may be given at the beginning of meals. Dr. d'Ancona, of Italy, gives gr. jss. of zinc phosphide (in divided doses) daily, for many weeks, with decided benefit to drinkers. $. Tinct. gent, co., Tinct. calumbas co aa 3 j. Tinct. nucis vom gtts. v.-xv. M. To be taken before meals. For rum stomachs. Loomis. Oxide of zinc, in doses of from three to five grains, twice or three times a day, has produced good results in chronic alcoholism. The tincture of digitalis, in teaspoonful doses every two, three, or four hours, has cured many cases of delirium tremens promptly, and with- out producing any unfavorable symptoms. ANiEMIA, Mixtures for. Dr. Wm. Goodell says : Basham's iron mixture, with the addition of fractional doses of strychnia, will be found very © PKESCRIBEKS MEMOKANDA. admirable in its effects. There are so many indifferent recipes for making this celebrated mixture, that I shall here give the one which seems to be the best : ^ . Tinct. ferri chlor fl. 3 iij. Acid. acet. dil fl. | ss. Liq. ammonias acetat fl. | iijss. Curacose, Syr. simplicis aa fl. 3 j. Aquae ad. fl. % viij. M. S. — One tablespoonf ul after each meal. The following formula makes another very elegant and generally useful preparation of iron : IJ • Tinct. ferri chlor fl. 3 ij. Acid, phosphor, dil fl. 3 iij. Spts. limonis fl. 3 j. Syr. simplicis fl. § ijss. Aquas ad. fl. § vj. M. S. — One tablespoonf ul after each meal. The dilute phosphoric acid is added, both be- cause it is a valuable nerve-tonic and because it has the property of disguising the styptic taste of the iron — so much so that children readily take this mixture. pkesceibek's memokanda. 9 There are two other tonic preparations which are prescribed very frequently in the Hospital of the University of Pennsylvania, and with excel- lent results. One of them is Blaud's pill, which Niemeyer extols so very highly : I£. Pulv. ferri sulph. exsiccata, Potass, carb. puras aa 3 ij. Syrupi q. s. M. Divide into pills no. xlviij. During the first three days one pill is to be taken after each meal. On the fourth day four pills are taken during the day, on the fifth day five pills ; on the sixth day six — that is to say, two pills after each meal. For three days more six pills are taken daily ; then the dose is to be increased by one pill daily until three pills are taken after each meal. On this final dose the patient is kept for three or four weeks, as the case may be. In stubborn cases I have occa- sionally increased the dose to the number of five pills thrice daily, and have seen no other bad effects from it than a feeling of fulness in the head. This immunity is probably owing to the conversion of the iron sulphate into a carbonate. The other preparation is a valuable alterative tonic, for the formula of which I am indebted to my friend, Dr. A. H. Smith : 10 prescriber's memoranda. I}. Hydrarg. chlor. corros gr. i-ij. Liq. arsenici chlor fl. § j. Tinct. f erri chlor. , Acid, hydrochlor. dil aa fl. 3 iv. Syr fl. § iij. Aquae ad. fl. 5 vj. M. S. — One dessertspoonful in a wineglass- ful of water, after each meal. Anaemic and chlorotic patients will fatten and thrive wonderfully on this mixture. I call it the Mixture of Four Chlorides. It should not be given for a longer period than two weeks at a time. To counteract the possible costive effect of sulphate of iron, this aperient mixture is given : 1$, . Pulv. glycyrrhizse rad. , Pulv. sennse aa § ss. Sulphuris sublim., Pulv. fceniculi aa 3 ij. Sacchar. purif 3 3 SS * M. S. — One teaspoonful in half a cupful of water at bed- time. Where the disease is due to torpidity of the ovaries, this prescription is used : $ . Ext. aloes 3 J. Ferri sulph. exsiccata 3 ij. Asaf cetidee 3 iv. prescriber's memoranda. 11 M. S. — One pill after each meal. This number to be gradually increased to two, and then to three pills, after each meal. If the bowels are at any time over-affected, return to the initial dose of one pill after each meal. Ancemia (iron and oxygen in). — Dr. Hay em, in conjunction with M. Begnauld, has made a number of observations on this subject. It was found that the administration of iron, in the form of Berlin blue, had no effect in im- proving the state of the blood or the appetite of the patients, unless inhalations of oxygen were also employed. They found that, if the inhalations of oxygen were desisted from, the patient 1 s condition retrograded, though it had been apparently improved ; while the simulta- taneous use of iron and oxygen produced a per- manent improvement, the red corpuscles being increased both in quality and in quantity. They arrive at the following conclusions : 1. The ac- tive preparations of iron act as a blood-pre- paring material, contributing especially to the formation of the red corpuscles ; 2. Iron does not always act alone, but in dyspeptic subjects inhalations of oxygen are also necessary, in order to completely subdue the chlorosis and anaemia. 12 presceibek's memokanda. ]> . Tinct. f erri chlor. , Acid, phosphor, dil aa fl. 3 j. Syrupi fl. 3 vj. M. Dose, a teaspoonful. I£ . Tinct. f erri chlor TT^ xx. Acid. acet. dil 7T^ xx. Liq. amnion, acet. . . . q. s. ad. fl. 3 j. jVI. Dose, two to four teaspoonfuls. T? . Ferri sulph gr. ij . Magnesii sulphatis . I jss. Acid, sulph. dil. Ti\_ xv. Infus. quassias q. s. ad. fl. ? j. M. Dose, a teaspoonful. The following tonic pills are much prescribed at the Gynecological Clinic of the Hospital of the University of Pennsylvania : 3 . Acid arseniosi, Strychnine sulph a a gr. j.-xxxv. Ext. belladonna gr. j.-v. Cinchonise sulph gr. jss. Pil. ferri carb. gr. ijss. M. et ft. pil. no. j. prescriber's memoranda. 13 5 . Acid, arseniosi gr. j.-xxxv. Cinchoniae sulph gr. jss. Ferri et potass, tart gr. ij. M. et ft. pil. no. j. The sulphate of cinchona in these pills may be advantageously substituted by a proportion- ate dose of sulphate of quinia, the former being used simply on account of its cheapness. One pill may be given after each meal. 3 . Vini ferri fl. 3 iij. Liq. potassii arsenitis, Syrupi aa fl. 3 ss. Aquae fl. 3 ss. M. Dose, one teaspoonful, diluted, after meals. In general anaemia and anaemia of nursing women. Best given in cod-liver oil. Injections of Ether and Brandy in the Acute Anaemia of Parturient Women. — In cases of vi- cious insertion of the placenta, when it pro- duces such an abundant hemorrhage that the woman is exsanguinated, and it becomes neces- sary at once to raise the temperature and stimu- late the nervous centres, M. Chantreuil advises the injection of sulphuric ether (4 grammes = | j. for example) into the subcutaneous cellular 14 pbesceibee's memoeanda. tissue. A little later we may use one or more similar injections of cognac. Under their influ- ence the faintings cease, the heat is re-estab- lished and the patient is reanimated. In this way, if transfusion becomes indispensable, we have at least gained time. . Hypodermic injections of brandy or whiskey, in half-teaspoonful or teaspoonful doses, re- peated every fifteen or twenty minutes in the acute anosmia caused by loss of blood, as in flood- ing or severe surgical operations, are of the greatest service, and sometimes become the chief reliance of the xDhysician. The following tonic mixtures are used in public institutions in New York City : 1} . Ext. cinchonise fl fl. 3 j. Ferri et ammonii cit 3 ij. Spts. aurantii (1:10) fl. § 3. Alcoholis fl. 3 iv. 01. cinnamomi TT^ xv. Aquae fl. 3 vj. Syrupi q. s. ad. fl. ? xvj. With the oil of cinnamon and water make water of cinnamon ; dissolve in this the ammo- nio-citrate of iron ; add the spirits of orange and the fluid extract of cinchona. Filter, and add prescreber's memoranda. 15 enough syrup to make the product measure one pint. Dose, a teaspoonful. 5 . Tinct. ferri. chlor fl. 3 ij. Aquas fl. 3 ij. # . Cinchonias sulph gr. xxv. Acid, sulph. dil q. s. Aquae , fl. § 3, Acid, citr 3 ss. Syrupi fl. I jss. Tinct. ferri chlor fl. 3 ss. Aquas q. s. ad. fl. 3 iv. M. Dose, a teaspoonful. I£ . Sol. cinchon. sulph. (30 grs. infl-lj.) A-3J- Acid, citr 3 ss. Syrupi fl. 3 jss. Tinct. ferri chlor fl. 3 ss. Aquas. . ., q. s. ad. fl. § iv. M. Dose, a teaspoonful. ]£ . Quinias sulph gr. xxv. Acid, sulph. dil q. s. Aquas fl. 3 ij. Tinct. ferri chlor fl. 3 ss. Spts. chloroformi fl. 3 vj. Glycerinas .q. s. ad. fl. 3 iv. M. Dose, a teaspoonful. Loomis. 16 prescriber's memoranda. ]£. Sol. quiniae sulph. (15 grs. in fl.lj.) fkjfl. Tinct. ferri chlor fl. 5 ss. Spts. chloroformi fl. 3 vj. Loomis. 3 . Ferri ammon. cit 3 j. Amnion, carb gr. xxx. Tinct. gent, co., Tinct. quassias aa fl. 3 ij. Syrupi fl. 5 jss. Aquae q. s. ad. fl. § viij. M. Dose, a dessertspoonful. Thomson. 3£ . Acid, muriat fl. 3 iij. Tinct. gent. co. , Aquae aa fl. § viij. M. Dose, a teaspoonful. ^ . Cinchoniae sulph 3 j- Acid, sulph. dil q. s. Aquae fl. % iv. M. Dose, a teaspoonful. Griffith's Mixture. Tfr . Cinchoniae sulph 3 j. Acid, sulph. dil q. s. prescriber's memoranda. 17 ^ . Ferri sulph gr. xx. Potassii carbon gr. xxv. Pulv. myrrhaB, Pulv. sacchari aa 3 j. Spts. lavand co 11. § ss. Aquae cirmamom q. s. ad. fl. 3 viij. M. Dose, half a tablespoonful. In preparing this, the sulphate of iron, dissolved in one-half fluid ounce of the cinnamon water, should be added last. The mixture should be made fresh, when needed. $. Ferri et ammon. cit., Ammonii carbon aa gr. xxxij. Syrupi, Aquae anisi aa fl. § ij. M. Dose, a teaspoonful. J. L. Smith. I£. Sol. cinchoniaa sulph. (30 grs. infl-|j.) A- 3 ij- Tinct. ferri chlor fl. 3 ij M. Dose, a teaspoonful. 3 . Ferri et potass, tart 3 j. Tinct. cinch, co fl. 5 iv. M. Dose, a teaspoonful. 18 prescribes' s memoranda. ]$ . Cinchonise sulph 3 j. Tinct. ferri chlor fl. 3 ij. Aquas q. s. ad. fl. § iv. M. Dose, a teaspoonful. I£ . Quiniaa sulph gr. xxx. Acid, sulph. dil q. s. Aquae fl. § ij. Tinct. ferri chlor fl. 3 ij. Or, Sol. quinise sulph. (15 grs. in fl-ii-).. |L Tiuct. ferri chlor fl. 3 ij. M. Dose, a teaspoonful. B . Potassii iodidi e . . 3 iv. Syr. ferri iodidi fl. § j- Tinct. calumbae q. s. ad. fl. J iv. M. Dose, a teaspoonful. 1$. Strychnise acet gr. j. Tinct. cardam. co fl. 3 ss. Alcoholis, Aquae aa fl. 3 ijss. Syrupi q. s. ad. fl. § iv. M. Dose, a teaspoonful. pkescribeb's memoranda. 19 If. Tinct. cinch, co., Tinct. gant. co aa fl. 3 j. M. Dose, a teaspoonful. ^ . Tinct. ferri chlor., Tincfc. nucis vom aa TT[_x. Aquas q. s. ad. fl. 3 j. M. One dose. To be taken thrice daily, after meals. Syr. Calcis Lacto-phosphatis is a solution of calcium phosphate in lactic acid and syrup, and contains in one fluid ounce : Calcium phosphate gr. xvj. Lactic acid gr. xxxiij. Syr. Ferri Quin. et Strych. Phospli. contains in one fluid drachm : Phosphate of iron gr. ij. Quinia gr. j. Strychnia gr- A- Wine of Iron, Beef, and Cinchona represents in one fluid ounce : Cinchona bark gr. xxxij. Extract of beef (Liebig's) .... gr. xvj. Pyrophosphate of iron gr. \iij. Dose, a teaspoonful. 20 peesceibee's memoeanda. I}. Ferri et ammonii cit gr. xx. Viiii xerici fl. ij. M. Dose, a teaspoonful. $ . Ferri et quiniae cit % j. Vini xerici fl. § ij. M. Dose, a teaspoonful. Vy. . Ferri et quinidiae cit 3 j. Vini xerici fl. § ij. M. Dose, a teaspoonful. 1$. Tinct. ferri chlor., Syrupi aa fl. § iv. Aqua3 fl. 1 viij. M. Dose, a teaspoonful. ^ . Quiniae sulph , 3 j. Ferri redacti 3 jss. Acid, arseniosi, Strychniae aa gr. 3 iij. Conf ect. rosae q. s. M. Divide into 60 pills. Winslow. pkescriber's memoranda. 21 ANAESTHESIA, Local. Take pounded ice or snow, and Common salt equal parts. Put both on a soft rag (musquito netting) ; mix it to form a kind of poultice and press it quickly against the skin where you intend to make an incision. In a very short time the skin freezes and becomes absolutely insensible and bloodless. As to the length of time this state of the skin may be maintained without endangering its vitality, it may be continued sufficiently long for the performance of any minor operation. As the temperature begins sinking the mo- ment the ice and the salt are brought in con- tact, all that is necessary for the performance of the operation must be ready before making the mixture. Special care must be taken to have the knife as sharp as possible, for the fro- zen skin is remarkably tough, and resists the instrument to a high degree. ANOREXIA, Mixtures for. Tinct. of nucis vomica? gtt. v. Ext. of gent gr. xv. Syr. aurantii cort 3 jss. Quinine wine 3 ivss. 22 pkescribek's memoranda. Make a solution. One-half to be taken half an hour before each of the two principal meals. In atonic dyspepsia. MUlii^s Carminative Elixir. I£ . Ginger J ss. Cinnamon, Long pepper aa 3 ij. Galanga, Nutmeg, Cloves aa 3 j. Cardamom 3 j. Alcohol 1 vj. M. Digest for fourteen days and filter. Dose : one to four teaspoonf uls in some suit- able vehicle. In atonic dyspepsia and flatu- lence. 5 . Anthemidis, Quassise aa 3 j. M. et ft. chart, no. 1. S. — Put in a pint of boiling water, and when cold strain ; take a wineglassful three times a day, before meals. As an appetizer. IjS, . Gentianse, Quassias, Cinnamomi aa 3 ij. prescriber's memoranda. 23 M. S. — Put in a pint of boiling water, and when cold strain ; take a wineglassful three times a day. An appetizer. ^ . Calumbse, Zingiberis aa 3 ss. Sennas 3 ij. M. et ft. chart, no. 1. B. — Put in a pint of boiling water, and when cold strain ; take a wineglassful three times a day. An appetizer. ANTISEPTIC SOLUTION AND OINT- MENT, Lister's. To thirty ounces of water add one ounce and a half of crystallized carbolic acid. This gives a solution of the strength of one part of carbolic acid to twenty of water. This is for washing out the wound, washing the surgeon's hands, for dressing the wound, and for spraying the wound during the operation or redressing. Dilute this solution with equal parts of water, or make one of half the strength, and you. have a solution of the strength of one to forty. This is for the sponges, instruments, etc. 24 prescrtber's memoranda. The articles necessary for operations or dress- ings are : {a). A steam -spray producer ; (b). A solution of carbolic acid (1 — 20) ; (c). A solution of carbolic acid (1 — 40) ; (d). Antiseptic gauze; (e). Apiece of Mackintosh cloth or rubber tissue ; (/). Drainage-tubes — a piece of soft catheter will answer ; (g). Carbolized oil-silk ; (7i). Bandages of antiseptic gauze ; (i). Catgut ligatures ; (j). Carbolized wax ligatures. All arteries should be tied with carbolized catgut ligature, and cut off short in the wound. The wound being thoroughly cleansed, a drain- age-tube with holes cut in the sides is passed through the wound, the parts brought together and secured by carbolized catgut or silk suture. Over the wound place a piece of carbolized oil- silk, dipped freshly in the 1 — 40 solution ; over this place two layers of prepared gauze, dipped in the 1 — 40 solution. On this place six or eight layers of the gauze, a piece of Mackin- tosh cloth being placed with the smooth sur- face down, between the superficial and the next- layer of gauze. The parts for a distance above prescriber's memoranda. 25 and below the wound are to be bandaged with rollers of antiseptic gauze. This dressing is not to be changed unless the patient has high fever coming on after the operation, or the discharge from the wound soaks through the dressing. As often as the discharge wets through the dressings, so often should the dressing be re- moved. All dressings should be made under the carbolic spray. Care must be taken, during an operation, that the ether does not take fire from the flame of the atomizer spirit-lamp. The flame. should be protected by gauze. — Little. $. Acid, borac. pulv., Cerse albae aa 1 part. Olei amygdal. expr. , Paraffini aa 2 parts. Rub the almond oil with the boracic acid to a smooth mass in a warm mortar ; then add the melted wax and paraffin, and triturate until cold. — Lister. ASPHYXIA. Asphyxia in Children — Harvey Byrd's Method of Artificial Respiration. — Bring the ulnar sides of the hands near together and with the pal- 26 pkesceiber's memoranda. mar surfaces looking vertically, and place them beneath the back of the infant, so that the ex- tended thumbs may aid, as far as possible, in sustaining the vertex and inferior extremities ; then, keeping the ulnar borders near together, so as to form a fulcrum, the radial borders or sides are simultaneously depressed to as great extent as practical — say forty-five degrees — be- low the horizontal line, and then gradually pro- nated or elevated to as many degrees above that line, thus facilitating the escape of air drawn into the lungs during the downward movement of the head and chest. Or the hands are placed as at first, and passed beneath the body of the child — on its back — and the superior and in- ferior extremities farthest from the operator seized, one by each hand, near the trunk, the ulnar borders of the hands and wrists forming the fulcrum — the head of the child being kept at a proper axis with the movements of the chest by the hands of an assistant, and the de- pression and elevation of the head and lower extremities proceeded with as already described. These alternate depressions and elevations of the two extremities, performed in a regular and gentle manner, and repeated at proper intervals, seldom fail in establishing respiration where it is possible of accomplishment. The cccasional pkescriber's memoranda. 27 dashing of cold water on the epigastrium, during the descent of the head and chest, will hasten respiration where the first few movements fail in its establishment. It is important that the head be kept, as far as practicable, from too much lateral movement, and not permitted to depart considerably from its antero-posterior axis with the vertebral column during the continu- ance of the process. To this end, in a critical case, the hands of an assistant may be brought into requisition. The importance of these re- marks will be apparent to intelligent readers on a moment's reflection. No impediment should be permitted in the way of free entrance of air into the lungs during the downward movement of the head ; and it is scarcely less important that no obstruction should oppose the escape of air during the upward movement of the head and chest. Dr. W. E. Forests Method of Artificial Respi- ration for the Asphyxiated New-born. — Place the child in the sitting posture in a pail or tub con- taining sufficient water to cover the lower ex- tremities and reach upward on the body nearly to the free border of the ribs, and having a temperature of 104°-110° F. Place the right hand behind the head and thorax of the child and allow its body to lean backward so as to 28 prescriber's memoranda. rest upon the hand. Carry the child's hands as far above its head as possible with your left hand. By this movement the ribs and shoulders are raised, while the head is thrown backward^ the thorax expands and air is drawn into the lungs. The second movement is to lower the arms of the child so that they fall by its side, while your hand, still retaining- those of the child in its grasp, rests upon the front of the child's thorax. The third movement is to lean the child for- ward, press suddenly downward upon its shoul- ders, and at the same time press the ribs inward with the hand in front. Dr. Wm. M. Polk says : " Catheterism of the larynx as a means of re- suscitating the asphyxiated has been suggested from time to time, but I know of no case estab- lishing its superiority so entirely as that which I report here [The Medical Record, vol. xvii. , p. 709] . With a stiff instrument the procedure is so simple, and so much more certain than all other methods of exciting respiration, that it seems to me it should be given more prominence than it has hitherto enjoyed. The condition that exists in actnal or impending asphyxia, such as the asphyxia of the new-born, of the drowned, of convulsions, of cases of opium or prescreber's memoranda. 29 carbonic oxide poisoning, etc. , is most favorable for the performance of the operation. The fol- lowing are the details of the procedure. In the adult or child with teeth, fix the jaws open by means of a cork, seize the tongue with a tena- culum or other instrument, draw it well out, and let it be held by an assistant. Pass the index finger of the left hand well down into the mouth, find the epiglottis, go beneath it, and place the finger over the laryngeal opening. Take a stiff catheter, No. 8 or No. 10, with the right hand, and using the left index finger in position as a guide, pass the instrument into the larynx. Be sure that the eyes of the instrument are well beyond the vocal cords. The assistant now extends the patient's arms above the head, the operator at the same time blowing up the lungs through the catheter. The arms are next brought down, and expiration accomplished by compressing the chest and abdomen. A respi- ratory act is thus accomplished. The proced- ure is continued with regularity, so as to simulate, as nearly as possible, the normal res- piratory interval. The insufflation through the catheter must be done gently." Dr. C. H. Humphreys has used nitrite of amyl successfully in the asphyxia of the new- born, when all other measures had failed, 30 peesceibee's memoeanda. including Dr. Forest's method of artificial respi- ration. Place two or three drops on a handker- chief and lay it over the child's face, continuing at the same time some method of artificial respiration (in his case Sylvester's) ; allow it to remain about a minute, and then remove the cloth and observe the effect. ASTHMA. Apomorphia, subcutaneously in -fa gr. doses, has been found effective. I*. Lobelise fol. pulv., Stramonii fol. pulv., Belladonnae fol. pulv aa 3 ij. Potass, nitrat. pulv 3 iij. M. Keep tightly corked. The patient is required to shut himself in a small, warm, close room, and sprinkle the medicine on live coals, or smoke it in a fresh clay pipe, till relief is obtained, which is usual- ly within ten or fifteen minutes. Br. E. M. Lawrence, who has systematically studied the effect of ethyl iodide, recommends inhalations of 15 to 20 drops of this ether from prescriber's memoranda. 31 a handkerchief, repeated three or four times daily, keeps the system constantly impregnated with iodine, and so proves a most useful agent in spasmodic asthma and other forms of nervous dyspnoea, as also in the dyspnoea of chronic bronchitis. We may mention, besides, the good results obtained by its inhalations in hay asthma. It seems to favor oxygenation of the blood and stimulates the respiratory muscles. ty . Tinct. lobeliaB § j. Ammon. iodidi . . . t 3 ij. Ammon. bromidi 3 iij. Syr. tolutan § iij. M. S. — A teaspoonful every one, two, three, or four hours. Bartholow. Of this prescription Dr. Bartholow says : "It gives relief in a few minutes, and sometimes the relief is permanent." The inhalation of carbolic-acid spray of a strength of five per cent, is now being used with advantage in coughs, bronchitis, etc. It is believed by some to be an absolute cure for all inflammations of the mucous membrane of the nose, throat, and lungs, and produces the 32 PRESCRIBER'S MEMORANDA. desired effect by being brought into direct con- tact with the parts affected. I}. Iodide of potassium 3 ij. Decoction of senega 3 iij. Tiuct. of lobelia 3 vj. Camphorated tinct. of opium. 3 vj. M. S. — One to two teaspoonfuls three to four times per day. For asthma where there is em- physema or chronic bronchitis. I£. Spts. aether, co., Liq. morph. sulph. (U.S.). . .aa, fl. § j. M. Dose, from one teaspoonful to a table- spoonful. BALANITIS. .Dr. Vipecos publishes his treatment of this disease. First, he washes the glans with a weak solution of salt water; and after dressing the parts, he applies tannin dissolved in alcohol, equal parts. After the parts are dried, cold water is freely applied. By the fourth day, with this treatment, the inflammation has dis- appeared. prescriber's memoranda. 33 BILIOUSNESS. The latest remedy for this affection is euony- min (Wahoo bark). I> . Euonymin 3ij. Ext. hyoscyami 3 j. Ext. gentianse gr. x. M. et div. in pil. no. xx. S. — One before dinner every second or third day. Especially serviceable in cases of hepatic dys- pepsia or u bilious attacks," with furred tongue, pale stools, lassitude, and general malaise. If the bowels are torpid, a little extract of nux vomica may be added. J^ . Mass hydrargyri, Ext. colocynth co aa gr. iij. M. et div. in pil. no. ij. S. — Take at once. To be followed by a saline purge. fy . Tinct. nucis vomicae gr. iv. "Resin podophyllin gr. iij. Ext. taraxaci gr. vj. Pil. catharsis co gr. xij. Fel. bovini gr. xxiv. M. Ft. pil. no. xij. S. — One at bedtime. Parker. 3 34 prescriber's memoranda. Excellent in u biliousness " with atony of the bowels. Miller's Pills. J},. Pulv. scammon., Pulv. aloes, Pulv. gambogise, Hydrarg. chlor. mit., Potass, bitarfc aa gr. xx. Ext. taraxaci q. s. M. Divide into 20 pills. This combination acts well in cases of chronic constipation with bilious symptoms. 1£. Pil. hydrarg., Pulv. aloes Soc, Pulv. rhei, Ext. hyoscyami aa gr. vj. M. et div. in pil. no. vj. S. — Two every other night. BLADDER, Inflammation of. The following is frequently employed at Jef- ferson Medical College Hospital of Philadel- phia: prescriber's memoranda. 35 3£ . Pulv. opii gr. xi j. Camphorae gr. xxx. Ext. belladonna? gr. iij. Cacao q. s. Mix et div. in suppos. no. vj. S. — One each night before retiring. In a very complete article on " chronic cysti- tis" M. Chauvel indicates the following prep- arations : ^ . Turpentine § ss. Camphor gr. xv. Ext. hyoscyami gr. ss. M. S. — The ingredients are to be well mixed, and a piece the size of a cherry-stone taken morning and evening. Mr. Teevan and Dr. G-eo. Johnson recommend an exclusive milk diet in the treatment of cystitis and vesical irritation in children. For adults, one pint every two hours. Thompson frequently prescribes, with success, an infusion which can be given in all forms of chronic cystitis : 5-. Uva3 ursi fol 3 3 . — ij . Pareiras bravaB rad 3 j.-ij. M. S. — Boil in a quart and a half of water 36 PRESCRIBE!^ MEMORANDA. to a quart. Take from fl. § ij. to fl. 3 iv. , four or five times a day. M. Gosselin recommends benzoic acid, to pre- vent the development of ammonia. He gives at first fifteen grains per diem, gradually increasing to sixty and even ninety grains, without causing any trouble, save a slight parching of the throat. This treatment generally neutralizes the acidity of the urine after seven or eight days. Mr. Nunn uses quinine injections in cases of chronic cystitis with decomposition of the urine within the bladder. The following is the method of preparing and of using the solution : Dissolve twenty grains of disulphate of quinine in twenty-five ounces of water by the aid of a few drops of dilute sulphuric acid or a tea- spoonful of common brown vinegar. Of this so- lution inject into the bladder two or three ounces, and let it remain." The stigmata of maize is highly recommended by Mr. Dessein — infusion ( 3 ij. to Oj.). Wine- glassful every three or four hours. B . Borax I j. Glycerine 3 vj. M. Tablespoonful to a pint of water, and used as an injection in chronic cystitis. peesceibee's memoeanda. 37 ^ . Acid boracic 3 ij. Syr. lemon, Syr. zingib aa § j. Aquae ad. § vj. M. S. — A tablespoonful every two or three hours, in water. Langenbeck states that in atony of the blad- der associated with enlarged prostate, in el- derly men, in which the organ is never com- pletely emptied of urine, he has lately tried the hypodermic injection of ergotine with n>ost sur- prising results. In three cases the contractile power was at once increased, so as to enable the patient to discharge the additional urine, and in a few days it hu,d so augmented that very little urine was left behind. After one or two injec- tions the improvement was considerable, and even a diminution in the size of the prostate seemed to have ensued. Dr. Israel says that he has derived the same benefit from the employment of ergotine, and refers to the case of a patient who was thus enabled to hold his water for three hours, whereas before he voided it every ten min- utes. 38 presckibeb's memoranda. BLISTERING FLUID. Granville's Blistering Lotion. V} . Aq. ammon. fort 3 iv. Spts. rosemary 3 iij. Spts. camphor 3 j. M. Produces vesication in from three to ten minutes. Granville' s Blistering Lotion^ stronger than c I) . Aq. ammon. fort 3 v. Spts. rosemary 3 ij, Spts. camphor 3 j. Cut a piece of linen the shape and size to be vesicated, saturate with above, apply, and cover for a few minutes with a dry cloth. BRONCHITIS. Dr. Bozzi has ascertained, as the result of a large experience, that the following medication cures acute bronchitis in the most certain and rapid manner : ^ . Yellow sulphide of antimony, Dover's powder aa gr. xv. Powdered sugar Bijss. M. Divide into ten parts, and take one prescriber's memoranda. 39 every three hours — but no more than four doses should be taken in the twenty -four hours. The same medication is also very useful in acute exacerbations of chronic bronchitis, as well as in that symptomatic of cardiac and pulmonary diseases. The diet should be limited to the use of warm sweetened milk and chicken soup. The temperature of the sick-room should not be lower than 60° Fahr. 1} . Vini ipecacuanhae 3 ij. Liq. potassii citratis 3 iv. Tinct. opii camphoratse, Syr. acaciae aa 3 j. M. S. — A tatlespoonful thrice daily in the first stage of ordinary acute bronchitis. Da Costa. This union of the sedative effects of opium with the excito-secretory action of the ipecacu- anha on the congested mucous membrane has been found very serviceable. I£ . Fl. ext. yerba santa 3 vj. Fl. ext. senegae § iv. Syr. prun. virginian 3 ij. Aquaa ad. 3 iv. M. S. — A teaspoonful every three hours. 40 prescriber's memoranda. Should the cough be aggravating, add a little opium. ?. Vin. antimonial 3 ss. Vin. ipecac . 7T|_ xv. Tinct. camph. co 71^ xx. • Mucilag. acacias, Syr. scillse aa 3 iv. M. S. — 3 j. every two or three hours. In bronchitis, etc , for a child two years old. Ellis. 3 . Antim. tartarat gr. j. Potass, nitrat 3 j. Mist, anrygdal § iij. M. S. — 33. every two* hours. In pneumo- nia, bronchitis, etc. Ellis. Blache has administered capsules containing thirty-five centigrammes of the crude petroleum with the following results : in chronic bronchitis, where expectoration is abundant, there is rapid diminution of secretion, and less frequency of the fits of coughing. In asthma similar results are obtained, with the disappearance of dysp- noea. In simple acute bronchitis, ifc has pro- duced a rapid amelioration. pkescriber's memoranda. 41 I£ . Tinct. eucalyptus glob 3 iv. Syr. acacias § j. Aq. menthae pip ad. ? ilj. M. S. — 3 j. every three hours. In bron- chitis with profuse expectoration. For other prescriptions for bronchitis, see Cough Mixtures. BURNS. $ . White glue § vijss. Water, cold O j. Glycerine fl. § j. Carbolic acid fl. 3 ij. Soak the glue until it is soft ; then heat on water-bath until melted ; add the glycerine and carbolic acid, and continue heating until, in the intervals of stirring, a glossy, strong skin begins to form over the surface. When needed for use, heat on water-bath until melted, and apply with a flat brush over the burned part. ]£ . Pulv. tragacanthse g ij. Pulv. acacias 3 iv. Syr. fusci (or molasses), Aquae bullientis aa Oj. M. Apply on sheet lint and cover with oil- silk. Buck. 42 prescribes' S MEMORANDA. Lime Liniment. ^ . Olei lini § vij. Aquae calcis fl. § viij . M. Apply on sheet lint and cover with oil- silk. A retired foundryman claims that powdered pine charcoal thickly dusted over a burn is a never-failing and speedy remedy. 3 . Iodoform 3 j. Spermaceti J j. Ext. conium 3 ij. Carbolic acid. gtt. x. M. S. — Spread on some soft material and cover the parts. I) . Sodas carbonat § vj. Aquae Oiij. M. Apply freely by means of old cloths or sheet lint, and do not remove for three days. Result : Immediate relief to pain ; rapid healing-. CALCULI, Biliary. Dr. Buckler states that chloroform in from twenty to sixty drop doses every three or four prescriber's memoranda. 43 hours, will in every instance dissolve hepatic calculi. As an addition to this treatment, and in cases where for some reason chloroform can- not be borne, he uses Stewart's hydrated succi- nate of the peroxide of iron, which contains a very large proportion of nascent oxygen. Dose, a teaspoonf ul after meals. CANCER. Cancer of the Cervix Uteri. — Whenever practi- cable, the whole cervix is removed by either the hot or cold wire. If this cannot be done, Dr. Goodell removes the malignant growth by scraping, or by means of the gouge-forceps, and the surface is subsequently charred with the thermo- cautery. This radical treatment is re- inforced by subsequent applications of the ethy- late of sodium. Tn these operations he finds that injections of ordinary vinegar form an ex- cellent means of controlling any embarrassing bleeding. Dr. Daniel Lewis says the treatment of can- cer by caustics is of almost equal value with that by excision, and is so recognized by many recent authorities. The agents which are in most common use are the strong sulphuric acid, nitric acid, caustic potash, terchloride of anti- 44 peesceibee's memoranda. mony, bromine, chloride of zinc, and arsenious acid. The principal objection to most of these is the excessive pain attending their application. The least painful of the above-named is the arsenious acid, used according' to the method practised by Dr. Marsden, of the London Cancer Hospital, who, after an experience of nearly twenty years, and covering upward of six thou- sand cases of cancer, pronounces it superior to every other caustic. He recommends it in every form of cancer, except the cystic or col- loid varieties — provided the disease does not exceed four square inches in size — when re- moval by the knife appears to be the only remedy. Arsenic may be used in this way for cancers in every situation, except the interior of the mouth or nose, localities where the nature of the remedy makes it dangerous. The formula used at the Cancer Hospital is the following : ]> . Arsenious acid 3 ij. Mucilage of gum acacia 3 j. Mix into a paste too thick to run. This is to be spread over the entire surface of the cancer, provided this does not exceed one square inch in size ; a bit of dry lint is then placed over the sore in order to absorb any excess of paste. In prescriber's memoranda. 