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AN INDEX
DISEASES AND THEIR TREATMENT,
WORKS BT
THOMAS HAWKES TANNER,
M.D., F.L.S., ETC.
There is a common character about the writings of Dr. Tanner — a character- istic which constitutes one of their chief values; they are all essentially and thoroughly practical. Dr. Tanner never, for one moment, allows this utilitarian end to escape his mental view. He aims at teaching how to recognize and how to cure disease, and in this he is thoroughly successful. . . . They contain, indeed, a wonderful mine of knowledge. — Medical Times.
I.
THE PRACTICE OF MEDICINE. Sixth American, from the last London edition. Revised, much enlarged, and thor- oughly brought up to the present time. With a complete Sec- tion on the Diseases Peculiar to Women, an extensive Appen- dix of Formulae for Medicines, Baths, &c. &c. Royal octavo, over HOC pages. Price, in cloth, ^6.00; leather, ^7.00.
II.
A PRACTICAL TREATISE ON THE DISEASES OF INFANCY AND CHILDHOOD. Third American, from the last London edition, revised and enlarged. By Alfred Meadows, M.D., London, M.R.C.P., Physician to the Hos- pital for Women and to the General Lying-in Hospital, &c. &c. Price ^3^.00.
This book of Dr. Tanner's has been much enlarged and the plan altered by Dr. Meadows. As it now stands, it is probably one of the most complete in our language. It no longer deals with children's diseases only, but includes the pe- culiar conditions of childhood, both normal and abnormal, as well as the thera- peutics specially applicable to that class of patients. The articles on Skin Dis- eases have been revised by Dr. Tilbury Fox, and those on Diseases of the Eye by Dr. Brudenell Carter, both gentlemen distinguished in these specialties.
III.
AN INDEX OF DISEASES AND THEIR TREATMENT. Second Edition. Revised by W. H. Broadbent, M.D., F.R.C.P., &c. One volume, octavo. Price ^3.00.
IV.
MEMORANDA ON POISONS. A New and much Enlarged Edition. Price 75 cents.
AN
INDEX OF DISEASES
AND THEIR
TREATMENT.
BY
THOMAS HAWKES TANNER, M.D.,F.L.S.
SECOND EDITION. REVISED
BY
W. H. BROADBENT, M.D.,
FELLOW OF THE EOTAL COLLEGE OF PHYSICIANS,
PHYSICIAN TO THE LONDON FEVER HOSPITAL,
PHYSICIAN TO ST. MARY'S HOSPITAL AND LECTURER ON
MEDICINE AT ST. MARY'S HOSPITAL MEDICAL SCHOOL.
PH IL ADELPHI A: LINDSAY AND BLAKISTON.
1877.
/^fe
^6N r/fggv APR 26 1918
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<&fBRA^
COLLINS, PRINTER.
PREFACE
THE SECOND EDITION^
A NEW edition of the Index has been urgently demanded for some, time. In its preparation, the plan and objects of the Author have been constantly borne in mind, and while every section has been carefully revised and considerable alterations made, these have only been such as were required in order to incorporate new knowledge, or to render diagnosis more definite. There has thus been no change, either in principles or in method, and it is hoped that the volume will continue to serve effectually the purjjose for which it was originally desiffned.
PEEFACE
THE FIRST EDITION
The present volume is intended to facilitate the daily work of the busy practitioner ; and especially to help him in successfully managing such cases of disease as do not yield to treatment so readily as might be desired. The student who wishes to learn the nature of the tools with which he will have to work, and the best mode of employing them, must seek for this information in other treatises. But it is hoped that the actual laborer, who has employed his customary weapons and finds himself baffled, will receive useful suggestions from the following pages.
In constructing the various articles of which this Index is com- posed, the Author has endeavored by giving a brief description of each disease to make its diagnosis sure. With regard to the sections on Treatment, it is to be remembered that the numbers appended to the drugs not only refer to the Formulae, but indicate those remedies on which it is believed that reliance should be chiefly placed. As a rule, however, most of the agents which have been recommended by different authorities are mentioned; although where they a,re not deemed particularly useful, either no reference is given for the mode in which they are to be prescribed, or they are placed in a separate paragraph.
It is only necessary to add that the Formulae have been reprinted from the last edition of the Author's Practice of Medicine, with a few alterations and additions. Each prescription has been written in accordance with the rules and preparations of the British Pharma- copceia, — a work which the practitioner will esteem the more highly, the more attentively he studies its pages.
TABULAR SYNOPSIS.
ABSCESSES :—
I. Abscess of Brain, p. 67. II. Abscess of External Auditory Canal, p. 185.
III. Abscess of Tonsil, p. 253.
IV. Eetro-Pharyngeal Abscess, p. 225. V. Empyema, p. 101 ; 206.
YI. Abscess of Abdominal Walls, p. 33. TIL Hepatic Abscess, p. 133. VIII. Perinephritic Abscess, p. 198. IX. Abscess around Caecum, p. 55 ; 199. X. Prostatic Abscess, p. 214. XI. Pelvic Abscess, p. 33 ; 196. XII. Ovarian Abscess, p. 186.
XIII. Abscess of Vaginal Labia, p. 277.
XIV. Lumbar, Psoas, and Iliac Abscess, p. 162. XV. Mammary Abscess, p. 163.
XVL Abscess of Bone, p. 182. XVII. Boils, p. 50. Styes, p. 242. XVIII. Carbuncle, p. 56. XIX. Bubo, p. 53. XX. Strumous Abscess, p. 232.
BLADDER DISEASES :—
I. Vesical Irritability, p. 271. II. Vesical Spasm, p. 272.
III. Vesical Paralysis, p. 272.
IV. Vesical Inflammation —
1. Acute Cystitis, p. 271.
2. Chronic Cystitis, p. 271.
V. Vesical Tumors, p. 272. VI. Urinary Calculi, p. 260. VII. Enuresis, p. 105.
TABULAR SYNOPSIS.
BLOOD DISEASES:— I. Anaemia, p. 38. II. Chlorosis, p. 69. III. Graves' Disease, p. 123. lY. Leucocythemia, p. 160. Y. Hypersemia, p. 143. YI. Ichorhsemia, or Pyasmia, p. 145 ; 218. YII. Piarhsemia, p. 205. YIII. Acholia, p. 33. IX. Glucohaemia, p. 121.
X. Ursemia, p. 259. XI. Hagmatozoa, p 124. XII. Thrombosis, p. 250. Embolism, p. 100. XIII. Scurvy, p. 233. XIY. Purpura, p. 218. XY. Black Leg, p. 49. XYI. Cellulitis Yenenata, p. 63. XYII. Glanders, p. 120. XYIII. Hydrophobia, p. 142. XIX. Elephantiasis Graecorum, p. 99. XX. Pellagra, p. 195.
BLOODYESSEL DISEASES :— I. Aortitis, p. 41. II. Aortic Aneurism, p. 39. III. Phlebitis, p. 200. lY. Phlebolites, p. 201. Y. Phlegmasia Doleus, p. 201. YI. Naevus, p. 173.
BONE DISEASES:— I. Caries, p. 61. II. Necrosis, p. 174. III. Periostitis, p. 198. lY. Osteitis, p. 182. Y. Osteomyelitis, p. 183. YI. Osteomalacia, p. 182. VII. Osteoid Cancer, p. 182. YIII. Eickets, p. 228. IX. Coccyodynia, p. 74. X. Spina Bifida, p. 236.
TABULAR SYNOPSIS. i
BRAIN DISEASES :—
I. Apoplexy, p. 43. Cerebral Hemorrhage, p. 43.
II. Hydrocephalus, p. 141. Hydrocephaloid Disease, p. 14 L.
III. Coma, p. 75.
IV. Compression of Brain, p. 7.5. V. Concussion of Brain, p. 75.
VI. Coup de Soleil, p. 83.
VII. Inflammation —
1. Simple Meningitis, p. 64.
2. Cerebritis, p. 64.
3. Acute Encephalitis, p. 65.
4. Chronic Encephalitis, p. 67.
5. Softening ; Induration ; Tumors, p. 67, 68.
6. Tubercular Meningitis, p. 66.
7. Hypertrophy ; Atrophy, p. 68.
VIII. Alcoholism —
1. Delirium Tremens, p. 87.
2. Dipsomania, p. 91.
IX. Insanity^ —
1. Progressive Paralysis, p. 148.
2. Insanity with Epilepsy, p. 149.
3. Mania, p. 149.
4. Puerperal Mania, p. 216.
5. Monomania, p. 149.
6. Dementia, p. 150.
7. Idiocy, p. 150.
8. Cretinism, p. 84.
X. Headache, p. 127. XI. Vertigo, p. 270. XII. Paralysis, p. 188.
XIII. Epilepsy, p. 106.
XIV. Chorea, p. 72. XV. Aphasia, p. 41.
XVI. Convulsions, p. 79. Eclampsia Nutans, p. 98.
BREAST DISEASES :—
I. Inflammation —
1. Acute Mammitis, p. 165.
2. Chronic Mammitis, p. 165.
II. Tumors —
1. Lacteal, p. 164.
2. Fatty, p. 164.
3. Enchondromatous and Fibroid, p. 164.
4. Fibro-Plastic, p. 164.
5. Hydatid, p. 164.
6. Chronic Mammary, p. 164.
7. Mucous Cysts, p. 165.
8. Carcinoma, p. 55.
III. Mastodynia, p. 168.
TABULAR SYNOPSIS.
BREAST DISEASES— {continued) :— IV. Mammary Abscess, p. 163. "V. Mammary Hypertrophy, p. 163. IV. Mammillary, or Nipple Diseases, p. 165. VII. Agalactia, p. 35. VIII. Galactorrhoea, p. 115.
CALCULOUS CONCRETIONS :— I. Rhinolithes, p. 228. II. Phlebolites, p. 201.
III. Intestinal Concretions, p. 152.
IV. Gall-Stones, p. 115.
V. Pancreatic Calculi, p. 188. VI. Urinary Calcnli, p. 260. VII. Tophi or Chalk-Stones, p. 122. VIII. Lacteal Calculus, p. 164.
CANCER (p. 55) :—
I. Varieties —
1. Scirrhas, or Harel Cancer, p. 55.
2. Medullary, or Soft Cancer, p. 55.
3. Epithelial Cancer, p. 55.
II. Sub-Varieties —
1. Colloid, or Cum Cancer, p. 55. • 2. Melanoid, or Black Cancer, p. 55.
3. Osteoid Cancer, p. 55.
4. Fungus Hsematodes, p. 55.
5. Villous Cancer, p. 55.
III. Of Special Organs —
1. Cancer of Tongue, p. 252.
2. Cancer of Tonsil, p. 253.
3. Cancer of (Esophagus, p. 179.
4. Cancer of Stomach, p. 116.
5. Cancer of Duodenum, p. 93.
6. Cancer of Rectum, p. 219. 1. Cancer of Liver, p. 129.
8. Cancer of Kidney, p. 214.
9. Cancer of Pancreas, p. 188.
10. Cancer of Breast, p. 165.
11. Cancer of Vulva, p. 275.
12. Cancer of Uterus, p. 265.
13. Cancer of Penis, p. 197.
14. Cancer of Testicle, p. 248.
15. Chimney-Sweeper's Cancer, p. 69.
16. Cancer of Bladder, p. 273.
17. Pulmonary Cancer, p. 216.
18. Cardiac Cancer, p. 58.
19. Mediastinal Cancer, p. 154.
TABULAR SYNOPSIS.