45 the course of an hour the lint becomes dry and hard, and adheres firmly to the parts. In the course of twenty-four hours some inflamma- tory action is visible in the tissues immedi- ately adjacent to the cancer. There is often also some pain, but this is not usually severe, and lasts but for a day or two. After the lapse of two or three days, according to circumstan- ces, bread and water poultices, changed every few hours, are to be constantly applied over the sore. A distinct line of demarcation is usually to be seen by this time, and the slough gradu- ally separates and comes away, leaving a heal- thy, cup-like depression, varying in depth and size according to the mass removed. Granula- tion proceeds rapidly, and the case is then treated as a simple ulcer. The slough sepa- rates at periods varying from six to thirty days, according to it3 size. The disease usually comes away entire with the slough ; but, where this is not the case, the paste is to be applied to the remaining portion, as in the first instance, every second or third day, till the desired effect is produced. The arsenic appears to have a posi- tive power of election, so that, if applied to sound tissue along with the cancerous, the diseased part alone is destroyed. Marsden's large experience seems to prove this conclu- 46 pkesceibee's memoranda. sively. The arsenical paste is equally applicable to cancer, whether on the lip, face, head, arm, hand, abdomen, breast, penis, testicle, labium, scrotum, or foot; but must, as I have stated, be carefully watched, and never applied where the disease involves more than four square inches of tissue. Many medullary and scir- rhous cancers can be removed in this way, but it is especially applicable to the epithelial variety. Marsden believes that nine out of ten cases of this form may be perfectly cured if taken in time. Dr. Frank H. Hamilton says that the results of his investigation were unfavorable to cauter- ization as compared with excision. When the growth was removed by cauterization, the return was much earlier than when the knife was used. The question may be mooted, but it has not been decided in favor of caustics for the removal of either cancer or epithelioma. There are circumstances which warrant the use of caustics, but we must deny that it is the most radical method of curing either of these diseases. Dr. L. D. Bulkley says that arsenic seems to have an elective power, and does what no other caustic does — penetrate the diseased and not the healthy tissue. The pain attending the use peescbebee's memoranda. 47 of the caustic paste i.3 inconsiderable. For that epithelial variety of cancer which begins upon the face between the ages of thirty-five and forty, and which, if treated superficially, will go on and form what is frequently called rodent ulcer, he believes it is a cure. Ghian turpentine has lately been recom- mended as a curative agent in cancer. Like the famous condurango, it is probably destined to prove utterly worthless. CARBUNCLE. M. Cezard recommends the following plan of treatment for carbuncular affections. First, support the organism; and second, neutralize the morbid effect of the poison. The one ob- ject may be accomplished by giving acetate of ammonia in doses varying from an ounce and a half to six ounces in twenty-four, and the other by the use of iodine, which may be given by the mouth or hypodermically. Local treatment should be instituted as soon as possible, and the swelling should be treated both by sub- cutaneous injection and by wet applications of iodine in a solution of one to one hundred. 48 pkescribeb's memokanda. Poultices are thought to create a tendency to the formation of more carbuncles, if continued too long-. Quinine and iron should be given in large doses, also stimulants should be used freely. I£ . Calcii sulphide gr. x. Pulv. sacch. alb q. s. M. Twenty powders. S. — One every three hours. CATARRH, Nasal. For Dr. Massei, ozsena is a parasitic disease, and hence antiparasitic treatment is indicated. He divides his treatment into three stages, ac- cording to the following indications : dilatation of contracted nasal passages, cleansing and disin- fection of affected regions, and local medication. 1. Dilatation. — When respiration is rendered difficult from contraction of the nasal passages by hypertrophy of the mucous membrane, and by the presence of a considerable quantity of thick and hardened secretion, Massei dilates them by the use of urethral bougies. 2. Cleansing and Disinfection. — When the passages are sufficiently dilated, he orders fre- quent injections through them, by means of Fauvel's retro -pharyngeal syringe, of a very prescreber's memoranda. 49 weak solution of salicylic acid ( 1 part to 500 of water). He considers this solution useful, not only as a disinfectant, but also as an astringent. 3. Local Alterative Medication. — After the nasal fossas are well cleansed, he makes appli- cations, by means of the speculum nasi, of pow- dered calomel, upon the ulcerated portions of the mucous membrane. Massei warns practitioners that, when the ex- udation diminishes, there is always a halt in the course of the disease. It is just then that pa- tience must not be lost, but the insufflations rather insisted upon until complete cure is ob- tained. Although the present state of science does not permit the full acceptation of the parasitic theory of ozsena, still the excellent results ob- tained by this Neapolitan practitioner dispose us to follow the treatment which he proposes. $ . Loaf sugar 2 parts. Borax, Common salt aa 1 part. Oil of peppermint, a few drops. Triturate. S. — To be used as a snuff several times daily. 4: 50 prescriber's memoranda. Dr. Ferrier recommends for post-nasal catarrh a mixture of subnitrate of bismuth, 3 vj., pow- dered gum acacia, 3 ij- , and muriate of mor- phia, gr. ij., well mixed and used as a snuff in severe coryza or post-nasal catarrh. It acts in a most charming manner. Dr. A. G. Burness modifies Dr. Ferrier's snuff by using the lighter subcarbonate of bismuth, omitting the acacia, and using a little starch in- stead, if necessary. Dr. Pugin Thornton recommends the use of the following solution in the treatment of ozsena : B. Sodas carbonatis, Sodas biboratis aa, 3 ij. Liq. sodas chlorinatas 3 ss.- 3 ij- Glycerini § j. Aquae ad. § vj. M. Apply cold by means of a hand-spray ap- paratus. Dr. Q. C. Smith recommends for nasal catarrh liquor bismuthi and water, equal parts, applied one to three times a day, to nostrils, pharynx and naso-pharyngeal cavity, freely, with a spray- producer. Sulphocarbolate of zinc, in weak solution, as mentioned by other writers, he re- prescriber's memoranda. 51 gards also as a very efficient remedy ; applied in the same manner. Dr. Lennox Browne recommends : J$, . Borax 3 iij. Salicylic acid 3 ij. Glycerine § ijss. Water, to make § iij. From one to two drachms in one -half pint of water, applied by means of a douche. Is espe- cially useful in catarrh with ulceration, usually due to syphilis. For simple catarrh he uses : 1$. Chloride of ammonium, Borax aa gr. x. M. The above mixtures may be used advanta- geously with a spray-producer. It is generally accepted that the douche is not a safe method of treating nasal catarrh. I) . Iodoform gr. v.-viij. Ether fl. 3 j. -jss. Dissolve, and add : ^ . Vaseline § j. Ottar roses tt[ v.-viij. S. To be applied with a brush. 52 PRESCRIBER's MEMORANDA. CELLULITIS, Pelvic. Dr. William Goodell recommends the follow- ing : ' ' If you cannot abort the attack, take up the treatment regularly, and the first two and most important indications are : to stop the pain and to prevent the formation of pus. The medicines demanded are full doses of opium and bromide of potassium, together with from thirty to forty grains of quinia daily. In addition to this, paint the abdomen with iodine and put on a poultice. Some practitioners use as many as half a dozen poultices daily. The reason of this is that the poultices, being uncovered, dry up rapidly. If the poultice is covered with oiled silk, or greased brown paper,' one poultice will remain soft for twenty-four hours. Dur- ing this time the patient should be kept under the influence of large doses of quinia and morphia. Quinia contracts the capillaries, les- sens the flow of blood to the womb, and also inhibits the migration and transformation of white corpuscles into pus- corpuscles. If the woman be plethoric, the morphia may be given by the mouth with neutral mixtures and wine of ipecac, or in some other fever mixture. In some cases tonics are demanded. Occasionally pkesckibeb's memoranda. 53 the application of belladonna and blue ointment locally is of benefit. " The disease ends either by resolution or in the secretion of pus. When pus is formed the tumor usually becomes a little softer, and this condition of things is accompanied by chills, night- sweats, and hectic fever, although these symptoms cannot be regarded as in any way pathognomonic. In nine out of ten cases the end is by resolution. When pus is formed the condition immediately becomes troublesome. " If the sickness, therefore, lasts for more than a week, and the local tenderness increases, ap- ply the hot- water douche to the tender cervix. Then you will very often find that after a few days the pain and inflammation subside, but there is still some fever in the afternoon. Now is the time to apply flying blisters. Begin with a good-sized one applied over the sore iliac region. In some cases this will be all that is required. When the pelvic tumor still remains, however, put another blister over the womb, and then another over the other side of the abdomen, and then begin over again, so going the rounds and keeping the skin raw in spots until you have gained the resolution of the exu- dation. In some rebellious cases of pelvic peri- tonitis a hard, tumor -like mass may exist for 54 prescreber's memoranda. some time in the abdomen. I say pelvic peri- tonitis because cellular tissue would not harden in this way, but would degenerate into pus. When the cellulitis preponderates you are more likely to have pus formed, and instead of the chronic local hardness you have a chill and high pulse. " Very often the pulse will have fallen below 100 and the temperature will have almost reached the normal, when a sudden chill will supervene, and the patient will complain of pain in the opposite iliac region. This is quite common as a sequel of abortion and in the puer- peral state, but is rare after operations. When this metastasis occurs the only thing to do is to begin again with large doses of quinia and of morphia, and give ten grains of quinia at a time, and, if necessary, from one-fourth to one- eighth of a grain of morphia hypodermically. This second attack will generally be found to be more manageable than the first. " When pus is formed, tonics are demanded, and among them iron. Never give iron, how- ever, in the early stages of the disease, as it is only too liable to send the blood to the womb, and so increase the already inflamed condition of that organ. Never keep the poultices on after the formation of pus has begun. Some presckibee's memoranda. 55 authorities hold that poultices tend to the for- mation of pus. " It is in these later stages of the disease that muriate of ammonia is a very excellent remedy; so, too, is aconite. I usually prescribe the fol- lowing : U I£. Mist, glycyrrhizae comp fl. 3 vj. Ammonii chlor 3 ij. Hydrarg. chlor. corrosivi gr. j. Tinct. aconiti radicis gtt. xxiv. "M. S. — A tablespoonful in water every six hours. u Suppose that you are convinced that pus has formed and that you are unable to secure its absorption by medicinal means. Examine the vagina and see if you can detect any soft point which fluctuates, or pits upon pressure. The most common site for the pointing of pus formed, as a result of pelvic cellulitis and peri- tonitis, is the vagina ; the next most common site is the rectum. Of these two the vagina is the more desirable. Occasionally the pus emp- ties into the bladder. " When the spot has been found where the ab- scess is beginning to point, make an incision large enough to admit of a free drain of pus. Be as sure as you can be, however, before you 56 peesceibee's memoeanda. cut an opening that all the small abscesses, if such there be, have melted down to form one large one. If the abscess is very slow in point- ing you will have a perfect right to search for the best point at which to introduce the aspira- ting-needle. In this way you may empty as many separate collections of pus as you can find." CHANCRE. Br. F. N. Otis gives the following rules for excision of the initial lesion of syphilis : First cleanse the parts thoroughly by gentle bathing in warm water ; in all open lesions apply a solution of carbolic acid of a strength of one part to forty of water, after which raise the mass of induration between the forefinger and thumb, and encircle it firmly at the base with a piece of fine silver or malleable iron wire. The indurated part may be separated from the normal tissue in the same way by compression between the arms of a bent probe, being careful to include the en- tire induration. Now, with a narrow, sharp- pointed bistoury, pierce the tissues at the cen- tre beneath the compressing wire or probe, and peesceibee's memoeanda. 57 cut well under and out, including all the indura- ted and a little of the sound tissue of that side. This effected, from the place of beginning cut out in the same way on the opposite side. Be assured, by careful examination, that every por- tion of the neoplasm is removed ; then intro- duce uninterrupted sutures of silk or silver wire at intervals of one-fourth of an inch. The patient should be kept in the recumbent posture, the parts constantly wet with carbolated water, until the third day, when, on removal of the sutures, union by first intention will, as a rule, have taken place. The resulting cicatrix may indu- rate to a greater or less degree, but rarely, if ever, to the extent of inducing a solution of continuity. In no case does this procedure lessen the necessity for constitutional treat- ment. Dr. F. R. Sturgis says : " As regards treat- ment, it is simple, and, so far as local trouble is concerned, effective in the majority of cases. In the first place, let me beg of you never to cauter- ize an initial lesion unless it should be attacked by phagedena. I know it is the rule to cauter- ize every suspicious-looking ulcer ; but, in the case of the initial lesion, it not only does harm in irritating an otherwise simple ulceration, but it retards its healing. Dress the lesion simply ; 58 prescriber's memoranda. sometimes a piece of lint laid over the ulceration or erosion will suffice, but at other times a little more active treatment may be requisite. Of all dressings I much prefer the dry, and of those iodoform heads the list, either alone or in com- bination with other drugs. Thus : I£ . Iodoform pulv. , Lycopodii pulv equal parts. Or, $ . Pulv. zinc, ox 2 parts. Pulv. iodoformi. 1 part. Or, 1$. Pulv. hyd. chlor. mit 1 part. Pulv. iodoformi 2 parts. Calomel, without anything else, may also be used with advantage. A mode much practised in the German hospi- tals is to apply a piece of the emplastrum de vigo cum mercurio, the size of the ulcer, di- rectly upon the sore, and leave it thus protected from the air until the ulcer heals up. The Emplast. Hydrargyri, U.S. P., will answer as well. If you prefer to use a wet dressing, a weak solution of carbolic acid is the best, of which the following may serve as an example : pkesckiber's memoranda. 59 I£. Cryst. acid, carbol gr. ij. Aquas § iv. M. Apply on lint or cotton thrice daily. CHILBLAINS. I£ . Acid, carbol 3 j. Tinct. iodinii 3 ij. Acid, tannici 3 ij. Cerat. simplicis § iv. M. S. — Ointment to be used at night. Bartholow. Poicder to prevent chilblains : ^ . Sodium borate 3 parts. Alum, Benzoin aa 2 parts. Mustard 12 parts. Orris-root, Bran aa 10 parts. Almond-skins 30 parts. M. Mix with a little water and apply. Bandt. 60 prescriber's memoranda. Wash for Non-ulcerated Chilblains : I£. Sulphate of aluminum and potash 1 part. Vinegar, Weak alcohol aa 25 parts. M. Dissolve and filter. Apply night and morning. Beasley. Ointment for the same : }£ . Prepared lard 8 parts. Crystallized acetate of lead ... 1 part. Distilled cherry-laurel water.. 2 parts. M. Apply night and morning. Giacomini. Ointment for the same : ^ . Tincture of benzoin 1 part. Glycerine 2 parts. Linseed oil. 3f parts. Yellow cerate 2 parts. Spirits of lavender f part. Mix carefully. Apply night and morning. Orosi. I£ . Yellow wax 2 parts. Linseed oil 3f parts. Tincture of benzoin 2 parts. Glycerine q. s. M. Reveil. prescreber's memoranda. 61 For Unbroken Chilblains. ^ . Sulphuric acid 3 j- Spirits of turpentine 3 j. Olive oil 3 iij. Mix the oil and turpentine first, then gradu- ally add the acid. To be rubbed on two or three times a day. For Unbroken Chilblains. #. Lard I iv. Turpentine § j. Camphor 3 ij. Oil of rosemary 1TL xv. Rub in with continued friction. For Broken Chilblains. ^ . Yellow wax, Olive oil, Camphorated oil aa § iij. Goulard extract § jss. Melt the wax with the oil, then add the camphorated oil and Goulard extract. ]£ . Sulphurous acid 3 parts. Glycerine, Water. aa 1 part. M. 62 prescriber's memoranda. CHAPS, etc. J$. Resinge |j. Cerse 3 iij. Adipis % ij. Zinci oxidi : 3 vij. M. I£ . Glycerine 3 ij. Spermaceti 3 j. White wax gr. xv. Essence of bitter almonds. . . . gtt. xvj. Melt the spermaceti and the wax together, add the glycerine and the essence, and stir till cold. Bouchut. CHOLERA INFANTUM. Dr. J. L. Teed says that in the congestive diarrhoea of children the following will be found to relieve the condition in a short time : ^ . Hydrarg. chlor. mite gr. ~nj Pulv. ipecac gr. ~h—h Morphia acetat gr. / "-To o to each powder. To be repeated every two prescriber's memoranda. 63 or three hours for a few doses ; to be followed by sodas potass, tart. In the hyperasmic form he gives a mild aperient first, then — 1£. Hydrarg. c. creta, Pulv. rhei, Pulv. cinnamomi aa gr. j. repeated several times, afterward chalk mixture with bismuth. In the bilious form he first gives a mild laxa- tive in plenty of mucilaginous base. Then mer- cury and chalk with ipecac and sodas bicarb. , followed by ipecac and opium, and that by nitromuriatic acid and syrup. In chronic diarrhoea with watery stools, he uses hydrarg. c. creta gr. -g every hour. In the choleraic form (cholera infantum) he uses calomel in gr. J to gr. j. doses, in a little sugar, dry, on the tongue. Acetate of lead and morphia, in small doses, may prove of service. Stimulants are to be given. ^ o o gr- morphia may be used subcutaneously. Hot applications may allay vomiting. Dr. C. H. Avery has used the following, with excellent results, in the treatment of cholera infantum : 64: pbesckiber's memobanda. 3 • Acid, carbolic gr. xxiv. Spts. vini gtt. xxiv. Aquas menth. pip % jss. Mucil. acac 3 vi. Syr. papaveris rf . 3 vj. Tinct. opii gtt. x. M. et S. — Teaspoonful every two hours. Apply a spice-poultice to the stomach, made of cloves, cinnamon, and ginger mixed with brandy. The first effect is to check the vomiting, com- monly at once. The second effect is to change the character of the passages, which usually occurs within twenty-four hours. The third effect is to reduce the frequency of the pas- OHOREA. ]£ . Chloral hydrate 3 ijss. Tinct. hyoscyami ^ j. Syr. limon ad. § j. Aquas cinnamomi § iv. M. et S. — Dose, 3 j. four times a day. Peyroud speaks highly of the use of arsenic subcutaneously in chorea. He uses : pbesckibek's memobanda. 65 I£ . Liq. potassse arsenitis | ss. Aquas pur § j. M. From 5 to 10 drops of this solution, repre- senting from 2-J to 5 drops of Fowler's, is in- jected every third or fourth day. The chorea is cured, and the children gain in flesh during the treatment. It never causes inflammation or abscess. Simon says : " When the physician is called at the outset of the disease, dry cups should be applied along the spine each morning. In the way of calmants, he gives tinctures of aconite or hemlock, also tincture of colchicum as an antirheumatic. The acute stage being past, he orders tonics, phosphate of lime, saline baths, gymnastics. He does not advise the seaside for excitable subjects. If one desires the vivifying effect of the sea-air, it is best to keep the little patients at some distance from the shore. He also uses chloral in syr. camomile. Ether-spray to the nape of the neck, and the internal use of Fowler's solution, have given good results. Dr. Hayden has used strychnia and phospho- rus, in three-minim doses of the liquor, and 5 66 prescriber's memoranda. ethereal tincture, three times a day, with good results. COLIC, in Children. Dewed s Mixture : 3£ . Magnesiae carb § ss. Tinct. asaf ostidaB gtt. xl. Tinct. opii gtt. xx. Sacch. alb 3 j. Aquas destillat § j. M. Twenty drops for child two to four weeks old. $ . Tinct. asaf oetidse gtt. xv. Tinct. cinnamomi § ss. Syr. rhei aromat 3 iij. Aquas § jss. M. Dose, 3 j. Brunner. 5 . Potass, carb gr. ij. Olei cajeput TT^ j. Aquas anethi 3 ij* M. S. — Three or four times a day. Fothergill. prescriber's memoranda. 67 This alkaline mixture will afford speedy relief to infants who have griping pains after taking milk — a condition very frequent and exceedingly annoying. Colica Pictonum. — Croton-oil, in half -drop doses, combined with sufficient opium to relieve the pain, and repeated every three or four hours until free evacuation of the bowels is pro- duced. CONJUNCTIVITIS. I£ . Sodas biborat gr. x. Aquae |ij. M. To spray the eyes in conjunctivitis during nflammation. Later the next may be used. ]£. Alum vel. potass, chlorat 2 parts. Aquae 100 parts. M. To cleanse the eyes. 3£ . Sodium chlor 3 j . Aquae gj. M. 68 prescreber's memoranda. ]£. Hydrarg. oxid. flav gr. ij. Vaseline § j. M. Seely. 3 • Zinci sulphatis, Cupri sulph., Ferri sulph., Alum sulph aa 3 j. M. Saturated solution for severe cases, weaker solution for milder cases. Holmes. 1$. Liq. plumbi subacetat § j. AquaB 3 iij. M. To be applied by the surgeon to the everted lids, and then washed off with water. BtTLLER. CONSUMPTION. 1$, . Olei morrhuae fl. § j. Tinct. iodinii comp TT^ xvj. M. Dose, one to four teaspoonfuls. 3$. Mist, olei morrhuse fl. J j. ^Etheris TIL xvj. M. Dose, one to four teaspoonfuls. presceiber's memoranda. 69 IjL Olei morrhuas, Mucil. acacias aa fl. 3 ij. Fiat emulsio et adde — Syrupi calcis lactophosphatis . fl. § ss. ^ . Morph. sulph gr. ij. Acid, sulph. dil . . gtt. ij. M. et adde — Tinct. serpentarias § j. Vini antimonii, Vini ipecacuanhas aa 3 ij. Tinct. anisi 3 j. Syr. pruni Virgin § iv. M. ft. sol. Dose, a teaspoonful every two or three hours. $ . Syr. calcis lactophosphat J ij. Spts. frumenti § V J SS - Glycerinas purse \ vj. Tinct. cinchonas 3 jss. ]£ . Vini f erri § iv. Quin. sulphat § j. Glycerinas puraa § viij. Spts. frumenti § iv. 70 prescriber's memoranda. I£. Glycerin as purse, Spts. frumertti aa ^vj. Ext. pruni Virgin fl. § iv. Useful with a cough, when the tonic and seda- tive influence of the cherry bark is indicated. Of either of these three mixtures one or two tablespoonfuls may be given three or four times a day. Dr. H. Gibbons, jr., uses the following to re- lieve the night cough and restlessness of pa- tients suffering with phthisis : $. Tinct. belladonnas 3 ij- Syr. scillas § ij. Morphias sulphatis gr. iv. Syr. tolutani ad. § iv. M. S. — A tablespoonful at bedtime, re- peated, if necessary. " Rye and Rocky 3 . Spiritus f rumenti Oj . Glycerine § ij. Rock candy § xvj. Fothergill says, with reference to the treat- ment of early phthisis: "It is as important to study the tongue as the chest ; attention prescriber's memoranda. 71 to the stomach and bowels is as essential as the treatment of night- sweats. It is use- less to give cod-liver oil when the tongue is covered with thick fur ; administer rather a co. calomel and colocynth pill every night, and a nitrohydrochloric acid mixture with an infu- sion of cinchona, ter die, until the tongue clears. If the tongue is raw, give bismuth with an al- kali, and milk diet. Seltzer water and milk may be used when milk alone is too heavy and constipating. When the tongue becomes nor- mal, then the cod-liver oil and iron may be ad- ministered. Diarrhoea is checked by a pill of f erri sulph. , gr. ss. , and opium gr. j. ; rice-water being used as a drink. Hydrobromic acid with spts. chloroform affords relief from harassing cough. " 1£ . Yolk of eggs no. ij. Mint-water 3 iijss. Triturate, and add by trituration — Loaf sugar, grained § ij. Triturate, and add by trituration — Cod-liver oil 3 viij. Spts. frumenti 5 vijss. Tinct. opii camph % iij. M. Make emulsion. 72 pbesceibek's mdbmoranda. Tasteless Cod-liver Oil Mixture. ty . Olei morrhuae 3 vij. Spts. lavand. comp., M. Brandy aa 3 j. $ . Olei morrhuse § ss. Mucilag. acaciae § ij. Sacchari 3 ij. Tinct. lavand. comp Tf^ xx. Aquae § ss. M. Dose : A teaspoonful. Agreeable form of taking cod-liver oil, for children. Farquharson. ^ . Olei morrhuae, Aquae calcis aa fl. § viij. Olei cinnamomi gtt. x. M. Dose, a tablespoonful. $. Olei morrhuae 18 parts. G-lyconini (see third below). 9 parts. Spts. ammon. arom 1 part. Vini Xerici 20 parts. Spts. amygdal. amar 2 parts. M. All to be taken by weight. The spiritus amygdalae amarae is made by mixing one part of oil of bitter almonds with sixty-four parts of al- cohol. Dose, a tablespoonful. prescriber's memoranda. 73 3. Olei morrhuse 20 parts. Olei phosphorati (1 per cent. ) 2 parts. Glyconini 7 parts. Spts. amnion, arom 1 part. Syr 10 parts. Acidi phosphor, dil 4 parts. Spts. amygdal. arnar 2 parts. M. All by weight. Put the glyconin into a mortar and add the oils to it in very small quan- tity at a time, triturating the mixture actively and constantly. Then add the other ingredi- ents in the order in which they are named. Dose : a tablespoonf ul. ^ . Olei morrhuaB fl. § ij. Aquae calcis fl. § ss. Syr. calcis lactophosph fl. § jss. M. Dose, a tablespoonful. Bosley. Glyconini. ^ . Vitellorum ovorum 4 parts. Glycerinse 5 parts. Beat or whip the yolks of the eggs, which must be fresh, in the usual manner ; pour the liquid into a bottle, add the glycerine, and shake 74: prescriber's memorajstda. them well together. One pint of cod-liver oil requires about four fluid ounces of glyconin to emulsionize it. Dr. Reuss does not desire to make creasote an universal panacea in phthisis, but he be- lieves that, administered in an inoffensive form, it may render great services. The formula which he employs is the following : ^ . Pure balsam of tolu 4 parts. Pure beach creosote 1 part. Excipient q. s. M. He gives this preparation in the form of dragees, or capsules, and orders two in the morning and two at night, gradually increasing the dose up to ten per day. The committee of the New York Therapeuti- cal Society, from an investigation of the evi- dence before them, felt warranted in drawing the following conclusions : 1. That the addition of ether to cod-liver oil, in about the proportion of fifteen minims to each half- ounce (or an equivalent amount of the compound spirit of ether), will succeed in pkescribeb's memoranda. 75 the vast majority of cases in enabling" the pa- tient to take the oil, even though it previously disagreed. 2. That, in some cases in which the oil still disagrees after the addition of the ether, the difficulty may be overcome by giving the ether separately from fifteen minutes to half au hour after the oil is taken. JNo facts have been laid before the commit- tee having a bearing upon the question as to whether the etherized oil is superior to the plain oil in its ultimate effect upon nutrition, supposing them to be equally well tolerated by the stomach. COUGH MIXTURES. Stokers Cough Mixture. I£ . Ammon. carb gr. xxxij. Ext. senega fld., Ext. scillas fld aa 3 j. Tinct. opii camphorat 3 vj. Aquae § jss. Syr. tolut q. s. ad. § iv. M. S.—A teaspoonful. 76 pkescribeb's memoranda. WedeVs Pectoral Powder. 3£ . Acid, benzoici gr. viij, Sulphuris loti gr. lxxv. Glycyrrhizse rad 3 ijss. Iridis florentin. rad 3 ss. Sacchari 3 v. Olei anisi, Olei f oeniculi aa gtt. iv. M. Fiat. pulv. Dose, a tablespoonful three or four times a day, in bronchitis, severe cough, or croup. 32 . Pulv. ext. glycyrrh. , Pulv. sacchari, Pulv. acacias . . .aa 3 j. Tinct. opii camph fl. 3 ss. Vini antimonii fl. 3 ij. Spts. aetheris nit fl. 3 j. Aquas q. s. ad. fl. § iv. M. Dose, a teaspoonf ul. Shake before using. This mixture makes a good vehicle for the ad- ministration of muriate of ammonia. ^ . Potass, bromidi 3 iv. Potass, cyanidi gr. iv. Syr. pruni Virgin fl. § iv. M. Dose, a teaspoonful. prescriber's memoranda. 77 1$, . Amuionii carbon gr. 1. Potass, iodidi 3 iij. Syr. pruni Virg. , Spts. aether, co aa fl. § jss. M. Dose, a teaspoonf ul. Stimulant and ex- pectorant. Katzenbach. I£ . Tinct. tolutanae fl. 3 ij. Syr. senegas fl. 3 ss. Acid, acet fl. § jss Syr. pruni Virg q. s. ad. fl. J ij. M. Dose, a teaspoonf ul. I£. Acid, hydrocyan. dil., Chloroformi purif aa, fl. 3 j. Tinct. hyoscyami, Syr. tolutani, Aquas camphoras, Mucil. acacias aa fl. § j. M. Dose, a teaspoonful. Katzenbach. The inhalation of carbolic acid spray, of a strength of five per cent. , is now being used with advantage in coughs, asthma, and chronic ca- tarrh. 78 presckebee's memoranda. I£. Acid, hydrocyan. dil gtt. viij. Syr. simp 3 ijss. Aquae destill 3 xv. M. S. — Teaspoonful every four hours In case of failure, the dose to be increased till one and a half teaspoonful is taken every three hours. Night cough of children. Macdonald. $ . Tinct. nucis vom fl. 3 ij. Vin. ipecac fl. 3 ijss. Syr. sarsap. co. s Syr. senegae aa fl. § jss. M. Dose, a teaspoonful, for children. ]£ . Potass, nitrat gr. j. Spts. aether, nit., Syr. ipecac aa fl. 3 ss. Syr. pruni Virg fl- 3 ij. Aquae q. s. ad. fl. | j. M. Dose, a teaspoonful, for children. Robinson. 5 . Vini antimonii fl- 3 j. Syr. ipecac fl. 3 ij. Tinct. opii camph fl. 3 j. Spts. aetheris nit fl- 3 ij. Ext. glycyrrhizae gr. xv. Aquae fl. 3 ij- M. Dose, one or two teaspoonfuls. frescrebeb's memoranda. 79 $. Potass, cyanidi > gr. ij. Viiii antimonii fl. 3 i j. Syr. tolut., Mucil. acaciae aa fl. § ss. Aquae q. s. ad. fl. § ij. M. Dose, a teaspoonful. I£ . Acid, hydrocyan. dil tf^ x. Syr. papav. alb 3 iij. Aquae flor. aurant ad. § vj. M. S. — 3 j. , capiend. secund. vel tert. horis. In spasmodic cough for a child three years old, the dose may be cautiously increased. Ellis. 1£ . Acid hydrobrom. dil. (34$) ... fl. 3 ss. Spts. chlorof ormi 71^ xv. Syr. scillae fl. 3 j. Aquae q. s. ad. fl. § j. M. One dose, to be taken twice or thrice daily, for nervous cough. J£ . Ammonii carbonat 3 ss. Syr. senegae fl. 3 iv. Syr. ipecac fl. 3 ij. Syr. tolut fl. 3 iv. Ext. gly cyrrh 3 ss. Aquae cinnam q. s. ad. fl. § iv. M. Dose, a teaspoonful, for children. Bosley. 80 pkescbiber's memoranda. 5 . Morphias sulph gr. xvj. Syr. scillas, Syr. ipecac aa fl. § xvj. Syr. tolut., Syr. pruni Virg aa.fl. § xij. Tinct. benz. co., Tinct. sanguinarias aa fl. J iv. Aquas fl. § vj. M. Dose, a teaspoonful. ]£ . Ammonii chloridi gr. iijss. Potassii chlorat gr. xl. Syr. senegas fl. 3 iv. Syr. ipecac e fl. 3 iij . Syr. tolut fl. 3 v. Ext. glycyrrhizas 3 j. Aquas cinnam q. s. ad. fl. § iv. M. Dose, a teaspoonful, for children. BOSLEY. 3 . Acid, hydrobrom gtt. xx. Ext. scillas gr. ss. Spts. chloroform fl. 3 ss. M. S. — Every three hours. FOTHERGILL. pbescribeb's memoranda. 81 B . Ammoiiii chlor gr. xx. Aceti scillse fl. 3 j- Mist, glycyrrhizse comp fl. 3 vij. M. Dose, two to four teaspoonfuls. 5 . Ammonii carbon gr. x. Syr. ipecac fl. 3 jsa. Tinct. opii camph fl- 3 j. Syr. pruni Virg fl. 3 ss. Aquae q. s. ad. fl. 1 ij. M, Dose, a teaspoonful for children with bronchitis. Robinson. 3. Tinct. opii camph., Spts. ammon. arom aa fl. § j. Ext. ipecac fl. 3 ss. Syr. pruni Virgin . fl. § j. Aqua3 q. s. ad. fl. § iij. M. Dose, a teaspoonful for infants. $ . Potass, chlorat 3 j. Ext. glycyrrhizaa 3 ss. Ammonii chlor 3 j. Aquas fl. § iv. M. Dose, a teaspoonful. Wheelock. 6 82 pbescbibeb's memobanda. 5 . Potass, iodid 3 iij. Tinct. tolut fl. 3 j. Ext. pruni Virg. fl. . , fl. 3 j. Syrupi fl. g j. Spts. setheris co fl. § ij. Aquae fl. I j. M. Dose, a teaspoonful. J anew ay. ]£. Acid, hydrocyanic, dil., Chloroform aa 3 j. Tinct. hyoscyam § ss. Aquae camph ad. § ij. M. S. — Teaspoonful in a wineglass of water, three or four times a day, to relieve the cough of consumption. A. A. Smith. CONSTIPATION. ]£. Ext. rhamni pursh. (cascara) . § j. Ext. belladonnae 3 j. Tinct. nucis vomicae 3 ij. Syrupi et aquae aa ad. § iv. M. S. — Spoonful three times a day. In ob- stinate chronic constipation. Clabke. pbesckeber's memoranda. 83 $. Ext. colocynth. comp gr. ij. Ext. belladonnas gr. £. Ext. gentianae gr. j. Olei carui gtt. ss. M. et ft. pil. no. 3. To be taken at bedtime. The pulvis glycyrrhizas comp. of the Prussian Pharmacopoeia is another good laxative. Pa- tients can take it for months, and always with benefit. The formula for it is as follows : ^. Pulv. glycyrrh. rad., Pulv. sennas aa 1 ss. Sulphuris sublim., Pulv. f osniculi aa 3 ij. Sacchar. purif § jss. M. S. — One teaspoonf ul in half a cupful of water, at bedtime. Goodell. ]£ . Ext. belladon gr. v. Ext. nucis vom gr. x. Ext. colocy. co 3 j. M. et div. pil. no. xx. S. — One at bedtime. If the colocynth gripes, add 3ij. of bicarb, sodas and divide into 40 pills, and take two at bedtime. Thomson. 84 peesceibeb's memoeanda. IJ. Aloes Soc gr. ss. Rhei gr. ij. Ext. bell gr. -fo M. Ft. pil. p. r. n. Da Costa. 1$. Res. podophylli gr. xxiv. Gambogias 3 j. Pulv. aloes § ss. Hydrarg. chlor. mit 3 ij. Pulv. zingiber., Pulv. capsici aa 3 ij. Ext. taraxaci q. s. M. Divide into 240 pills. Janeway. I}. Pulv. rhei, Pulv. aloes aa gr. xv. Ext. bellad., Ext. nucis vom. , Resin, podophylli aa gr. iij. Olei caryophylli gtt. v. M. Divide into 12 pills. Dose, one pill mornings and evenings. Buckthorn (Rhamnus frangula) is a favorite and useful remedy with the profession, as a cathartic and laxative, especially in combination with other remedies. From repeated trials a pkescribee's memoranda. 85 better effect from rhamnus purshiana, or cas- cara sagrada, is obtained in the form of the fluid extract. An excellent combination, in constipation dependent upon an atonic condition of the alimentary canal, is the following : If. Ext. cascara sagrada fl 3 j. Ext. malt, Syr. simp aa ad. § v. M. S. — 3 j. ter in die. Dr. G. S. Wells believes that cascara sagrada, in moderate doses, is the best single remedy for costiveness yet introduced into practice. He combines it with nitro-muriatic acid, and sometimes adds one-fortieth grain doses of strychnia. Has tried cascara cordial in up- wards of thirty cases. It is too weak for drachm doses, and he thinks that more of the base can be used without injuring its claims for elegance. CONVULSIONS IN CHILDREN. Ijfc . Chloral hydrate gr. x. Fresh milk 1 j. M. Rectal injection. 86 pkescriber's memoranda. In very young children the dose should be re- duced by injecting one- third, one -fourth, one- sixth, of this quantity of chloral. Hot baths, mustard, lancing the gums when necessary, etc., are all to be attended to. Chloral gives better results than any other drug. Ferrand advises the hot bath, bromide of potassium internally, inhalations of chloroform; in case of extreme violence of the convulsions, anointing the axillas with belladonna ointment. If the indications require action of the bowels, he prescribes calomel in place of the bromide, or alternating with it. Id grave forms it is well to apply leeches back of the ears. Dr. A. A. Smith says, whatever the cause, the convulsion should be arrested and another prevented by the administration of anaesthetics, preferably chloroform. If the convulsions are due to pain produced by causes other than those which can be readily removed — as an overloaded stomach, which can be easily emptied — opium is the most valuable remedy, and he employs it if the child is more than four months old. Convulsions dependent on the pain of teeth- ing should be controlled : first, by opium, and second, the gum-lance. Convulsions dependent on the pain produced by worms, or other foreign bodies in the intes- prescriber's memoranda. 87 tinal canal, or errors in feeding, should be first controlled by opium, and then a cathartic should be given. The cathartic and opiate may be combined with advantage. If the gums are hot and swollen, they should be lanced. If it is time for the tooth to appear, the gum should be scarified. The hot bath in the treatment of convulsions should be rejected. If the child is under four months old, give a teaspoonful of the following mixture every hour : If. Sodae bromid. , Chloral hydrate, Sodas bicarb aa gr. viij. Aquae § j. M. Double the quantity may be given to a child from six weeks to four months of age, every hour or two hours, according to the frequency and the severity of the convulsions. Dr. J. Lewis Smith relies upon the bromides, of potassium preferably, in large doses fre- quently repeated — two to six grains for a child over two months and under one year of age, re- peated every ten, fifteen, or twenty minutes, ac- cording to the severity of the case — to control 88 pkescriber's memoranda. the irritation produced by the irruption of the teeth. He gives hydrate of chloral in convul- sions of children, and always by rectal injec- tion. He believes the hot bath to be a bene- ficial agent, and certainly when a child is threatened with convulsions, has twitchings, etc. He does not give anaesthetics in this class of cases. Dr. S. T. Hubbard fears to use opium in children. He has used the bromides and chloral with good success in the treatment of convul- sions of children. He uses chloroform, and be- lieves that anaesthetics are beneficial in arresting the convulsions. He uses a modified hot bath : strip the child, then wrap it in flannel wrung out of hot water, and cover with a dry flannel blanket. Dr. Engel reports a case in which the nitrite of amyl was successfully used. The parents had lost three children previously by epileptiform convulsions of the same character as those af- fecting the present case. The child, eighteen months old, had continued in convulsions for five hours, and was apparently moribund, when, as a last resort, five drops of the amyl were given along with one-fourth grain of morphia. The child at once went off into a quiet sleep. prescribeb's memoranda. 89 CONVULSIONS, Puerperal. Br. H. H. Kane believes that chloral gives the best results in this disease. He recommends a rectal injection of 3 j. of chloral in milk, fol- lowed by others of 15 gr. each every hour until the convulsions cease. Dr. T. Gaillard Thomas says : ' ' Stop the con- vulsions and do not permit them to return, and for that purpose use chloroform. Get the kid- neys to work as soon as possible ; deliver the woman as soon as can be done with safety to the mother and the child." The late Dr. Edmund R. Peaslee said : " Place the woman at once under the use of chloroform, for the purpose of preventing the further occur- rence of convulsions. She may be held under its influence for almost any length of time, if it is properly administered, and not to the extent of producing stertorous breathing. This is done with the view of saving the brain, relieving the pressure upon the great nervous centres. Next, in every possible way hurry the labor. Get rid of the child as soon as possible ; save it if you can; at the same time do not risk the life of 90 prescriber's memoranda. the mother. Secure free action of the skin, the kidneys, and the bowels, without delay. " CROUP. A teaspoonful of glycerine often proves emetic to young children with croup. Dr. Fordyce Barker speaks highly of from 3 to 5 grains of turpeth mineral, repeated if vom- iting does not take place. The ^o to -fg- gr. apomorphia has been used for the same purpose. Also to cure without producing vomiting. Dr. Smidowisch mentions four cases in which apomorphine was used by him. with success in croup and acute laryngitis. In these cases large doses were borne ; for instance, to one boy, one and one-half year old, who was suffering from severe croup, from 0.06 (seven-eighths of a grain) to 0. 07 (one and one-tenth of a grain) of a gramme per day for five days was given. But toward the close of the disease a dose of 0.004 (grain one-sixteenth) of a gramme could not be borne. This case is the more interesting be- prescriber's memoranda. 91 cause, after two and one-half years, a second attack of croup in the same child was likewise removed by the use of apomorphine. In the second instance the dose given was from one to one and a half teaspoonful of a one per cent, solution of apomorphine hourly. Dr. Netolitzky has employed the treatment of croup recommended by Dr. Schutz three years ago, in nine cases with seven recoveries. He used the following formula : Vy . Bromi puri, potass, bromidi, aa grs. vijss.-xv. • aquae, 3 v.-vij. M. This solution was poured on a small sponge or on cotton, and the patients inhaled the va- por given off by it for five or ten minutes every half -hour. The potash is added to retard the too rapid volatilization of the bromine, which ne- cessitates also a frequent moistening of the sponge or cotton. When there was a tendency to renewal of the exudation, the inhalations were continued for a prolonged period, but weaker solutions were used. Ipecac and other expectorants were given at the same time. One great advantage of these inhalations is the fa- cility with which they can be administered, no special apparatus being required. They do not excite any affection of the respiratory organs. and are not specially liable to excite cough. 92 prescriber's memoranda. I£ . Vin. antimon 3 rj. Syr. papaveris 3 iv. Syr. tolu 3 ij. Aquas I j. M. Administer in as large doses as possible without producing vomiting, and repeat every hour. Delafield. ~Rf. Tinct. eucalyptus 3 iv. Syr. limon § ss. Aquae pur ad. f iij. M. Teaspoonful every hour. Spoken of highly in croup and diphtheria by Dr. Walcher. Acid, hydrocyanici dil. Dose, 1fT[_ -£~j. always to be cautiously given. ¥?, . Acidi hydrocyan. dil TIL ij. Tinct. hyoscyam TTL xx. Syr. aurant 3 ss. Mist, amygdal § ij. M. Dose, 3 ij . may be given frequently in per- tussis, laryngismus stridulus, croupy cough, etc., to a child five years old. 3 j. for a child two years old. Ellis. pbescbiber's memoranda. 93 COUNTER-IRRITANTS AND CAUSTICS. 3. Chloral hydrate, Gum camphor aa 3 ij- Rub together in a mortar until an oily liquid results. An excellent application in neuralgia. 1$ . Iodin. pur | ijss. Potass, iodid § ss. Spts. rectificat fl. § xij. Alcohol ^iv t The above is the correct formula, for Church- ill's tincture of iodine, as given in the fifth edition of his work on Diseases of Women. An elastic pencil of lunar caustic may be prepared by dipping a laminaria-tent, two mil- limetres in diameter, into tolerably thick mu- cilage, and then rolling it in finely powdered nitrate of silver. After drying, an elastic pencil, the size of the ordinary slate, remains, which may be readily introduced into the uterine or other cavity without fear of fracture. The above method of cauterizing the cervix and in- terior of the uterus will be found of ready ser- vice and of extreme value by those engaged in gynecological practice. 94 prescriber's memoranda. Mb Creadtfs Plaster. Spread adhesive plaster with oleoresina cap- sici, leaving, however, a narrow margin all around free. DobelVs Solution. $ . Acid, carbol 3 jss. Sodas bibor., Sodae bicarb aa 3 ij. Glycerinae fl. g iij. Aquae q. s. ad. Oij. M. For external use. The so-called painless caustic powder of Es- march is prepared as follows : Arsenious acid, 1 part ; morphia sulphate, 1 part ; calomel, 8 parts ; pulv. gum arabic, 48 parts. M. Strong Croton- Oil Paint {Corson 1 s). $ . Olei tiglii. , fl. 3 ij. iEtheris sulph * , fl. 3 iv. Tinct. iodine fl- 3 ij- Potass, iodid gr. xx. Iodine crystals gr. x. M. Shake well before applying. Two to four coats at a time, and on an average once a week, over a space from one to five inches square ; less in females than in males. prescriber's memoranda. 95 Mild Croton- Oil Paint (Corson's). 9 . Olei tiglii fl. 3 ss. JEtheris sulph fl. 5 j- Tinct. iodinii fl. 3 ijss. M. For children and delicate females. Vienna Paste. 5 . Potassse, Calc. caustic aa equal parts. M. When used, mix with equal part of strong alcohol. Comers Powder. 5 . Acid, arsenios 3 ij. Hydrarg. sulph. rub § j. Carbon animalis 3 ij. M. CYSTITIS (see Bladder). DIABETES MELLITUS. Dr. George W. Balfour recommends the milk treatment, especially if conjoined with other treatment which is considered appropriate to such cases. 96 pbesceibeb's memoranda. A. Bouchardat, Professor of Hygiene to the Faculty of Medicine at Paris, states that, by a comparison of the articles of food which a diabetic patient may take without prejudice, it is quite possible to keep up a sufficient degree of variety to make a very satisfactory living. All sorts of meats, roast and stewed, and even dressed with spices, but not with flour ; fresh- water and marine fish, the eating of which sup- plies the want of bread to some extent — at least more than meat; oysters, mussels, crabs, lob- sters, etc. Eggs in all forms, with good, rich cream, but no milk, vegetables, cabbage, salads, lettuce, fruits, such as strawberries, peaches, etc. Thomas King Chambers, of London, recom- mends opium, stating that in some cases it seems to diminish the amount of urine, and that he had never distinctly traced any harm to its action. For a tonic he would use iron and strychnia, but not cinchona. Iodide of potassium has proved useful in his hands, but he adds that it was prescribed on purely empirical grounds. Thomas Hawkes Tanner, of London, recom- mends the following, viz. : presceibee's memoranda. 97 ^ . Ferri ammon. cit 3 j. Spts. amnion, aromat fl. 3 vj. Potass, bicarb 3 ij. Infus. calumbas q. s. ad. fl. § iij. M. A tablespoonful to be taken twice a day, with one tablespoonful of lemon-juice in a little water. He also recommends the use of opium as fol- lows : $. Pulv. opii, Quiruge sulph aa gr. j. For one pill ter die. For the purpose of checking the conversion of food into sugar, he believes the following pre- scription to be useful : I£ . Creasoti TTL xx. Pulv. aromatici 3 iv. Mucilag. acacise q. s. M. Divide into twenty pills. One to be taken three times a day. Dr. Austin Flint states that he has employed the bromide of potassium in several cases of dia- betes, with favorable results. While he does not claim in behalf of this remedy a specific cura- tive agency in saccharine diabetes, yet he thinks it worthy of extensive trial in order to ascertain 7 98 peesceibee's memoeanda. whether it should not be classed among those remedies which are sometimes useful. Dr. J. Y. Dale has found nitrate of uranium, given in from one- to two-grain doses, three times daily, to be an efficacious remedy in dia- betes. The fluid extract of ergot has been used with beneficial results for diminishing the quantity of urine in cases of diabetes — one drachm, or half a drachm, three times a day. Sulphide of calcium has a good reputation as a remedy for diabetes. DXARRHCEA. The value of oxide of zinc in diarrhoea has long been known, but is apt to be overlooked. Some recent reports on the subject have bee a made by Dr. Tyson, and Dr. Bonamy, of Nantes. The formula which the latter uses is : ]$ . Zinci oxidi gr. liv. Soda3 bicarb gr. vijss. M. et div. in chart, no. iv. S. — One to be taken every six hours. In all the cases which he observed, oxide of zinc produced a rapid cure of diarrhoea. In pkesceiber's memoranda. 99 fourteen cases observed by Puygautier the cure was even more rapid, since in only one case were three doses of the medicine required. The results are considered to have been more satisfactory, inasmuch as in several cases the malady had endured from one to many months, and other methods of treatment had not pro- duced any improvement. Thus, he concludes that, although by no means to be held as ex- clusive treatment, the employment of oxide of zinc deserves to be more generally known as useful in diarrhoea. $ . Olei ricini fl. 3 iv. Mucil. acacias * 3 iv. Tinct. opii fl. 3 ij. Tinct. rhei arom fl. 3 iv. Aquas menthse pip q. s. ad. fl. § iv. M. Dose, a teaspoonful for children, in diar- rhoea. BOSLEY. 1}. Tinct. opii, Tinct. rhei arom., Spts. camphorae aa fl. 3 ss. Tinct. cardam. co fl- 3 ij. Aquas anisi q. s. ad. fl. 3 iv. M. Dose, a teaspoonful for children, in diar- rhoea. Swezey. 100 prescriber's memoranda. I£. Ext. rhei fl \ cclvj. Ext. ipecac fl \\]. Sodae bicarb gr. Dxij. Glycerine fl. § xij. Aquas menthas pip Oxij. M. Dose, } to 1 teaspoonful two or three times a day, for children. Squibb. $. Mist, cretse fl. 3 v. Tinct. catechu, Tinct. opii camph aa 3 jss. M. Dose, a teaspoonful. I£. Plumbi acetat „ gr. xx. Pulv. opii gr. x. M. Divide into 10 pills. 5 . Magnes. calcin 3 j. Spts. ammon. aromat TT^ xl. Tinct. asafcet 3 3. Anisette 3 vj. Aquas cinnamom q. s. ad. | vj. M. S. — Dose, one teaspoonful every half- hour till relieved, for a child from three weeks to four months old, suffering 1 from flatulent diarrhoea. prescrtber's memoranda. 101 5. Tinct. opii camph., Syr. rhei arom aa fl. J ss. Aquae calcis fl. § ij. M. Dose, a teaspoonful for children, in diar- rhoea with acidity. Ackermann. Squibb 1 s Cholera Mixture. ]£. Tinct. opii, Tinct. capsici, Spts. camphorae aa 5 j. Chlorof ormi fl. 3 iij. Alcoholis q. 3. ad. fl. § v. M. Dose, 20-40 minims. West's Mixture. If. Olei ricini fl. 3 ij. Pulv. acaciae, Pulv. sacchari aa 3 ij. Tinct. opii TI\_ xxj. Aquae cinnamom q. s. ad. fl. J iv. M. Dose, a teaspoonful for children, in diar- rhoea. I£. Bismuth subnit., Cretae praecipit a a gr. xxx. Pulv. opii gr. j . M. Divide into 10 powders, for children. J. Lewis Smith. 102 pbesckiber's memokanda. 1$, . Bismuth subnit gr. iv. Pulv. ipecac, co gr. j. M. One dose, for children. I£ . Bismuth subcarb., Pepsini aa gr. ij. M. One dose, for children. I£. Bismuth, subnit., Pepsini aa gr. v. M. One dose, for children. Swezey. Dr. J. M. Fothergill writes as follows : £ l Look at the treatment of diarrhoea. How common- ly is an astringent mixture containing an opi- ate prescribed without further reflection ? Of course, in a great many cases, immediate effects are produced which are gratifying to the pa- tient. Yet, in a certain percentage of cases, such a plan is not only not successful, but does harm. In those cases where there is an offend- ing mass in the intestines setting up a secretion to sweep it away — but where the secretion is set up too low for its removal — there is a teas- ing diarrhoea, a persistent desire to go to stool, with small, ineffective motions, affording no re- lief. Here the ordinary diarrhoea mixture only pkescriber's memokanda. 103 does harm, and what effect it has is to arrest a spontaneous reflex act often of a beneficial character. The proper treatment is to admin- ister a dose of castor- oil, or, better still, a scru- ple of rhubarb in powder, by which secretion is set up above the offending' mass and it is swept away, after which the diarrhoea ceases. The secondary action of rhubarb in constipating the bowels renders it the agent par excellence for the treatment of this form of diarrhoea. The astringent and opium treatment of diarrhoea is equally or still more out of place in those cases where there is a fecal mass lodged or accumu- lated in the rectum. Every surgeon who sees much of diseases of the rectum has instructive stories to tell of cases where the patient has consulted a large number of eminent physicians, without avail, for a persistent diarrhoea. The usual mixtures, in great variety, are prescribed, without effect. At last the persisting tenesmus drives the patient to a rectal surgeon, who, on examination, finds a solid mass in the bowel, around and past the sides of which the thin fecal motion passes. Here diarrhoea is the only possible means by which the bowels can be emptied ; and it is fortunate that the astrin- gent mixtures are inoperative to arrest this diarrhoea, else the patient's condition would in- 104 prescriber's memoranda. deed be a serious one. The mass is removed, and then the diarrhoea spontaneously ceases." ]£. Tinct. opii, Tinct. capsici, Tinct. rhei arom., Spts. menthas pip., Spts. camphoras aa equal parts. M. Dose, 20-40 minims. Ruschenberger. I£. Tinct. capsici fl. § j. Tinct. catechu, Tinct. kino, Tinct. kramerias. aa fl. § iv. Tinct. opii fl. § iij. Spts. menthas pip fl. § ij. Spts. camphorae, Aquas aa fl. § ix. M. Dose, 30-60 minims. Hope's Mixture. E . Acid, nitrici Tf^ viij. Tinct. opii 7^x1. Aquas camphoras fl. § viij. M. Dose, a tablespoonf ul. peescbibek's memoranda. 105 Modification of Hope's Mixture (Thomson). ^ . Acid, nitric, dil 3 ij. Tinct. camph., Tinct. opii aa 3 j. Syr. zingiber 3 iv. Aquae menthas pip ad. § vj. M. S. — Tablespoonful doses to be used after a cathartic. ]£. Tinct. opii, Tiuct. capsici, Spts. carnphoras, Spts. menthae pip aa fl. 3 ij. Aquae fl. | j. M. Dose, a teaspoonful. I£ . Bismuth subcarb gr. ij. Acid, tannici gr. j. Pulv. ipecac, co gr. J. M. One dose, for children, in diarrhoea. Yf,. Bismuth subnit., Sodas bicarb., Pulv. sacchari, Pulv. acacias, Pulv. zingiber aa equal parts. M. Dose, a tablespoonful, for adults. Wheelock. 106 prescriber's memoranda. 5 • Tinct. calumbse 3 xv. Tinct. opii deodor 3 j. M. S. — A teaspoonful in a wineglassful of water, before meals. Bartholow. This formula is best adapted to a condition such as the following, viz. : soon after taking food, pain referable to the small intestine, nau- sea, loose evacuations containing undigested ali- ments, and followed by weakness and depres- sion. Coto-bark has proved itself very efficient in diarrhoea, but especially in that of phthisis. May be given in form of powder or fluid ex- tract. For diarrhoea due to deficient nerve -supply to the mucous membrane (summer diarrhoea), salicine, gr. v., every four hours. Place the patient in bed. A. A. Smith. ^ . Bismuth subnitrate 3 j. Morph. sulph gr. j. M. et div. chart, no. xii. S. — One every six or eight hours, in simple chronic intestinal catarrh. Clark. prescriber's memoranda. 107 Dr. A. A. Smith, to clear the bowels of curdy masses due to acidity in the diarrhoea of chil- dren, prefers the following to castor- oil : $ . Pulv. rhei rad gr. xv. Sodae bicarb gr. xxv. Aquas menthae pip § ij. M. S. — 3 j. for a child from two to four years old. This is to be followed by chalk mixture. In the diarrhoea of dentition he first lances the gums, and then gives : 3 . Sodae bromid 3 ss. Mucil. acaciae, Aquae pur aa. q. s, ad. § ij. M. 3 ]*• every three hours, for a child between six months and a year old. Dr. Alexander Hutchins has treated in private practice, in three months, twenty-seven cases of serous diarrhoea in infants, ranging from two months to two and one-half years of age, using one drug only ; some of the cases were seen but once, many only twice, and none above four times ; in all the disease was promptly and permanently controlled. He says : 41 The form in which I have used the calcium 108 pkesckibek's memoranda. salt would be represented in a formal prescrip- tion thus : " ]£ . Acid salicylic gr. xxij. Cretas prseparat gr. viij. " Misce accurate. Divide in chart, no. vj. (gr. v.), vel. no. x. (gr. iij.). S. — One every two to four hours." " In the process of mixing the powder an effer- vescence occurs, which alarms the attendant, but which the prescriber recognizes as due to the release of carbonic acid in the formation of the new salt. Also, in the process of mixing, a pun- gent odor of chlorine is not infrequently per- ceived. One physician informs the writer that this is probably due to the impurity of the pre- pared chalk. The prepared chalk of the shops is a residuum of the manufacture of chlorinated soda, and if the chalk be imperfectly washed an odor of chlorine will be perceived. This is an impurity of the drug, and should be avoided." DIPHTHERIA. Dr. R. Carney and Rokitansky speak highly of chloral as a local application in this disease. Dr. John A. Erskine Stuart says that sulphur precipitatum (milk of sulphur) used as a topical pkesceeber's memokanda. 109 application, has been very useful in his prac- tice in seven cases of diphtheria, either blown on through a quill, or stirred up with water and swabbed on. It causes, almost immediately after application, blackening of the membrane and detachment of it. To show its rapidity of action, six of these cases only required an av- erage of 2.6 visits. In opposition to the views of Dr. Oertel, and of Dr. Braithwaite, and the gentleman appointed to report (the two latter criticising his first notice of the subject in the Practitioner of April, 1870), he says : "I am of opinion that the action of sulphur in this dis- ease is a specific action, not a mere c scouring powder ' (Dr. Oertel), nor that its action is princi- pally by friction. I use no friction. I have found the application of carbolic acid, sulphur- ous acid, and solution of muriate of iron, in equal parts, a pretty sure remedy locally applied, but deleterious from making fresh abrasions a fitting field for the growth of new membranes. The use of strong caustics is to be strongly de- precated. The sulphur treatment is easily used, and is not at all disagreeable to the patient." Dr. Larue recommends the followicg as a gargle. In the case of an infant the solution may be applied to the throat with a brush. 110 prescriber's memoranda. ^. Salicylic acid, Biborate of soda aa 3 ij. Carbolic acid fl. 3 j. Water J iv. M. If hemorrhage occur in the throat, equal parts of tannin and borax is serviceable. Solu- tion of chlor. potass, is useful in many cases. Feed your patients on good, nourishing food from the beginning. M. Yidal recommends the topical use of tar- taric acid in diphtheria. In his opinion it is necessary to make use of topical agents against the false membrane, for it has a great tendency to spread. He employs the following formula: 1$. Acid tartar 2 parts. Glycerinse 3 parts. Aquae menthse 5 parts. M. The acid acts upon the false membrane, con- verting it into a gelatinous mass, and favors its expulsion. Chlorine water has been highly recommended, and the following is a formula for its prepara- presckeber's memoranda. Ill tion : Put sixty grains of finely powdered chlor- ate of potash in a strong pint bottle, pour upon it two drachms of strong muriatic acid, close the mouth of the bottle until the violent efferves- cence ceases, add one ounce of water and shake well, add another ounce and shake again, and so on until it is filled ; keep in a dark place, and tightly corked. One or two tablespoonfuls may be taken frequently, according to age ; an adult may take a pint in twenty-four hours. Dr. A. Erichsen recommends strongly the cyanide of mercury in minute doses, in diph- theria. Of twenty- five cases treated, only three proved fatal. With its use the membranes be- came thinner and less adhesive, and even where they had extended into the larynx, threatening obstruction, they had separated, and the larynx again became free. The writer believes that mercury shortens the duration of the diphtheri- tic process, and that this preparation does not, like the others, disturb digestion or nutrition. To syphilitic children it may be given for months without disturbance, in doses of -£g of a grain three times daily. The ordinary dose for a child under three years of age is -^ of a grain, once every hour or two. 112 presceiber's memoranda. The following is the formula : 1^ . Hydrargyri cyanatis gr. j. Aquae distill 5 v j- Svr. simplicis § ss. M. S. — Half or a whole teaspoonful every hour. Dr. Frickelton gives the following treatment of diphtheria, which has been very successful in his hands : 3£ . Potass, chlor 3 j. Acid, hydrochlor. dil 3 ij. Tinct. f erri. chlor 3 iij. Aquae ad. § viij. M. S. — A teaspoonful every three hours. No fluid to be taken with the medicine, nor within fifteen minutes after taking it. As an applica- tion to the throat in severe cases, he uses one part tincture of iron to two of the above mix- ture, applied with a brush. If the fever is very high, he adds tincture of aconite to the mixture. ^ . Potass, chlor 3 ss. Tinct. ferri chlor fl. 3 j . Aquae q. s. ad. fl. I j. M. Dose, one teaspoonful. prescriber's memoranda. 113 ^ . Natr. benz. pur gr. lxxv. Aquge dist., Aquse menthae pip aa 3 x. Syr. aurant. cort 3 ij» M. Infants under one year, 3 ij. every hour. Children from one to thres years, § ss. every hour, the amount of benzoate in the prescrip- tion being increased from 75 to 110 or 125 grains. From three to seven years of age, the amount in the prescription is increased to 3 ij. to 3 iij., and for adults from 3 iij. to 3 vj. The throat is to be powdered with the ben- zoate three or four times daily, and a gaigle of the strength of five per cent. used. Letzerich. ]£. Tinct. guaiaci, Glycerines equal parts. M. S. — Teaspoonful every one, two, three, or four hours. DYSENTERY. Thirty grains of ipecac made into bolus or suspended in orange-syrup. No fluid is allowed for one hour before and three hours after the dose has been taken. Often cures also chronic diarrhoea of long standing. An emetic action is not desired. 114 prescriber's memoranda. Deb finds ixora dandanea a very valuable remedy in cases of dysentery, when adminis- tered in the early stages of the disease. He uses a tincture of the fresh root (four ounces to the pint of alcohol), in doses of two to four grammes (one-half to one drachm). It causes no nausea, and, moreover, has an aromatic, agreeable taste. Dr. Robert M. King speaks highly of the use of ergotin hypodermically, or in pill-form, as follows : 1£. Ergotinse 3j. Ext. nucis vom. gr. v. Ext. opii aq gr. x. M. Ft. pil. no. 20. S. — One every six hours. DYSMENORRHEA. The following combination is well spoken of by Dr. Pattee, in ovarian dysmenorrhcea : $. Tinct. pulsatillae, Tinct. actese albae, Tinct. cimicifugae aa gtt. xv. Aquas fl. § iv. M. S. — A teaspoonful three or four times a day. pkescribeb's memoranda. 115 Dr. Atthill, in his Clinical Lectures, advises from three to ten drops of Fowler's solution in dysmenorrhoea, combined with ten- drop doses of tincture of digitalis, three times a day, be- tween the periods. He has often obtained the best results from this treatment. I£. Tinct. nucis vom., Sol. Magendie 5a 3 j. Ext. belladonnse fl gtt. xv. M. S. — Take five drops three times a day be- tween the periods. DYSPNCEA. Berthold gives an account of several cases of severe convulsive asthma where quebracho seemed to . produce a very happy effect in dysp- noea. In one case, a gentleman of sixty-five was found in a violent attack, pulse 108, res- piration 64- A teaspoon ful of the tincture was given every hour, and at the end of three hours the respiration was reduced to 30, and the pa- tient rapidly recovered without other medicine. In some fourteen other cases a similar happy result was obtained, though not always with the 116 peescbibeb's memoeaxda. same promptitude. In the case of a lady of sixty, suffering from mitral insufficiency, with stenosis and frequent attacks of frightful dysp- noea, where digitalis had failed, quebracho gave relief. The subcutaneous use of morphia often proves of great service. Also dry cups. For cardiac dyspnoea, Professor See recom- mends : 1£ . Potass, iodid 3 vss. Syr. cort. aurant § xijss. Dose, two to four tablespoonfuls per day. Each spoonful must be dissolved in a tumbler of water. Patients suffering from heart disease take iodide of potassium very well — better than other patients. The following are the drawbacks of this drug : 1. Bleeding from the buccal membrane, or bronchitis and haemoptysis in tuberculous pa- tients. (Phthisis is, therefore, a counter-indi- cation for the use of iodide of potassium. ) 2. Loss of flesh ; in fat individuals this is to be regarded as a favorable symptom. 3. Loss of strength ; in such cases the treat- ment must be suspended at once. 4. Loss of appetite. prescriber's memoranda. 117 Opium may be added to iodine, in order to prevent the evil effects of the latter : I£ . Potass, iodid 3 vss. Syr. cort. aurant § xijss. Ext. thebaic gr. j.-jss.- Dose, from two to four spoonfuls per day. For the ext. thebaic, the syrup papaveris may be substituted : § jss. Opium is given here with a view of making the iodine more easily tolerated, and of dimin- ishing the cough, which greatly inconvenien- ces the patient. Another very useful combination is that of digitalis with iodine, as the one has a soothing influence on the dyspnoea by acting on the lungs, and the other increases the action of the heart and modifies the arterial tension. The follow- ing formula will be found to answer well : ]£ . Julep gommeux | iij. Potass, iodid gr. xv. Tinct. digit. . . .* 3 x. Or the following formula : 3. Ext. gent gr. j. Pulv. f ol. dig gr. jss. To take one pill three times daily, together with the sol. of iodine, which we have men- tioned above. In cases where patients cannot 118 prescribeb's memobanda. take digitalis, chloral will bo found to be a good substitute. Thus : I£ . Julep gommeux § iv. Potass, iodid 3 ss. Chloral hydrate 3 j. To be taken every two hours during the day. DYSPEPSIA. 3 . Sodas bicarb 3 iv. Tinct. zingiber fl. 3 ij. Tinct. gent, co fl- 3 j- Aquas fl. 3 v. M. Dose, two teaspoonfuls in atonic acid dys- pepsia. 3 . Sodse bicarb gr. xx. Acid, carbol .' gtt. ij. x\cacias. 1 Sacchari aa q. s. Spts. lavandulas co fl. 3 ij. Aquas q. s. ad. fl. § j. M. Dose, a teaspoonful two hours after meals, in dyspepsia with fermentation. prescriber's memoranda. 119 $ . Sodas bicarb 3 j. Pulv. rhei § ss. Spts. inenthas pip fl. 3 ij. Aqu.se q. s. ad. fl. § iv. M. Dose, a tablespoonful in acid dyspepsia. Dr. Willis recommends, in that form of dys^ pepsia attended with rapid fermentation of food and evolution of gas soon after a meal, fifteen to twenty drops of chloroform in a little sweet- ened water. It expels the gases from the stom- ach in a few minutes, and averts fermentation promptly, without any unpleasant effects. Anise Cordial. ]£. Infusi anisi ( 3 ij. to Oj\), Genevae (gin) aa fl. ^ j. M. Dose, half a teaspoonful, in cases of flat- ulence and colic. I£. Gum camphor, Pulv. ginger, Capsicum aa gr. j. M. et div. in pil. no. vj. S. — One p. r. n., for gastric and intestinal flatus. 120 prescriber's memoranda. ]£. Tinct. gent, co., Ext. valeriani fl aa. § iv. Tinct. nucis vom 3 j. Sodas bicarb 3 iij. Acid, carbol gtt. x. M. S. — One teaspoonful after meals. The carbolic acid is added to prevent acid fermenta- tion in the stomach. It also serves to preserve the mixture. Dyspepsia, with Constipation. 1$. Sulphur, sublim., Potass, bitart., Sodas bicarb., Sodas et potass, tart aa equal parts. M. Dose, a tablespoonful mixed with sweet- ened water. Maxwell. I£. Bismuth, subnit., Sodas bicarb. , Cretas prasparatas aa 3 j. M. Divide into 12 powders. Trousseau. Where there is torpor of digestion joined with very marked sympathetic nervous disturbances, Dr. Pepper uses the following formulas : presceibeb's memoranda. 121 If. Sodae bicarb 3 iij. Acid, hydro-cyan. dil. . . . r gtt. xlviij. Tinct. valeriani fl. 3 j. Syr. zingiber fl. § ij. M. S. — A teaspoonful thrice daily, in water. If. Quinise sulph gr. xvj. Strychnia? sulph gr. \. Acid, muriat. dil fl. 3 jss. Syr. zingiber q. s. ad. fl. § iv. M. S. — Two teaspoonfuls in water, after meals. Where there is marked hepatic disturbance, the following prescriptions are excellent : $„ Acid, muriat. dil fl. 3 ss. Tinct. nucis vom fl. 3 ss. Infus. gent, co q. s. ad. § iv. M. S. — A teaspoonful in water, after meals. I}. Bismuth, subnit. . , 3 jss. PepsinaB 3 jss. Strychniae sulph gr. j. Tinct. cardam. co. . . .q. s. ad. fl. 3 iv. M. S. — A teaspoonful thrice daily, in water. If there is much flatulence, an increase is made in the quantity of bismuth and pepsine. If the 122 prescriber's memoranda. case be merely one of gastric atony, the amount of strychnia is increased. I£ . Tinct. capsici 3 v. Pulv. cubeb 3 ij. Tinct. cinchonas 3 iv. M. S. — A teaspoonful t. i. d., for nausea and gastritis of alcoholism. 1$. Ext. nucis vom gr. v. Sodas bicarb., Rhei pulv aa 3 j. M. et div. in pil. no. xx. S. — One t. i. d. Delafield. 1$. Bismuth, subnit., Magnesias carb aa gr. xvj. Acid, hydrocyan. dil 7T}_ v. Aquas § iv. M. Dose, 3 ij. for a child three years old, in flatulent gastrodynia and gastralgia. I^. Bismuth, carb gr. j.-ij. Magnesias carb gr. iij. Tinct. hyoscyam TT^ v. Infus. rhei 3 ij. In atony and irritability of the stomach. Ellis. pbescribek's memoranda. 123 3?. Pepsini gr. lxiv. Acid, hydrochlor fl. 3 ss. Glycerines fi. § jss. Aquae fl. | ijss. M. and filter. Dose, tablespoonful in cases of slow digestion. 1$. Cimicif ugaa § j. Gentian as, Zingiberis aa 3 j. M. et ft. chart, no. j. S. — Put in a pint of boiling water, and when cold, strain ; take a wineglassful three times a day. Tonic. I£. Potass, bromid § j. Ferri sulph. exsic 3 ss. Calumbse, Zingiberis aa 3 iv. M. et ft. chart, no. j. S. — Put in a pint of boiling water, and when cold, strain ; take a tablespoonful three times a day, in nervous dyspepsia. DROPSY. Dr. Thomas, of Kentucky, has found Ascle- pias Syriaca of value in dropsy, without refer- 124 pkescbibeb's memokanda. ence to the nature of the cause, but especially is it serviceable in engorgement of the liver, being in many cases superior to either calomel, leptandrin, or podophyllin. In no case, when used in doses which come short in effect of causing vomiting, does this remedy fail to cause profuse diaphoresis, and remove dropsical accu- mulations. He employs the following formula : 1^. Strong decoction of asclepias Syriaca fl. § xij. Decoction of phytolacca de- candra fl. § iv. Whiskey fl. § vj. White sugar fl. | iv. M. From one-half teaspoonful to two tea- spoonfuls thrice daily, according to the age of patient and effect produced. 3$. Teaspoonful doses of carbonate of iron, with one pint of marsh- mallow tea, three times a day. 1$. Inf us. digitalis § ss. Potass, citras gr. xv. M. S. — Every three or four hours. Poultices of digitalis leaves, with tinct. apo- presckibeb's memoranda. 125 cynum. cannab., gtt. x. every two hours, are also serviceable. V f . Broom-tops, Juniper berries, Dandelion root aa J ss. Aquas Ojss. M. Boil to one pint. Dose, one teaspoonful. Two drachms of the bitartrate of potassse can be substituted for the dandelion. Dickinson. EARS, Inflammation of. A round piece of wicking may be used to cleanse the ear, instead of a syringe. It may be introduced by the patient himself. A gentle, rotary motion will carry it to the bottom of the meatus, where it quickly absorbs the pus. This is to be repeated until the ear is cleansed, and a piece is left in situ. It may be medicated with an alkaline solution or with salt water. 