DEFORMITIES :—
I. Spinal Curvature, p. 237. II. Rickets, p. 228.
III. Spina Bifida, p. 236.
IV. Osteomalacia, p. 182. V. Coccyodynia, p. 74.
VI. Wry-Neck, p. 279 VII. Club Foot. p. 73. VIII. Flat Foot, p. 113. IX. Knock-Knees, p. 158. X. Epispadias, p. 144. XI. Hypospadias, p. 144. XII. Cretinism, p. 84.
DEGENERATIONS OF TISSUE:— I. Patty Degeneration, p. 111. II. Amyloid Degeneration, p. 37.
III. Mineral Degeneration, p. 169.
IV. Osteomalacia, p. 182. V. Cardiac Atrophy, p. .57.
VI. Hepatic Degeneration, p. 131.
VII. Renal Degenerations, p. 223.
VIII. Arcus Senilis, p. 112.
IX. Cerebral Softening, p. 67.
DROPSY (p. 92) :— I. Ascites, p. 45. II. (Edema, p. 179.
III. Anasarca, p. 38.
IV. Sclerema, p. 231.
V. Bright's Disease, p. 50 ; 223. VI. Acute Desquamative Nephritis, p. 175. VII. Hydrocephalus, p. 141. VIII. Hydrothorax, p. 143 ; 206,
IX. Pneumothorax, with Effusion, p. 209. X. Cardiac Dropsy, p. 60. XI. Hydro Pericardium, p. 142 ; 198. XII. Beriberi, p. 48. XIIT. Hydrocele, p. 140. XIV. Scrotal (Edema, p. 233. XV. Hydronephrosis, p. 142. XVI. Hydrorachis, p. 143 236.
TABULAR SYNOPSIS.
BROrSY— {continued) :— XVII. (Edema of Glottis, p. 150. XVIII. Ovarian Dropsy, p. 186.
XIX. Dropsy of Fallopian Tube, p. 111.
EAR DISEASES :—
I. Otitis—
1. Inflammation of External Meatus, p. 183.
2. Inflammation of Membrana Tympani, p. 184.
3. Inflammation of Tympanic Cavity, p. 184.
II. Diseases of Eustachian Tube —
1. Obstruction of Tube, p. 110.
2. An Open Condition of Tube, p. 111.
III. Otalgia, or Earache, p. 183.
IV. Otorrhoea, p. 185. V. Otorrhagia, p. 185.
VI. Deafness —
1. Rheumatism of Ear, p. 86.
2. Gout of Ear, p. 86.
3. Nervous Deafness, p. 87.
VII. Hsematoma Auris, p. 124.
ENTOZOA (p. 103) :—
I. Trematoda, or Flukes —
1. Fasciola Hepatica, p. 103 ; 124.
2. Distoma Lanceolatum, p. 103.
3. Distoma Ophthalmobium, p. 103.
4. Distoma Crassum, p. 103.
5. Distoma Heterophyes, p. 103.
6. Distoma Haematobium, p. 103 ; 124.
7. Tetrastoma Renale, p. 103.
■ 8. Hexathyridiura Pinguicola, p. 103. 9. Hexathyridium Venarum, p. 103 ; 124.
11. Cestoda, or Tapeworms —
1. 'J'senia Solium, p. 103.
2. Taenia Mediocanellata, p. 104; 153.
3. Taenia Marginata, p. 104.
4. Taenia Echinococcus, p. 104.
5. Bothriocephalus Latus, p. 104 ; 153.
III. Nematoda, or Round Worms —
1. Ascaris Lumbricoides, p. 104; 153.
2. Ascaris Mystax, p. 104.
3. Tricocephalus Dispar, p. 104.
4. Trichina Spiralis, p. 104 ; 255.
5. Strongyhis Bronchialis, p. 104.
6. Eustrongylus Gigas, p. 104.
7. Sclerostoma Duodenale, p. 104.
8. Oxyuris Vermicularis, p. 105.
9. Dracunculus Medinensis, p. 92 ; 105.
IV. Acanthotheca (not true Helminths) —
1. Pentastoma Taenioides, p. 105.
2. Pentastoma Constrictum, p. 105.
TABULAR SYNOPSIS.
Ef^TOZO A— [continued) :—
V. Pseudelniinths —
1. Dactylius Aeiileatus, p. 105.
2. Spiroptera Hominis, p. 105.
3. Diplosonia Crenatum, p. 105.
4. Gordius Aquaticus, p. 105.
EPIPHYTES (p. 107):—
I. In Cutaneous Diseases —
1. Microsporon Furfur, p. 107; 251.
2. Microsporon Mentagrophytes, p. 107; 251.
3. Microsporon Audouini, p. 107; 251.
4. Tricophyton Tonsurans, p. 107; 208; 251.
5. Tricophylon Sporuloides, p. 107 ; 208.
6. Achorion Schonleinii, p. 107 ; 251.
II. In Stomach Diseases —
1. Sarcina Ventriculi, p. 107 ; 119.
2. Cryptococcus Cerevisias, p. 107 ; 119.
III. In Aphtliaj—
1. Oidium Albicans, p. 43; 107.
2. Leptothrix Buccalis, p. 43.
IV. In Fungus Foot of India —
Chionyphe Carteri, p. 107.
EPIZOA (p. 108) :—
I. On the Skin—
1. Pediculus, or Louse, p. 108 ; 202.
2. Pulex Irritans, or Flea. p. 108.
3. Chigoe, or Jigger, p. 108.
4. Ticks, or Ixodes, p. 108.
5. Argades, p. 108.
6. Acanthia Lectularia, or Bug, p. 108.
7. Leptus Autumnalis, or Harvest Bug, p. 108.
II. In the Skin—
1. Acarus Seabiei, or Itch Insect, p. 108 ; 229.
2. Acarus Folliculorum, or Pimple Mite, p. 108.
EYE DISEASES:—
I. Diseases of Eyelids —
1. Ectropion, p. 99.
2. Entropion, p. 105.
3. Epiphora, p. 107.
4. Ophthalmia Tarsi, p. 181.
5. Ptosis, p. 215.
6. Trichiasis, p. 255.
II. Varieties of Sight —
1. Emmetropia, p. 100.
2. Myopia, p. 172.
3. Presbyopia, p. 213.
4. Asthenopia, p. 46.
5. Astigmatism, p. 47.
6. Color-Blindness, p. 74.
7. Hypermetropia, p. 143.
TABULAR SYNOPSIS.
EYE DISEASES— (co«^«i?ied) :—
8. Amblyopia, p. 36.
9. Diplopia, p. 36 ; 91.
10. Hemiopia, p. 36 ; 129.
11. Hemeralopia, p. 36 ; 128.
12. Nyctalopia, p. 36 ; 179.
13. Photophobia, p. 201.
III. Conjunctivitis —
1. Catarrhal Ophthalmia, p. 76.
2. Purulent Ophthalmia, p. 77.
3. Strumous Ophthalmia, p. 78.
4. Granular Conjunctiva, p. 78.
IV. Sclerotitis—
1. Rheumatic Ophthalmia, p. 231.
2. Catarrho-Rheumatic Ophthalmia, p. 232.
V. Corneitis —
1. Keratitis, p. 81.
2. Syphilitic Keratitis, p. 81.
3. Opacity of Cornea, p. 81.
4. Ulcers of Coiniea, p. 81.
5. Conical Cornea, p. 82.
6. Arcus Senilis, p. 82.
VI. Diseases of Iris —
1. Iritis, p. 155.
2. Inflammation of Iris and Cornea, p. 156.
3. Mydriasis, p. 156.
4. Myosis, p. 157.
VII. Choroiditis, p. 72. VIII. Retinitis, p. 225. IX. Cataract, p. 62. X. Muscse Volitantes, p. 170. XL Glaucoma, p. 120. XII. Amaurosis, p. 35. XIII. Exophthalmos, or Proptosis Oculi,. p. Ill; 123; 214.
FEMALE ORGANS OF GENERATION (Diseases of ) :— I. Vulval Pruritus, p. 275.
II. Vulval Tumors —
1. Encysted Tumors, p. 276.
2. Fibrous and Fatty Tumors, p. 276.
3. Warty Growths, p. 276.
4. Hypertrophy of Labia, p. 276.
5. Abscess of Labia, p. 277.
6. Pudendal Hsematocele, p. 277.
III. Inflammation of Vulva —
1. Simple Vulvitis, p. 277.
2. Gangrenous Vulvitis, p. 277.
3. Follicular Inflammation, p. 277.
4. Erythema, p. 278.
5. Infantile Leucori'hcea, p. -278.
TABULAR SYNOPSIS. '
FEMALE ORGANS OP GEl<iERAT10^—{contmuecl) :- IV. Yulval Corroding Ulcer, p. 27.5. V. Vulval Cancer, p. 27.5. VI. Clitoritis, p. 73. VII. Vascular Tumor of Urethra, p. 270.
VIII. Vaginal Diseases —
1. Vaginal Occlusion, p. 267.
2. Vaginismus, p. 268.
3. Vaginitis, p. 268.
4. Vaginal Prolapsus, p. 268.
5. Vaginal Tumors, p. 268.
IX. Pelvic Cellulitis, p. 196. X. Pelvic Hematocele, p. 196.
XI. Uterine Diseases —
1. Amenorrhoea, p. 36.
2. Leucorrhcea, p. 102 ; 160 ; 269.
3. Dysmenorrhoea, p. 95.
4. Menorrhagia, p. 168.
5. Uterine Hemorrhage, p.. 265.
6. Endometritis, p. 102.
7. Metritis, p. 169.
8. Ulceration, p. 266.
9. Cancer, p. 262.
XII. Uterine Tumors —
1. Fibroid Growths, p. 265.
2. Polypi, p. 266.
3. Cystic Growths, p. 266.
XIII. Uterine Displacements — ■
1. Prolapsus and Procidentia, p. 263.
2. Retroflexion and Anteflexion, p. 264.
3. Retroversion and Anteversion, p. 264.
4. Inversion, p. 265.
XIV. Diseases of Ovaries and Oviducts —
1. Ovaritis, p. 187.
2. Ovarian Tumors, p. 186.
3. Displacements of Ovary, p. 186.
4. Dropsy of Fallopian Tube, p. 111.
XV. Impotence and Sterility, p. 146. XVI. Gonorrhoea, p. 121. Urethritis, p. 260. XVII. Syphilis, p. 244.
FEVERS (p. 108; 112):—
I. Continued Fevers —
1. Simple Continued Fever, p. 233.
2. Typhus, p. 258.
3. Typhoid Fever, p. 257.
4. Relapsing Fever, p. 221.
11. Intermittent Fevers —
1. Intermittent Fever, or Ague, p. 151.
2. Brass Founder's Ague, p. 50.
• TABULAR SYNOPSIS.