3 . Tinct. acid, hydrobromic 3 iij. Syr. limon ad. § ij. M. 3 t. i. d., with inhalations of benzole where the tinnitus is of a knocking, pulsating 126 prescreber's memoranda. character ; of no service where it is of a roaring character. Fox. ECZEMA. ]£ . Iodinii crystal § ss. Acid, carbol. crystal | j. Mix with gentle heat. Dilute with equal quantity of glycerine for the first application. A camel' s-hair brush, or glass rod may be used to apply the remedy. It is indicated where there is intense itching, with probable presence of parasites. Bellamy. 3 . Hydrarg. ammoniat gr. xv. Glycerini amyli § j. M. MULLER. $ . Liq. plumb, subacetat § j. Glycerini § ss. Cherry-laurel water § iijss. M. S. — Lotion. Bartholow. This will be found to be very serviceable in eczema, characterized by great heat and red- ness and excessive discharge. In this same condition Dr. Tilbury Fox re- commends the following : prescriber's memoranda. 127 I£ . Acid. nit. dil 3 ss. Plumb, acetat gr. v. Aquae % vj. M. S.— Lotion. ^ . Pulv. alum | ij. Pulv. zinci oxid 3 iv. Pulv. rad. iridis § ij. Pulv. amyli 1 viij. M. S. — Apply locally. Hebra. ^ . Olei cadini ^ ss. Glycerines 3 j. Ung. diachylon § ijss. In squamous eczema with thickening of the skin. G. H. Fox. EMPHYSEMA. B. Potass, chlorat 3 jss. Tinct. belladonnas § jss. Ext. pruni Virg. fl. , Tinct. cinchonas co aa § ij. M. S. — A dessertspoonful four times a day. Da Costa. 128 prescriber's memoranda. Where the emphysema is accompanied by chronic bronchitis and loss of appetite, Dr. Da Costa has found the above prescription the most efficient. He advises also that dry cups be ap* plied to the chest night and morning. ENDOCARDITIS. It is the rule to give tonics as soon as possi- ble and to get the patient up, but the proper plan of treatment is to keep the patient flat in bed for some days after all evidence of active mischief has passed away. The growth of con- nective tissue in the valve-curtains, which is lighted up by the inflammatory storm that passes over the endocardium, persists some time after the endocarditis itself is over, and it is the mutilation caused by the contraction of the neoplasm which is chiefly to be dreaded. Con- sequently the true line of practice is to reduce the strain upon the inflamed valve -curtains by complete rest and the administration of agents which lower the blood-pressure within the heart and arteries. The more the connective- tissue growth can be limited at the outset, the less the future mutilation of the valves. J. MlLNER FOTHERGILL. presckibek's memoranda. 129 EPIDIDYMITIS. Tobacco and linseed-meal poultice at night. Ij,. Ung. belladonna?, Ung. stramonii. aa 3 ij. M. External use. and I£ . Tinct. cantharides gtt. vj. Ext. Pulsatillas fl gtt. x. Aquas § jv. M. S. — Teaspoonful every three hours. F. J. Bumstead, M.D., recommended that absolute rest in a recumbent posture should be enjoined immediately upon the first symptoms of the accession of an epididymitis. The bowels should be cleared by a cathartic, such as citrate of magnesia. If there is much febrile disturb- ance, give aconite, support the inflamed testi- cle, and smear it with : $ . Ext. belladonnas 3 ij. Glycerinae § ss. Aquas 3 j. M. Moisten also a piece of lint with the same, and apply constantly. When fluid is found in the tunica vaginalis, resort to the multiple punctures recommended 9 130 prescriber's memoranda. by Velpeau. By so doing you will give imme- diate relief and arrest the progress of the dis- ease. This treatment, to which may be added sedatives internally in certain cases, and in cases of delayed resolutions careful strapping of the testicle, comprises about all the routine treatment of this author, who was a well-known authority in venereal diseases. EPILEPSY. Dr. C. M. Shields recommends : ^ . Root of r/hite peony * x. Boiling water 1 gallon. Boil to two quarts and filter. Take one ounce three times a day. ^. Sodas bromid., Potass, bromid., Ammon. bromid aa 3 iij. Potass, iodid. , Ammon. iodid aa 3 jss. Ammon. carb 3 j. Tinct. calumbae fl. § jss. Aquas q. s. ad. fl. § viij. M. Full dose, one and a half drachms be- fore each meal, and three drachms at bedtime. Brown- SJsquard. prescriber's memoranda. 131 5 . Potass, bromid gr. xxv. Tinct. belladonnas T^ v. Aquae q. s. ad. fl. 3 j. M. One dose, to be taken thrice daily. I> . Potass, bromid gr. xxx. Ext. conii 11 Tl\ xv. Aquas q. s, ad. fl. 3 j. M. One dose, to be taken thrice daily. ]£. Potass, bromid., Ammon. bromid aa gr. xxx. Ext. ergotae fl 7T[ xv. M. One dose, to be taken thrice daily in cases characterized by considerable maniacal excite- ment following the attack, indication of cerebral congestion, and especially where hemorrhage is feared. Charles K. Smith. ERECTILE TUMORS. Verneuil recommends injections of small quantities of the following solution : $. Distilled water, Perchloride of iron aa § j. Chloride of sodium 3 j. 132 pkesckibee's memokanda. Several punctures may be made, and a few drops injected at each, the skin surrounding the tumor being firmly pressed by the ring of a key, to prevent absorption taking place bef oro the clot is formed. See also Naevi. ERYSIPELAS. Dr. C. G-. Rothe has been accustomed for years to employ painting of the inflamed sur- face and its surrounding parts, every two hours, with a mixture of carbolic acid and oil of tur- pentine : Jf, . Acidi carbol. 1 part. Spts. vini 1 part. Olei terebinthinas 2 parts. Tinct. iodini 1 part. Glycerinse 5 parts. He has had occasion to be well satisfied with its success. The applications are entirely painless, and do not even excite heat of the skin. Commonly this is found wrinkled and pale on the second day. Dr. A. Jacobi recommends the local applica- tion, all around the edges of the erysipelas, of crystallized carbolic acid 1 part, and oleic acid, pbesceiber's memoranda.' 133 8, 10, 12, or 14 parts. The inunction must be repeated every ten or twelve minutes, each in- unction lasting- from three to four minutes, and continued until the erysipelas ceases to spread. Dr. John E. Brackett uses the following hy- podermically in erysipelas : I£. Acid, carbol., Alcohol aa 3 ss. Aquae dist § ij. M. Of this solution he injects five syringefuls in the hand and arm at points where the redness is most intense, 5 . Morphias sulph gr. iij. Ferri sulph 3 ij. Vaseline § j. Apply over inflamed part on lint, and bandage tightly and evenly. EYES, Inflammation of. (See also Conjunc- tivitis.) ^ . Morph. sulph gr. iij. Zinci sulph g-r. ij. Aquas dist § j. M. S. — Apply two drops directly to the eye every three hours. 134 prescriber's memoranda! Prof. Meigs recommends the following for ophthalmia neonatorum : A solution of nitrate of silver (three-fourths of a grain to the ounce). This was injected under the lids twice a day. For the lids themselves he employed the fol- lowing : I£ . Soda3 boratis gr. xij. Zinci sulph gr. j. Aquce camphoras fl. 3 j. Aquas dist fl. § j. M. S. — To be applied to the lids two or three times a day. Inject between the lids every half-hour a solution of alum (from five to eight grains to the ounce), the strength of the solution to be gradually diminished as the case gets better. Dickson. FEET, Perspiration of the. Dr. Gordon says that systematic faradization of the parts control excessive perspiration of the hands and feet. Dr. F. C. Ainsworth recommends the follow- ing : bathe the feet every morning with warm soap and water, dry them gently with a towel, and, while they are yet moist enough to cause prescriber's memoranda. 135 the powder to partially adhere, apply freely this mixture to the whole foot : J£ . Pulv. alum exsiccati § iij. Acid, salicyl 3 jss.-iij. M. Change the shoes and stockings daily. Dr. Charles Ambrook recommends a one per cent, watery solution of permanganate of pot- ash. Bathe the feet night and morning, and oftener if necessary. The discoloration of the skin is temporary. A strong solution of boracic acid has been used with good results. ]J . Acid, salicyl gr. xv. Amyli gr. cl. Talci I iij. M. For sweating feet. Kohnhorn. Dr. Ortega prescribes baths of a solution of chloral — 1 in 50 — and wrapping the feet in a cloth dipped in a similar solution. A powder, composed of 3 parts salicylic acid and 87 parts of magnesium silicate, is used in the German army as a remedy for sweating of the feet. 136 prescriber's memoranda. FEVER, Milk. I£ . Tinct. aconit. rad gtt. xx. Antimon. et potass, tart g-r. ij. Spts. etheris nitrici, Syr. simplicis aa § j. Aquas aurant. flor 3 ij. M. S. — A teaspoonful in a wineglassful of sugar and water, every two hours. Fordyce Barker. In addition to this, Dr. Barker gives nutritious, easily digested food ; applies the child to the breast as soon as the patient has recovered from the exhaustion of labor ; attends to the state of the bowels; gives a diaphoretic anodyne, and has the nurse rub the breasts from circum- ference to nipple with warm sweet oil every three hours. FISSURE, Anal. Instead of employing forcible dilatation, Dr. Hamon applies to the fissure, with a camel's-hair brush, a solution consisting of one part of chlo- roform to two parts of alcohol. Two or three applications, at intervals of two or three days, usually suffice to effect a cure. The first appli- prescrtber's memoranda. 137 cation is very painful, but each subsequent one becomes less so. FRECKLES. $ . Hydrarg. bichlor gr. vj. Acid muiiat. dil 3 j. Aquas § iv. Alcohol, Aquas rosae aa § ij. Glycerines § j. M. Apply at night and wash in the morning with soap and water. Take of finely powdered sulphophenate of zinc, one part ; oil of lemon, one part ; pure alcohol, five parts ; collodion, forty-five parts. Mix well together by trituration. This has been found efficacious as a local application against freckles and other slight skin diseases. FURUNCLES and other Suppurative Af- fections, 3 • Calcii sulphide gr. x. Pulv. sacch. alb gr. xxx. M. et div. chart, no. xx. S. — One four times a day. 138 prescriber's memoranda, GLEET. The passage of a well-oiled steel sound every fourth day. Slitting the meatus, if it is narrow. B . Pulv. cantharidum gr. £. Olei terebinthinae gtt. v. M. S. — One pill, thrice daily, in obstinate gleet. This is reported as very efficient in old and refractory cases. Should strangury be brought on, discontinue for a day or so. 3£ . Acid, tannici gr, x. Bismuth, subnit 3 ij. Aquae rosse fl. 1 vj. M. S. — Shake and use three times daily, as an injection. Maury. GONORRHOEA. Lafayette Mixture. I£. Balsam, copaibae., Spts. aetheris nitros aa § j. Liq. potassae 3 ij- Ext. glycyrrhizae § ss. M. et ad. : Olei Graultheriae gtt. xx. Syr. acacias ad. § vj. M. S. — Tablespoonful after each meal. prescriber's memoranda. 139 Reverdiri's Mixture for Blennorrlioea (first few days). $ . Pounded sugar § iij. Bicarbonate of soda 3 v. Benzoic acid 3 jss. Essence of lemon q. s. M. Teaspoonful six times a day, in a tumbler of water. Follow by injection and balsam co- paibae. ^ . Gurjun balsam 3 j. Gum arabic 3 j. Infusion of anise 3 x. Syr. of catechu 3 iij. Syr. of poppies , 3 iij. M. Half to be taken before breakfast, half before dinner ; after each a glass of wine. The pain ceases in three or four days, the discharge diminishes ; cure results in ten days, on the average. In vaginitis a cure is obtained in six to ten days. Vidal. Dupouy uses from sixty to seventy-five grains of Kava root, a species of pepper from Oceanica, which is grated and macerated in a quart of water for five minutes. It is filtered and taken in two doses in the course of the day, either before or after eating, until a cure i3 effected. Twenty 140 pkescbiber's memoranda. minutes after the first dose there is a desire to urinate, but there is less burning and the urine is clearer. Cure in from ten to twelve days, without digestive disturbance. Put the patient in bed. Give him mucila- ginous drinks. Soak the penis twice a day in hot water for fifteen minutes. In a majority of cases cure will be effected within ten days. GOITRE. Dr. Flashar reports the case of a young country-girl of seventeen, who had a large ex- ophthalmic goitre, sometimes accompanied by palpitations. He used, without results, the sub- cutaneous injections of ergotine. This remedy was then injected into the parenchyma of the goitre, and after three injections the tumor dis- appeared entirely, and has not returned after many years. The first injection was followed by a severe pain in the side of the neck and head, with . sensation of intense heat in the head, ear, and jaw 3 and redness of these parts. 5 • Ammon. chlorid 3 vss. Syr. simpl 5 ss * Aquae cinnamomi § iv. M. S. — Take 3 j. three times a day. Has been very successful in effecting a cure. Stevens. peesckibee's memoranda. 141 Injections of absolute alcohol into the sub- stance of the goitre once a week or two weeks — fifteen to twenty drops — have produced good results. Continue for several months. GOUT. LallemancCs Specific. ^. Ext. colchici acet., Ext. opii aquosum aa gr. xv. Potass, iodid 3 iv. Potassas acetat 3 ij. Aquae dist fl. 3 iijss. Vini alb fl. % iv. M. S. — Twenty drops three times a day. HEMORRHAGE. Dr. A. L. Ranney gives the following rules for meeting all possible indications in the treat- ment of hemorrhage : 1, always ligate the bleeding vessel Id moderate hemorrhage, when convenient to do so ; 2, use compression over the wound on the main trunk in moderate hem- orrhage, when ligature of the wounded artery is inconvenient ; 3, in violent hemorrhage en- large the wound and tie the artery ; 4, as a rule, never attempt ligation except when bleeding actually exists. The exceptions to this rule 142 pkescbiber's memokanda. are : #, in exposed vessels of large calibre de- manding ligature as a safety measure ; 5, in delirium tremens, following an injury ; c, when necessity for transportation exists ; 5, ligation should, as a rule, be applied at the bleeding- point, and not remote from it ; 6, use the ex- ternal wound as a guide to your incision to reach the vessel, except when the wound exists on the side opposite to the vessel injured, when a probe may be cut down upon ; 7, always use the greatest precaution to avoid needless loss of blood in reaching the vessel until the fingers can compress it; 8, the artery, when found, should be tied above and below the wounded portion, and at a bifurcation three ligatures should be used. In case the lower end cannot be discovered, use compression in the wound as a substitute for ligature ; 9, a ligature should not be placed close below a large branch ; 10, in recurring hemorrhages the treatment should depend on the color of the blood and on the severity of the hemorrhages. If the hemorrhage springs from the proximal end of the artery : a, tie if possible ; 5, amputate if necessary ; c, use styptics and compression, if both are impossible ; 11, amputation is preferable to ligature: a, when great swelling of the limb renders ligation diffi- cult ; &, when exhaustion of the patient forbids pkescriber's memoranda. 143 further search for the vessel ; c, when compe- tent assistance is needed and not attainable ; 12, in case a large vessel is injured without actual hemorrhage, hot flannels to the limb are indicated as a preventive measure ; 13, in case an aneurism is the seat of the hemorrhage — provided the aneurism is traumatic in its origin — it should be treated on the same principles as if it were a wounded artery. Pecholier's favorite prescription in haemopty- sis is as follows : ^. Ipecacuanhae contus 3 jss. Aquas bulliente fl. 5 iv. Make an infusion; filter; add syr. acaciae, fl. § j. Give a tablespoonful every hour or two. The first dose may cause vomiting ; but this soon ceases, and indeed, may be prevented by the addition of a few drops of laudanum. The absorption of the emetic being thus rendered easier, pulmonary anaemia is rapidly and surely produced. ]£ . Acid, sulph. arom T^xl. Ext. hematoxyli 3 j. Tinct. opii camph fl. 3 iv. Syr. zingiber q. s. ad. fl. § j. M. Dose, two teaspoonfuls in haemoptysis. 144: prescriber's memoranda. Vesical Hemorrliage. u If instruments are really necessary to with- draw blood and urine, then the slow injection of iced water, or, better still, of iced infusion of matico, may be useful. Even a mild solution of the tincture of the perchloride of iron, as a cold injection, I have known in one case to suc- ceed when all others have failed ( 3 j. t. ferri, | iv. aquse). ' ; Keep the patient on his back, and forbid straining as far as possible in passing water. To this end give opium liberally to subdue the painful and continued action of the bladder. Apply cold by means of bags of ice to the peri- neum and above the pubes. Better still, intro- duce small pieces of ice into the rectum. Do not use an instrument if it is possible to do without it. There is a great dread in some people's minds about the existence of a large coagulum in the bladder. Leave it alone ; it will gradually be dissolved and got rid of by the continued action of the urine." Sir Henry Thompson. Dr. Prout observes: u When the bladder be- comes distended with blood, and complete re- tention of urine in consequence takes place, recourse must be had to a large -eyed catheter pkescklbek's memoranda. 145 and an exhausting syringe, by the aid of which and the occasional injection of cold water, the coagula may be broken up and removed. If the hemorrhage be so profuse that the bladder becomes again distended with blood in a very short time, the injection of cold water into the rectum or bladder is sometimes of great use ; and should these means fail, from twenty to forty grains of alum may be dissolved in each pint of water injected into the bladder, a rem- edy that seldom fails to check the bleeding, even when the cause is malignant disease." In urethral hemorrhage ergot has acted well. Give fifteen-drop doses of the fluid extract every fifteen minutes. Boyland. Br. W. A. Gordon commends very highly the use of tincture of hydrastis Canadensis in uterine hemorrhage, menorrhagia, and dysmen- orrhcea. He says : "The tincture I use is prepared after the fol- lowing formula : I£. E,ad. hydras. Can. (fresh). ... 3 ij. Aquas dist Oj. " Maintain at a temperature of 120° F. for twenty-lour hours; then add spts. rect., Oj., remove from the bath, and in three days it is 10 146 pbesceibeb's memobanda. ready for use. In those urgent cases where I formerly resorted to half -drachm and drachm doses of the fluid extract of ergot every twenty or thirty minutes, I now use the tincture of hy- drastis in doses of from twenty to thirty drops, repeated the same as ergot, until the active hemorrhage is controlled. The remedy is then continued in small doses — say two to five drops every two to four hours, according to the urgency of the symptoms." In dysmenorrhoea he combines it with bro- mine, with good results. Nervous patients should not be given over ten drops of the following solution : 3£ . Bromini gtt. j. Aquse dist Oj. Large doses continued for several weeks pro- duces membranous dysmenorrhoea. Dr. Penrose, in a paper ' ' on vinegar as a rem- edy in the treatment of post-partum hemor- rhage," claimed the following advantages : 1. It could be easily obtained. 2. It could be easily applied, and instantly, without special apparatus. 3. It always cured the hemorrhage, at least it had not failed in his practice. 4. It was sufficiently irritating to excite the prescrd3er's MEMORANDA. 14:7 most sluggish uterus to contraction, and yet not so irritating as to be subsequently injurious. 5. It was an admirable antiseptic. 6. It acted on the lining membrane of the uterus as an astringent. The remedy was applied as follows : saturate a rag with vinegar, carry it into the cavity of the uterus, and squeeze it. In the vast majority of cases the hemorrhage ceased as if by magic, when the vinegar passed over the surface of the uterus and vagina. It could be easily repeated if the first application failed. Nitrite of amyl in post-partum hemorrhage has been used with most satisfactory results by Dr. Elias W. Kern. The patient was in collapse when the nitrite was given by inhalation. The hemorrhage ceased at once and permanently, and the patient was restored. Solutions of Ergotine for Hypodermic Injection — (These Besnard). 1. Ergotine, 2 grammes (3ss.); water, 15 grammes ; glycerine, 2 grammes (Hildebrandt). 2. Ergotine, 2 grammes ; water, 15 grammes; glycerine, 15 grammes (Moutard-Martin) ; 1 gramme of this solution contains 0.666 millig. of ergotine, and is equivalent to 0.50 of ergotine. 148 pkescriber's memoranda. 3. Ergotine, 2 grammes ; water, 30 grammes (Bucquoy). 4. Yvon's extract of ergot, 1 gramme, 20; water, 8 grammes, 80 (Dujardin Beaumets). A strong solution double the strength of the pre- ceding. Yvon's extract is recommended for its un- alterability, and because each gramme corre- sponds to one gramme of ergot. ]£ . Ergotini gr. xxxvj. Glyceringe, Aquae aa Tf^ cviij. M. Ergo tin solution for hypodermic use. Dr. Porak cites three cases of obstinate nasal hemorrhage, each of which was promptly ar- rested by a single hypodermic of ergotin. His formula was : Bonjean's ergotin, two grammes; glycerine, thirty grammes. M. Twenty drops hyp oder mically in the lip or cheek. HAIR, Falling of. Hoffmann's Balsamic Mixture is composed of the oils of lavender, cloves, cassia, thyme, lemon, mace, and neroli, of each four parts ; balsam of Peru, twelve parts, and alcohol, 1,000 parts. It is also called Hoffmann) ] s Balsam of Life. peesceibeb's memoeanda. 149 ^ . Hoffmann's balsamic mixture. 25 parts. Glycerine 25 parts. Rose-water 100 parts. Tinct. cantharid , . . . 4 parts. Carbonate of ammonia 5 parts. M. Shake well and filter after one hour. Rub in well once a day for a hair tonic. 3 • Cologne Oj. Tinct. sang 3 ij. Glycerinse § ij. Tinct. canth § ss. Castile soap (grated fine) § ss. M. Apply once a day with a brush, to pre- vent the hair from falling. ^. Ung. petrolei, Olei ricini aa § ss. Hyd. ox. rub gr. v. Liq. ammon. fort fl. 3 ss. Olei rosmarini gtt. v. M. For falling of the hair in cases where it occurs without obvious cause. J. Startin. ^ . Baras sulphid 3 jss. Zinci oxid 3 vj. Mix with water to form a paste ; apply for three minutes and wash off. A depilatory. McCall Anderson. 150 prescriber's memoranda. ~fy . Sodse sulphid gr. xlv. Calcis caust., Pulv. amyli aa 3 ijss. Make into a paste with a little water, and apply for one or two minutes. A depilatory. BOUDET. 1£. Liq. amnion, fort., 01 ei amygdal., Chloroformi aa, 3 ijss. Spts. rosmarini § ss. Olei limonis ess q. s. M. For falling of the hair. Wilson. 3 . Sodae salicyl 3 ss. Acid carbol 3 ss. TJng. simplex § j. M. For alopecia areata. HEADACHE. As to the treatment of headache. Dr. Day ad- vises, as a preliminary step, a diligent search after the cause of the disorder, which, when found, should be removed as speedily as possi- ble. The remedies to be used are tonic or cal- mative, as the case may require. If the brain prescriber's memoranda. 151 be over- excited, bromides of potassium and ammonium, chloral hydrate, and morphia as a hypodermic injection or in other form, may be used. The morphia, combined with an infini- tesimal dose of atropia, and used with care, has been found to be an invaluable remedy, even in cases of organic disease. In nervous headaches, a stimulating emetic of sulphate of zinc, mus- tard, or ipecacuanha, will act like magic, as will also a mustard-leaf at the back of the neck, the feet and legs being at the same time put into hot water. In the neuralgic variety tonics are serviceable, especially cod-liver oil, phosphorus, quinine, and arsenic. The local application of aconitina ointment is serviceable in that form known as brow-ague. As a general treatment, it is recommended to elevate the head at night, and to make use of a hard pillow. In every case, the first principle to inculcate is rest. Dr. "Weir Mitchell, relating a case of migraine occurring in a girl seven years and a half old, exhibiting the congestive type, and for which he prescribed small doses of bromide, gr. iij., and tinct. belladonnas, gtt. iij., observes that the use of the old domestic remedy — a tight bandage — during the attack, is useful. He em- ploys a rubber bandage, applied thoroughly 152 prescreber's memoranda. from the eyes up, with a thin pad over each temporal artery, if the temporal ridge be sharp enough to keep the bandage from squeezing the arteries, and over the two occipital vessels. Instead of caoutchouc, a well-applied muslin bandage may be put on, and then wetted, using compresses over the temporal arteries. The comfort thus given is sometimes surprising. Br. Seguin, in the treatment of migraine, eliminates all psychic stimuli so far as is possi- ble. He also orders alkalies, and in anaemic cases iron and cod-liver oil, while he prohibits the use of carbohydrates and flour. During the attack he recommends rest, with depriva- tion of light and food. In cases in which the attack is anticipated, he relieves it by the ad- ministration of the fluid extract of Paullinia sorbilis — two teaspoonfuls in the course of one to two hours, or the powder of the same plant, twenty to thirty grains every half -hour ; caff ein, two grains hourly, repeated three or four times, or croton- chloral, fifteen to twenty grains re- peated about four times, are also useful. Sub- cutaneous injections of morphia or atropine are disapproved of, although they may occasionally be of use. The treatment in the intervals be- tween the attacks consists in the administra- prescriber's memoranda. 153 tion of alcoholic extract of cannabis Indica to the extent of one-third of a grain daily before each meal. This dose may be increased after some weeks to one-half grain, and, in men, to two-thirds of a grain. The pills are to be taken on an average for about three months. The author places the means here mentioned, in re- lation to their action in migraine, upon the same footing as potassium bromide in epilepsy. HEART DISEASE. Dr. T. Grainger Stewart finds that improve- ment follows the use of cardiac tonics, particu- larly iron, in disease of the heart characterized by pallor, restlessness, headache, slight dropsy, and breathlessness. Dilatation and partial fail- ure of the heart's action are usually found with these symptoms. He gives the tincture of per- chloride of iron, sometimes to the amount of twenty minims every two hours, more frequently every four hours, continuing its use for days to- gether. In many cases improvement follows very speedily. To obviate the gastric derangement so often following upon the use of iron, he com- bines the chloride of ammonium with it, half a grain to each minim of the tincture. The com- bination renders the administration of iron pos- 154 prescriber's memoranda. sible in patients who otherwise can scarcely use it ; indeed, in no other way can iron be ad- ministered in sufficient quantities to afford re- lief, and in many instances to save life. 1$. Tinct. ferri perchlor 3 ij. Syr. zingiber 3 vj. Infus. digitalis § v. M. Tablespoonful three times daily, for car- diac weakness, with dilatation of the ventricles. In the weak heart of elderly persons, Dr. Fothergill combines digitalis with chloroform : If. Tinct. digitalis \ x. Spts. chlorof ormi 71^ xx. Infus. buchu § j. M. For one dose. In conditions of debility, where it has to be taken continuously for months or years at a time, he recommends it in pill-form, combined with iron and bitters, as : If. Pulv. digitalis 3 j. Ferri sulph. exsic Sij. Strychnise gr. ij. Pulv. pip. nig 3 ij. Ext. gent. 3 ij. M. For sixty pills. One or two twice daily, after meals. prescriber's memoranda. 155 1$. Fl. ext. cactus grandiflor .... 3 j. S. — Capiat TT^ iij. to x., p. r. n., for palpita- tion of the heart. HERNIA. Dr. F. H. Hamilton, on posture and traction in the treatment of strangulated and incarcer- ated hernia, gives the following conclusions : 1. Hernial apertures are not under the con- trol of the muscles. 2. Posture does not relax the aperture when the seat of the hernia is in the sac itself, nor when it is at the internal ring in inguinal hernia. 3. Neither warmth nor cold, nor any other sort of local applications are capable of relaxing the apertures. 4. Neither do chloroform nor other anass- thetics affect hernia apertures, except, perhaps, in cases where the hernia is very recent. 5. In short, hernia apertures can seldom be affected at all by any means brought to bear upon them, whether local or general ; but this is not requisite for relief, since the strangulation is not the result of contraction of these aper- tures, but of the pressure of the distended her- nia upon them. In regard to the postural treatment, he says : 1. Taxis is of prime importance. 156 pkesckibee's memoranda. 2. Internal traction is only second to this in value. It is to be effected by securing- paralysis of the abdominal muscles and exciting peri- stalsis in the intestines. 3. Chloroform, hot baths, and other similar agents, are the best means for accomplishing muscular relaxation, peristalsis, and antiperis- talsis. 4. Ice can only relieve the t{ buttonholing," when this is due to congestion, and when it is applied very early. Opium is of a somewhat limited application. 5. Emetics may be of service by causing an upheaval of the viscera, and also, probably, by exciting peristalsis. 6. Purgatives act by causing peristalsis and antiperistalsis below the seat of stricture. 7. Stimulating enemata and enemata of to- bacco also induce peristalsis, and are both direct and indirect in their effects. 8. All positions of the patient are beneficial in which the viscera are drawn upward; and that is likely to be of most service which causes the most efficient inward traction, at the same time that it does not interfere with the trial of taxis. Dr. Post attaches great importance to inward traction, and relates a case in which it was sue- prescriber's memoranda. 157 cessful after Dr. Kearney Rodgers had decided upon herniotomy. The following is the method by which inward traction was effected : a stout man was directed to raise the patient's hips up- on his back, by carrying his knees across his shoulders, when in a few minutes the hernial tumor disappeared. This method was practised successfully for many years by Dr. Holt, of New Orleans, when he was living in Wilkinson County, Miss. He styled it the inversion of the patient. While the patient was thus inverted an assistant was en- gaged in making traction upon the abdomen. HERPES. M. A. Fournier recommends, in cases of her- pes zoster, that the ulcerated vesicles should be washed with a solution of hypochloride of soda diluted with half its volume of water, and the wound then covered with cotton-wool impreg- nated with a powder composed of subnitrate of bismuth, four parts, and calomel and oxide of zinc, of each one part. Should the eruption be extensive, absolute repose is recommended, to- gether with bran or starch baths ; and, inter- nally, opium and bromide of potassium. 158 prescriber's memoranda. Cover the part thoroughly with collodion in herpes zoster. The relief is usually prompt and permanent. HICCOUGH. Dr. Ortille was successful, with gr. - 3 L 6 - of mu- riate of pilocarpine, in curing hiccough which had resisted every remedy. Spray the epigastrium for ten minutes with sulphuric ether, then the site of the phrenic in the neck. Repeat twice a day, if necessary. Regoni. HYDROPHOBIA. Hypodermic injections of curare, one grain every half -hour until spasms cease, and contin- ued pro re nata, have effected cures in several cases. ^ « Curare gr. x. Aquas TTL c. M. Bartholow. prescriber's memoranda. 159 INEBRIETY. Ij, . Tinct. capsici ' gtt. x. Tinct. nucis vom gtt. x. Acid, nitric, dil gtt. xx. Aquae § j. M. S. — Take as a draught in water three or four times a day to remove the nausea, depres- sion, and craving for drink. INSOMNIA. 3 . Chloral hydrate 3 iij. Potass, bromid 3 iv. Tinct. opii 3 j. Syr. aurant. cort | ss. Aquas ad. § iij. M. S. — Take 3 j. To be repeated, if neces- sarv. Kane. INSANITY. Dr. George H. Savage, of the Bethlehem Asylum, gives the results of his experience in the treatment of insanity, more especially in the use of drugs. Early removal from home he considers the first step in almost all cases. He 160 pbescbibeb's memoranda. finds few cases of sthenic insanity. Stimulants should therefore be used instead of depressants. Food well selected and administered is at the basis of treatment. He thinks well of the shower-bath in cases due to self-abuse, and of the wet pack, especially in the mania of hys- tero-epilepsy. He uses no form of opium but morphine. Melancholies seem to do well under its use, but the cure takes so long that time may be the curative agent after all. It is most beneficial in climacteric and senile cases, and most hurtful in mania. He thinks chloral has, all things considered, done as much harm as good. He finds it useful in epileptic mania, in cases due to excess of alcohol, and in puerperal cases. In wildly maniacal and erotic patients he gives it in from ten- to thirty-grain doses rubbed up with an equal quantity of camphor in syrup. He found alarming symptoms to fol- low, however, in one case, after twenty grains of the mixture had been taken, Succus conii and hyoscyamine he uses spar- ingly in noisy and destructive cases. He has almost discarded bromide of potassium, except, presumably, for epilepsy. Prefers saline pur- gatives to all others, and Hunyadi Janos to all other waters. Next to quiet and absence from home, stimulants take rank. He finds koumiss pbesceibee's memoranda. 161 of use in hysteric dyspepsia and anorexia, in doses of a pint daily, as it is easily digested and prevents waste. As emmenagogues he uses Griffith's mixture and compound decoction of aloes or tincture of black hellebore. He thinks amenorrhoea is seldom a cause of insanity in otherwise healthy subjects. It is often due to the same cause as its accompanying depression. He uses the above remedies if the menses do not reappear after the general health has been restored by iron or other tonic treatment. Finds physostigma of some use in the conges- tive stage of general paralysis, inducing remis- sions of the prominent symptoms. Does not have a high opinion of electricity, though he has used it rather too seldom to speak with authority. Has noticed recoveries after the occurrence of some local inflammation so often as to suggest the propriety of more common use of counter-irritation. In gouty cases, cure the gout, and you may cure the insanity. Gen- erally speaking, treat causes and conditions. Moral treatment must, however, he thinks, be for a long time, and perhaps forever, the chief aim. With correct management from the start, nearly all cases of insanity unattended by pa- ralysis or physical decay, may be cured. 11 162 prescriber's memoranda. INTERTRIGO OF INFANTS. Wortheimber says : When the stools are thin and of acid smell, he employs two or three times daily the following powder : $ . Calcis precipitat gr. jss. Bismuth, subnitrat gr. j. Sacchari albi gr. iij. M. In other cases, where the discharges have a less serous character and are characterized rather by abundant yellowish white flakes of caseine, minute doses of muriatic acid produce better results. The fact, however, still remains, that many cases will be found rebellious to every treatment, and recovery will be effected only by the employment of a wet-nurse. Great care must be taken to remove wet diapers, and to insure the underclothing's being always dry. It is better in washing the folds of the skin — the favorite seat of intertrigo — to use lukewarm soap and water, as this removes more easily than cold water the accumulated fatty secre- tions. Powders should be used locally only when the epidermis is sound ; otherwise they are injuri- ous by adhering to the secretions and forming crusts j which act as foreign bodies and increase , prescriber's memoranda. 163 irritation. The sporules of the lycopodium, ow- ing to their oily nature, are preferable to the different amylaceous powders. Still better is an admixture of semen lycopodii with finely powdered subnitrate of bismuth or oxide of zinc. Whenever the intertrigo is so advanced as to present moist excoriations, a different treatment should be immediately adopted. The author strongly disapproves of the use of the so-called "drying salves" prepared with animal fats, such as zinc and lead ointments, and attributes the severity of many cases that have come under his care to the injurious effects of their long and lavish use. A decided preference is expressed for the unguentum diachyli of Hebra, and its employment in fresh cases is generally satisfactory. In other cases it fails, and the author has of late employed, in severe forms of the disease, a remedy that has completely ful- filled every expectation, namely, corrosive sub- limate. His method of using this latter remedy is very simple. The solution employed is : I£. Hydrarg. chlor. corrosiv 0.05 Aquse dist 100 M. About one grain to four ounces of water. 164 prescriber's memoranda. Pieces of lint are soaked in this solution and laid upon the diseased surface. It often suffices to apply the solution in this manner three or four times a day for an hour at a time, and it is rare that the application must be continuous. IODOFORM. The very unpleasant pungent odor of iodo- form can be almost completely masked by oil of peppermint. For instance, iodoform 3 ss. , vase- line §ij., rubbed up with six drops of oil of peppermint, makes an ointment with a pleasant, aromatic scent. Shake tincture of iodine with a fragment of fused potassa till the color be removed. Cover the odor of the iodoform thus produced by the addition of eau de- Cologne. Dip lint in this solution, allow it to dry, and one has an excel- lent application for indolent ulcers, anal fissures, burns, etc. ITCHING (Pruritus). 1$. Prepared chalk 10 parts. Coal tar 1 to 4 parts Glycerine 5 parts. Simple cerate 50 parts. pkesckiber's memoranda. 165 Or the following : 1>. Prepared chalk 8 parts. Coal tar 1 to 2 parts. Linseed oil 20 parts. Shave off the hairs, or cut them very short ; then apply this ointment once or twice a week. For barber's itch. 1. Ablution with tepid water to be substi- tuted for paper after defecation. 2. Suppos. ext. bellad., gr. ss. , every night. 3. Bowels regulated with a mild laxative, as acid tartrate of potash with confection of senna. 4. Mixture containing small doses of quinine and arsenic, two or three times a day. Glycerinum acid, carbolic, at bedtime every night, and the following to be applied every morning : 1$. Hydrarg. chlorid. mit 3 j. Camphor 3 ss. Vaseline 3 vjss. M. Iy. Acid, carbolic „ . . . . 3 j. Olei olivae § j. Apply with the finger at bedtime. Glycerite of tannin, or a mixture of equal parts of compound tincture of benzoin and wa- 166 prescriber's memoranda. ter. The best application is strong mercurial ointment at bedtime, or — I£. Ungt. hydrarg. fort 3 j. Chloroform 3 j. Adipis benzoat 3 j. Acid, carbolic gr. xv. M. S. — Use every night. 1$. Schule's hydrocyanic acid .... 1TL xxx. Liq. morph. sulph 3 j. Tobac. opt 3 j. Aquas q . s. ad. 3 ss. To be used night and morning. For Pruritus Ani. 1$. Balsam of Peru § j. Benzoic acid gr. ex. Oil of cloves gtt. xl. Alcohol 3 ijss. Simple cerate § vij. Dissolve the essential oil and the benzoic acid in the alcohol, and mix them with the cerate. Lastly, add the balsam of Peru. It is said to effect a cure in twenty-four hours. For scabies. Dr. Andrew J. B. Jenner, of Detroit, writes : "Experience has taughfc me that men of a nervous-bilious temperament frequently suffer prescriber's memoranda. 167 from itching of the scrotum — and women of the same temperament, from itching of the puden- da. There is no eruption in either case. Scratching the parts, however, produces such an exquisitely voluptuous sensation, and so in- tensifies the itching, that continued scratching frequently abrades and excoriates the parts. Such pruritus is not a disease of itself, but merely a symptom of hyperesthesia of the local cutaneous nerves, caused by the permeation of uric acid or bile. Such cases are invariably re- lieved by the internal use of the tincture of aconite. In severe cases the same remedy may be applied externally. The following prescrip- tion will, in most cases, suffice : 1$. Tinct. aconiti rad 3 j- Ex. aquae 3 xij. u Cujus cochleare unum magnum ter quaterve in die summendum." Dr. Auerbach has for some time treated pruritus by the application of balsam of Peru, and with the greatest success. After the first rubbing into the part great relief is obtained. Cure results in a few days. M. Marius Key recommends the glycerole of cade as a local application in the treatment of pruritus of the vulva. The formula he employs 168 peesceibek's memokanda. is one drachm of oil of cade to half an ounce of glycerole of starch. In combination with it he uses tonics, hip-baths, and emollient injec- tions, to which laudanum is freely added. He has tried this treatment only once in a really rebellious case, but that time with success. Wear a piece of cotton-wool, of the size of a walnut or larger, at the anus ; a few shreds of the wool should be inserted inside the sphincter, and this will be sufficient to retain the whole in its place. A fresh piece must be used after evacuation. Pruritus ani. Dr. John Pirnat says that with the following treatment for itch he cured, in one week, be- tween eighty and ninety students in 1862, and it has never failed in his hands since : 1$. Calc. ox § vj. Aquas O v. M. Let stand for half an hour, then add : 1^. Zinci sulph § j. Sulph. sub „ J iij. M. Put it in an iron vessel and let it boil for half an hour, stirring continuously ; then allow it to cool. Pour the liquid into a bottle, and label " Liq. Sulphuris Comp." Let the patient be well washed, then rub thoroughly with this solution the whole body every night before going to bed, for three sue- prescriber's memoranda. 169 cessive nights, without changing the clothes ; at the same time let the patient take every morn- ing a dose of mag. sulph., or the following : ly, Potassaa tart 3 ijss. Sulph. sub § vj. Rhei pulv % j. Sacchari alb 3 ss. M. S. — Two teaspoonfuls in a glassful of water three times daily, till the bowels are freely opened, then once or twice a day. On the third day the patient should wash thoroughly with warm water and castile soap, then dress in clean clothes, when the cure is complete. To conceal the smell of the above preparation, oil of cloves, roses, or bergamot, may be used. IJ. Iodini gr. xij. Potass iodid gr. vjss. Alcohol I j. Aquas § v. M. For itching of the scrotum. I> . Hydrarg. bichlorid gr. vj . Spts. rosmarini, Alcohol aa 3 j. Mist, amygdal. arnar 3 vj. M. Pruritus. Wilson. 170 prescriber's memoranda. ^ . Camphoras, Chloral hydrate aa 3 j. Ung. aquae rosse § j. M. Pruritus. Bulkley. LAXATIVE BREAD. Mr. W. H. Taylor says that he has bread pre- pared as follows, and finds it most useful in constipation and as a laxative in piles : coarse Scotch oatmeal, whole wheaten flour, coarse ordinary flour, of each equal parts. The bread can be lightened by yeast, or, to a two-pound loaf, one tablespoonf ul of baking-powder, made of four ounces of bicarbonate of soda, three ounces of tartaric acid, one pound of ordinary flour, rubbed well together, and kept dry in a tin or well -corked bottle. The bread keeps well, and a two-pound loaf will be sufficient for a week, baking a portion once or twice a day in conjunction with ordinary bread. LAXATIVE AND PURGATIVE MIX- TURES. ^. Pil. hydrarg., Resin, scammonii, Pulv. aloes aa gr. xx. Olei carui q. s. M. Divide into 20 pills. prescriber's memoranda. 171 * l Rags" Pills. Yf,. Pulv. rhei, Pulv. aloes, Pulv. gentianse, Pulv. saponis aa gr. xx. M. Divide into 20 pills, Segur*8 Pills. Yy, . Pulv. aloes gr. lx. Ext. colocynth. co gr. xxx. Ext. hyoscy ami gr. xxx. Ext. nucis vom gr. xv. M. Divide into 60 pills. Squibtfs Laxative Pills. Ifr . Resinse podophylli gr. xxxvj. Ext. bellad. alcoh gr. xviij. [or] Ext. hyoscy am. ale, Pulv. capsici, ^ Pulv. sacch. lactis aa gr. cxliv. Pulv. acaciae gr. xxxvj. Glycerinse TTJ_ xl. Syrupi q. s. M. Divide into 144 pills. Dry them by ex- posure to the ordinary temperature, until just hard enough to retain their form. Then put them into a well-stoppered bottle. 172 prescriber's memoranda. I£. Ext. colocynth. co gr. xxxvj. Resin, podophylli gr. ix. Resin, leptandrae gr. iij. Pulv. jalapae. gr. vj. Pulv. aloes Soc gr. xij. Ext. hyoscyam gr. vj . Olei menthse pip gtt. v. M. Divide into 24 pills. Walker's Pills. $. Ext. nucis vom., Ext. belladonna aa gr. v. Ferri sulph. exsic, Ext. aloes aa gr. x. M. Divide into 20 pills. A pleasant method of administering castor- oil consists, says Dr. Starke, in mixing the oil with coarse granular sugar until a thick paste is formed. This usually requires about one part of oil to three of sugar. The addition of a small amount of cinnamon-powder suffices to give the mass a pleasant taste. The writer finds this candy uniformly successful in children, who will rebel against the oil in any other form. The bulk is so great that this mode of adminis- tration is almost necessarily confined to chil- prescriber's memoranda. 173 dren's practice. For adults, the addition of compound liquorice-powder, in the proportion of one part to two of oil, will form a bolus which can be readily swallowed. Rub two drops of the oil of cinnamon in an ounce of glycerine, and add an ounce of castor- oil, to render the oil palatable. M. Yvon finds that the disagreeable taste of sulphate of magnesia may be completely con- cealed by the addition of a few drops of the essence of mint, provided that the quantity of the vehicle be small. He advises that 5 vj. of the sulphate should be dissolved in about § j. of water, two or three drops of the essence of mint being then added ; or the flavoring agent may be added "to the salt, and the patient di- rected to dissolve the whole in as small a quan- tity of water as possible. r) . Ferri sulphatis g-r. ij. Magnesii sulphatis 3 ij. Aquas fl. 3 j. M. Dose, a tablespoonf ul , in constipation of anaemia. 174 peesckibek's memoranda. ^ . Pulv. sennse 2 parts. Pulv. glycyrrh. rad 2 parts. Pulv. f oeniculi 1 part. Sulphuris loti 1 part. Pulv. sacchari 6 parts. M. Dose, 30 to 60 grains. LEAD-POISONING. Milk as an Antidote to Lead- Poisoning. — A singular fact is given of the effect of the habit- ual use of milk in white-lead works. In some French lead-mills it was observed that, in a large working population, two men who drank much milk daily were not affected by the lead. On the general use of milk throughout the works, the occurrence of lead-colic ceased. Each oper- ator was given enough extra pay to buy a quart of milk a day. From 1868 to 1871 no cases of colic had appeared. LUPUS. Dr. H. G. Piffard reports several cases of lupus treated by excision, scraping, or actual cautery, or by a continuation of these means. Thorough prescriber's memoranda. 175 and radical treatment is insisted upon; every lupus-cell must be destroyed. We must seek to replace the lesion by a cicatrix, to prevent a relapse in situ aud the development of the dis- ease elsewhere. This is best done by excising or scraping away the lupus-tissue, and then em- ploying- the galvanic or other actual cautery. Internal remedies are of value only as benefit- ing the general health of the patient. Scraping, followed by the actual cautery, is the least pain- ful of the radical operations proposed, and cica- trization is most rapid, the resulting scar being smooth and less disfiguring than that following spontaneous involution or the potential caustics. Success depends upon the thoroughness in op- erating. Relapses in situ occur usually in three months; elsewhere they may appear later. Here constitutional treatment is very necessary. 5 • Iodini, Potass, iodid aa 3 ss. Glycerines 3 j. M. Lupus. McCall Anderson. Tubercular Lupus of the Face. 1. Cover the parts invaded by the tubercles with an ointment made as follows : 176 prescriber's memoranda. I£ . Bromide of mercury 3 jss. Axungia 3 v. 2. Cod-liver oil, two tablespoonfuls night and morning. 3. Take, morning and evening, before meals, a tablespoonf ul of the following solution : 1$, . Distilled water 5 viijss. Chloride of sodium 3 iv. Iodide of potassium 3 1£- Considerable amelioration took place in two months. Hardy. MALARIA. From experiments conducted at Bellevue Hos- pital, Dr. Gaspar Griswold found that pilocarpine administered hypodermically will cut short the chill of intermittent fever. It also, in a large number of cases, aborted the paroxysm, that is, by inducing a profuse sweat, prevented any hot stage following. The dose is one-fifth of a grain of the muriate. Dr. Fordyce Grinnell says that, while he was occupying the position of Government physician at the Wichita Indian Agency, he treated 135 cases of intermittent fever with ten-drop doses pbescriber's memoranda. 177 of tincture of iodine in a third of a glass of sweetened water, three times a day, with the most beneficial results. He says : " The remedy seemed to act almost as if by magic ; in many instances the paroxysms were not repeated after the medicine was given." Dr. P. Filatow has used the infusion of sun- flower. The infusion is prepared by cutting the stem of the sunflower (fresh or dry) into small pieces, and macerating it for three or four days with common cognac, when it acquires the color of sherry and the distinctive taste of the drug. The dose is a tablespoonful three times a day. Dr. Masoti gives his experience in the use of carbolic acid. The patient had suffered with intermittent fever for ten months, and was treated by a quack with all kinds of bitters and by bleeding. Then quinine was freely taken, with an infusion of tobacco, without success. Carbolic acid, one- tenth of a grain, was then given, and in three days the fever commenced lessening in intensity, and at the ninth day dis- appeared. The carbolic acid was mixed with strong coffee, made very sweet. The next case of intermittent fever had been of five months' standing, and was similarly treated successfully. 12 178 peesceibeb's memoranda. Haberkorn has very successfully used the ethereal oil of mustard, on account of its anti- bacterial properties, in the pernicious fevers of malaria. He gives two or three drops a day in a great quantity of distilled water ; or better, from two to four drops in a ten per cent, alcohol solution. His results have been ' ' most remark- able. " Surgeon W. E. Saunders speaks of the suc- cessful use of nitrite of amyl in the cure of ague, where he gave it in two-drop doses by in- halation, combined with the oil of coriander in equal quantities. He regards it as a powerful diaphoretic, and uses it in all cases of fever to produce diaphoresis. Dr. L. Austin Porter says : a I have been using sulphite of soda in many of the malarial fevers. I find the results quite satisfactory, not a grain of quinine being necessary. It has appeared to me that cases thus treated are less subject to a relapse ; the career of the fever is cut percep- tibly short, and convalescence immediately be- gins. I take the tongue of the patient as my guide- board for the administration of this salt. When I find ifc presenting a broad, flabby appear- ance, with pale texture, and covered either with prescriber's memoranda. 179 a pasty white, yellow, or brownish coat, with bad taste in mouth and fulness of stomach, sulphite of soda is my remedy; and with these signs I regard it as a very valuable remedy. But if the condition of the tongue be different from that here described, it will do more harm than good. It is absurd to administer it to a patient whose tongue is red, red-edged with fur in centre, or even covered with fur entire, while the body of it is red, or in which red papillse are projecting up above the coating. There is nothing that will clean off the tongue quicker than this salt. • ' My mode of giving this remedy is to use about sixty grains, divided into ten powders- one powder given every two hours in mucilage, albumen, or slippery -elm tea.' 7 Where Anaemia is a Prominent Symptom in Malaria. Vf, . Ferri et potassas tart gr. v. Liq. potass, arsenitis TT^ ij. Potass, bicarb gr. x. Tinct. nucis vom 71^ v. Aqua? ad. 3 j • To be taken in a wineglassful of water, before eating. J. 0. Webster. 180 pbescriber's memoranda. Tonic in Malarial CacJiexia. fy . Quinias sulph gr. ij. Acid . arsenios gr. -j- -. Pulv. capsici gr. j. Ext. taraxaci q. s. To be taken before each meal. MENSTRUAL DISORDERS (See Dysmen- orrhea and Hemorrhage). Dr. J. R. Black gives bromide of ammonium in too frequent menstruation, in ten-grain doses before each meal and at bedtime, in those cases of menstruation occurring in women from pu- berty to their thirtieth year, in whom the in- terval is about two weeks and the irregularity is not due to displacements, inflammation, nor de- generations, but seems to be due to over-excite- ment of the genital organs. For irregular menstruation, when associated with and dependent on ansemia, neuralgia, and neurasthenia, the following may be used : 3^ . Tinct. f erri mur 3 x. Liq. potassge arsenitis 3 ij. M. Sig. — Twelve drops after each meal, through a glass tube, in about one-third glass of water. pbescbiber's memoranda. 181 For Delayed Menstruation : #. Apiol , 3ij. Liq. potass, arsenitis 3 j. Tinct. ferri chlor 3 ij. Syrupi 3 iij. M. S. — Teaspoonful, t. i. d., before meals, for one week, and alternate with simple chaly- beate treatment. MILK, Suppression of. MM. Boucher and Fonssagrives have estab- lished the efficaciousness of the ricinus communis for increasing or re-establishing the secretion of milk. It is used thus : a handful of the leaves of the ricinus communis are boiled in a litre of water. The breasts are bathed with the decoc- tion for fifteen or twenty minutes ; there is then applied to the nipples a poultice made with a part of the same leaves, which is left on till they become dry. The result is obtained after a few hours ; but, if the secretion is very tardy, fumigation of the genital organs with the boiled leaves may be added. MOLES. Dr. Thomas writes: U I strongly advise the acid nitrate of mercury in removing moles from the face. The acid should be applied with 182 peesceibee's memoeanda. a splinter of wood, and gently rubbed on the part for several seconds, according to the thick- ness of the growth. Great care should be taken to prevent the acid from reaching the surround- ing skin. There is absolutely no pain attending the application, and the growth gradually shriv- els away, and the slough falls off in about a week. NBTTLERASH. I£ . Atropia sulphat gr. i. Aqua3 dist. s (xlycerinas , aa 3 ss. Pulv. tragacanth q. s. M. Ft. pil. no. x. S. — A pill morning and Dr. G-uibout remarks that in ordinary cases of urticaria the treatment is very simple ; but, when it becomes chronic aud dependent upon permanent dyspeptic derangements, medical agents are required. In this case we may have to resort to emetics, purgatives, or stimuli, etc., of which he prefers strychnia. Dr. Q. C. Smith says : First give a full emetic dose of ipecac, and after it has acted thorough- ly* gi ve fl» ex k of belladonna, in small doses, pkesceiber's memoranda. 183 every two hours, until its characteristic flush of the skin is produced on the face, or until vision is considerably disturbed. This degree of im- pression should be maintained, gradually dim- inishing the dose for two or three days. Such constitutional treatment as may be indicated in each case should be duly instituted, though many cases require nothing further than the belladonna. NEURALGIA. In neuralgia of the fifth pair, Prof. Fereol, of Lyons, believes he can report good results from the following : I£. Cupri ammonio-sulphat gr. j.-iv. Syr. florum aurant fl. 3 j. Aquae dist fl. 3 iij. One-third as a dose, three times a day. It gives a fetid odor to the breath, which should be disregarded. Dr. B. M. Griffith recommends the following for trifacial neuralgia : I£ . Croton chloral 3 ij. Syr. aurant § ss. Simple elixir § ijss. M. S. — Half tablespoonful in water, once in two hours, until paroxysm is relieved. Chloral 184 peesckibek's memoranda. hydrate will not do. This potion to be increased or diminished according- to age, condition, etc., of patient. Follow, after quieting pain, with : I£ . Quinise sulph 3 j. Tinct. gelsemium 3 jss. Simple elixir 3 iij. M. S. — Teaspoonful once in two hours, un- til six portions-have been taken each day. Duquesnel's aconitia has been used with marked success in some cases of facial neural- gia. Commence with T \-$ gr. , and gradually in- c ease to -g^, or until pricking and tingling are manifested or the pain is alleviated. Professor Massini, of Basle, recounts his ex- perience of the use of gelsemium in the treat- ment of eighty cases of neuralgia of the trige- minus. In cases of this sort Dr. Massini gives twenty minims of the tincture every half-hour up to three doses, and he finds that the first dose usually affords relief, and that the pain rapidly subsides after a second or third dose has been taken. He has never found it necessary to ex- ceed sixty minims, and only in one case did this quantity produce unpleasant head-symptoms. The cases in which the remedy produces most prescriber's memoranda. 185 benefit are those of simple rheumatic neuralgia of the alveolar branches of the trigeminus ; in those it rarely fails. It also sometimes relieves the pain remaining* after the stopping of a carious tooth. Where there is any inflammatory affection of the bone or periosteum, no good can be expected from the remedy. The medi- cine may, if necessary, be repeated several days in succession, the active principle rapidly pass- ing off by the kidneys. Marino publishes the results of his experiments with ergot: 1, in tic-douloureux, local injec- tions of ergot give better results than any other remedies, quinine included ; 2, the results are equally good in hemicrania ; 3, in some cases of sciatica, very good results have been obtained, while in other cases no relief has been afforded to the patient ; 4, ergot should be administered in other cases of neuralgia, especially if the lat- ter is caused by blood-poisoning or cachexia ; 5, the injection itself is often painful, but ab- scesses do not often supervene ; the pain gen- erally ceases in half an hour, especially if a cold compress has been immediately applied to the place. The neuralgic symptoms, as a rule, disappear after one or two injections ; but it is advisable to continue them for some time ; 6, the 186 pkescribeb's memoranda. dose for one injection varies from fifteen centi- grammes (two grains) to two decigrammes (three grains) of ergot dissolved in water or glycerine. M. Mauriac treats the neuralgia symptomatic of syphilis with iodoform pills, according to the following formula : I?. Iodoform powder gr. xx. Ext. and powder of gentian. . q. s. Divide into twenty pills, two or three to be taken daily. ^ . Aconitias gr. iv. Veratrias gr. xv. Glycerine 3 ij. Cerati 3 vj . M, S. — To be rubbed over the parts. Care should be taken to see that there is no abrasion of the skin. Da Costa. Among the many local applications in neural- gia, Prof. Da Costa has found this one the best adapted for general use : $ . Yeratriaa 3ij. Adipis I j. M. et ft. ungt. For external use. prescriber's memoranda. 187 ^ . Tinct. aconiti rad fl. 3 ij. Chloroformi fl. 3 j. Tinct. iodinii co fl. 3 ij. M. Apply with a brush. James Mason recommends : I£ . Chloroformi pur. , Tinct. aconiti (F lemming's) aa 3 iij. Tinct. capsici 3 j. Tinct. pyrethri, Olei caryoph., Pulv. camp aa 3 ss. M. As a local anaesthetic while extracting" teeth, and to relieve toothache. The tooth and sur- rounding gum are dried, four or five drops of the mixture applied, and the tooth extracted without pain by warmed forceps. To relieve toothache, fill the cavity of the tooth with a pellet of cotton soaked in the mixture. I£ . Ext. belladonnas gr. x. Ext. stramonii 3 ss. Acid, tannic gr. viij. Adipis q. s. ad. § j M. et ft. ungb. For external use. 188 prescriber's memoranda. P. Squire's Formula for " Chlorodyne" 1^. Chloroformi purif fl. J iv. iEtheris fort fl. 5 j. Alcoholis fort fl. 5 iv. Syr. fusci fl. § iv. Extr. glycyrrh. pulv ? ijss. Morphias hydrochlorat gr. viij. Olei menthae piper 7T[ xvj. Acid, hydrocyan. dil. (2#) fl. § ij. Syrupi fl. § xvijss Dissolve the morphia and oil of peppermint in the alcohol ; mix the chloroform and ether with this solution. Mix the liquorice with the syrup and add the molasses. Shake these two mixtures well together ; lastly add the hydro- cyanic acid, and again shake well. Dose, 5 to 10 minims or 10 to 20 drops. Always shake the mixture before using. 1$. Morph. mur gr. ss. Chloral hyd., Chloroform aa 3 ss. Tinct. cannab. Ind., Tinct. capsici, Acid, hydroycan. dil aa TT\_ xx. Spts. menth. pip TT^ x. Syr. sassafras co ad. | j. Dose, |j. prescreber's memoranda. 189 This I have named Elixir Chloroformi Com- positus, and can heartily recommend it to those who have been in the habit of using ehlorodyne. McNutt. 3 . Quinias sulph. , Ferri pyrophosph aa 3 3. Strychnia3 gr. j. Acid, phosph. dil. (tribas) .... fl. 3 ij. Syr. zingiber fl. § ij; Aqua? q. s. ad. fl. 5 iv. M. Dose, a tablespoonful. NiEVUS. Sodium ethylate, used since 1871 by Br. J. Brunton, is prepared by adding the metal sodium, piece by piece, to absolute alcohol in a wide- mouthed bottle ; when effervescence ceases, a crystalline substance, C2 H5 NaO, has been de- posited at the bottom of the flask. Dr. Rich- ardson has the credit of bringing this and other alcoholic and ethylic derivatives into notice in 1870. He says : ki When it is brought into con- tact with water it is decomposed ; the sodium becomes oxidized by the oxygen of the water, forming sodium hydrate, the hydrogen of the 190 pkescriber's memokanda. water going" to reconstitute the common or ethy- lic alcohol. The change of ethylic alcohol into sodium transforms it from an irritant to a caus- tic. Laid on dry parts of the body, the sodium ethylate is comparatively inert ; but, as soon as the part to which the substance is applied gives up a little water, the transformation described above occurs, caustic soda is produced in con- tact with the skin in proportion as water is eliminated, and there proceeds a gradual de- struction of tissues, which may be moderated so as hardly to be perceptible, or may be so inten- sified as to act almost like a cutting instrument." It is, therefore, valuable for the destruction and removal of malignant growths beyond the reach of the knife, by application to the surface or by subcutaneous injection into the growths. Upon the unbroken skin only slight pain is caused, quickly checked by the addition of chloroform. These alcohols dissolve opium — also suggest- ing to Dr. Richardson the possibility of a sure, rapid, and painless caustic. Caustic alco- hols may be used in combination with local an- aesthesia from cold. Thus, with ether-spray and the subcutaneous injection of caustic alco- hol, we have a valuable means for treating a poisoned wound, such as a snake's or a mad dog's bite. So possibly for cystic tumors. Po- pkesckcbee's memoranda. 191 tassium and sodium alcohol dissolved in the volatile hydride of amyl produces a caustic so- lution ; applied to the skin, the hydride evapo- rates, the caustic remains. Compared with the action of nitric acid, there is less destruction of epidermis and less paiu, and hardly any scar- ring, the action of the ethylate being limited to the spot where it is applied. B. W. Richardson says that the ethylates are sometimes called alcohols, because in them the atom of hydrogen, which in alcohol is, with its radical, combined with oxygen, is replaced by an atom of sodium or potassium. He treated, in 1870, a small nsevus, on the neck of a child two years old, with sodium ethylate. This nasvus was cured by six applications of the fluid, and a sound surface left. Soon afterward another, as large as a half-dollar, and quite prominent, was treated in the same manner. The application gave very little pain. The nsevus soon turned dark. In three days a firm, harl incrustation had formed. A few days later this was dry enough to be lifted off. The naavus had been reduced in size. Sodium ethylate was again applied as at first, and so on till the nasvus was removed and a natural surface left. Time required, nine weeks and three days. 192 prescriber's memoranda. NIGHT-SWEATS. Dr. Murrell, in a series of interesting and instructive papers, reviews the various agents known to check night-sweating. Oxide of zinc has long proved trustworthy in doses ranging from two to ten grains at bed-time. Sulphate of atropia, Eolith to Tooth grain, in- jected hypodermically, has lately proved most valuable, a single dose often checking the sweats for many days. It is often noticed that the first night shows no good effects, but, on the second night, without any fresh injection, the sweats disappear, to return slightly the next night, and, on the fifth night, they will be as bad as ever, but will then be speedily arrested by another dose. Gallic acid, quinine, and iron, all play an useful role in the treatment of indi- vidual cases. In nitrite of amyl, administered in minim doses, we have a recent valuable addi- tion to our remedies. In seventeen test-cases it relieved fourteen ; it has not, however, yet proved so prompt as atropia in its action. Water, applied locally, as hot as can well be borne — indeed, a few degrees hotter — often re- lieves local sweating. Sage tea has at times proved valuable. In Dover's powder we have a most valuable therapeutic agent in doses of five pkesckiber's memoranda. 193 grains once or twice in the night ; and, while it is inferior to atropia, it is far more reliable than oxide of zinc. Picrotoxine, the alkaloid of cocculns Indicus, has yielded excellent results. Dr. William Murrell gave pilocarpine, the alkaloid of jaborandi, in seventeen cases of con- sumption night-sweats, in all of which it did some good, and in most cases was a great suc- cess. G-ive it in pill — one -twentieth of a grain at bedtime only, or three or four times in the day. Night -sweating of phthisis and other diseases is treated in the Hospital of the University of Pennsylvania, with small doses (-^-j to -£& gr.) of atropia combined with small doses of jaborandi, which does away with the occasionally un- pleasant effects of the atropia. Dr. Q. C. Smith recommends, as very efficient in the night-sweats of phthisis : ^ . Zinci oxid gr. j. Acid pyrogallici gr. ij. Atropiae sulph gr. T ^. M. S. — For one pill. Dose, j.-ij., thrice daily. 13 194 prescriber's memoranda. For Night-sweats of Consumptives : I£ . Acid salicyl 1 part. Amyli 3 parts. Talci , 29 parts. M. Ft. pulv. The whole body is to be powdered every night. If the skin should be too dry, lard, alcohol, and tannin is rubbed in to make the powder adhere. To prevent the burdensome cough produced by the salicylic acid, the mouth and nose are cov- ered with a cloth. Kohnhorn. NIPPLES, Fissure of. I£ . Plumbi nitrat gr. x-xx. Glycerinse § j. M. S. — Rub on the sore nipples. Fordyce Barker. ^ . Aquse rosse § iijss. Liq. plumb, subacetat. dil . . . . § ss. Ext. opii aq 3 j. Sig. — Use as a lotion, wetting linen in this and covering the breast with two thicknesses of it, having previously applied a bread and milk poultice to the breast. This is recommended by Dr. Barker in in- flamed nipples. pkescriber's memobanda. 195 Dr. M. O'Hara has found the following appli- cation to fissured nipples very satisfactory, giving prompt relief to pain : I£ . Iodoformi 3 ss. Collodion § j. M. S. — Paint on the part from time to time. Dr. Buttler says : When fissures of the nipples are not due to some constitutional cause, tinc- ture of benzoin freely applied to the parts will, in about five to ten days, effect a cure. Only the first application is painful. Tincture of benzoin forms a covering on the surface of the nipple, and so protects it from the child. Lactation is never interrupted by this process of treatment. ^ . Iodoform 3 ij. Balsam Peru. . § j. M. S. — For external use. ORCHITIS (See also Epididymitis). Dr. Z. C. McElroy gives the following plan of management of this painful disease. It consists in hypodermic injection of morphias sulph., in 196 PRESCRIBES MEMORANDA. £ gr. doses, into the cellular tissue of the scro- tum, and internally : 3 . Calomel gr. iij. Ipecac pulv gr. x. M. S. — Take at once. Administer a saline cathartic in the morning and follow with smaller doses of calomel and ipecac every six hours. Repeat hypodermics of morphise, p. r. n. Apply locally : $ . Hydrarg. ammoniat 3 j. Cerati simp § j. M. Ft. ungt. S. — Apply as directed. A saline cathartic and belladonna extract, made soft and smeared over the scrotum, has given good results. ONYCHIA MALIGNA. Dr. Gaetano was called to a little girl ten years of age, who had suffered severely for six months with peri- and sub-ungual ulceration of the right index finger. Having softened and raised up the nail as much as possible, he dropped a concentrated solution of morphia upon the sore, with which he kept it in contact a quarter of an hour. He then covered the prescriber's memoranda. 