FEY ERS—icontmued) :—
III. Remittent Fevers —
1. Remittent Fever, p. 222.
2. Yellow Fever, p. 279.
IV. Eruptive Fevers —
1. Rubeola, p. 166 ; 229.
2. Smallpox, p. 234.
3. Cow-Pox. p. 83.
4. Chicken-Pox. p. 68.
5. Measles, p. 166.
6. Scarlet Fever, p. 230.
7. Dengise, p. 88.
8. Erysipelas, p. 109.
9. Miliaria, p. 169. 10. Plague, p. 205.
FORMULiE (p. 281]:—
I. Aliments, p. 283.
II. Alteratives and Resolvents, p. 290. III. Antacids, p. 299. lY. Antiseptics, p. 301. Y. Antispasmodics, p. 304. YI. Astringents, p. 306. YIL Baths, p. 310. YIII. Cathartics and Anthelmintics, p. .^14. IX. Caustics and Counter-irritants, p. 323, X. Diaphorectics and Diuretics, p. 325. XI. Emetics and Expectorants, p. 329. XII. Gargles and Inhalations, p. 331. XIII. Lotions, Liniments, Oollyria, and Ointments, p. 334. XIY. Narcotics and Sedatives, p. 341. XY. Refrigerants a,nd Salines, p. 351. XYL Stimulants, p. 353. XYII. Tonics, p. 355. XYIII. Uterine Therapeutics, p. 366. XIX. Electro-Therapeutics, p. 371. XX. Climates for Invalids, p. 378. XXI. Mineral Waters, p. 409.
FURUNCULAR INFLAMMATIONS :— I. Boils, p. 50.
II. Carbuncles, p. 56.
III. Malignant Yesicle, p. 162. lY. Styes, p. 242.
TABULAR SYNOPSIS.
GOUT AND RHEUMATISM:— I. Gout, p. 122. II. Acute Rbeumatism, p. 225.
III. Chronic Rheumatism, p. 226.
IV. Rheumatoid Arthritis, p. 227. V. Lumbago, p. 161 ; 226,
VL Pleurodynia, p. 207 ; 226. VII. Sciatica, p. 177 ; 226 ; 231. VIII. Rheumatic Ophthalmia, p. 231.
IX. Gouty and Rheumatic Deafness, p. 86.
HEMORRHAGE (p. 126) :—
I. Hemorrhagic Diathesis, p. 126. II. Epistaxis, p. 107,
III. Cerebral Apoplexy, p. 43.
IV. Cerebral Hemorrhage, p. 43 ; 63. • V. Cephalohfematoma, p, 63.
VL Otorrhagia, p. 185. VII. Haematoina Auris, p. 121. VIII. Spinal Hemorrhage, p. 238. IX. Stomatorrhagia, p. 241.
X. Hsemoptysis, p. 125.
XL Pulmonary Apoplexy, p. 216. XII. Hsemateraesis, p. 123; 125.
XIII. Metena, p. 167.
XIV. Apoplexy of Liver, p. 131. XV. Hsematuria, p. 124,
XVI. Menorrhagia, p. 168.
XVII. Uterine Hemorrhage, p. 265.
XVIII. Pudendal Hsematocele, p. 277.
XIX. Pelvic Haematocele, p, 196.
XX. Scrotal Hematocele, p. 140.
HEART DISEASES:—
I. Pericarditis, p. 198. Hydro-Pericardium, p. 142 ; 198. II. Endocarditis, p. 101.
III. Myocarditis, p. 172.
IV. Valvular Diseases, p. 60.
V. Cardiac Hypertrophy, p. 59. VI. Cardiac Dilatation, p. 58. 2
TABULAE SYNOPSIS.
HEART DISEASES— (con^mued) :—
VII. Cardiac Atrophy —
1. Simple Atrophy, p. 57.
2. Fatty Degeneration, p. 57.
3. Fatty Growth, p. 58.
YIII. Cyanosis, p. 85. IX. Cardiac Rupture, p. 59. X. Angina Pectoris, p. 39. XI. Cardiac Aneurism, p. 57. XII. Cardiac Cancer, p. 58.
XIII. Cardiac Functional Derangement, p. 58.
XIV. Intra-Thoracic Tumors, p. 154.
|
ERNIA (p. 136):— |
|
|
I. General Varieties, p. 136, |
|
|
1. |
Reducible. |
|
2. |
Irreducible. |
|
3. |
Incarcerated. |
|
4. |
Strangulated. |
|
II. Special Hernias, p. 137. |
|
|
1. |
Oblicpie Inguinal. |
|
2. |
Direct Inguinal. |
|
3. |
Congenital. |
|
4. |
Femoral. |
|
5. |
Umbilical. |
|
6. |
Ventral. |
|
7. |
Obturator. |
|
8. |
Ischiatic. |
|
9. |
Perineal. |
|
10. |
Vaginal. |
|
11. |
Labial. |
|
12. |
Diaphragmatic. |
INFLAMMATION (p. 147) :—
I. Nervous System —
1. Cerebral Meningitis, p. 64.
2. Cerebritis, p. 64.
3. Encephalitis, p. 65.
4. Spinal Meningitis, p. 239.
5. Cerebro-Spinai Meningitis, p. 239.-
6. Myelitis, p. 171.
7. Neuritis, p. 178.
II. Organs of Respiration —
1. Laryngitis, p. 158.
2. Tracheitis, or Croup, p. 85.
3. Bronchitis, p. 50.
4. Pleurisy, p. 206.
5. Pneumonia, p. 208.
6. Pleuro-Pneumoiiia, p. 207.
TABULAR SYNOPSIS.
INFLAMMATION— (co7i<«itted) :—
III. Organs of Circulation —
1. Pericarditis, p. 198.
2. Endocarditis, p. lOL
3. Myocarditis, p. 172.
4. Aortitis, p. 41.
5. Phlebitis, p. 200.
IV. Organs of Digestion —
1. Glossi'tis. p. 252.
2. Stomatitis, p. 241.
3. Parotitis, p. 195.
4. Tonsillitis, p. 253.
5. Pharyngitis, p. 200.
6. (Esophagitis, p. 180.
7. Gastritis, p. 118.
8. Duodenitis, p. 93.
9. Enteritis, p. 102.
10. Typhlitis, or Ctecitis. p. 55.
11. Perityphlitis, p. 199.
12. Colitis (Dysentery), p. 94.
13. Rectitis. p. 221.
14. Hepatitis, p. 133.
15. Pancreatitis, p. 188.
16. Splenitis, p. 240.
V. Urinary Organs —
1. Nephritis, p. 174.
2. Acute Desquamative Nephritis, p. 175.
3. Chronic Desquamative Nephritis, p. 176.
4. Acute Cystitis, p. 271.
5. Chronic Cystitis, p. 271.
6. Urethritis, p. 260.
VI. Male Organs of Generation —
1. Balanitis, p. 47.
2. Prostatitis, p. 214.
3. Testitis, p. 248.
VII. Female Organs of Generation —
1. Vulvitis, p. 277.
2. Clitoritis, p. 73.
3. Vaginitis, p. 268.
4. Pelvic Cellulitis, p. 196.
5. Metritis, p. 169.
6. Endometritis, p. 102.
7. Ovaritis, p. 187.
VIII. Eye—
1. Conjunctivitis, p. 76.
2. Sclerotitis, p. 231.
3. Corneitis, p. 81.
4. Choroiditis, p. 72.
5. Iritis, p. 155.
6. Retinitis, p. 225.
IX. Bone—
1. Periostitis, p. 198.
2. Osteitis, p. 182.
3. Osteomyelitis, p. 183.
TABULAR SYNOPSIS.
INFLAMMATION— (co«^2«Me£^) :—
X, Various Organs and Tissnes —
1. Mammitis, p. 165.
2. Otitis, p. 183.
3. Peritonitis, p. 199.
4. Myositis, p. 172.
5. Angeioleucitis, p. 38.
6. Adenitis, p. 34.
7. Housemaid's Knee, p. 140.
8. Cellalitis Venenata, p. 63.
INTESTINAL DISEASES:—
I. Duodenal Disease —
1. Duodesitis, p. 93.
2. Duodenal Dyspepsia, p. 93.
3. Perforating Ulcer, p. 93.
4. Cancer, p. 55.
II. Enteritis, p. 102. HI. Csecitis, p. 55. Perityphlitis, p. 199, IV. Dysentery, p. 94.
V. Diarrhoea, p. 89. Melsena, p. 167. VI. Cholera, p. 70. VII. Flatulence, p. 113.
VIII. Colic—
1. Simple Colic, p. 74.
2. Copper Colic, p. 80.
3. Lead Colic, p. 159.
IX. Constipation, p. 78. X. Intestinal Obstraction, p. 152. XI. Intussusception, p. 155. XII. Intestinal Worms, p. 153.
XIII. Intestinal Perforation, p. 153.
XIV. Intestinal Concretions, p. 152.
XV. Diseases of Rectum —
1. Rectitis, p. 221.
2. Foreign Bodies in Rectum, p. 118.
3. Rectal Ulcers, p. 220.
4. Rectal Stricture, p. 220.
5. Rectal Prolapsus, p. 219.
6. Rectal Polypus, p. 219.
7. Pruritus Ani, p. 215.
8. Rectal Neuralgia, p. 219,
9. Fistula in Ano, p. 112.
10. Hsemorrhoids, p. 126.
11. Cancer, p. 219.
XVI. Hernia, p. 13G.
TABULAR SYNOPSIS. xxi
KIDNEY DISEASES :—
I. Inflammation —
1. Nephritis, p. 174.
2. Acute Desquamative Nephritis, p. 175.
3. Chronic Desquamative Nephritis, Contracted Gran-
ular Kidney, p. 176.
II. Renal Degeneration —
1. Fatty Degeneration, p. 223.
2. Amyloid Degeneration, p. 223.
3. Cystic Degeneration, p. 224.
III. Hydronephrosis, p. 142.
IV. Renal Cancer, p. 222. Y. Renal Tubercle, p. 224.
YI. Renal Parasites, p. 224. YII. Diabetes Mellitus, p, 88. YIII. Diuresis, p. 91. Polyuria, p. 213. IX. Chylous Urine, p. 72. X. Hsematuria, p. 124. XL Urinary Deposits, p. 261. XIL Urinary Calculi, p. 260. XIII. Enuresis, p. 105. XIY. Urajmia, p. 259. XY. Supra-Renal Capsular Disease, p. 242.
LARYNGEAL AND TRACHEAL DISEASES :— I. Aphonia, p. 42.
II. Laryngitis — ■
1. Acute Laryngitis, p. 158.
2. (Edema of Glottis, p. 159.
3. Chronic Laryngitis, p. 159.
III. Laryngismus Stridulus, p. 158. lY. Dysphonia Clericorum, p. 97. Y. Diphtheria, p. 90. YI. Croup, p. 85. YII. Foreign Bodies in Air-Passages, p. 114. YIII. Haemoptysis, p. 125.