197 diseased part with very finely powdered nitrate of lead and enveloped the finger with a bandage. The pain was almost immediately relieved, and the patient slept soundly that night for the first time in a long period. Cure in five days. PARALYSIS, Spinal. Dr. Wm. T. Plant recommends the following in spinal paralysis of infants : If the initiatory fever is high, aconite in minute and frequent doses will be in place, with tepid bathing. And as in other cases, where a child is feverish, ap- parent causes of irritation should be relieved. If the gums are swollen by coming teeth ; if constipation is present ; if there are evidences of worms in the bowels ; if there is any want of activity in the digestive processes, you will know what to do. As soon as attention is drawn to the spine by the discovery of paralysis, your thoughts will naturally turn to those agents whose physio- logical effect is to diminish the blood- supply of the cord. Chief among those at present known are ergot and ergotine, and less certainly, belladonna and potassium bromide and iodide. Possibly the hyperaemia of the cord may be lessened by ru- 198 peescbibee's memobanda. befacients to the spine. Tincture of iodine con- siderably diluted is a good agent for this pur- pose. The following is a good rubefacient lo- tion : ]$. Spts. rectificat., Acid, acetici, Tinct. capsici equal parts. M. S. — Wet a cotton cloth with it and lay along the spine. The application of leeches may also be of service. After a little time — two to three weeks — if the palsied muscles are not steadily regaining their power, resort should be had to those agents that stimulate muscular contractility. Chief among these are strychnia and electricity. Of the former, I would commence with a small dose, not exceeding the fiftieth of a grain to a child of two years. Remember that half a grain has killed a grown person. The quantity may be increased gradually and guardedly. In electricity we have a most valuable means of restoring lost power to muscles. PATENT MEDICINES. Walker's California Vegetable Vinegar Bit- ters. — Each bottle contains from nineteen to twenty fluid ounces, consisting of a decoction of presceiber's memoranda. 199 aloes and a little gum guaiac, anise seed and sassafras bark, in water slightly acidulated with acetic acid, possibly the result of secondary fer- mentation, or added in the form of sour cider. Each bottle contains also about one ounce of Glauber's salt, oiie-fourfch of an ounce of gum arabic, and from one-half to one ounce of alco- hol. (Eberbach, Hoffmann, Nichols.) BrandretJV s Pills. — Each box contains twenty- four or twenty-five pills, weighing about two and one -half grains. The twenty-four pills con- sist of ten grains of podophyllum root, ten grains of extract of the same, thirty grains of the ex- tract of poke-berries, ten grains of powdered cloves, from two to five grains of gamboge, traces of Spanish saffron, and a few drops of oil of peppermint. (Hager.) Radway's Ready Relief. — This is a light brown liquid, consisting of three parts of soap lini- ment, one part of the tincture of capsicum, one part of aqua ammonia, and one part of alcohol. (Hager, Heckolt, Hoffmann.) Radway's Renovating Resolvent. — Each bottle contains about six fluid ounces of a vinous tinc- ture of cardamom and ginger, sweetened with sugar. (Hager. ) 200 pkescribee's memoranda. Pierced Golden Medical Discovery. — Each bot- tle contains one drachm of the extract of let- tuce, one ounce of honey, one-half drachm of the tincture of opium, three ounces of dilute alcohol, and three ounces of water. (Hager.) Pierce's Favorite Prescription. — A greenish brown, turbid liquid, consisting of a solution of one-half ounce of sugar, one drachm of gum arabic, in eight ounces of a decoction made from two drachms of savine, two drachms of white agaric, one and one -fourth drachm of cinnamon, and two drachms of cinchona bark ; to this mixture are added one-half drachm of tincture of opium, one-half drachm of tincture of digitalis, and a solution of eight drops of oil of anise in one and one -half ounce of alcohol. (Hager.) Van Buskirk's Fragrant Sozodont. — A red liquid, consisting of a solution of one-half drachm of white castile soap in one ounce of alcohol, three-fourths of an ounce of water, and one- fourth of an ounce of glycerine, colored with cochineal, and flavored with oils of wintergreen, cloves, and peppermint. The powder which ac- companies each bottle consists of a mixture of precipitated chalk, powdered orris-root, and car- bonate of magnesia. — (Wittstein, Hoffmann.) prescriber's memoranda. 201 Ayer's Cherry Pectoral : ^ . Morph. acetat gr. iij. Tinct. sanguin. Canaden 3 ij. Vini antim. et potas. tart. , Vini ipecac aa 3 iij. Syr. pruni Virgin § iij. M. Hamlin's Wizard Oil: ^. Spts. camph § j. Spts. ammon., Oil sassafras aa § ss. Oil cloves 3 ij. Chloroform, Oil turpentine aa § ss. Alcohol ad. § v. M. Perry Davis* Pain Killer : ^ . Spts. camph | ij. Tinct. capsici 5 3- Gum guaiac J ss. Alcohol § iij. Tinct. myrrh to color. M. Hamburg tea, so popular as a domestic reme- dy, is composed as follows : senna leaves, eight 202 pbescbibeb's memobanda. parts ; manna, four parts ; coriander, one part. Mix. PHARYNGITIS. In chronic pharyngitis apply a solution of nitrate of silver, thirty grains to the ounce. I£ . Tinct. guiaci ammoniat 3 v. Tinct. aconit rad. , Tinct. belladonnae aa 3 ss. Syr. lemon § ss. A quae cinnamomi ad. § iv. M. S. — Take 3 j. every three hours, for acute pharyngitis. ^ . Tinct. aconit. rad gtt. xv. Acid, hydrocyan. dil gtt. xx. Liq. ammon. acetat § ij. M. S. — Teaspoonful every two or three hours, according to the severity of the case. Acute and subacute pharyngitis. I£ . Zinci sulph 3 ij. Potass, chlorat § j. Morph. sulph gr. ij. M. et div. in chart, no. xij. S. — Dissolve one in a tumbler of water, and use for a gargle. R. R. Lincoln. prescbiber's memoranda. 203 In chronic pharyngitis, where the blood-ves- sels of the pharynx are enlarged and tortuous, and the secretions moderate, Mr. Dabney reports excellent results from the following : ^ . Ergotine gr. xx. Tinct. iodini fl. 3 j. Glycerines fl. 5 j- M. S. — Apply to the pharynx freely twice daily with a camePs-hair brash. If. Hyd. bichlor gr. vj. Acid, hydrochlor gtt. xij. Syr. simp § j. Aquae dist ad. § viij. M. S. — Use several times a day, as a gargle in syphilitic sore throat. I£ . Acid, acetic, dil TT[_ xv. Glycerinae 1P C xviij. Aquas I j. M. S. — Use for a stimulant gargle. ^ . Acid, hydrochlor 7T[_ xij. Glycerinae fT^ xxiv. Aquae I j. M. S. — Use for a stimulant gargie. 204 prescriber's memoranda. Potass, bromid gr. x. to ^ j. S. — Use for an antiseptic gargle. B Potass, chlorat gr. xij to § j. Potass, permang gr. vj . to § ij . Acid, carbolic gr. ij. to § j. M. S. — Use for an antiseptic gargle . Ij, . Acid, tannic gr. xij. Alcohol TT[ vj. Aquse camphor § j. M. S. — Use for an astringent gargle. I£ . Ahiminis gr. viij . to § j. Boracis gr. xxiv. Glycerinse Tf^ xxiv. Tinct. myrrhse Tf|_ xxiv. Aqua3 1 j. M. S. — Use for an astringent gargle. ^ . Krameria inf us § ss. Aquae Oj. M. S. — Use for an astringent gargle. prescriber's memoranda. 205 Strength of Solutions for Spraying : 3 . Acid, tannic gr. iij . to § i. Ferri perchlor gr. iij. to § j. Zinci chlorid gr. ij. to § j. M. S. — Astringent. 3 . Acid, hydrocyan 3 j. to J j. Potass, bromid 3 j. to % j. M. S. — Sedative. r) . Acid, tannic gr. x. to 3 j. Ferri perchlor gr. v. to 5 j. M. S. — Haemostatic. 1$, . Lime-water J ]• Acid, carbolic gr. iij. M. S. — Antiseptic. PTYALISM. 3 . Hypophosphifce of soda 3 ij. Hypophosphite of lime 3 ij. Water 3 iv. M. Dose, tablespoonful every four hours. Burner. 206 prescriber's memoranda. Stop mercury and use warm baths, and the following diuretic : fy . Potass, citrat § j. Aquse \ iv. M. 3 j. four times a day in water. Keyes. PERINEUM, Laceration of. Dr. Goodell advises the immediate operation, which he has found to be very successful in in- complete lacerations. In complete lacerations it is not as successful as the secondary opera- tion. In the primary operation, in order to put in the stitches accurately, Dr. Goodell recom- mends that ether be given, and that a sponge be placed high up in the vagina to stop the flow of the lochia, which embarrasses the operator. The stitches are applied as in the secondary op- eration, and merely twisted together. In the secondary operation, if the sphincter ani is in- volved, he always imbeds the first two stitches. On the eighth day all the stitches are removed, except the lowest. The faeces are then softened by an injection of warm sweet oil, and the bowels are moved twelve hours later by an ounce dose of castor-oil, aided, if necessary, by an in- peesceibee's memoeanda. 207 jection. After the bowels have been emptied, the remaining stitch is removed. PILES. Dr. F. P. Atkinson says, in the acute stage they are inflamed, of a dark red appearance, and give rise to a throbbing, burning pain, or like that which would be produced by the appli- cation of a red-hot coal. Mr. Biddle, a fellow- practitioner, tells me that in this stage the effect of calomel-dusting is something wonderful, and that relief is more quickly gained from this than anything with which he is acquainted. He con- siders that it acts in a twofold manner, viz.: upon the liver and at the same time as a local sedative. Sponging also with hot water gives marked relief. If this treatment prove ineffi- cient, and the pain be very excessive, leeches may be applied to the anus, or an incision made into the centre of the swelling and the contents squeezed out. In the subacute stage the feeling complained of is more that of weight and tension, though on going to stool the pain is often very acute. To relieve the existing condition, the compound gall ointment, or a solution of acetate of lead and opium, should be freely and frequently 208 peesceibee's memoeanda. applied, and an enema of cold water used after each action of the bowels. In the chronic stage the best application is the common pitch ointment. For this useful piece of knowledge I am indebted to a Mr. Corbett, and he, it appears, got the hint from an old nurse by seeing her apply some tarred rope. Its astringent effect is something remarkable, and I know of nothing which acts so quickly and effectually. The general treatment has to be directed toward altering the particular mode of living which has brought about the abnormal condition. Lansing says he has found ergotine supposi- tories, used night and morning, efficacious in bleeding piles. $ . Pulv. opii gr. xx. Liq. plumb, acet 3 ij. Vaseline 1 j. M. For painful hemorrhoids. Dr. Cuffer extols the anaesthetic action of iodoform in fissura ani and haemorrhoids. A ten per cent, solution in ether may be used with an atomizer. pkesckiber's memokanda. 209 ^ . Iodof ormi 3 ]'• Acid, carbo. Acid, tannic aa gr. xv. Ext. belladonnas, Pulv. opii aa gr. viij . Vaseline § j. M. Ft. ungt. Geo. Ross. Dr. Edmund Andrews has recently made a laborious inquiry into the results of over three thousand three hundred cases treated by hypo- dermic injection of carbolic acid, reported to him by about three hundred physicians. From a study of these cases he deduces the belief that, if the following rules be observed, the method of treatment by hypodermic injection will be less painful than any other, and equally safe : 1. Inject only internal piles. 2. Use diluted forms of the remedy at first, and stronger ones only when these fail. 3. Treat one pile at a time, and allow from four to ten days between the operations. 4. Inject from one to six drops, having smeared the membranes with cosmoline to guard against: dripping. Inject very slowly and keep the pipe 14 210 prescriber's memoranda. in place a few moments to allow the fluid to become fixed in the tissues. 5. Confine the patient to bed the first day, and also subsequently if any severe symptoms appear. Prohibit any but very moderate exer- cise during the treatment. The operation is to be performed in the fol- lowing way : The pile is exposed to view, and the anus smeared with an ointment to prevent smarting in case the fluid should chance to drop. The operator then takes a sharp-pointed hypodermic syringe, charged with the carbolized liquid (which has been used in varying strength from one part of the crystallized carbolic acid to thirty of olive oil or glycerine, up to equal parts), and slowly throws a few drops into one of the piles. The pipe is left in the puncture a few moments to prevent the fluid from running out, and to allow it to become fixed in the tissue. The pile turns white, and in the most success- ful cases withers away without pain, suppura- tion, or sloughing. Only one pile is treated at a time, and about a week is allowed between the sessions, until all are cured. Most of the cases thus operated upon suffer a sharp tem- porary smarting, and a few have a terrible and prolonged agony. The majority are cured, how- ever, without interrupting the patient's business. peesceibee's memoranda. 211 5 . Extract of belladonna 3 ij. Iodoform 3 j. Acetate of lead 3 ss. Cosmoline § j. M. S. — Apply three or four times daily. The above will be found a most excellent application for painful or inflamed piles. The tumors should be bathed in cold water just before each application, and the bowels kept freely open with a gentle purgative. $ . Bismuth, subnit. , Tannin aa 3 ss. Ext. bell 3ij. TJngt. stramon § jss. M. Ft. ungt. Use fuller's earth in addition, as a local appli- cation. C. H. Avery. PLEURISY. Dr. J. Lewis Smith speaks of the treatment of this disease in children as follows : In the beginning of the disease measures should be adopted which are appropriate for reducing in- flammation and limiting exudation. The ab- 212 pbescribek's memoranda. straction of blood in idiopathic pleurisy may be beneficial, if judiciously employed, but only one or two or three leeches should be employed in a robust child, two, three, or four years old. As a rule, the loss of blood is injurious in all cases of secondary pleurisy, such as follows scarlet fever, etc., and also if the quantity of effusion is great. Emollient and simply irritating poul- tic3s are serviceable in the first stage, and he recommends a mixture of one part of mustard to sixteen of linseed. It should be made very wet, spread thin, applied over the chest in front and behind, covered with oil-silk, and changed twice in twenty-four hours. For children under six or seven months of age, rubbing the chest with camphorated oil and applying a simple poultice, may be sufficient. Blistering at this early stage should not be employed, as it increases the inflammation, and Dr. Smith has seen a case which terminated fatally, in which there was found an increased area of inflammation corresponding exactly in situation, size, and shape to that of a blister that had been applied. The indications for the use of internal reme- dies in the first stage, are to diminish the fre- quency of the pulse, relieve the pain, and allay the cou^h. pkescriber's memoranda. 213 To a child tliree years old the tincture of aco- nite may be given in doses of half a drop, and for a child six years old in doses of one drop every three hours, for two or three days. In the first stage of primary pleurisy the cardiac sedatives may be used. But digitalis is a safer and better remedy in all other cases, and it also can be used in the second stage. To a child two years old the tincture of digitalis may be given in doses of one drop every tliree hours, and to a child five years old, two drops with the same interval. An opiate is ordinarily required, Dover's powder, one to three grains, every three hours. Hyoscyamus may be used to relieve the pain and cough. Digitalis may be combined with an opiate ; and morphine and aconite may be combined. In secondary pleurisy, digitalis is preferable to aconite. In the second stage, unless the effusion is small, measures designed to remove it are re- quired. The propriety of using blisters in this stage is very doubtful. A relaxed condition of the bowels favors ab- sorption of serous effusion. Diaphoretics do not aid much in the removal of the fluid. Pilocar- pine produces a depressing effect which renders it unsafe. 214 presckibek's memoranda. Diuretics and tonics are beneficial. Digitalis with the acetate of potash is very serviceable. ^ . Infus. digital § iv. Potass, acetat 3 j. M. S. — Teaspoonful every three hours to a child four or five years old. Bitter tonics are especially useful in this stage, and the acetate of potash may be combined with a decoction of cinchona, with good results. A full amount of nutriment should be taken, with but little fluid. Of course, the suggestion to use a dry diet and diminish the quantity of drink, is not applicable to young children. If the appetite and the general health are good, and there are no symptoms due to the presence of the fluid, but little medication is necessary. If there are such symptoms and the fluid does not disappear, the question of surgical inter- ference arises, and the indications for it are the following : 1. Oppressed breathing due to the liquid present, whether it be sero-fibrinous, purulent, or hemorrhagic. 2. If there be flat percussion-note over the entire affected side, with displacement of the heart, even if there be no dyspnoea, for the latfcer may occur suddenly. pkescribee's memoranda. 215 3. Moderate effusion without material de- crease in quantity by absorption after some weeks of treatment. There is danger that catarrhal pneumonia, terminating in cheesy pneumonia and tuberculosis, may occur in por- tions of the compressed lung. Besides, the longer the lung is compressed, the more slowly will it return to normal expansion after the pressure has been removed. 4. A moderate quantity of fluid coexisting with disease of the opposite lung, or of the lung of the affected side. 5. Extension of the inflammation to the peri- cardium. Pericarditis, as an extension of the inflammation, is not infrequent. 6. The existence of valvular lesion of the heart. 7. The presence of pus ; empyema. The operation of thoracentesis should be performed in the eighth intercostal space, on a line perpen- dicular with the angle of the scapula. The ad- mission of air to the pleural cavity should be carefully avoided. The thickness of the thora- cic wall is about half an inch — in emaciated children it is less. In the introduction of the canula, the sharp needle should not be used ; to the depth of one inch is sufficient to pass beyond the exudation and allow the liquid to flow 216 peesceibee's memoeanda. through the canula. Washing out the pleural cavity is unnecessary ; it is injurious rather than beneficial, except in cases in which the pus is offensive. To empty the pleural cavity and approximate the pleural surfaces is the in- dication. Dr. Smith thinks there will be a reac- tion against the removal of a portion of the ribs in cases of empyema. Vigier recommends the nitrate of pilocarpine, in \ gr. doses, night and morning, to remove the fluid in the pleurisy of children. Dr. Salvatore Caro preferred an infusion of jaborandi — two drachms of the leaves to three or four ounces of water and taken at two or three doses — to hypodermic injection of pilocar- pine, for removing fluid from the pleural cavity. ^. Potass, acet., Infus. digital aa 3 ij.-iv. M. S. — This amount each day ; or, I£. Pulv. digital., Pulv. sillae, Hydrarg. chlor. mit aa gr. x. M. Ft. pil. no. x. S.— One pill thrice daily. Alonzo Clark. pbesceibeb's memoranda. 217 The indications for the treatment of subacute pleurisy are to subdue the inflammation and promote absorption of the effused fluid. Dr. Clark, to accomplish the first of these. effects, uses blisters — three being usually sufficient — selecting three spots and applying only one blister at a time, the second and third not being placed in position until the spot of the former application has healed. As a diuretic he uses potassii iodidi, thirty grains a day ; if this fail to diminish the fluid, he has resource to the above formulas. If constitutional effects of mercury declare themselves, he returns again to the potassii iodidi. Dr. Clark uses other means, as purgatives, vapor-baths, and mild counter-irri- tants when he thinks them indicated, but, having exhausted all medical means without effect (as is sometimes the case), he either resorts to the trocar or does nothing. Dr. Hunt has employed jaborandi in cases of subacute pleurisy, with success. He gave it in as large as half-drachm doses every two hours. As a rule, tonics are indicated in subacute pleurisy. 218 prescriber's memoranda. PNEUMONIA. The Practitioner records four cases of pneu- monia which were supposed to have been cut short by means of aconite. The drug was given in minim doses of the tincture every half- hour for four hours, and then in the same dose every four hours. The administration was begun on' the first day, when there were crepitant rales, cough, and rusty expectorations, and seemed to have an abortive effect. It is supposed to be especially indicated in the first stage of the in- flammation. In catarrhal pneumonia the following treat- ment is pursued in the Hospital of the Univer- sity of Pennsylvania : To lessen the fever, the two best remedies are quinia and digitalis. Salicylic and carbolic acid have been tried with the same object in view, but have failed. The quinia and digitalis are administered as long as the fever lasts, either separately or in combination. The usual dose is one grain of digitalis and two grains of quinia thrice daily. When cough is among the symp- toms, opium is given. To stop the distressing night- sweats, atropia is used. To promote absorption and produce counter- prescriber's memoranda. 219 irritation, blisters are applied to the chest, and the following prescription administered : I?. Potass, iodid 3 j. Ammonii rauriat 3 ij. Mist, glycyrrhizae comp. ..... fl. § vj. M. S. — A teaspoonful four times a day. POLYPI, Nasal. The treatment adopted consisted in freely puncturing these growths from the anterior nares by means of an ordinary acupuncture- needle, thus allowing the fluid of which they largely consist to drain away. To prevent them from refilling, a solution of carbolic acid and glycerine, which has a most marked drying-up effect, was daily injected into the nostrils for some time. In this way many cases were dealt with successfully where the growths were of a limited nature and the patient averse to their evulsion. Reginald Harrison. M. Barthelemy treated successfully a case of naso-pharyngeal polypus, in a child fourteen years old, by the interstitial injection of chloride of zinc. 220 presckibkr's memoranda. M. Th. Auger advises a solution of perchlo- ride of iron instead of the chloride of zinc. Inject five or six drops of acetic acid, by means of a hypodermic syringe, into the body of the tumor, which will usually shrink up and drop off in a few days. POULTICES. Volkhausen prepares a substitute for linseed- meal poultice by saturating a piece of thick, white felt-paper with a decoction of linseed. This is to be immersed in hot water before it is applied, when it swells considerably. It must be covered with some impermeable material, and fastened securely in place, and ordinarily does not require removal before twelve hours have elapsed. Dr. T. Lauder-Brunton says that the proper way to make and apply a poultice is to make a flannel bag the required size, fill it with linseed poultice made as hot as possible, and place be- tween this and the skin a piece of flannel doubled ; over the poultice wrap more flannel or cotton-batting. PRESCRIBES' S MEMORANDA. 221 PLASTER-OF-PARIS. Dr. T. E. Wilcox, Assistant Surgeon, U. S. Army, says : A little bicarbonate of soda or potassa added to the water in which the hands are washed after applying plaster-of-Paris ban- dages, etc., immediately removes the unpleasant feeling left by the plaster. PROLAPSUS ANI. Dr. Vidal recommends injection of a solution of ergotin. The Paris Medical mentions three cases in which this method was employed. In one of these the prolapse, which had existed for eight years, yielded to the treatment in three months. PROLAPSUS UTERI. A glass speculum is introduced into the va- gina, so as to push the uterus into its place. Through the speculum a metallic tube or syringe, with the end containing about thirty grains of tannin, is passed. With a piston the tannin is pushed against the uterus, the syringe with- drawn, and the packing neatly and effectually completed, with a dry probang, around the 222 prescriber's memoranda. mouth and neck of the womb. After the pack- ing is completed, the probang is placed against the tannin, in order to hold it, and the specu- lum is partially withdrawn. The packing is now fully secured, and the instrument removed. The application of tannin holds the uterus firmly and securely in place, not by dilatation of the walls of the vagina, but by corrugating and contracting its parts. At first the application may be made weekly ; finally, but once or twice a month. It not only overcomes the hypertro- phy and elongation of the cervix, but even, the writer thinks, induces a slight atrophy of the parts. As a remedy for leucorrhcea, where the seat of the inflammation is at the mouth of the womb, or within the vagina, it actually gives speedy relief. Hochenburgh. QUININE, Preparations and Methods of Administration. ^ . Quinise sulph gr. x. Pulv. capsici gr. iij. Pulv. opii gr. j. M. Alonzo Clark. Dr. Jaffe, of the Hamburg General Hospital, reports very successful results from the hypo- prescriber's memoranda. 223 dermic use of the muriate of quinia and urea (made by combining twenty parts of muriate of quinia with twelve parts of muriatic acid and three parts of urea). The compound is soluble in equal parts of water, and such good results have been obtained by its use that it should be more widely known and used. A fifty per cent, solution is recommended ; from five to fifteen grains may be injected. The local irritation is very slight, at most consisting only of a circum- scribed burning pain, without redness or swell- ing. Scarcely any subjective sensations have been noticed after as large doses as fifteen grains. The anti-febrile effects are marked, intermittents being cured after the second or third injection. Milk is recommended as a good solvent of quinine, and is said to disguise its bitterness. One grain is said by Mr. Batterbury to dissolve in an ounce of milk, and render it scarcely bit- ter, while two grains do not make it markedly bitter. Further, five grains dissolved in two ounces do not render it very unpleasant, while, put in a tumbler of milk, the bitterness all but disappears. Mr. Palmer, of the Birmingham General Dispensary, recommends a solution of quinine in glycerine — one grain to one drachm. 224 pbescriber's memoranda . A dose of this can be given in a wineglassful of milk. Milk would seem to be a good vehicle in which to give quinine to children, but with re- gard to solubility we cannot understand why so few doctors make use of the neutral sulphate of quinine, which is soluble in water without the addition of acid, and which, therefore, offers every facility for administering quinine in a liquid form. Dr. S. Ashhurst says that if cinchona be mixed in the proportion of one grain of alkaloid to four grains of sugar of milk and one-tenth of a grain of bicarbonate of soda, it will leave no bitter taste in the mouth. The mixture may be taken dry or dissolved in water. Signor Cozzolino recommends the sulpho-thy- mate of quinia — a compound of sulphuric and thymic { thymol) acid and quinia— as worthy of ranking beside the sulphocarbolate or salicylate of the same alkaloid. It is freely soluble in acidulated water, in ether, and in alcohol. Dose is the same as the above-mentioned salts. He also calls attention to soda-thymate as a pleasant carminative mouth-wash in aphtha and muguet, and as an injection in vaginal, uterine, and vesical affections. presckibek's memoranda. 225 3. Ferrisulph., Quinize sulph., Pulv. aloes. aa gr. xx. Ext. nucis vom gr. v. Exfc. gentian q. s. M. Divide into 20 pills. ^ . Quinias sulph gr. xl. Ferri sulph gr. xx. Ext. nucis vom gr. v. M. Divide into 20 pills. Solubility of Quinine Salts. Quinine sulphate dissolves in 100 parts of water. " bisulphate u 10 1 ' muriate u 24 " 1 ' bromide u 50 " hypophosph. a 60 4 ' valerianate a 110 u " tannate a 500 Dr. Starke advises that, before swallowing powders or pills of quinia, a weak tartaric acid lemonade be taken to hasten the action of qui- nine. 15 226 prescribeb's memoranda. Lent's Solution of Quinine, for Hypodermic Use. I£ . Quin. disulph gr. 1. Acid, sulph. dil 7TL c. Aquse font § j. Acid, carbolic, liq IT^ v. Place the quinine and the water in a porcelain dish over a spirit-lamp and heat to the boiling- point, then add the sulphuric acid, stirring with a wooden spatula. Filter at once into a bottle and add the carbolic acid. This solution gives gr. vj. to the 3 j. When it gets below 50° F., precipitation will occur, and it must be warmed before using it. RHEUMATISM. Dr. H. Gibbons, sr., says that much benefit has been derived, in some cases of chronic rheu- matism, by wrapping up the knee, or ankle, or foot with eucalyptus leaves, renewing them daily for a week or more. These leaves are an active stimulant to the surface, and will produce vesi- cation if their use be long continued. A solution of salicylic acid and borax, each, gr. x. to fl. § ]'., has a bitter taste and acid reac- tion ; whereas a solution of ten grains of the former and fifteen of the latter to the ounce has no disagreeable taste, is nearly neutral, and is just as valuable therapeutically. prescriber's memoranda. 227 $. Sulphur § ij. Potass, bitart § j. Pulv. rhei 3 ij. Guaiaci resiu 3 j, Mellis lb. j. Pulv. myristica 3 ij- M. S. — Take two large teaspoonfuls at night and morning for three days, in honey or mulled wine. Stille. I£. Pulv. resin, guaiaci, Potass, iodidi aa gr. x. Tinct. colchici sem fl. 3 ss. Aquas cinnam., Syrupi aa q. s. ad. 5 j- M. S. — A dessertspoonful to a tablespoonful, thrice daily. Pepper. There is a liniment known under the name of Russian Spirit, which is used for rheumatism. The formula is : $. Olei sinapis dist 12 parts. Olei terebinth 75 Camphorae . 75 Liq. amnion, fort 75 Tinct. capsici 75 Alcoholis fort 1,000 228 peesceibee's memoeanda. Treatment of Bheumatic Fever. — The presi- dent summed up the results of the discussion on this subject as follows : First, they had as yet no stable criterion whereby to determine the therapeutic effects of any drug upon rheumatic fever. Secondly, therapeutic conclusions were apt to be vitiated by failing to distinguish be- tween two forms of the disease. Third, while the influence of salicylic acid and its compounds somewhat spee lily relieved the malaise of which the rheumatic sufferer complained, it was ex- tremely doubtful whether they in any degree diminished the peril of secondary cardiac or other inflammatory complications. Lastly, it was left uncertain whether they succeeded in removing that actual pathological state of which, in a sense, these other things might be said to be the expression. In short, there was almost a greater tendency to relapse with the salicy- lates than otherwise. — The British Medical Asso- ciation. I}. Lin. aconit. 3 ij. Lin. belladonnas 3 ij. Glycerinae ad. 1 ij. M. Apply locally over seat of pain. Fothergill. pkesceiber's memobanda. 229 This liniment is especially advised when the pain is confined to the sciatic nerve, offering marked relief. Treacle may be substituted for the glycerine with advantage. A convenient mode of application is to spread the above on a V-shaped piece of lint and place on the thigh. 5.. Acid, sulphur 3 j. Olei olives 5 j. Olei terebinthinEe § j. Add the acid gradually to the oil, stirring in mortar. When cold, add the oil of turpentine and mix. Prof. Bartholow states that no single remedy can be applied to every case of acute rheuma- tism. For successful treatment the form and type must be taken into consideration. 1. In the feeble, anaemic, nervous subject, he gives tinct. ferri chlorid. , 7T(_xxx., every four hours ; orders the joints to be kept at rest, wrapped in cotton, if the patient desires it ; and if they are very painful, small blisters (the size of a silver dollar) to be applied around them. An occasional laxative of Rochelle salt is added. The iron cuts short the disease, lessens the dan- ger of cardiac complication, and also has the 230 prescriber's memoranda. power, as Anstie pointed out, of preventing im- pending attacks. The blisters relieve pain and bring about a more alkaline condition of the blood and urine. Thus treated, cases of this type rarely last more than two weeks, heart- complication is infrequent, convalescence is rapid, and relapses uncommon. 2. Fat and flabby subjects require the alka- line plan: two drachms of potassium carbo- nate, one-half drachm of citric acid, and four ounces of water every three or four hours, until the urine ceases to be acid, when the amount is to be reduced one-half, the reduction being then continued daily until the fourth or fifth day, when, if the urine continue alkaline, quinia (six grains every four hours), or preferably tinct. ferri should be added. If the attack is severe, blisters are applicable. With this treatment, this class get well within two weeks. 3. Vigorous subjects, often with hereditary tendency. These cases are often promptly re- lieved by salicylic acid in scruple doses. Not less than 3 ij. should be administered in twenty-four hours, and considerably more may be required. It is more effective given in solution with an ex- cess of alkali. A cure is thus not unfrequently effected in three or four days, but some stomachs cannot bear it, and if it depress the heart, it prescriber's memoranda. 231 must be stopped. If after three or four days it produce no improvement, it is useless to per- sist in it. In all forms the diet should be liquid. Opium is objectionable by checking elimination ; atropia promotes elimination, and is therefore preferred as an anodyne, being given hypoder- mically in the neighborhood of the affected joints, and it is rarely necessary to exceed gr. -gV per day. Should cardiac complication arise, the carbo- nate of ammonia (gr. v. doses frequently), and infusion of digitalis, with hypodermic injection of morphia, should be given at once to dissolve fibrin, check inflammation, and lessen the work of the heart. When the acute symptoms have, subsided, substitute iron and quinine for the ammonia and morphia. Experience also shows a blister, on or near the prsecordia, to be useful. In sudden hyperpyrexia (fortunately very rare), where the temperature leaps without cause to 106°— 109° F., the cold bath is neces- sary to ward off certain death. Dr. Paul L. Brick recommends a steam-bath as the treatment for acute, articular, and mus- cular, as well as chronic rheumatism : Put from two to four red-hot bricks into a dry wash-tub, upon something to prevent the bricks 232 prescriber's memoranda. burning the tub, then put the affected limb or the whole patient, as the case may require, in a nude state, over the tub upon a board or chair, the whole to be covered with a blanket. Then sprinkle water on the bricks, creating steam, and producing a profuse perspiration upon the patient ; continue during twenty to forty min- utes, and repeat once in two days. ^ . G-ambogige, Myrrhaa, Canellse, Sodas salicyl aa § *]• Olei terebinth., q. s. to liquefy. M. S. — Use with steady friction twice daily, and then cover with, wadding. Dr. Gaston says that propylamine, in acute rheumatism, will subdue the pain in twenty-four to forty-eight hours. Dr. Tyson also recom- mends it where the salicylate of sodium is for any reason inapplicable. His formula is : I£. Propylamin. chlorid gr. xxiv. Aquee menthas 3 vj. ]VI. S. — § ss. every two or three hours. Benefit was apparent in twenty-four hours. pbescribek's memoranda. 233 Dr. Wm. Corson uses this formula in rheu- matism with much success : 1^ . Ammonia? phosphat. 3 jss. Tinct. colchici sem § j. Tinct. aconit. rad 3 ij. Syr. simplicis § iij. M. S. — 3 j. every three or four hours. Prof. Gubler used, in chronic arthritis, ten parts of iodoform to twenty of sulphuric ether and twenty of alcohol. When dissolved, the lini- ment should be applied to the diseased joint by means of a pencil. The parts should then be covered with a piece of oiled silk. For the same affection, Dr. Cottle dissolves iodoform in chlo- roform. RINGWORM. The remedies in common use act in two ways : 1st, by setting up a sufficient inflamma- tion in the skin to lead to the destruction of the disease ; 2d, by simply antagonizing- the tri- chophyton tonsurans. Remedies which act in the manner first indicated are such as acetum cantharidis and strong acetic acid ; sulphur 234 • peescribek's memoranda. ointment, the white precipitate ointment, and sulphurous acid lotion belong to the other class. Many remedies combine these two actions, as, for example, chrysopharric acid ointment, iodine liniment, and strong" carbolized glycerine. Strong remedies are always contra-indicated. It is always very unwise to trust strong reme- dies in unskilled hands. When the disease ex- tends over a large surface, milder measures must be resorted to — tincture of iodine of dou- ble strength is a good and safe mode of treat- ment. This may be followed by the use of the nitrate of mercury ointment, diluted according to circumstances, or an ointment containing the red and white precipitate of mercury and sul- phur, or the oleate of mercury (10 per cent.). Goa powder or chrysophanic acid, in strength of thirty grains to the ounce, is very effective in some cases. When carefully watched so as to guard against the severe inflammation it is lia- ble to set up, it is a good application. Inasmuch as ringworm is usually associated with a generally unhealthful condition of the skin, which is badly nourished, such tonics as iron and arsenic are indicated. This is quite in accordance with the fact that many local dis- eases are influenced by general treatment. LlVEING. prescriber's memoranda. 235 Mr. James Startin has found the following treatment most successful in a large number of cases of ringworm of the scalp : 1. Well wash the parts affected with just enough soft soap to make a wash ; thoroughly dry, and then apply, with a thick camel-hair brush, some blistering fluid. 2. After a few days, when the inflammation has subsided, use alter- nately the following applications : ol. cadini, creasote, and tincture of iodine in equal parts, and a lotion of hyposulphite of soda, two drachms to the ounce of water, with a little compound tincture of lavender. 3. If the skin should be sore from the use of the above appli- cations, then the use of the white precipitate ointment of the British P/iarmaeopceia, diluted with equal parts of vaseline, will prove most beneficial. Mr. Startin does not think we can ever give a prognosis of complete cure of these cases of obstinate ringworm under three months ; but he has never found the above to -fail. Mr. J. Naish Smart thinks that a very effec- tual remedy exists in perchloride of mercury in solution of two grains to the ounce of water with the addition of a little spirits of wine or ether to make it soluble. This solution 236 prescriber's memoranda. carefully applied with ' a camel-hair pencil two or three times a day, Mr. Smart has never known to fail even in most stubborn cases. SCIATICA. Br. Wm. Pepper says: " When there is distinct local inflammation, I am accustomed to treat the disease with large doses of iodide of po- tassium and minute doses of the bichloride of mercury. If we desire to cause absorption of inflammatory matters inside the sheath, the best way to do so is by means of severe blister- ing", or by the actual cautery. The actual cau- tery, in particular, has great absorbent action, and powerfully relieves over-sensibility of the nerves. Another excellent treatment is by hypodermic injections of morphia and atropia right down into the adjacent muscular struc- tures. For this purpose we are in the habit of using here from one-sixth to one -fourth of a grain of morphia, and from one-ninetieth to one-sixtieth of a grain of atropia. In employ- ing this formula, you must be careful, as the disease subsides, that the opium-habit is broken. Indeed, the formation of such a habit should be guarded against by intermitting the treat- ment from time to time. In still other cases, prescriber's memoranda. 237 again, where the localized pain has been intense, I have derived most excellent resnlts from the hypodermic injection of from eight to twelve minims of chloroform, taking great care to keep the needle out of the way of the arteries. Though incomparable as a tempo- rary destroyer of pain, the effects of the chloro- form are not very permanent. Galvanism is very quick in some instances to relieve pain. The mode of application should be with the positive pole at the seat of the pain and the negative pole along the nerve -trunk. Where the muscles have wasted to any great extent, the faradic current is the best." Dr. Ebrard, physician to the Hospital of Nimes, for many years has treated the pains of sciatica and other neuralgias without having re- course to any other electric battery than a smoothing-iron, which, along with vinegar, is to be found in every house. This is how they are employed : The iron is heated hot enough to vaporize the vinegar, and is wrapped up in some material, preferably woollen ; it is then dipped in the vinegar, and applied on the painful part. The operation is repeated two or three times in the day. It rarely happens that the pain has not disappeared at the end of twenty-four hours. This action is easily understood. On account of 238 peesckiber's memoranda. its contact with the fire the iron becomes mag- netic ; and if an acid be added while it is hot, electricity is produced, and the same effects are obtained as with an electric battery. There are two varieties of sciatica : one in which the nutrition of the limb is unchanged ; the other, accompanied by atrophy of the limb. In the first class the neurilemma alone is affected; in the second, the nerve- fibres are attacked by the inflammation and cause atrophy of the limb. There are two kinds of pain, one present only on motion of the limb, the other when the limb is at rest. In all cases the first element of cure is rest. To this, in cases of the first class, must be added blisters and hypodermic injections. The pain being allayed, dry fumigations should be used. Dry heat is better than douches of sulphurous or terebinthinate vapors. In de- fault of the former, vapor-douches give the best results. Dr. Lange suggests nerve -stretching by flex- ing the thigh upon the abdomen forcibly. SEA-SICKNESS. The inhalation of nitrite of amyl is strongly recommended by Mr. C. Clapham, who is sup- ported, though less enthusiastically, by Dr. Lee- prescriber's memoranda. 239 son. The latter reports to the Lancet that he gave it until full flushing- was produced. In three-fourths of his cases no vomiting occurred afterward ; in another fourth they still felt sick, and in a final fourth it seems to have been use- less. He finds toleration of the drug soon be- comes established. Great caution should be used with this drug, and there is a tendency to give too large doses. Two minims will usually suffice when it is first given. Chloral hydrate, in fifteen-grain doses, has been used with success in a number of cases. Bromism has been strongly recommended by Dr. George M. Beard. SEMINAL DISORDERS. Bumstead gives the following prescription for its special tonic effect upon the genital organs : I£ . Tinct. f erri chlor § iij. Ext. ergot, fl. (SquibVs) § iij. M. S. — A teaspoonful in water after each meal. 240 peesceiber's memoeanda. As a direct means of diminishing the fre- quency of the emissions, the doctor recom- mends : ^ . Potass, bromid J j. Tinct. ferri chlor § j. Aquae 3 iij. M. S. — From one to two teaspoonfuls in water, after each meal and at bedtime. The avoidance of tobacco in all its forms, cleanliness of mind and body, laxatives when needed, and, in a word, attention to the rules of hygiene, are to be strictly enjoined. $ . Potass, bromid § j. Ext. belladonnas fl., Ext. gelsemin fl aa 3 ij. Syr. simp § jss. Aquae menthae pip 3 ij. M. S. — Teaspoonful t. i. d. Anaphrodisiac. Bartholow. ^ . Zinci sulph gr. xij. Morphias sulph gr. iv. Atropiae sulph gr. ss. Aquae dist § j. M. Prostatic injection. Bartholow. prescreber's memoranda. 241 3. Argent, nitrat gr. x. Aquas 3 j. M. Prostatic injection. Bartholow. ]$ . Tinct. canthar gtt. vj. Tinct. f erri chlor gtt. xv. -xx. M. S. — Thrice daily in water. H. C. Wood. This prescription has been found to cure im- potence with spermatorrhoea so speedily as to commend itself to the use of all medical men in the treatment of these cases. 5 . Tinct. cantharidis v . . . 3 j. Tinct. cannab. Indie, Sol. morphias, bi-mec aa 3 ij. M. S. — Fifteen drops, t. i. d. Aphrodisiac. Bartholow. B» Tinct. nucis vom 3 j. Tinct. actea racemos 3 iij. M. S. — Twenty drops, t. i. d. Aphrodisiac. Bartholow. 16 242 pbescriber's memoranda. SINUSES. Sinuses in which Necrosed Bone cannot be found, ViUate J s Mixture in the Treatment of. — The original composition of the mixture was : J$. Liq. plumbi subacet § j. Zinci sulph. cryst., Cupri sulph. cryst aa 3 ss. Aceti vini albi fl. 3 vjss. The mixture was injected once a day, and proved a more satisfactory application than any other. Some patients complained of severe pain, others felt but slight inconvenience from it. SLEEPLESSNESS (See Insomnia). Alcohol administered in one or two teaspoon- ful doses at bedtime gives excellent results, es- pecially in elderly patients. ty . Sodas bromid. § j. Pepsin sacchar 3 iij. Liq. carb. pulv § ss. Digitalis tinct § ss. Ergot, ext. fl., Acid, phosphor, dil aa fl. § ij. M. S. — Teaspoonful, t. i. d., before meals, in one-third of a glass of water. Hammond. prescriber's memoranda. 243 Chloral hydrate is a valuable remedy for this affection. It may advantageously be combined with the bromide of potassium. SKIN DISEASES (See also Eczema, Herpes, etc.). Rosacea of the Face. — Wash the face sev- eral times with very warm water, then — 1$, . Sulph. sublim § j« Tinct. camph 3 ij.-iv. Etheris sulph > j. Aquas q. s. ad. § viij. M. Bathe the face at night with this and let it dry on. In the morning wash and apply — B . Zinci oxid 3 ss. -j. Ung. petrolei \ j. M. Improvement begins in a week, but the treatment should be continued several months. Topical Use of Ergotine in Acne Rosacea, etc. Dr. Eldridge used hypodermic injections every three days of the following : ergot, gr. xv. ; glycerine, 3 ss. ; aquae, 3 ij. In a week or ten days after the injection the surface presented a softened, whitened, shrunken condition. 244 prescriber's memoranda. Eczema Intertrigo of Infants. I£ . Plumbi acetat , . . . gr. xxx. Acid. acet. dil 3 ij. Glycerine 5 jss. Aquae rosge ad. § viij. M. Wash the sore parts well with soap and water, dry carefully, then apply the above. ]£ . Powd. quicklime 3 viij. Washed sulphur 5 iv. M. and add one gallon of boiling water. Stir and allow to settle, and then decant. Use as a wash, allowing it to dry. At the end of three or four hours the dust may be washed from the skin. A second application may be necessary. It does not irritate the skin. Scabies. $ . Hydrarg. bichlor 3 ij. Pulv. capsici 5 iv. Pulv. sulph 1 iv. Adipis lb. iv. Mix by gentle heat, and keep stirring until cold. Dr. Lamberti reports a case of herpes zoster, or " shingles," which he cured in a single day peesceibeb's memoranda. 245 by means of carbolic acid. He painted carefully the vesicles with the liquid, using a camel-hair brush, and then covered the whole part with a thick layer of cotton-wool. Tt caused severe burning" pain for two hours, after which ease was obtained, and the patient, having received a dose of chloral hydrate, fell asleep, and awoke the next day feeling quite well. Nothing more was done, but the cotton- wool was left on for three days. On its removal then, the vesicles were all dried up, the crust adhering to the cotton- wool, and the spots that remained were not in the least tender. A. saline purgative and a drink containing bicarbonate of soda were the only medicines taken. No return has occurred after two years. 5 . Sulph. sublim § j. iEtheris fl. 3 iij. Glycerinse fl. | j. M. Ft. paste. ^ . Sulph. sublim 3 iij. Spts. camph fl. 3 i j. Sodae biborat 3 j. Glycerinse fl. 3 iij. Aquae fl. J vj. M. Ft. lotion. 246 prescriber's memoranda. R . Iodinii gr. cxxviij. Brominii gr. ccxl. Alcoholis (94$) fl. § viij. M. 1$. Saponis viridis § ij. Alcoholis fl. 1 iv. M. Compound Tincture of Soap. 3 . Saponis viridis. § j. Alcoholis, Olei cadini aa fl. § j. M. I£. Pulv. ararobae (goa-powder). 1 to 4 parts. Oleo-paraffini (vaseline) 10 parts. Melt the vaseline on a water-bath, add the goa-powder, stir and heat for about ten min- utes ; then strain quickly into a capsule stand- ing on ice, and stir briskly until cold. IjL Empl. plumbi., Oleo-paraffini (vaseline) aa § j. Melt the lead-plaster together with the vase- line, then stir them in a warm mortar continu- ally until cool. Piffard. rRESCRIBER's MEMORANDA. 247 3 • Emplast. plumbi § v. Olei olivae fl. 5 iv. Olei lavandulag fl. 3 j. Melt the lead -pi aster and oil together at a gentle heat ; then stir until the mixture begins to stiffen, and incorporate with it the oil of lavender. Hebra. ^ . Hydrarg. amnion. gr. xl. Oleo-paraffini (vaseline) \ j. M. ^ . Hydrarg. oxid. rubri gr. lx. Oleo-paraffini (vaseline) 1 j. M. I£. Hydrarg. oxid. rubri, Plumbi acetat aa gr. viij. Cerati § j. M. McKay. ]£. Liq. picis alkal. (see p. 248).. fl. 3 j. Cerati 5 j. M. • I£ . Potass, iodid 3 ij. Ung. stramonii 5 j. M. 248 peesceebee's memoranda. 3 . Ung. hydrarg. nitrat 3 jss. Ung. acidi carbol § ss. Ung. zinoi oxid § j. M. Z^. P&cw Alkalinis. ^ . Liquid tar 3 ij. Caustic potash 3 j. Distilled water 3 v. All by weight. Add the potash to the water and make solu- tion, and then add the tar and grind in a mor- tar. One part to twelve or sixteen of water for external use in eczema. Stronger, if necessary, for chronic cases. Bulkley. V f . Iodinii, Potass, iodid aa 15 ( § ss.). Glycerinse 5(3]'-). M. Lupus. Anderson. Ungt. BocJiardi. 5 . Iodinii 0.70 (gr.'x.). Hydrarg. chlor. mitis . . 2 ( 3 ss.). Unguenti 50 ( * j. 3 vj.). M. Lupus. prescriber's memoranda. 24:9 ]£. Zinci chlorid., Zinci oxidi aa q. s. M. Lupus. Squire. ^. Vini ferri (B. Ph.) 45 ( I jss.). Syr. tolutani 15 ( 3 iij.). Liq. potass, arsenit 4 ( 3 j.). Aquas anethi 60 ( § ij. ). M. Dose, one to two teaspoonfuls. Eczema. Wilson. I£. Hydrarg. ammon 1 (gr. xv.). Glyc. amyli 30 ( I j.). M. Eczema, etc. Muller* 3£ . Acid, boracic 1 (gr. xv. ). Aquas 30(?j.). M. Eczema and pruritus ani. SQUIRE. ^. Aconitias 0.06 (gr. j.). Unguenti 4 (3 j.). M. Pruritus. Satterlee. 5 . Tinct. digitalis 8-15(3 ij.-iv.). Glycerini 20 ( 3 ss.). Aquae rosae 180 ( § vj.). M. Pruritus. T. Fox. 250 prescriber's memoranda. $. Iodinii 0.75 (gr. xij.). Potassii iodid 0.40 (gr. vij.). Alcohol 30 (§].). Aquae 150 ( J v. ). M. Pruritus scroti. Barosii. I£ . Acid, carbol 4-8 ( 3 j.-ij- )• Glycerini 40 (§].). M. Localized pruritus. Bronson. I£. Hydrarg. sulph. flav 1 (gr. xv.). Olei theobromae, Olei ricini, Olei amygdal aa 20 ( 3 v.),. M. Pityriasis. Malassez. I£. Hydrarg. chlor. corros. . . 0.06 (gr. j.). Tinct. benz 8 ( 3 ij. ). Aquae 125 (§vj.). M. Acne. T. Fox. 1^ . Ergotin 1 (gr. xv.) . Glycerini 2.50 ( 3 ss.). Aquae 8 ( 3ij.). M. TT^ij.-iij. as a hypodermic injection in rosacea. Eldridge. prescriber's memoranda. 251 I£ . Acid, benzoic 0.12 (gr. ij.). Aquse 30 (§j.). M. Lotion for urticaria. Squire. $ . Sodse salicyl 5 (gr. lxxx.). Acid, carbol 2 (gr. xxx.). • Unguenti 40 ( I j. 3 ij.)- M. Alopecia areata. Eichorst. ^ . Hydrarg. chlor, corros 1 (gr. xv.). Capri acetat 4 ( 3 j.). Cerati 60 (lij.). M. Parasiticide. 3 . Calcii sulphid 6(3 jss.). Collodion 30 ( § j.). Favus. Gamberini. fy. Hydrarg. chlor. mit 3 (gr. xlv.). Ungt. aquse rosse 30 ( 5 j-)- M. Ephelis. Corbel-Lagneau. 1^. Hydrarg. chlor. corros. 0.50 (gr. viij.). Zinci sulphat. , Piumbi. acet aa 2 ( 3 ss.). Aquas 250 (I viij.). M. Ephelis. Hardy. 252 prescriber's memoranda. 5 . Barii sulphid 6(3 jss. ). Zinci oxid 24 ( 3 vj. ). Mix with water to a paste. Apply for three minutes and then wash off. Depilatory. Anderson. 3 . Potass, sulphid 6(3 jss.). Zinci iodidi 24 ( 3 vj.). M. Depilatory. Colan. Vienna Paste. ^ . Potassse, Calc. caust aa q. s. M. When used, mix with an equal weight of strong alcohol. 1$, . Antimonii chlorid 2 ( 3 ss ). Zinci chlorid 4 ( 3 j.). M. Add a little flour to make a paste. Caustic. Cazenave. ^. Potass, iodo-hydrarg 1 (gr. xv.). Sacch. lact 10 X 3 ijss.). Syr. acacige q.s. (q. s.). M. Make 100 pills. Syphilis — one to five pills daily. Hallopeau. prescriber's memoranda. 253 STRANGURY. Mr. G. Dannecy proposes the following 1 to prevent strangury from blisters : The blister- ing- plaster, having been spread of the shape and size indicated, is dusted with a mixture of equal parts of coarsely powdered cantharides and carbonate of soda. The powder is then strongly pressed with the palm of the hand, to insure the adherence of the powder, and the surface is covered with oiled tissue-paper. This method has been used exclusively for several years past, and only one complaint has ever been noted, no matter what may have been the size of the blisters. STOMATITIS. Dr. S. Ullman reports that in children of an early age, and during the process of dentition, he has employed the following prescription in stom- atitis, with a most happy result : IJ. Acid, salicyl gr. v. Acid, tannic gr. v. Soaa3 bibor 3 ss. Potass, chlorat 3 j. Sacchari albi 3 ij. M. Fiat pulvis. S. — Apply a pinch on the tongue twice or thrice a day. 254: prescriber's memoranda. In some affections of the throat of an ulcera- tive nature this combination is excellent. The whole may be added to two or four ounces of aqua distillata, and the directions given accord- ingly. SYPHILIS. $ . Hydrarg. proto-iodid gr. xx. Tragacanthae q. s. M. Ft. pil. no. cxx. Commence with one after each meal and in- crease one every third day until the teeth com- mence to get sore, or the bowels disordered, when you drop two pills from each dose and continue their administration regularly. Keyes. Or, ~fy . Mass. hydrarg gr. 1. Ft. pil. no. c. Use in the same way. Or, I}. Mass. hydrarg.. Ferri sulph. exsic aa gr. 1. Ext. gentian q. s. M. Ft. pil. no. c. If the patient is anaemic. Keyes. prescriber's memoranda. 255 5 . Hy drarg. bichlorid gr. j. Tinct. cinchona co. , Aquae .. . . . aa § iij. M. S. — Teaspoonful after meals. In cases of anaemia the tincture of the sesquichloride of iron (3 iij.) may replace the tincture of cin- chona. Keyes. l< Ricord's Mixture," which has been so highly recommended in syphilitic affections, is com- posed as follows : ^ . Hydrarg. iodid. rub gr. iv. Potass, iodid § j. Fl. ext. sarsap. comp § j. Aquae q. s. ad. 3 v M. S.— Teaspoonful. 3 . Potass, iodid 3 ij. Hydrarg. biniodid gr. ss. Syr. aurant. cort § j. Tinct. aurant. cort 3 j. Aquae ad. 3 iv. M. S. — Teaspoonful in water after eating. Mixed treatment. Keyes. 25G peescbibek's memoranda. Or, I£. Hydrarg. biniodid . . . . gr. iij. Potass, iodid gr. cl. Gum tragacanth, Glycermae au, q. s. M. Ft. pil. no. 1. Keyes. fy. Hydrarg. biniodid gr. iij. Potass iodid 5 ijss. Aqua* dist 3 ijss. Syr. simplicis q. s. ad. fl. § x. M. S. — A tablespoonful three times daily. Tertiary syphilis. TAPE-WORM. Ijt . Pumpkin seeds 3 xx. Sugar gr. cc. Etherial ext. of male fern. ... 3 ij. Decoct, pomegranate root. ... 3 x. M. Ten grains of calomel are administered, after which the patient fasts for twenty-four hours, taking nothing except slippery- elm tea. One half of the above mixture is given in four equal doses, at intervals of fifteen minutes, and if it does not produce catharsis within two prescrlber's memoranda. 257 hours, prompt purgation is produced by either castor-oil or rochelle salts. E. H. M. Sell. Dr. Ridder has used salicylic acid with satis- factory results. The mode of administration is as follows : An ounce of castor- oil is given in the morning, and the patient's diet restricted during the day, so as to keep the intestinal canal as empty as possible. On the following morn- ing half an ounce of castor-oil is given at seven o'clock ; at eight o'clock twelve grains of sali- cylic acid are given, and this dose is repeated every hour until a drachm of the acid has been taken ; half an hour after the last dose, another half ounce of castor-oil is administered. After the passage of the worms the rectum is washed out with injections of water. The only un- pleasant effect produced by the treatment is a slight nausea, which is not, however, bad enough to keep the patients from returning to work on the same afternoon. Osinum basilicum is a new anthelmintic. This plant, which is known in Buenos Ayres under the name albaliaca, exerts a powerful action on intestinal worms, expelling them from their haunts with very great rapidity. The part 17 258 peesceibee's memoeanda. used is the juice, and it is given in doses of about two ounces, followed in two hours by castor-oil. It acts more powerfully and cer- tainly as a vermifuge than calomel, santonin, kousso, or kamala, and, on the other hand, pos- sesses the great advantage of doing no harm if worms be not present, exerting then merely an aperient and disinfectant action. THE TONGUE IN DISEASE. Henning says : " 1. The elongated and pointed tongue invariably indicates irritation and deter- mination of blood to the stomach and intestines. The extremities are often cold. It is also asso- ciated with excitation of the nerve-centres. This tongue is often found, but more especially among children. The indications are to allay irritation and divert the blood from the stomach and bowels. We should be very careful how we make our prescription in such cases, as, if we give an irritant cathartic, it invariably aggravates the disease. 2. The pinced and slirunken tongue indicates atony of the digestive organs, often found in dyspepsia and kindred diseases. The treatment is plain, the pathological conditions evident at a glance, from the appearance of the tongue. 3. The coating (saburra) or fur should be well studied. It may be greater or less in pbescriber's memoranda. 259 thickness, dry or moist, or clammy, more accu- mulated at the posterior portion. It is said that when the tongue is heavily coated at the base, with a deep yellow coat, the liver is at fault. This is not always the case ; and, from my ob- servation, more often not the case. I have seen cases of jaundice with a white-coated tongue. Tobacco-chewers nearly always have a yellow- coated tongue, and their liver may be sound. 4. The dry tongue has a very important significance. When we have patients who are suffering from some form of fever, pneumonia, or any other acute disease, with such a tongue, they are in danger, and require close attention. In such cases nutri- tion and assimilation are suspended, and food can- not well betaken, and, if taken, cannot be properly assimilated. When given, it should be in fluid form, and always above the temperature of 100°, and of a character nutritive and digesti- ble. The digestive organs can do but little work, yet proper food, given at proper intervals, does good ; but these organs need all the rest they can get until the disease has subsided. Dry- ness of the tongue is also associated with vascu- lar excitement, and particularly with excitation of the ganglionic and nerve-centres. Hence the arrest of secretion and this dryness. Here we readily read the state of the nervous system. 260 peesceibee's memoeanda. In many cases, the sympathetic nerve is not only excited and irritated, but there is involuntary contraction of muscular tissue, thus suspending the secretions of the several organs. The indi- cations are, proper sedatives for the vascular excitement, and diaphoretics for contractions or excitement of the nerves, associated with other proper treatment. By this course we shall soon see our patient with a moist tongue, arid some of the secretions re-established. 5. Often the tongue changes in the disease from the dryness above referred to, to a brown or black color, with sordes about the teeth. The common idea is that the system is in a typhoid condition. This is true ; yet it undoubtedly means, also, that the blood is in a septic condition — a very im- portant fact for us to know. Then our best an. tiseptics should be given with stimulants and tonics. Thus we can readily read, from the ap- pearance of the tongue, the condition of the digestive organs, the functions of nutrition and assimilation, the condition of the nervous sys- tem, and the state of the blood. Of course, we must take all other symptoms into considera- tion. Yet the appearances of the tongue, as pointed out, seldom fail in giving us, at a glance, valuable information as to the true condition of the system." pkesckibek's memoranda. 261 TONSILLITIS. Dr. H. C. Hov/ard declares that, with one thorough application of nitrate of silver (solid stick) to the tonsils :n the first stage of acute tonsillitis, he has rarely failed to prevent suppu- ration. Dr. Hale has prescribed baryta iod. in hyper- trophy of the tonsils, with very gratifying results. It effects a rapid diminution in the size of the glands, even when they have been indurated for some years. Equal parts of tinct. guaiaci and glycerine, given in teaspoonful doses every hour or two hours, produces excellent results in acute ton- sillitis. Rubbing the tonsils daily with citric acid is highly lauded in enlargement of the tonsils. TYPHOID FEVER. Sir William Jenner asserts the impossibility of cutting short a case of typhoid fever by means of treatment. In treating cases it must be borne in mind, first, that the disease, in the majority of cases at least, is produced by the 262 prescriber's memoranda. action of a small portion of the excreta from the bowels of a person suffering from typhoid fever; that air from a drain, or air blowing over dried feculent matter, may convey the poison to the patient ; or his own fingers may carry it to his mouth ; or that the vehicle for the poison may be a fluid — for example, milk or water ; and that the poisonous proper- ties of the excreta may be destroyed by boiling the fluid in which they are contained, though not by filtering the fluid; secondly, that the natural duration of a well-developed case of typhoid fever is from twenty- eight to thirty days. By self -treatment in the earliest stages of typhoid fever the patient is prone to do him- self great mischief, either by taking violent exercise, strong stimulants, or drastic medi- cines, according to his fancy. Many of the worst cases have appeared to owe their gravity to exercise taken at a time when the nervous system could ill afford any strain, and hence, no typhoid fever case ought to be removed a great distance, if away from home. The diet should be liquids, with farinaceous food and bread in some form, if wished ; broths with vegetable juices, strained fruit-juices, avoiding grapes on account of skins and seeds. Milk must be used with caution. If the curd be undigested, great prescriber's memoranda. 263 evils arise, and the patient is placed in jeopardy. " Do not forget that a pint of milk contains as much solid animal matter as a Midsized mutton- chop. What typhoid fever patient can digest two to four mutton chops per diem f A patient is weak from the fever, and not from lack of food. Pure water may be given ad libitum. If the bowels are confined, use simple enemata. Small doses of mineral acids are grateful and perhaps beneficial. Thus, the fever is to be met by rest, quiet, fresh air, mixed liquid food and blood-diluents, and by the exclusion of fresh doses of poison ; the intestinal lesion, by the careful exclusion from the diet of all hard and irritating substances, and the removal from the bowels of any local irritant. Headache may be alleviated by either hot or cold applications, and ceases spontaneously in about ten days. Sleeplessness, also, generally disappears in the second week ; still, if it be persistent, henbane, bromide of potassium, and chloral are valuable, alone or combined. With high temperature, a tepid bath or sponging the surface will often induce sleep. Opiates are to be avoided. No treatment can arrest or limit the specific changes in the intestinal glands ; but over the diarrhoea, which usually accompanies these changes, we can, in many cases, exercise a decided influence 26 i prescriber's memoranda. by careful attention to diet, as above directed, and avoidance of accumulation of undigested food. So long as not more than three to five actions occur in twenty-four hours, the looseness is rather advantageous. If the stools be found to consist of curdled milk, the remedy is obvious; if too alkaline, dilute sulphuric acid sometimes affords marked relief ; if very offensive, impal- pable animal charcoal frequently acts as a charm. Sometimes constipation is present, with an extensive ulceration of the ileum ; then, small-sized enemata of thin gruel, every other day, are safer than large quantities less frequently. The most important and not un- frequent cause of inaction of the bowel in ty- phoid fever is deep ulceration of one or more Peyer's patches. Large, superficial ulcers favor diarrhoea; a single small, deep ulcer will para- lyze the action of the bowel — a most important point to bear in mind. This state of things, too, is frequently the cause of excessive tym- panites between the third and fourth weeks of the fever. Of all remedies, turpentine exter- nally is most generally used at these times, but in no case have I seen a diminution of the disten- tion, which seemed to be projiter 7wc. Charcoal to relieve fetor, pepsin to promote digestion, alcohol in fit doses to improve nerve-energy and prescriber's memoranda. 265 so to increase the muscular power of the bowel, are each and all valuable in turn. A long tube passed up the bowel will often be the means of discharging- large quantities of flatus. In in- testinal hemorrhage, if it be never so small, the patient must be kept recumbent, and not al- lowed to make any effort when using the close pan. If he be unable to pass urine when recumbent, the catheter must be used. Starch enemata, with ten to fifteen drops of laudanum at once, and acetate of lead, with three to five drops of laudanum every two or three hours by the mouth, or gallic acid and iced water, are to be administered. It is highly requisite to keep the bowels empty, and, therefore, give essence of meat alone, and no milk. If the hemorrhage be sudden, copious, and repeated, ergotine, subcutaneously, with an ice-bag over the ileum, may be employed. The faintness due to hem- orrhage must not be removed by stimulants. Perforation is always fatal, in Sir William's experience. The value of treatment by cold baths has not carried conviction to the lectur- er's mind. Both quinine and salicylate of soda, employed to reduce high temperatures, have caused disappointment. Free action of the skin is often attended with great relief, and nothing assists this action so readily as a large, 266 prescriber's memoranda. warm and moist flannel, covered with oiled silk, applied over the abdomen and chest, com- bined with the administration of warm, bland fluids. When, as in the latter stages, the per- spiration is profuse and exhausting, the patient must be lightly clothed and his skin wiped every few minutes, if necessary, with a warm napkin, and dry clothes placed between the wet linen and the skin. Alcohol must be given carefully to increase nerve-force, and sponging with tepid vinegar and water is sometimes of much service. To avert death from failure of the heart's power, alcohol is the great remedy. Delirium due to fever is never conjoined with headache ; headache in typhoid fever may be most intense, delirium most violent, but the headache ceases before the delirium begins ; if conjoined, we must look for that rare complica- tion — intra-cranial inflammation. Alcohol is, as a rule, the remedy for delirium, but must be used with caution ; more than twelve ounces of brandy are seldom necessary in twenty-four hours to meet all the demands upon alcohol, and, if there be a doubt as to quantity, it is better, in typhoid fever, to give the minimum amount the benefit rather than the maximum ; the reverse holding good in typhus fever. Tre- mor is sometimes excessive ; in such cases it is prescriber's memoranda. 267 almost always a symptom of deep intestinal ulceration. A small, deep slough will be ac- companied with great tremor; a large ex- tent of superficial ulceration may be unat- tended by symptoms. " Sir William Jenner concludes in these words : ' ' While admitting without reserve that heroic measures, fearlessly but judiciously employed, will save life when less potent means are useless, the physician whose experience reaches over many years will, on looking back, discover that year by year he has seen fewer cases requiring heroic remedies, and more cases in which the unaided powers of nature alone suffice for effecting a cure ; that year by year he has learned to regard with greater diffidence his own powers, and to trust with greater confidence in those of nature." The remedies which have been found at the University Hospital to exert the most powerful influence upon the follicular intestinal catarrh always present in typhoid fever, are, first and foremost, the nitrate of silver, and next the sub- nitrate of bismuth and carbolic acid. There would seem to be abundant evidence that ni- trate of silver reduces the size of the enlarged follicles, relieves the inflammatory engorge- ment, and allays the hyperesthesia of the nerves. 