LIYER DISEASES :—
I. Hepatic Congestion —
1. Passive Congestion, p. 130.
2. Active Congestion, p. 130.
3. Apoplexy of Liver, p. 131.
II. Hepatic Hypertrophy, p. 132.
TABULAR SYNOPSIS.
LIVER DISEASES— (cow^mt(ed):—
III. Inflammation —
1. Hepatitis, p. 133. ■ 2. Cirrhosis, p. 134.
3. Syphilitic Hepatitis, p. 134.
4. Inflammation of Bloodvessels, p. 135.
5. Of Biliary Ducts and Gall-Bladder, p. 135.
IV, Hepatic Atrophy—
1. Acute or Yellow Atrophy, p. 129,
2. Chronic Atrophy, p. 129.
V. Hepatic Deg'eneration —
1. Fatty Degeneration, p. 131.
2. Amyloid Degeneration, p. 131.
3. Pigment Liver, p. 132.
YI. Hepatic Tumors —
1. Cystic, p. 132.
2. Cavernous, p. 132.
3. Tubercular, p. 132.
4. Hydatid, p. 132. ■
YII. Hepatic Cancer, p. 130. YIII. Gail-Stones, p. 115. IX. Jaundice, p. 157. X. Acholia, p. 33.
LUNG DISEASES :—
I. Catarrh, p. 62. Congh, p. 82. II. Influenza, p. 148.
III. Bronchitis —
1. Acute Bronchitis, p. 50. ,
2. Chronic Bronchitis, p. 51.
3. Catan'hus Senilis, p. 52.
4. Plastic Bronchitis, p. 52.
5. Mechanical Bronchitis, p. 52.
6. Secondary Bronchitis, p. 52.
7. Hay Asthma, p. 52.
lY. Hooping-Cough, p. 139. Y. Asthma, p. 46.
YI. Enaphys&ma—
1. Yesicular, p. 100.
2. Interlobular, p. 101.
YII. Pulmonary Condensation —
1. From Yarious Causes, p. 216.
2. Pulmonary Apoplexy, p. 216.
3. Cirrhosis of Lung, p. 73 ; 217.
4. Acquired Pulmonary Collapse, p. 217.
5. Atelectasis, p. 47 ; 217.
YIII. Pleurisy, p. 29-6. Pleuro-Pneumouia, p. 207. IX. Hydrothorax, p. 143 ; 206- X. Pneumothorax, p. 209.
TABULAR SYNOPSIS.
LUNG DISEASES— icontmued) :— XL Empyema, p. 101 ; 207. XII. Pneumonia, p. 208.
XIII. Pulmonary Gangrene, p. 217.
XIV. Phthisis, p. 202.
XV. Pulmonary Cancer, p. 216. XVI. Intra-Thoracic Tumors, p. 1.54. XVII. Foreign Bodies in Air Passages, p. 114. XVIIL Dyspnea, p. 98. Orthopncea, p. 182. XIX. Hsenioptysis, p. 12.5.
LYMPHATIC DISEASES:—
I. Angeioleucitis, p. 38. *
II. Adenitis, p. 34.
III. Cellulitis Venenata, p. 63.
IV. Tabes Meseuterica, p. 246.
MALE ORGANS OF GENERATION (Diseases of) :-
I. Diseases of Penis —
1. Balanitis, p. 47.
2. Hypospadias and Epispadias, p. 144.
3. Phimosis, p. 200.
4. Paraphimosis, p. 195.
5. Priapism, p. 213.
6. Prostatitis, p. 214.
7. Prostatic Enlargement, p. 214.
8. Cancer, p. 55 ; 197.
II. Diseases of Testicle —
1. Acute Testitis. p. 248.
2. Chronic 'I'estitis, p. 248.
3. Abscess and Fungus, p. 249.
4. Scrofula, p. 249.
5. Neuralgia, p. 176.
6. Tumors, p. 253.
7. Varicocele, p. 269.
8. Hydrocele and Hematocele, p. 140.
III. Diseases of Scrotum —
1. Acute (Edema, p. 233.
2. Elephantiasis, p. 232.
3. Chimney-Sweeper's Cancer, p. 69.
IV. Impotence and Sterility, p. 146.
V. Gonorrhoea, p. 121. Urethritis, p. 260. VI. Spermatorrhoea, p. 236. VIL Syphilis, p. '244. Bubo, p. 53. VIII. Syphilization, p. 246. IX. Syphiliphobia, p. 244.
TABULAR SYNOPSIS.
MELANOSIS :—
I. True Melanosis, p. 168. II. Spurious Melanosis, p. 168.
MISCELLANEA :— •
I. Expectation of Life, p. 111.
II. Death Causes, p. 81.
III. Weight of Body, p. 278.
IV. Temperature of Body, p. 247.
V. Spirometry, p. 240.
YI. Suspended Animation, p. 242. VII. Bites of Venomous Reptiles, p. 49. VIII. Bites of Rabid Animals, p. 49. IX. Obe'sity, p. 179.
X. Dyspnoea, p. 98. Orthopnoea, p. 182. XL Sleeplessness, p. 233. XII. Cough, p. 82. XIIL Hiccough, p. 138. XIV. Dysphagia, p. 97. XV. Vomiting and Retching, p. 273. XVI. Blows and Braises, p. 50. XVII. Burns and Scalds, p. 54. XVIIL Anorexia, p. 39. XIX. Headache, p. 127. Vertigo, p. 270.
MOUTH DISEASES:—
I. Inflammation, etc. — '■
1. Follicular Stomatitis, p. 241.
2. Ulcerative Stomatitis, p. 241.
3. Cancrum Oris, p. 241.
4. Stomatorrhagia, p. 241-
II. Toothache, p. 254.
III. Aphthae of Mouth, p. 43.
IV. Parotitis, p. 195. V. Tonsillitis, p. 253.
VI. Elongation of Uvula, p. 200.
MUSCULAR DISEASES :— I. Myalgia, p. 171.
II. Pleurodynia, p. 207.
III. Myositis, p. 172.
IV. Phantom, or Muscular Tumors, p. 170. V. Contusions of Abdominal Parietes, p. 79.
VI. Abscess of Abdominal Parietes, p. 33. A^II. Lumbar, Psoas, and Iliac Abscess, p. 162.
TABULAR SYNOPSIS.
NERVOUS DISEASES:—
I. Hysteria, p. 144. Bed Case, p. 48. II. Catalepsy, p. 61. Ecstasy, p. 98.
III. Chorea, p. 72.
IV, Tetanus, p. 249. Trismus Nascentium, p. 256. V. Epilepsy, p. 106. Convulsions, p. 79.
VI. Sleeplessness, p. 233. VII. Hypochondriasis, p. 143. Syphiliphobia, p. 244.
VIII. Inflammation, etc. —
1. Neuritis, p. 178.
2. Neuroma, p. 178.
IX. Neuralgia —
1. 'I'ic Douloureux, p. 177.
2. Hemicrania, p. 129 ; 177.
3. Sciatica, p. 177; 231.
X. Hooping-Cough, p. 139. XI. Asthma, p. 46. XII. Laryngismus Stridulus, p. 158.
XIII. Nostalgia, p. 178.
XIV. Headache, p. 127.
NEURALGIA (p. 176) :—
I. Neuralgic Toothache, p. 255. II. Tic Douloureux, p. 177 ; 250.
III. Hemicrania, p. 129; 177.
IV. Sciatica, p. 177 ; 231. V. Mastodynia, p. 166.
VI. Intercostal Neuralgia, p. 151. VII. Neuralgic Dysmenorrhcea, p. 95. VIII. Neuralgia of Testicle, p. 247. IX. Neuralgia of Rectum, p. 219. X. Spasm of Bladder, p. 272.
NOSE DISEASES :— I. Lipoma, p. 174. II. Polypus, p. 174. IIL Ozsena, p. 187. IV. Epistaxis, p. 107. V. Rhinolithes, p. 228. VI, Rhinorrhoea, p. 228.
PANCREATIC AND SPLENIC DISEASES :— I. Pancreatitis, p. 188. II. Pancreatic Tumors, Cancer, etc., p. 188.
TABULAR SYNOPSIS.
PANCREATIC AND SPLENIC BISE A.SES—{conimued) :— III. Pancreatic Calculi, p. 188. lY. Splenitis, etc., p. 240. Y. Splenic Enlargement, p. 240.
PHARYNGEAL AND (ESOPHAGEAL DISEASES :— I. Dysphagia, p. 97.
II. Pharyngitis —
1. Erysipelatous Inflammation, p. 200.
2. Syphilitic Ulceration, p. 200.
3. Elongation of Uvula, p. 200.
III. Retro-Pharyngeal Abscess, p. 225. lY. (Esophagitis, p. 181. Y. (Esophageal Cancer, p. 179. VI. (Esophageal Stricture, p. 180. YII. (Esophagism. p. 180.
POISONS (p. 209) :—
I. — Irritants, p. 209.
1. Acids and their Bases —
Mineral Acids —
Sulphuric.
Nitric.
Hydrochloric.
Mixed Acids. Yegetable' Acids —
Acetic.
Tartaric.
Oxalic. Phosphorus.
2. Alkalies and Alkaline Salts —
Ammonia, Potash, Soda, and their carbonates. Nitrate, Sulphate, and Bitartrate of Potash. Lime, Baryta and its salts.
3. Metallic Compounds —
Arsenic.
Mercury.
Lead.
Copper.
Antimonial compounds.
Zinc, Silver, Tin, Bismuth, Chrome, Iron.
4. Yegetable and Animal Irritants.
5. Irritant Gases.
II. — Narcotics, p. 212.
1. Opium.
2. Hydrocyanic Acid.
3. Nitro-Benzole, Aniline.
4. Chloroform, yEther, Amylene.
5. Alcohol.
6. Henbane, Lettuce-opium, Nightshade.
7. Narcotic Gases.
TABULAR SYNOPSIS. xivi
POISONS— (co?2(;/ni(efZ) :—
III. — Narcotico-Irritants, p. 212.
1. Nux Vomica, Brucia, Strychnia.
2. Belladonna, Aconite, Stramonium, Colchicum, Hel
lebore.
3. Digitalis, Tobacco, Lobelia Inflata, Camphor.
4. Hemlock, Coccuhis Indicus, Darnel-seeds.
5. Laburnum, Yew.
6. Ergot of Rye, Poisonous Fungi.
SKIN APPENDAGES (Diseases of) :— I. Alopecia, or Baldness, p. 35. II. Trichiasis Oiliorum, p. 255. in. Onyxis, p. 181. lY. Onychia, p. 181. Y. YerruciB, or Warts, p. 270. YI. Phthiriasis, or Lousiness, p. 202. YIL Tinea, p. 250. YIII. Dracontiasis, p. 92. IX. Mycetoma, p. 171.
SKIN DISEASES :—
Order I. E.xanthemata —
1. Erythema, p. 110.
2. Roseola, p. 228.
3. Urticaria, p. 262.
Order II. Yesiculse — ■
1. Sudamina, p. 242.
2. Miliaria, p. 159.
3. Herpes, p. 138.
4. Pemphigus, p. 197.
5. Rupia, p. 229.
Order III. Pustulse —
1. Ecthyma, p. 99.
2. Impetigo, p. 145.
Order lY. Parasitici —
1. Tinea Tonsurans, p. 251.
2. Tinea Favosa, p. 251.
3. Tinea Decalvans, p. 251.
4. Tinea Sycosis, p. 251.
5. Tinea Yersicolor, p. 251.
6. Plica Polonica, p. 208.
7. Scabies, p. 229.
Order Y. Papulae —
1. Strophulus, p. 242.
2. Lichen, p. 161.
3. Prurigo, p., 214.
Order YI. Squamae —
1. Lepra, p. 160.
2. Psoriasis, p. 215.
3. Pityriasis, p. 205.
4. Eczema, p. 99.
5. Ichthyosis, p. 145.
i TABULAR SYNOPSIS.
SKIN DISEASES— (co?2^mMed):—
Order VII. Tubercula —
1. Barbadoes Leg, p. 48.
2. Molluscum, p. 170.
3. Acne, p. 33.
4. Lupus, p. 162.
5. Frambcesia, p. 115.
6. Keloid, p. 1.57.
7. Vitiligo, p. 273.
SPINAL COED DISEASES:—
I. Inflammation, etc. —
1. Spinal Meningitis, p. 239.
2. Cerebro-Spinal Meningitis, p. 239.
3. Myelitis, p. 239.
4. Spinal Hemorrhage, p. 239.
5. Tumors, p. 239.
6. Hydrorachis, p. 52 ; 143.
7. Concussion, p. 76.
8. Spinal Irritation, p. 238.
II. Paralysis —
1. Paraplegia, p. 190.
2. Reflex Paralysis, p. 237.
3. Progressive Locomotor Ataxy, p. 191.
4. Sclerosis of Lateral Column, p. 192.
5. Infantile Paralysis, p. 192.
6. Hysterical and Rheumatic Palsy, p. 193.
7. Progressive Muscular Atrophy, p. 193.
8. Pseudo-Hypertrophic Paralysis, p. 194.
9. Mercurial Palsy, p. 194.
10. Lead Palsy, p. 194.
11. Paralysis Agitans, p. 194.
III. Tetanus —
1. Trismus, or Lock-jaw, p. 249.
2. Opisthotonos, p. 249.
3. Emprosthotonos, p. 249.
4. Pleurosthotonos, p. 250.
5. Trismus Nascentium, p. 256.
IV. Spina Bifida, p. 236.
STOMACH DISEASES :—
I. Dyspepsia—
1. Simple Dyspepsia, p. 96.
2. Gastralgia, or Heartburn, p. 116.
3. Gastrodynia, or Stomach-cramp, p. 119.
4. Pyrosis, or Water-brash, p. 218.
5. Slow Digestion, p. 96.
6. Bulimic Dyspepsia, p. 54.
II. Gastritis —
1. Acute Gastritis, p. 118.
2. Chronic Gastritis, p. 1L8.
3. Gastric Catarrh, p. 118.
4. Induration of Pylorus, p. 118. 5 Dilatation of Stomach, p. 119.
TABULAR SYNOPSIS. s
STOMACH DISEASES— {contmued) :—
III. Gastric Ulcer, p. 117.
IV. Gastric Cancer, p. 116.
V. Gastro-cutaneoiis Fistula, p. 119. VI. Gastro-colic Fistula, p. 119. VII. Hsematemesis, p. 123. Vomiting and Retching, p. 273. VIII. Metena, p. 167.
THYROID GLAND DISEASES:— I. Bronchocele, p. 53. II. Cretinism, p. 84. III. Exophthalmic Goitre, p. 53; 121.
TONGUE DISEASES :— I. Glossitis, p. 252. IL Ulcers, p. 252.
III. Cancer, p. 252.
IV. Cracked Tongue, Tumors, etc., p. 253. V. Aphthae, p. 43.
TOOTHACHE :—
I. Caries, p. 254. II. Inflammation of Pulp, p. 254.
III. Necrosis of Fangs, p. 254.
IV. Neuralgia, p. 255.
TUBERCULAR AND STRUMOUS DISEASES:— I. Tuberculosis, p. 256. Scrofula, p. 232. II. Phthisis, p. 202. Phthisis Laryngea, p. 159.
III. Hydrocephalus, p. 141.
IV. Tabes Mesenterica, p. 246.
V. Tubercular Peritonitis, p. 199. VI. Tubercular Meningitis, p. 66. VII. Tuberculosis of Liver, p. 132. VIII. Renal Tubercle, p. 224. IX. Strumous Abscesses, p. 232.
X. Strumous Adenitis, p. 34; 232. XL Strumous Ulcers, p. 232. XII. Strumous Ophthalmia, p. 78. XIIL Scrofulous Testicle, p. 249. XIV. Rickets, p. 228. XV. Angular Curvature of Spine, p. 237.
TABULAR SYNOPSIS.
TUMOES (Benign) :-
I. Polypi —
1. Nasal, p. 174.
2. Rectal, p. 219.
3. Yaginal, p. 268.
4. Uterine, p. 266.
II. Cerebral Tumors, p. 68.
III. Intra-Thoracic Tumors, p. 154.
IV. Spinal Cord Tumors, p. 239. V. Hepatic Tumors, p. 132.
VI. Tumors of Testicle, p. 248. VII. Mammary Tumors, p. 163. VIII. Muscular, or Phantom Tumors, p. 170. IX. Renal Tumors, p. 222 ; 224. X. Vesical 'i'umors, p. 272. XL Vulval Tumors, p. 276. XII. Vascular Tumors of Urethra, p. 270.
XIII. Vaginal Tumors, p. 268.
XIV. Ovarian Tumors, p. 186. XV. Uterine Tumors, p. 265.
XVI. Hasmorrhoids, p. 126.
ULCERS :—
I. Cancerous Ulceration, p. 56. II. Rodent Ulcer, p. 228.
III. Scrofulous Ulcers, p. 232.
IV. Syphilitic Ulcers, p. 244. V. Lupus, p. 162.
VI. Typhoid Ulcers, p. 257. VII. Varioloid Ulcers, p. 234. VIII. Dysenteric Ulcers, p. 94. IX. Ulcers of Cornea, p. 81. X. Ulcers of Tongue, p. 252. XL Gastric Ulcer, p. 117. XII. Ulcers of Duodenum, p. 93.
XIII. Ulcers of Rectum, p. 220.
XIV. Vulval Corroding Ulcer, p. 275. XV. Ulceration of Cervix Uteri, p. 266.
XVI. Chilblains, p. 69.
XVII. Chapped Hands, p. 68. XVIII. Onychia, p. 181.
TABULAR SYNOPSIS.
VENEREAL DISEASES (p. 270):— I. Balanitis, p. 47. II. Vulvitis, p. 277.
III. Gonorrhoea —
1. Gonorrhoea in Male, p. 121.
2. Chronic Gonorrhoea, or Gleet, p. 122.
3. Gonorrhoea in Female, p. 122.
IV. Syphilis—
1. Primary Syphilis, p. 244.
2. Constitutional Syphilis, p. 245.
3. Infantile Syphilis, p. 245.
V. Bubo, p. 53.
VI. Syphiliphobia, p. 244.
VII. Syphilization, p. 246. VIII. Syphilitic Keratitis, p. 81.
IX. Syphilitic Iritis, p. 155.
X. Gonorrhoea! Ophthalmia, p. 76.
XL Syphilitic Tumors of Brain, p. 66.
XII. Syphilitic Laryngitis, p. 158.
XIII. Syphilitic Bronchitis, p. 52.
XIV. Syphilitic Ulceration of Fauces, p. 245. XV. Syphilitic Affections of Tongue, p. 252 ; 253.
XVI. Syphilitic Hepatitis, p. 134. XVII. Syphilitic Sarcocele, p. 248. XVIII. Syphilitic Ulceration of Labia Uteri, p. 266. XIX. Syphilitic Lepra, p. 160. XX. Syphilitic Rupia, p. 229.
APR 2^ 1918 4LBRABi
INDEX OF DISEASES
ABSCESS OF ABDOMINAL WALLS— From Abscedo, to form an abscess. — May result from external violence; furuiicular inflammation, and erysipelas; or from extension of disease in other parts. Many examples of latter: — Inflammation and suppuration of vermiform appendix of ctecum, the pus working its way to surface somewhere about right inguinal region. — - Suppurative inflammatory action apt to occur in areolar tissue of pelvis; in either ovary, especially in delicate and strumous women : abscess after- wards points in one of groins, in hypogastric region, or in vagina, bowel, etc. — Inflammation and suppuration of adipose and areolar tissues around one of kidneys (perinephritic abscess) may occur from blows or falls upon back, or from derangement of general health. In favorable cases, abscess points in one loin : occasionally pus burrows amongst dorsal muscles, being ultimately discharged into ureter, or into cavity of peritoneum. — A circum- scribed abscess may form between liver and diaphragm or in peritoneum, from partial or general peritonitis: the pus, confined by adhesions, either approaches surface at some part of abdominal wall, or bursts into sac of peritoneum, or into bowel, etc. — In all forms, when abscess points, it is to be carefully opened. Strength to be supported by ammonia and bark, or quinine ancl steel: animal food, milk, cod-liver oil, malt liquors. — See Con- tusions of Abdominal Wcdls; Ovaritis; Pelvic Cellulitis, etc.
ACHOLIA. — From 'A, privative; xo^: bile. Synon. Absence of Bile. — Arrest of the functions of the liver; so that matters from which bile is formed accumulate in the blood, producing toxfemia. — It arises in certain diseases of liver — such as acute atrophy, impermeability of the bile ducts, cirrhosis, extensive cancer, fatty degeneration, etc.
Symptoms. Abnormal states of nervous system. Excitement. Noisy delirium. Convulsions. Typhoid prostration. Coma. Hemorrhage from stomach and bowels. Ecchymoses. Jaundice (in a few instances).
Treatment. Active purgatives. Croton oil, 168, 191. Podophyllin. 160. Benzoic acid, 49. Hydrochlorate of ammonia, 60. Nitro-hydrochloric acid, 378. — See Hepatic Atrophy.
AGINESIA. — From 'A, priv. ; xivrjan;, motion. Synon. Immohilitas ; Eremia. — Paralysis of motion. — See Pccralysis.
ACNE. — Perhaps a corruption of 'kxixal, pimples on the face at the age of puberty; or from 'A, priv., and xn'lu, to itch, because there is an absence of irritation. Synon. Gidta Rosacea; Copper Nose; Stonepock. — A chronic tubercular skin affection, the seat of which appears to be the seba- ceous follicles of skin, characterized by small isolated pustules, with deep 3
34 ADDISON'S DISEASE— ADENITIS.
red bases. These pustules, after suppurating and bursting, leave behind them minute and hard red tumors.