268 peesceiber's memoranda. It has also been settled by numerous experi- ments that the nitrate of silver is the most easily administered of the three astringents above mentioned, and the best tolerated by the sys- tem. If there is any putrid element in the dis- ease, carbolic acid is employed instead of the nitrate of silver. The nitrate of silver is ad- ministered in doses of one -fourth of a grain four times a day. This treatment is persevered in until the ulcers have entirely healed. If the discharge from the bowels is composed of small, semi-solid stools, it is, with propriety, disregarded; but if the stools are watery and large, opium is administered in pill-form, com- bined with the nitrate of silver. From one- fourth to one grain of the powdered opium is given three times a day. If there is constipa- tion instead of diarrhoea, belladonna is given conjointly with the nitrate of silver. Great care is had with regard to the diet when the catarrhal inflammation of the intestines is present. The food employed is of course as di- gestible as possible. Milk has been found to be the best diet in this disease. If the curd ap- pears in the stools, the milk is diluted with water or lime-water. Of this mixture of milk and lime-water three ounces are given every two hours, or a little over two pints in the course of prescriber's memoranda. 269 twenty-four hours. When the bowels are tor- pid, beef or mutton broth is given alternately with the milk. The beef-tea employed is prepared after the following recipe : Take a quantity of tender meat, and, after cutting off the fat, chop it up fine, put it in a bowl, pour a pint of water over it, and let it stand overnight. The water should be kept just on a simmer, the temperature never being allowed to go above 140°, otherwise all the albumen is coagulated, and so either left on the sieve in straining, or introduced into the stom- ach in the form of curds. After this simmering solution has been allowed to stand overnight, pour it into the pipkin and heat again gently, with enough salt to give it flavor, and, if neces- sary, add a drop or two of muriatic acid. Then pour it out over a hair-sieve into a jar. The re- sulting solution will be found to contain all the nutriment possible, and to be the most valuable kind of stimulant and laxative. When the fever is high, the patient is given all the food he can take. Care is had, however, that in allowing food the already inflamed in- testinal tract is not further irritated. The poison in the blood is controlled by means of quinia and nitro-muriatic or salicylic acid. As a general thing, salicylic acid is only em- 270 prescriber's memoranda. ployed where there is some putrid discharge joined with high fever. Quinia is considered : 1, to neutralize the effects of the septic poison in the blood ; 2, to act as a good tonic to the mus- cular and nervous systems ; 3, as tending to check febrile action; and 4, to remove any malarial element that happens to be present. Quinia is never given in the enormous doses advised by the German physicians. It has been found that such doses will break down high fever, but they produce entirely unnecessary irritation of the gastric mucous membrane. About twelve grains of quinia are given in the course of the twenty-four hours. The temperature is kept down by preventive measures rather than by the cold bath, which is regarded as a last resorfc. It is unnecessary after this to say that the practice of the Univer- sity Hospital is wholly opposed to the indiscrimi- nate cold bathing in typhoid fever, so much in vogue in Germany within a year past. When temperature runs up despite the use of drugs, in the milder cases sponging of the whole body are practised every two hours, the sponges being squeezed out of a mixture of water and bay -rum, at a temperature of from 60° to 80°. If this does not succeed (it rarely fails), and if the patient's temperature mounts up to 104° or 105°, pbesckeber's memoranda. 271 he is then wrapped up in sheets wrung out of cold water. If the temperature still runs up to such an extent that life is threatened, the pa- tient is placed in a cold bath until the bodily temperature is sufficiently reduced. Before the local lesions appear, the fever can be more boldly attacked ; but when, in subse- quent stages, it runs high, it is regarded as par- taking of the nature of a sympathetic fever, largely dependent upon the amount of intestinal lesion, and the use of baths at this period is thought to be attended with great risk. If the cold bath is used at all (except as a last resort, and when temperature cannot be reduced in any other way), it is employed during the first ten days in cases where the temperature rises above 103° and cannot be controlled by frequent spong- ings, large doses of quinia, diaphoretics, etc. With regard to the use of stimulants, the hos- pital practice is not in favor of administering them simply because a patient has the fever. It is believed that stimulants are only demanded for the relief of certain symptoms. As a gen- eral thing, they are not given to children before the age of puberty. They are administered only to old persons, and to meet certain indications, viz.: 1, ataxic nervous disturbances, such as sleeplessness, twitchings of the muscles, ma- 272 peescbibek's memoranda. niacal delirium ; 2, circulatory disturbances, such as feeble and rapid pulse, and feeble de- velopment of the first sound of the heart; 3, profound asthenia, as shown by great tremu- lousness, inability to make any movement, and tendency to slide down off the pillow ; 4, dry and brown tongue, with sordes on lips, teeth, and tongue. The milder forms of stimulus are always used at first. The one most frequently employed is wine-whey. This is made in the proportion of one part of sherry to three of milk, and as much as a gill or half a pint of it is given in the course of three hours. If the symptoms increase, stronger stimulants are used, such as whiskey. Whiskey is usually given in lime-water and milk ; the lime-water prevents the coagulation of the milk by the alcohol. These ingredients are mixed in the proportion of one tablespoonful each of whiskey and lime-water to every three ounces of milk. In this form half an ounce of whiskey is given every hour. If the stimulation is doing good, a diminution of the serious symp- toms is noted. If the symptoms increase, on the other hand, the amount of stimulus is re- duced. With regard to complications : relapses are always regarded as true second attacks of the pbesckibee's memoranda. 273 disease, and are treated accordingly. The treat- ment is resumed, the diet restricted, and the same general watchfulness had over the state of the case as during the course of the first attack. Hemorrhage occurring early in the attack is considered as of but little consequence ; but when it supervenes later — when the sloughs are thrown off — it is regarded as a very serious mat- ter. The treatment of hemorrhage is by abso- lute rest in bed for twenty-four hours, and by the administration of opium to produce complete quiet for the alimentary canal. The opium is given by the rectum, one grain of the solid opium being prescribed every two or three hours until the patient is gently under its influence. Of as- tringents for local action, acetate of lead is preferred. A suppository containing one grain of opium and three grains of the acetate of lead is given three or four times daily. Ergot, by reason of its action upon the walls of the ar- terioles, is also very highly prized. It is given hypodermically near the supposed seat of the hemorrhage. The food allowed is very small in quantity, and absolutely liquid. Peritonitis is treated by antiphlogistics, se- datives, perfect rest in bed, and a diet which leaves no residuum to irritate the bowels. 18 274 prescriber's memoranda. True perforation is regarded as beyond the reach of medical skill to mend. Br. Alonzo Clark reports one case in which opium cured the patient after perforation had occurred. TYPHO-MALARIAL FEVER. Br. Bartholow says that he has seen many cases of this disease, and has obtained the best results from the following ; I£. Tinct. iodini, Acid, carbolic equal parts. M. S. — Gtt. j.-ij. quarta vel sexta quoque hora. Quinine, he says, does nothing more than re- duce the pyrexia. When diarrhoea occurred, he used liq. potassas arsenitis (Fowler's), gtt. j. and tinct. opii deodorataa, gtt. ij.-v., every four hours. ULCERS. Martin's elastic bandage is an excellent meas- ure in chronic cases. A solution presented at the Bublin Pharma- ceutical Conference was prepared by shaking tincture of iodine with a piece of fused potash pbescribkr's memoranda. 275 until the color was removed, and covering the iodoform produced by the addition of eau de Cologne or lavender water. Lint dipped in this solution, and afterward dried, proved a pleasant and efficacious application for indolent sores. Dr. Keyes recommends the following in syphilitic ulceration : Ung. hydrarg. nitratis, diluted one-half ; or, I£ . Hydrarg. iodid gr. xx.-xl. Vaseline 33. M. External use. In Sluggish Sores. ^ Chloral hydrate gr. v.-xx. Aquae gjj. M. Ft. lotio. Keyes. M. Vidal made hi3 first experiments with pyrogallic acid in psoriasis in June, 1878, and has since employed it with success in the treat- ment of venereal ulcers. A man was inocu- lated with the matter of his soft chancre at two places on the abdomen. Phagedena attacked the punctures, as well as the original sore. The sore on the penis became as large as a franc, that of the right side of the abdomen increased to the size of a five-franc piece, and that of the 276 prescriber's memoranda. left side of the abdomen to the size of a two- franc piece. Under repeated cauterization with sulphate of copper the ulcers improved for a time, but again relapsed. At the end of a month, M. Vidal made use of an ointment composed of one part of pyrogallic acid to five parts of vaseline. Three applications were made during three successive days. The pain was moderate, and lasted only from eight to ten minutes. The sores then decidedly improved, and after three more applications healing rapidly took place. Subsequently, M. Vidal used the same ointment for ordinary chancres, and in two cases rapid and complete cure followed the third application. Once the pure acid was applied, but was no more effective, perhaps even less so, than the ointment. In cne case, auto-inocula- tion on the third day, after a third application of the ointment, gave a negative result. UTERUS, Diseases of the. Dr. Dabney has used the following with great success in cervical metritis : ^ . Ergotine gr. xx. Iodine fl. 3 j. Glycerine q. s. ad. n.-J j- M. Apply twice daily with camel's hair brush. prescriber's memoranda. 277 In cold weather, suppositories, made as fol- lows, are found of most service : J£ . Ergotine gr. xx. Ext. belladonna gr. ij. Cocoa butter q. s. M. Make six suppositories, and insert one into the vagina nightly, after using hot douche. In warm weather, a solution is preferable : I?. Ergotine (or Squibb's solid ex- tract) 3 ss. Ext. belladonna gr. vj. Water and glycerine, of each . fl. J iv. A pledget of cotton is saturated with this solu- tion, and inserted into the vagina at bedtime, after the use of the douche. The cotton should be removed in the morning. Dr. John M. Bennett, of Liverpool, treats chronic cervical metritis by injecting the cervix with icdine by means of a long-pointed hypoder- mic syringe. The solution is composed of iodide and bromide of potash, each twenty grains ; tincture iodine, one-half drachm ; water, two drachms. Three or more punctures are made, according to the amount of hyperplastic 278 prescriber's memoranda. tissue to be absorbed. Three operations are generally sufficient. Has never known it to cause any disturbance, while it has effected many cures after other methods have failed. Dr. Wallace says : " I have found the following- simple arrangement for intra-uterine medication answer very well : Cut the end off a flexible No. 10 catheter, pass the wire stilette through it, and make a knob on the end of it with wax and cotton-wool, which will just cover the end of the catheter ; then push up the stilette about an inch and a half, roll cotton- wool around it, and dip it in the solution to be applied (carbolic acid and iodine is excellent), and draw it within the catheter so that the knob just covers the end, give it a bend like a uterine sound, and pass it up to the fundus of the uterus ; then draw the catheter down the wire. This, of course, brings the medicated cotton-wool in con- tact with the uterus through its whole length. After leaving it in for a minute or two, it can be withdrawn. The speculum is not needed. The main recommendation of this arrangement is that it saves the cost of a 20s. or 25s. instrument, an important matter in these times." pkescriber's memoranda. 279 Ulcer 8 of the Neck of the Uterus. 1} . Glycerine 25 parts. Alcohol 12^- parts. Creasote (pure) 1 part. M. S. — Touch the ulcers twice a day with this solution. In twenty- eight cases of simple ulcers, twenty- six recovered in a week. In seven severer cases, all recovered in a little longer time. In two cancerous ulcers, no good resulted after forty days 7 treatment. The cases were then treated by iodoform. These results justify the belief that in simple ulcers — not specific — great good is obtained by the astringent and antiseptic properties of this wash or lotion. Dr. Robert Battey gives us the result of his observations in the intra -uterine use of iodized phenol during the past eight years. He combines one part of iodine with four parts of carbolic acid. It is applied to the uterus by means of slender, elastic hard-rubber probes wound with cotton- wool. The effects of the solution are regulated : (a) by the size of the cotton wrapper ; (b) by the depth to which it is carried into the uterus ; (c) by the number of probes successively employed ; (d) by the length of time the medicated cotton is allowed to 280 pkesckibeb's memoranda. remain in the uterus. The results of treatment have been : 1, perfect removal of cervical mucus ; 2, freedom from pain due to the local anaesthesia produced by the carbolic acid ; 3, rapid absorption of iodine into the circulation, evidenced by metallic taste in mouth and throat ; 4, softening and dilatation of the cervix ; 5, temporary arrest of leucorrhoea ; G, watery dis- charge sometimes bloody ; 7, exfoliation of superficial layer of mucous membrane ; 8, heal- ing of abrasions ; 9, disappearance of indura- tion; 10, permanent arrest of leucorrhoea; 11, removal of viilosities without the curette ; 12, disappearance of subinvolution ; 13, the menses become regular and healthy ; 14, the appetite and digestion improve without medicine ; 15, so freely is iodine absorbed that alteratives are not required ; 16, the form of the cervix and os are often completely changed, and assume even a virginal type ; 17, stenosis is not observed in many cases ; 18, barrenness is overcome. Rapid and at the same time satisfactory cure is not obtained, nor is it expected of any method of treatment known. I£. Bismuth, subnit., Glycerinae, aa q. s. to make a thick cream. Dr. Suesserott recommends gynecologists to prescribes' s memoranda. 281 use this in preference to other applications to ulcerations of the os and cervix uteri. He applies it through a glass tube, and retains it with a pledget of cotton. See also Dysmenorrhea, etc. URINE, Disorders, etc., of. A Novel Urinal. — A physician has lately at- tended a lady suffering with a large abscess, where the use of a pan for micturition was im- possible, and catheterism annoying, when the patient herself suggested the following expe- dient : she had a large, coarse sponge enclosed in an oil-silk bag, and applied to the parts, greatly to her comfort. He has since used the plan in other cases, with much satisfaction. 1^ . Acid, benzoic gr. xx. Syr. tolutani fl. Z j. M. S. — To be given every third hour, largely diluted with water, in urasmia. Benzoic acid has been found by Dr. Da Costa to prevent particularly the accumulation of the urinary salts in the blood. In addition to this treatment, the patient is thoroughly purged 282 peescriber's memoranda. with croton-oil. He is also given a warm bath, or, if he is too weak, a vapor-bath is taken in bed, by means of hot bricks wrapped in damp towels. In some cases dry cupping over the loins does good. 3 . Scammonii resinse gr* v. Potass, bitart gr. xx. Zingiberis gr. viij. M. S. — To be administered when needed, in ursemic coma. Geo. Johnson. #. Tinct. ergotse \ x. Tinct. f erri perchlor Tf^ v. Spts. chlorof ormi TT\_ v. Inf us. quassiae ad. § j. M. S. — Three times a day, for incontinence in the young. Rhus aromatica given in five cases of inconti- nence of urine in children and young persons ; results not nattering ; seemed to benefit in three of the cases. Retention may be due : 1, to congenital con- traction of the meatus, which requires surgi- cal enlargement of the orifice ; 2, to phimosis, where the preputial orifice is very small ; 3, prescreber's memoranda. 283 to stone in the bladder. It is more difficult to find a stone in the bladder when distended with urine than when empty. Great care is requisite when sounding a child. Incontinence is due : 1, to rectal complaints ; 2, to a tight foreskin ; 3, to a small congenital meatus ; 4, to calculus impacted in the urethra. Causes 3 and 4 are usually not sufficiently attended to. Stone im- pacted in the urethra may cause retention or incontinence, according to its location. A stone so impacted does not cause so much pain and discomfort as might be imagined. Milk dieting and the use of belladonna in noc- turnal, and strychnia and iron in diurnal inconti- nence, are indicated. Mr. Teevan. I£ . Potass, citrat § j. Sodae bicarb 3 v. Syr. limon J j. Aquae ad. § iv. M. S. — 3 j. every two hours, to render the urine alkaline. Roberts. 5 • Ext. belladonna fl - 3 j. or ss. Ext. buchu fl I j. Spts. etheris nitros § ij. M. S. — Teaspoonful three or four times a day, for dysuria in females. 284 prescriber's memoranda. Tinct. belladonnas, gtt. iv. to x. at bedtime. Chloral has been highly recommended by vari- ous authors in incontinence. From four to ten grains at bedtime, in milk or water. I£ . Strychniae gr. j. Puly. cantharides gr. ij. Morph. snlph. . .".- gr. jss Ferri pulv 3 j. M. Ft. pil. no. xl. S. — One three times a day to a child ten years old. S. D. Gross. This prescription will speedily relieve the ir- ritability of the bladder, especially if conjoined with such means as a cold shower-bath daily, the avoidance of irritant food and late suppers, the patient lying on the side or belly, and tak- ing care to drink nothing for a few hours preceding sleep, arid to empty the bladder on going to bed. Some recent British writers state that, after numerous failures with all orthodox modes of treatment, it was found that cutting off meat in the diet was sufficient, in many cases, to effect a rapid and permanent cure in enuresis in children. presckibek's memoranda. 285 VAGINA. M. Gallard states that he constantly recom- mends for vaginismus the gradual dilatation of the vagina by tents of progressively increasing size. According to the circumstances of the case, he impregnates these tents with different applications. He also believes that these topi- cal applications aid materially in curing vagi- nismus. For this purpose M. Gallard recom. mends the use of iodoform made up into an ointment (iodoform, cocoa butter, and fresh lard, equal parts). This preparation may be employed when there is rudeness or excoriation of the mucous membrane. If there is only pain, without any visible change in the mu- cous membrane, extract of belladonna, one part, and fresh lard, seven and a half parts, may be prescribed. In this, as in the previous case, the tents may be as small as possible. After the employment of the iodoform ointment it is well to replace it after a few days, when the redness and excoriations have disappeared, by the belladonna preparation. In both cases care should be taken to increase daily, by an imperceptible but still advancing gradation, the size of the tent. By this means, at no very dis- tant period, a tent is habitually employed 286 prescriber's memoranda. which is of such a size as to allow the introduc- tion of the male organ. In effecting this result the action of the narcotic substance and the progressive dilatation have both materially as- sisted each other. The following has been recommended for vaginismus : I£ . Olei theobromae 3 j. Potass, bromid gr. x. Ext. belladonnas gr. vj. Acid, thymic. gr. j. M. Fiat in suppositor. no. j. To be placed in the vagina every evening. 1^ . Potass, permanganat gr. xx. Potass, chlorat 3 iv. Aquae O ij. M. S. — Teaspoonful to be added to a quart of warm water, and used as a vaginal injection, night and morning, in soreness of the vagina. Non-specific and acute cases of vaginitis Dr. Goodsell treats by such hot and emollient injec- tions as flaxseed, or slippery-elm bark tea, to erescribek's memoranda. 287 which laudanum has been added ; the solution which he usually employs contains laudanum fl. | ij. to Oij. of flaxseed. When the inflam- mation has subsided, vaginal suppositories, con- taining five grains of iodoform, are ordered twice or thrice daily. In the chronic forms of this complaint, suppositories of tannin or of iodoform, or long tampons of absorbent cotton, are employed, which have been dipped in as- tringent solutions of acetate of lead and zinc, to which laudanum has been added. VERTIGO. In vertigo of gastric origin, the best results are obtained by the use of alkalies and bitter tonics. Most cases are decidedly benefited by the use of Vichy or Carlsbad waters, or by the bicarbonate of sodium after meals. The gen- eral tone of the system is invigorated by tonics before meals. Late in the course of the disease iron is given thrice daily in combination with one-thirtieth of a grain of strychnia. Another plan of treatment consists of the administra- tion of small doses of corrosive sublimate, while paying strict attention to the bowels and diet. 288 pbescribek's memoranda. VOMITING. Half a drachm of bromohydric acid in an ounce of water, four times a day, is % said to arrest the vomiting" attendant on ulcer of the stomach, and to enable the retention of solid food. It is possible that this remedy may prove of good service in controlling nausea from other causes. Dr. Wm. Boys says : " I have given sulphate of atropia in vomiting of pregnancy for years, and do not know of any case but what it afforded prompt relief. I give it after a formula recom- mended in the London Lancet, for the sweating of phthisis : 3£ . Atropise sulph gr. j. Morphias sulph gr. iv. Acid, sulph. arom 3 iij- Aquae 3 v. M. S. — Ten to twenty drops three times a day." Dilatation of the cervical canal for the vomit- ing of pregnancy is now regarded as not only an efficient means of treatment, but reasonably safe. The dilatation should not, however, be carried to the interior of the uterine cavity, but prescribeb's memoranda. 289 should rather be confined to the lower portion of the constricted part of the cervical canal, and even here need not be extensive. It may- be accomplished with the index finger, which should be gently carried through the external os with the rotating movement, until one-half of the first phalanx has been introduced. This may be easily accomplished with the multipara, but with the primipara it will generally be neces- sary to enlarge the os by previous dilatation, until room enough has been gained to admit the finger. The statistics of this method of treat- ment are not sufficiently large to warrant us in saying that it is wholly unattended with danger of abortion ; but from records of several cases, since 1875, it may be said that it is a safe and sure remedy. It was discovered by Copman in 1875, when he dilated for the purpose of produ- cing an abortion for the relief of vomiting, and instead of causing the abortion, he cured th vomiting. A writer relates, in the Louisville Medica* News, a case of incessant diarrhoea and morn- ing sickness cured by bromide of potassium. The patient had suffered during all her previ- ous pregnancies with this trouble, which lasted from the third month up to the time of deliv- 19 290 pkescbibeb's memokanda. ery. As all the remedies used for vomiting in pregnancy remained without effect, fit was thought that both the diarrhoea and vomiting were due to reflex irritation. He at once gave her twenty-five grain doses of bromide of potassium three times a day, the first dose half an hour before rising. As long as she con- tinued taking the medicine, the trouble did not return ; but so soon as she attempted to leave it off for a whole day, diarrhoea again set in. After the first week she was able to ward off all the symptoms with only one dose in twenty-four hours, half an hour before rising. During her next pregnancy, when again suffering from the old troubles, the same treatment was reverted to, and with the same success. Lubelsky has given almost immediate relief, in the vomiting of pregnancy, by spraying ether over the epigastric region and corresponding portion of the spinal column. Continue for three to five minutes, and repeat every three hours. At a recent meeting of the British Medical Association, Dr. Edwyn Andrew called attention to a new method of using ice. He thought that the effects of the cold could be supplemented prescriber's memoranda. 201 by combining with the ice during the process of freezing the active principles of drugs. In this manner ice may be rendered highly antiseptic, caustic, or styptic. In diseases of the throat and stomach, and in hemorrhage from the internal organs, ice might be pleasantly used to relieve symptoms, and at the same time to convey medi- cine or food to the stomach, when the latter would not retain them in any other way. ^ . Cerii oxalat gr. j. Ipecacuanhas gr. j. Creasoti gtt. ij. M. S. — To be taken every hour, in vomiting of pregnancy. Goodell. J$ . Cerii oxalatis gr. xxiv. Ext. hyoscyami gr. xxxvj. M. et ft. pil. no. xij. Take one twice a day, in the vomiting of pregnancy. $ . Chloral hydratis gr. x v.-xx. Milk §ij. Yolk of an egg j. Beat up well, warm, and inject into rectum. For reflex vomiting of pregnancy. Kane. 292 prescriber's memoranda. For Vomiting following the Use of Opium. 5 . Potio Riverius § v. Morph. sulph gr. j. Syr. aurantii, Salep aa § j. M. S. — Teaspoonful doses. C. H. Avery. To prevent the nausea and vomiting secondary to the use of opium, combine the drug with bromide of potassium. I£. Sol. morph. (U. S. P.) § j. Potass, bromid 3 j- M. S. — Teaspoonful doses. Metcalfe. WARTS. A writer in the British Medical Journal has successfully removed venereal warts by powder- ing over the surface twice daily with equal parts of burnt alum and tannin. As these growths occur chiefly in situations where mucous and skin surfaces are in contact and moist, this plan suggested itself. In the first case in which he applied it the warts were easily rubbed off in prescriber's memoranda. 293 the course of three or four days, and other cases have given equally good results. Warts are to be removed by means of the der- mal curette, as has been advised in Vienna. This spoon-shaped instrument must be tolerably sharp, and by a careful kind of cutting move- ment around the wart it may be removed bodily, leaving a slightly depressed surface, which bleeds a little ; as this heals, perfect epidermis is formed, with no scar, and the wart generally remains absent. The little operation is hardly at all painful. WICKERSHEIMER'S FLUID. For preserving animal substances, pathologi- cal specimens, etc. For injecting. ^j™" 1J. Arsenious acid. 16 grms. [ 3 iv.] 12grms. Sodium chlor . . 80 grms. 60 grms. Potass, sulph. 200 grms. 150 grms. Potass, nitrate. 25 grms. 18 grms. Potass, carb. . . 20 grms. 15 grms. Water 10 litres [qts.10^4-] 10 litres. Glycerine 4 litres. 4 litres. Wood-naphtha, f litre. f litre. 294: prescriber's memoranda. WHOOPING-COUGH. ]£. Acid, nitric, dil fl. 3 j. Syr. pruni Virg fl. § ss. Aquas q. s. ad. fl. § ij. M. Dose, a teaspoonful. 3 . Potass, bromid 3 jss. Aquae 3]. M. Spray for whooping-cough. Dr. B. F. Dawson recommends the local ap- plication of a solution of sulphate of quinia to the fauces. M. Dervieux believes he has found a preserva- tive means in aconite associated with ipecac and cherry-laurel water. This mixture is either a veritable preventive, or simply an abortive. His formula is as follows : I£. Ext. of aconite. . .05 grm.=f gr. nearly. Ch. -laurel water. 4 grm.— 1 dr. nearly. Syr. of ipecac. . . 3 grm. =| dr. nearly. Mucilage 200 grm. =6^ oz. nearly. This is given, as soon as the characteristic cough- presents itself, in doses of a teaspoonful fresckiber's memoranda. 295 every hour to young infants ; two teaspoonfuls to those more than three years of age, and a teaspoonful to adults every hour. In pertussis, Dr. Pollack, of Austria, recom- mends, for insufflation : J£. Quinias tannat, Sodae bicarb aa 5 parts. Pulv. acacia? 100 parts. M. Use with an insufflator. Dr. Hildebrandt is an advocate of petroleum in the treatment of pertussis. His mode of employment could not be simpler. Small bits of rags are dipped into it and placed beneath the pillow of the patient, or are suspended on wooden hooks at the head of the bed. This method is as simple as economical. I£. Pulverized belladonna.. 1 grm. (15 grs.). Oxide of zinc 1 grm. (15 grs.). Extract of wild thyme. . 2 grm. ( 3 ss.). Mix and divide into 40 pills. S. — From one to six per day. Bouchet. A writer in the Medical Record extols the vapor of cresoline as wonderfully beneficial in whooping-cough. Forty-eight hours after the 296 prescriber's memoranda. vaporizers were started the paroxysms ceased and did not return. His observations of this remedy were limited to its use in the u Shelter- ing Arms Nursery," where the children were exposed to the vapor continuously, and under favorable surroundings. Mr. Arthur Wigles worth began, over four years ago, to treat all cases of whooping-cough solely with the sulphate of atropia, from infants two months old to the adult. It re- quired some little time to find out the average dose to begin with; but he now begins with T |o of a grain (or one minim in a drachm of water), in children from one to four years of age, either diminishing or increasing the dose as occasion dictates ; and, except in very severe cases, only order it to be given once a day ; but when the nightly paroxysms are very severe, he orders half the dose to be repeated an hour before bedtime. The results that follow its administration may be summed up thus : 1st. There is steady di- minution in the number of paroxysms. 2d. There is a diminution in the duration of the paroxysms. 3d. There is a change in the char- acter of the "whoop," as if the vocal cords were not so closely approximated. Further, pkesceibek's memoranda. 297 if the atropine is withheld the beneficial effects derived from it subside. Dr. J. Lewis Smith speaks very highly of the beneficial effect of inhalation of carbolized vapor in whooping"- cough. The following is the pre- scription, used with the steam atomizer : I£ . Acid, carbolic 3 ss. Potass, chlorat 3 ij. Glycerinse 3 ij. Aquae 3 vj. M. To be used three times daily. He details a series of cases (not, however, very numerous) in which this treatment seemed to have a very decided effect in subduing the tendency to spasmodic cough, as well as the severity of the paroxysms. Dr. George Baylis reports ten cases successfully treated by him with the nitrate of amyl. Its combination with carbolic acid in the following formula, and given by a steam atomizer, has perhaps proved the most beneficial : I£ . Amyl nitrite 3 ss. Acid, carbolic gtt. x. Glycerine, Alcohol aa 3 ss. 31. S. — Use by inhalation with the steam 298 prescriber's memoranda. atomizer whenever the paroxysm is felt coming on. The inconvenience of this method of adminis- tration will, however, deter many from using it. In such cases the nitrite may simply be com- bined with alcohol and the carbolic acid and a few drops poured into a tea-cup or on a hand- kerchief and inhaled, while from one-half to two drops may be given upon a lump of sugar of the pure amyl nitrite, internally, every three or four hours. I have found this course of treatment in the majority of uncomplicated cases to give prompt relief to the little sufferers, and have a decided effect in shortening the course of the disease. Its use in controlling convulsions, especially those occurring in in- fants, I have found most decided. I do not consider it curative, but it possesses the power of controlling the spasms until curative remedies can be administered and have time to act. Colic, so frequently met with in young children, is generally aborted by the inhalation of this salt, giving almost immediate relief, followed shortly by a quiet sleep. In 1863, Prof. C. Binz, recommended for this obstinate complaint a solution of quinine and tan- nic acid ; and Dr. C. F. Swan states that he has pbesckibek's memoeanda. 299 adopted this remedy with great success in many cases of whooping-cough. The formula consists of a solution of quinine and tannic acid, 4 grins, of the former to 1 grm. of the latter, in water, syrup, licorice, etc. ; and it is to the local action of the quinine upon the fauces and glottis, as well as to its antispasmodic virtues, that the favorable results are attributed. Of 40 cases of whooping-cough in which this remedy was used, 3 were so mild as to require little or no treatment. No record is given in 6 cases ; and G children refused the medicine in consequence of its bitter taste. Two died of spasm of glottis marasmus respectively. Deducting the 17 cases from the 40, we find 23 left. Of these 23, 3 received no benefit, and 2 but little benefit from the quinine and tannin. But, in the case of the 15 'patients not heretofore considered, the disease was completely aboi'ted in an average period of 3.8 day 8, 3 of the cases being complicated by pneumonia, and 2 by capillary bronchitis. Sir Wm. GuWs Cough Mixture, said to be good in whooping-cough : $ . Olei morrhuas, Honey, Lemon juice aa equal parts. M. Dose, 3j.-3ij. 300 prescriber's memoranda. Dr. P. Brynberg Porter treated a large num- ber of cases of this disease with small doses of chloral, gr. iij.-viij. every four hours, with good success. WORMS. fy . Fl. ext. spigelias § j. Fl. ext. sennae § ss. M. S. — Ateaspoonful to a child of three to five years ; or I£ . Fl. ext. spigelise et sennas § J- Santonini gr. vii j. M. S. — Teaspoonful to a child of five. J. L. Smith. For the expulsion of the round worm no bet- ter formulae than these have been devised. They are found an effectual means also of de- stroying the ascaris vermicularis. Ijfc . Epsom salts 2 ounces. Common salt \ ounce. M. S. — Give two tablespoonfuls in a half -glass of water, with five drops carbolic acid, night and morning, for ascarides. The salt and carbolic acid will destroy the worms, and the brisk action of the salts will carry them out. Persevere. Barkley. prescriber's memoranda. 301 WOUNDS. Dr. Millet, a French army surgeon, recom- mends powdered aloes as a dressing for wounds, both as a means of favoring cicatrization and for closing them. It is said to relieve the severe pain of wounds almost immediately, and re- quires to be removed only at long intervals. 5 . Acid, tannic § ij. Alcoholis absolut fl. § ss. Athens fl. § ijss. Collodion q. s. ad. fl. § xij. M. Styptic colloid. 3. Collodion fl. I j. Olei ricini, Acid, carbolic aa fl. 3 ss. M. Carbolized collodion.