Varieties, 'lliree kinds — acne simplex, acne tndurata. and acne rosa- cea: characteristic distinctions indicated by their names. Acne simplex and acne indurata most common about puberty; appear on forehead or sides of cheeks ; are very protracted and frequently leave indelible cica- trices. Acne rosacea attacks the nose, is apparently rather an affection of the skin generally than of the glands : often connected with stomach or liver disease : mostly seen in persons of advanced years, especially if they have been hons vivcmts, etc.
Treatment. Attention to digestive and uterine functions. Arsenic, 52. Creasote. Corrosive sublimate. Green iodide of mercury. Nitrohydro- chloric acid. Solution of potash. Cod-liver oil. — Warm bathing. Iodide of sulphur ointment. Calomel ointment. Eed iodide of mercury ointment. In acne rosacea division of the varicose vessels by transverse incisions with a fine sharp knife ; at the end of a few minutes painting the nose with tinc- ture of perchloride of iron, so as to produce obliteration of the vessels, and contraction of the hypertrophied skin.
ADDISON'S DISEASE. — Applied to a peculiar degeneration of the supra-renal capsules. According to Addison the prominent symptoms were discoloration of the skin, and incurable anaemia. It is now said that the disease may exist without the skin becoming of a dingy or smoky hue. — See Supra-Renal Capsular Disease,
ADENITIS. — From AS-zjj', a gland ; terminal -e'l^^'s. Synon. Phlegmasia Glandulosa. — Inflammation of the lymphatic glands may accompany dis- ease of lymphatic vessels, or it occurs independently. Simple adenitis com- mon after eruptive fevers. Tubercular adenitis very frequently met with in strumous subjects.
Symptoms. Acute form : — Feeling of malaise: slight chills: symp- tomatic fever. One or more glands become swollen, hot, hard, tender, pain- ful. As tumefaction increases, skin over gland becomes red or livid. If convoluted tubes get obstructed, surrounding tissues rendered oedematous. Unless resolution occur, or acute stage subsides into chronic, suppuration takes place : abscess forms in interior of gland, or in surrounding areolar tissue.
Chronic variety : — Induration with persistent enlargement. Pain and heat slight. Skin retains its natural color. Areolar tissue unaffected, so that gland remains movable.
Strumous ctdenitis : — Usually chronic. Glands of neck, and those about base and angle of lower jaw, more frequently affected than any others. Sub- jects of this form are especially young children, though it is not a rare affection of strumous adults. Rarely any premonitory symptoms : first indi- cation of the disease an indolent swelling of one or more glands. If mischief increase, and especially if there be a tendency to suppuration, system suffers considerably ; the already weak patient becomes iri-itable and restless, tongue gets furred, pulse quick and feeble, bowels costive, appetite fails, urine scanty and loaded with urates. Where general health is very bad, inflamed glands rapidly undergo disorganization ; surrounding areolar tissue and skin get involved ; extensive indolent ulcers result. When lymphatic glands of the mesentery are affected with strumous inflammation, a special form of disease is set up (Tabes Mesenterica). — For Syphilitic adenitis, see Bubo. Malignant adenitis, see Cancer.
Treatment. Carbonate of ammonia, 361. Sulphide of potassium or calcium. Chlorate of potash, 61. Ammonia and bark, 371. Quinine, 379. Quinine and steel, 380. Iodide of ammonium and bark, 38. Phos- phate of iron, 405. Cod-liver oil. Bromide of ammonium. Hydrochlorate
ADENOMA— AMAUROSIS. 35
of ammonia. Conium. Iodide of iron. Corrosive sublimate. Red iodide of niercLuy. Nourishing- food : milk or cream. Sea, air. — Water dressing. Iodine liniment. Diluted red iodide of mercury ointment. Iodide of lead ointment. Injections into substance of the glands of solutions of iodine and iodide of potassium, or of acetic acid.
ADENOMA. — Malignant. Synon. Li/mphadenoma ; HodgMn's dis- ease. A disease in which the lymphatic glands become enlarged by increase of glandular structure.
Symptoms. Gradual painless enlargement of nearly all the lymphatic glands. Glands of neck, axilla, groins symmetrically enlarged, not inflamed or fused together; thoracic and abdominal glands also affected. Patient weak, loses flesh, soon out of bi-'eath (jn exertion ; frequently there is an excess of white corpuscles in the blood. There may be symptoms of pres- sure on root of lung or other structures in chest or abdomen. Gradual increasing debility.
No treatment of any avail. Strength to be sustained by nourishing food, cod-liver oil, etc.
AGALACTIA. — From 'A, priv. ; yd7,a, milk. Synon. Defechis Lactis ; Oligogalactia. — A diminution or complete absence of milk in nursing Avomen. May be caused by general weakness of constitution ; long-con- tinued mental anxiety; exhausting disease; general plethora; acute or chronic disease of breasts or nipples; torpor of the mammai; return of menstruation while suckling ; approach of change of life.
Unless cured, infant must be weaned to prevent its suffering from insuffi- cient nourishment. See F. 427.
AGUE. — From the French Aigu, acute. — See Intermittent Fever.
ALCOHOLISM. — Alcohol is a poison which especially affects the nervous centres and liver. In a large dose it may destroy life imme- diately.— See Delirium Tremens ; Dipsomania ; Poisons.
ALOPECIA. — From ^A%u->7ir]^, a fox — because this animal is said to be liable to baldness. Synon. Gapilloi'iun Defluviiim ; Lapsus Pilorum ; Baldness; Calvities {Calvus,\yd]d). — Loss of hair may be temporary or permanent. Senile calvities usually takes place gradually : hair fii'st becomes thin on crown of head, or on temples and forehead. A conse- quence of general loss of power; hair follicles participate in general weakening of nutritive functions. As follicular apparatus gets destroyed, the loss is generally irremediable.
In baldness occurring from debility, hemorrhages, fevers, tuberculosis, syphilis, etc., the hair follicles remain entire, though inactive. Such cases generally curable.
Treatment, Nourishing food. Quinine and steel, S80. Cod-liver oil. Scalp to be well brushed : to be washed with cold -wator every morning. Hairs which are withered and split to be cut off close to scalp. Blisters. Ammonia and cantharides liniment, 287. Cantharidcs, castor oil, balsam of tolu, etc., 287. Iodide of sulphur ointment, 310. Creasote and sulphur ointment, 311. Diluted iodine liniment. Diluted liniment of cantharides. Solution of ammonia Liniment of turpentine and acetic acid. Balsam of Peru. Glycerine. Oil of rosemary (Oleum Rosmarini). Oil of marjoram (Oleum Origani).
AMAUROSIS. — From 'Afxavpoio, to obscure. Synon. Gutta serena. — Partial or complete loss of vision from disease of retina, optic nerve, or brain. Reflex amaurosis due to remote causes, irritation of teething, intestinal worms, ovarian or uterine disease, pregnancy, etc. •
36 AMBLYOPIA— AMENORRHOEA.
Symptoms. Patient's gait and expression of countenance attract atten- tion. He walks with an air of uncertainty: his eyes, instead of beins^ directed towards surrounding objects, have an unmeaning look — appear to be staring at nothing, or are in constant rapid motion [nystagvius). In incomplete amaurosis, movements of iris sluggish and pupil dilated : in total blindness, pupil greatly dilated and iris immovable. When both eyes are affected, they are often unnaturally prominent and of an unhealthy color : sclerotica frequently of a yellow hue, and covered with varicose vessels. — Ophthalmoscope generally reveals either optic neuritis, or atrophy, or retino-choroidal changes — blood extravasations from retina or choroid; or effusions of serum between retina and choroid; or irregular patches of black pigment scattered over retina, or yellowish spots (fatty degeneration) ; or optic disk enlarged and irregular in outline, or sur- rounded by dusky halo, or of an extreme whiteness (from atrophy), with chronic congestion of retina. Atrophy may be secondary to neuritis or primary, in the latter case attributed with much probability to tobacco.
In comnieiieement, failure of sight only experienced occasionally, as after long-continued exertion of the eyes, reading by candlelight, etc. Sometimes it begins with indistinct vision — amJilyopia ; or objects appear double — diplopia ; or only one half of an object may be seen — herniopia. At the same time, frequently headache : ocular spectra become visible, patient complaining of muscse volitantes.
Another form of partial blindness is that in which patient can only see in broad daylight, being blind during remainder of twenty-four hours. This complaint — hemeralopia — usually met with in those who have been exposed to strong glaring light of tropics. In nyctalopia, converse condition of hemeralopia, vision most acute during twilight.
Treatment. Difficult to lay down rules, since the causes are so various and opposite. In all instances, attention to general health. Each case then to be studied in all its bearings, especially with reference to the cause. When manifestly resulting from reflected irritation of worms, decayed teeth, etc., treatment obvious. AVhen from inflammation, — strict quiet, warm baths, and low diet may be necessary : iodide of potassium; aconite; arnica; calo- mel ? ; bloodletting ? When from vascular exhaustion or nervous debility, — ■ preparations of iron, bark, good diet, sea air, and cold bathing. Strychnia injected into the temples in some few examples, may stimulate a torpid optic nerve into action : must be used with great caution. Electricity acts in same way. Counter-irritants behind ears, or to nape of neck, or to shaven scalp. Where there is degeneration of optic nerve, all remedies useless. — Avoidance of intemperance, tobacco, and sexual excesses. Not unlikely that smoking has some influence in causing degeneration of the optic nerve.
AMBLYOPIA. — From 'A^i^xvi, obtuse or dull ; co-^-, the eye. Synon. Diminished Acufeness of Retinal Perception. — Weakness of sight from disease of brain, of optic nerve, or of retinal expansion of optic nerve. — See Amaurosis.
AMENORRHCEA. — From A, priv.; ^171/, a month; ,'ico, to flow. — An absence of the menstrual flow. 'J'wo varieties : —
1. Retention of Menses. — The catamenia are secreted, but do not escape externally. May arise from occlusion of vagina; from an imperforate os uteri. Menses accumulate in uterine cavity, forming in time an appreciable abdominal tumor. An outlet must be made for the menstrual accumulation by very cautiously incising or puncturing obstructing membrane. If no spot or dimple, marking site where os uteri should exist, can be found, it may be necessary to puncture uterus through rectum. Antiseptic injections to be employed afterwards. All such operations attended with danger.
AMNESIA— AM S'LOID DEGENERATION. 37
2. Suppression of Menses. — Most common form of amenorrhoja. The flux liaviiiLi: been iiropcrly cstablislied, and having appeared regulacly for a longer or shorter time, becomes prematurely arrested.
May occur suddenly, while discharge is on, from mental shock, setting in of acute disease, exposure to damp or cold. Or takes place gradually; flow not returning at proper time, or becoming less and less for several periods and then entirely stopping. More constitutional disturbances in abrupt than gradual suppression. Latter most to be feared, as often indicative of more serious cause (severe anaemia, phthisis, albuminuria, etc.). Care neces- sary not to overlook pregnancy.
'I'reatment. If there he plethora: — ^Nitric acid, taraxacum, and senna, 147. Aloes, senna, and sulphate of magnesia, l.'iO. Gamboge, aloes, and blue pill, 174. Podophyllin and aloes, 422. Nitre, spirit of juniper, and nitrous ether, 221. Iodine. Iodide of potassium, 31. Aloes and savin pes- sary, 423. Knema of aloes. Bromide of potassium and cantharides, 422. Ergot of rye. Hot hip baths. Mustard pediluvia. Three or four leeches, repeated at intervals, to cervix uteri. Sinapisms to breast. Turkish baths. Simple diet. Avoidance of stimulants. If there he ancemia : — Steel and aloes, 154, 393, 404. Steel and anmionia, 401. Quinine and steel, 380. Steel and pepsine, 394. Spirit of juniper and acid tartrate of potash, 219. Oil of juniper, 229. Iodide of iron, 32. Iodide of iron and nux vomica, 421. Tincture of actea racemosa. Oil of rue and ergot of rye, 422. Valeria- nate of steel, savin, and assafoetida, 421. Mustard pediluvia. Galvanism. Nourishing food. Brandy; gin; wine. Waters of Spa, Ems, Schwalbach,
AMNESIA. — From 'A, priv. ; fj-vvnii, remembrance. Synon. Ohlivio ; Memoria Z)e/e^a.^Forgetfulness, or loss of memory. A prominent symptom, in certain cerebral diseases, etc.
AMYLOID DEGENERATION.— From Amylum. starch; Degenero, to degenerate. — 'I'he liver, spleen, and kidneys occasionally undergo a degeneration, -which has been described as Amyloid, Lardaceous. Waxy, Cholefiterine or Albuminous Infiltration ; nature and seat of morbid change ascertained by Virchow (1854-1859). In the human body two allied, but not identical substances : — •
(1) Bodies which, in form and chemical properties, are analogous to real vegetable starch, being round or oval, presenting concentric layers — e. g. the little corpora amylaeea of nervous system ; laminated bodies found in prostate of every adult man, and which sometimes form prostatic con- cretions ; and rare forms of a similar kind which occur in certain conditions of lungs.
(2) lu foregoing cases the starch-like matter lies between the elements of ^the tissues. Very different are those cases where there is a degeneration of
the tissues themselves; the deposited material here albuminoid and not starchy, 'i'he change begins in the muscular fibre-cells of middle coat of small arteries: walls of vessels get gradually thickened, while their calibre diminishes. Then the morbid process involves surrounding anaemic paren- chyma; extending until whole tissue in neighborhood of arteries is altered. Several organs are generally invaded simultaneously, and rendered incapable of performing their functions. Patients gradually assume a cachectic, broken- down appearance ; lose flesh and strength; dropsy often supervenes; urine gets albuminous if kidneys be affected; diarrhoea sets in when digestive tract is involved; and in spite of remedies death soon takes place.
When liver, spleen, or kidneys are organs affected, an unpractised eye may fail to detect alteration in structure unless there be an extreme amount of disease, when they are large, firm, heavy, and on section glistening. AVhen a liver is incised where amyloid degeneration is far advanced, a feeling is communicated like that experienced on passing a knife through wax : cut
38 ANASARCA— ANGEIOLEUCITIS.
surface presents a semi-traiispai'ent appearance. The gland is increased in size ; has some resemblance to a i'atiy liver, but its greater weight and firm- ness on handling distinguish it. If disease be very extensive, no trace of normal structure can be distinguished, thoug'h in an earlier stage the lobules are seen distinctly mapped out, owing to the matter being deposited within the lobule and in and among secreting cells.
Amyloid degeneration may exist alone, or in connection with tuberculosis, disease of bones, and syphilis. Thus, in phthisis, this form of hepatic disease is probably more common than fatty liver ; while sometimes amyloid and fatty deg'eneration occur together. So frequently has amyloid degeneration been found connected with caries or necrosis, that it was thought the osseous disease exercised some determining influence on its production, but amyloid degeneration is as frequently associated with phthisis and syphilis, as with bone disease. So it was considered that Bright's disease was often associated with amyloid degeneration, until the discovery that the former was some- times merely a symptom of the latter affecting kidneys. — See Hepatic De- generations ; Renal Degenerations, etc.
ANASARCA. — From 'Ava, through ; ffapl, the flesh. Synon. Hydrops Celhdaris Tothis Corporis ; Hydrosarca ; General Dropsy. — The more or less general accumulation of serum in the meshes of the areolar tissue throughout the body. May arise from heart disease or kidney disease, occasionally from disease of lung.
Treatment. According to disease by which it is caused. Compound jalap powder. Compound scammony powder. Elaterium, 157. Acid tar- trate of potash, 228. Chimaphila nmbellata, 221. Digitalis and squills, 219. Oil or spirit of juniper, 229. Colchicum. Tartarated iron.
Warm bath. Turkish bath. Bloodletting. Dry cupping to loins. Acu- puncture. Issues. — See (Edema; Dropsy.
AN.ffiMIA. — From 'A, priv. ; a?,ua, blood. Synon. Excemia ; Spana;- mia ; Hydremia; (?//(7fe7n?"a.— Deficiency or poverty of blood. The red globules, instead of existing in the proportion of 130 per 1000 parts of blood, as in health, are reduced to 80, 6U, or even less. The liquor sang-uinis is also poor in albumen, and may contain an excess of salts.
Symptoms. A pale, waxy, blanclied appearance of integuments and mucous membranes. Feeble, rapid pulse. Anorexia. Aortic and pulmo- nary systolic murmurs. Bruit de diable in jugular veins. Enlargement of ihyroid. Proptosis oculi. Attacks of fainting. Palpitation and dyspnoea, ffidema, and dropsical effusions into pleura, pericardium, or , peritoneum. Amenorrhcea. Occasionally, fatal syncope or coma.
Treatment. Iron, 380, 393, 393. 404, 412. Chemical food, 405. Bark, 371, 376. Manganese. Phosphorus. Aloetie aperients, with or without steel, 148, 393. 404. Pepsine, 394, 420 Peroxide of hydrogen increases the power of ferruginous tonics. Inhalation of oxygen. Alkaline hypo- phosphites. Nourishing food : — Milk ; raw eggs; brandy and ^gg mixture, 17; restorative soup, raw meat, 2; essence of beef, 1; malt flour, etc., as in Liebig's food, 5; fish; poultrj^; ronst beef and mutton; bitter ale; wine. Cod-liver oil, 389. Sea air. Mineral waters of Spa. Schwalbach. Bruke- nau. Franzensbad. — See Chlorosis.
ANESTHESIA. — From 'A, priv.; aloOdwiuai, to feel. Synon. Anal- gesia.— Paralysis of sensibility. — See Paralysis.
AUGEIOLETJCITIS. — From Ayyftoi^, a vessel ; Xevxhq, white ; terminal -itis. Synon. Lymphangitis ; Ivflammatio Vasorum Lymphcdicornm. — • Inflammation of the lymphatic vessels may result from external injury, or from absorption of some morbid matter — as in dissection wounds, unhealthy carbuncles, etc. Lymphatic glands usually involved.
ANGINA PECTORIS— AORTIC ANEURISM. 39
Symptoms. Formation of bright red streaks; running upwards from wound in course of absorbents, to the glands in which the vessels merge. Streaks, tender to touch ; the seat of stinging pains ; hard, lilv-e little cords. Glands in connection with affected vessels quickly become involved ; get swollen and acutely painful. Whole limb rendered puffy and tender. Great constitutional disturbance; chills or rigors; nausea and constipation, fever, restlessness, mental and bodily prostration.- — ^May end in resolution; suppu- ration ; chronic induration ; fatal exhaustion, or ichorha3mia. Often com- plicated with erysipelas or phlebitis.
Treatment. Sulphate of soda or magnesia, 48. Chlorate of potash, 61. Carbonate of ammonia, 361. Ammonia and bark, 371. Quinine, 379. Hydrochloric acid, 357. Purgative eneniata, 188, 190. Essence of beef, 1. Restorative soup, 3. Eggs, cream, and extract of beef, 6. Brandy and egg mixture, 17. Wine. Ice. Acid tartrate of potash drink, 3.56. Hydro- chloric acid and chlorate of potash drink, 358. — Fomentations. Linseed poultices. Extract of belladonna and water dressing. Bed to be placed in centre of well-ventilated room. Evacuation of pus by free incisions.
ANGINA PECTORIS.— From 'Ay;;:^^, to strangle ; Pectus, the breast. Synon. Orthopnaea Cardiaca ; Cavdionearalgia ; Cardiac Apnoea ; Suffocative Breast-pang. — A disease in which severe pain is felt about the chest, with a sense of strangulation and great anxiety. — Occurs most fre- quently in advanced vlife. More common in men than women. Has been found associated with valvular disease or fatty degeneration of heart; but more usually in connection with diseased coronary arteries.
Sympto.ms. Paro.xysms of intense pain about prascordial region, and sometimes down the left arm to the fingers' ends ; feeling of suffocation ; fearful sense of impending death. Seizure rarely lasts more than one or two minutes. May come on any time : if patient be walking he is obliged to stop immediately. During attack, pulse slow and feeble; breathing short and hurried ; countenance pale and anxious ; surface of body cold, perhaps covered with clammy sweat ; consciousness unimpaired. As struggle passes off, patient regains his usual health ; often appears quite well, lleart sounds may be normal. If death do not occur in any early seizure, it generally does so in some subsequent attack.
Treatment. During paroxysm : — Brandy or wine. Ethei", chloroform, and ammonia, 85. Hydrocyanic acid, soda, and morphia, 70. Belladonna. Camphor. Assafoetida. Inhalation of ether : or of nitrite of amyl five drops on lint. Sinapisms. Turpentine stupes. Friction. Flying blisters. Cold lotions to forehead.
During interval, : — Animal food ; milk or cream ; light wines. Ammonia and bark, 371. Mineral acids and bark, 376. Quinine and steel, 380. Quinine and belladonna, 383. Steel and pepsine, 394. Phosphate of iron, 405. Zinc and nux vomica, 409. Yalerianate of zinc and belladonna, 410. Sulphate of zinc and aconite, 413. Phosphate of zinc, 414. Phosphorus. Arsenic. Sulphur. Quinine. Belladonna plaster over prsecordia. An issue at nape of neck. Avoidance of cold, stimulants, strong exerci.se, walking soon after meals, sexual intercourse, and mental excitement.
ANOB-EXIA. — From 'A, priv. ; opslt?, appetite. Synon. Inappetentia. — Loss of appetite is a common symptom in most diseases. When present without apparent cause, attempts must be made to give tone to digestive organs. Mineral acids, pepsine, rhubarb, aloes, quinine, salicine, and bitter vegetable tinctures or infusions are the chief remedies.
AOETIC ANEURISM.— From 'Aoptr,, the great artery ; 'Aysupw'u, to dilale. — Varieties : — True aneurism, in which all the coats of artery dilate and unite in forming walls of pouch ; false aneurism, in which inner and
40 AORTIC ANEURISM.
iniddie arterial tunics being ruptured, walls are formed by cellular coat and contiguous parts ; and mixed or consecutive false aneurism, in ■which the three coats having at first dilated, inner and middle ones subsequently rupture as distension increases. When the two inner tunics are ruptured, and blood forces its way between them and outer coat by a kind of false passage, so as to form a spreading diffused tumor, disease known as dissect- ing aneurism. Lastly, varicose aneurisms are those where a communication has formed between aorta and either of the vente cavse, or between aorta and one of auricles, or between this vessel and right ventricle, or between aorta and pulmonary artery.
Aortic aneurism, a disease of advanced life, rather than of youth ; more common in men than in women ; often results from ossific or calcareous deposits, or from atheromatous or fatty degeneration of coats of vessel, and consequently other vessels are not uncommonly found affected at same time. May be produced in young subjects by strain or by pressure on chest of belts and straps. Death may result from internal or external hemorrhage, owing to rupture of sac; or sudden deatli may occur without any rupture (as from suffocation); or there may be gradual sinking from exhaustion caused by long-continued sufferii]g, or from the effects of pres- sure on the lungs or other organs, or from debility brought about by re- peated escape of small quantities of blood, or from coexistent tubercular consumption.
1. Aneurism of Thoracic Aorta.— Chiefly met with in ascending por- tion, or in transverse part of arch.
Symptoms. In early stage obscure, partly because they resemble those caused by heart disease. When tumor is of some size and has been quickly developed, there is disturbed action of heart with some modification of radial pulse; dujness on percussion over portion of vessel from which aneurism springs; pain about the chest and back, latter most constant and severe when erosion of bones of spine or sternum or ribs is going on. — Sup- posing aneurismal tumor becomes very large and pulsating, and rises out of chest, producing protrusion or absorption of sternum and ribs, then the diagnosis is easy.
When the sac presses upon trachea, there are dyspnoea and cough ; when on one or both re'current laryngeal nerves, cracked voice or complete aphonia with troublesome cough, severe paroxysms of laryngeal suffocation, and pain coming on at intervals ; wlien on oesophagus, dysphagia and symptoms of stricture; when on superior vena cava, great fu!nes3 of veins of head, neck, and upper extremities, perhaps with oedema ; when on thoracic duct, inanition and engorgement of absoi-bent vessels and glands ; when on root of one or other lung, cough, wheezing, dyspncea, absence or modification of respiratory sounds. When an aneurism of ascending aorta is in immediate neighborhood of the heart, patient often suffers from angina pectoris; when aneurism involves origin of innominate artery, right, if origin of left subclavian, left radial pulse maybe weakened or extinguished.
Amongst other symptoms, contraction or dilatation of pupil on affected side ; according as pressure is sufficient to paralyze, or only irritate, branches of sympathetic nerve. — Frequently diastolic shock felt or heard, or aortic second sound greatly intensified and sonorous. Sometimes a bellows-sound detected. If the heart be compressed by tumor, so as to impede normal action of valves, a systolic or diastolic bruit will result. Pressure on aorta, or on pulmonary artery, may also produce a murmur. In false aneurism there is sometimes a murmur both with entrance and exit of blood into sac ; or there may be one loud and prolonged and rasping bruit, from passage of blood over roughened inner surface of vessel. Murmur not always present. In true aneurism or mere dilatation of a part of the wall, murmurs seldom audible, but a roughened state of arterial tunics from degeneration or from atheromatous deposit, will give rise to a bruit. In
AORTITIS— APHASIA. 41
both forms, when a murmur exists, a peculiar thrilling- or purring- tremor may be felt.
Death may occnr from rupture externally, or into pericardium, or either pleural cavity, or into trachea, oesophagus, or a bronchial tube. Or patient may die from exhaustion consequent on lonp-coutinued suffering. Or there may be destructive inflammation of lung, owing to compression of pulmo- nary vessels, or to pressure on pneumogastric nerve. — Very rarely, cure hns resulted from solidification of fibrin.
Treatment. '^I'he same as for Aneurism of Abdominal Aorta.
2. Aneurism of Abdominal Aorta. — Often gives rise to acute pain in lumbar I'egion, shooting into either hypochondrium and downwards into thighs and scrotum. Pain aggravated by constipation : often relieved by lying on face. A tumor discovered by careful examination : constant and powerful pulsation communicated to hand. A short, loud, abrupt bellows- sound may be heard.
Treatment. General Rules: — In aortic aneurism, all bodily and mental excitement must be avoided. Pain, cough, dyspnoea, and other prominent symptoms to be alleviated. Generous reparative diet to be allowed : sherr}', Bordeaux, Rhine, or Hungarian wines; brandy or whiskey and water in small quantity, avoidance of malt liquors. Reduction of quantity of blood that the heart has to act upon by limiting the daily quantity of fluids taken to a pint (Sibson). Attention to be paid to digestive, secreting, and ex- creting functions.
Curative: — Iodide of potassium, in large doses, 31. Acetate of lead", in gradually increasing doses, perhaps up to twenty grains daily; with acetic acid. Ergot. lodo-tannin. Tincture of perchloride of iron, 101. Ammo- niated iron alum, 116. Locally: — Ice. Electricity. Electro-puncture. Belladonna plasters. Puncture with a small trocar and canula, and intro- duction of fine iron wire or horse-hair through latter, so as to afford an ex- tensive surface on which fibrin may coagulate (Murchison and Moore). In abdominal aortic aneurism, pressure Avith a tourniquet for several hours, patient being kept under influence of chloroform (William Murray). Val- salva's plan of frequent bleedings, while patient is kept on lowest possible diet, not to be recommended.
Palliative: — Opium. Morphia. Subcutaneous injection of morphia. Belladonna. Digitalis. Indian hemp. Camphor. Assafoetida. Spirit of ether or chloroform. Mercury, digitalis, and squills. Tracheotomy, if suf- focation threaten. Small bleedings, where there is great pulmonary con- gestion, or severe pain.
AORTITIS, — From 'Aoptrj, the great artery; terminal -itis. Synon. In- fiammatio Aortce. — Acute inflammation of aorta a very rare affection. Probably a blood disease : allied to rheumatism, like pericarditis and endo- carditis.
Symptoms. Very obscure. General uneasiness. Rigors followed by fever. Orthopncea, with frequent sense of suffocation. Pain and violent pulsation in vessel, (ireat palpitation. Sometimes, a loud systolic bruit. Pulse often unaffected.
Treat.ment. Iodide of potassium. Colchicum. Aconite. Opium. Spirit of ether. Spirit of chloroform. Warm baths. Dry cupping over spine. Ice to spine. Blisters.
Coats of aorta may undergo structural changes ; either as result of chronic inflammation, or of a simple degeneration of tissues. Calcareous or ossific, and atheromatous or fatty degenerations, most frequently met with in advanced life, although they may occur at an earlier period.
APHASIA. — From 'A, priv. ; puai,?, speech. — -A loss of the faculty of speech ; and (in most cases) of the power of expressing the thoughts by
42 APHONIA.
writing and gestures. A simultaneous loss, in a greater or lesser degree, of the memory of words, the memory of the acts by means of which words are articulated, and of intelligence (Trousseau).
Aphasia sometimes transitory, as occasionally during convalescence from severe attack of fever, when it may be owing to cerebral congestion or anajmia. It may be permanent, and due to softening of brain from embolism or thrombosis, or more rarely to cerebral hemorrhage. When lesions exist they usually affect the posterior portion of the third frontal convolution of the brain, on the left side. Aphasia is very frequently associated with right hemiplegia.
Symptoms. Sudden deprivation of power of speech. Perhaps, in a short time, one or two words can be uttered quite distinctly, which are then spoken in reply to all kinds of questions. In other cases several words are recovered and employed more or less appropriately, or again emotional expressions may be uttered with fiuency. which cannot be repeated in cold blood. Face intelligent. Movements of lips and tongue and larynx healthy. There may be consciousness of what is wished to be expressed, and yet complete ina- bility to express the thoughts by speech, writing, or even (frequently) by gestures. Aphasic patients know the use of objects (such as spoons, night- caps, pipes, etc.), though they cannot name them. Moreover, they can often play correctly at cards, backgammon, dominoes, etc. They can perhaps read ; but frequently if they understand what they peruse they forget directly, as they will pore over the same page again and again. There is the- greatest possible diversity, however, in the degree of impairment of the mental powers, 'i'hey can often copy written or printed words when unable to write a syllable spontaneously or from dictation.
Treatmrnt. In cases of aphasia without hemiplegia recovery may occur spontaneously. Probably any kind of treatment (by drugs, bleeding, or blistering) is injurious. In aphasia with hemiplegia medicine is powerless to effect a cure ; save in cases dependent on syphilis, wiien iodide of potas- sium is the remedy. Cases have occurred in which a patient has learnt over again to speak, as a child learns.
APHONIA. — From A, priv. ; (j)cov>2, the voice. — Loss of voice, from organic or functional disease of vocal cords, varies in degree from a slight impair- ment to complete dumbness. It is either temporary or permanent.
Vat{iet:ks. Aphonia may be due either to functional disorder, or to structural change.
(1) Funciional variety : — Hysterical aphonia typical. Generally allied with other symptoms indicative of its nature. In women, uterine functions frequently disturbed : irritation of one or both ovaries often present. Leu- corrhcea : amenorrhoea, or sometimes menorrhagia. — Patient speaks in a whisper for days together. Then power returns, but relapses are common. — Aphonia from fright occurs in men as well as in women. — If functional aphonia be of long continuance, the vocal cords will probably become flaccid and powerless. An examination by laryngoscope shows a paralytic con- dition of cords. Faradization very useful.
(2) Organic form : — Caused by inflammation, serous infiltration, ulcer- ation of mucous membrane about vocal cords; conditions detected by laryngoscope. May also arise from pressure of morbid growths in or near larynx, or on recurrent laryngeal nerves; disease of brain, producing paralysis of muscles of larynx, on normal action of which the tension and position of vocal cords depends.
Treatment. If functional : — Quinine and steel, 380. Quinine and nux vomica, 387. Cornpound iron mixture with aloes, 393. Phosphate of iron, 405. Strychnia and steel, 408. Zinc and nux vomica, 409. V^alerianate of zinc, 410. Nourishing food. Galvanism. Spray of astringent fluids, 262. Shower baths. Moral influence.
APHTHA OF MOUTH— APOPLEXY. 43
When organic : — For cure of inflammation and ulceration about vocal cords, sponging with solution of nitrate of silver (gr. 40 to fl. oz. j). When syphilitic, iodide of potassium to be also given. Spray of astringent fluids, 2G2. Scarification, in oedema of glottis. Removal of polypi or other growths by wire ^craseur. Ferruginous tonics. Cod-liver oil, etc. — For loss of the faculty of expressing the thoughts by speech, see Aphasia.
APHTH-ffi OF MOUTH.— From "ATtrco, to fasten upon. Synon. Sto- matitis Exudativa ; Muguet ; Thrush. — Aphthae consist of small, round, white, elevated specUs or patches, scattered over tongue and lining mem- brane of mouth, and sometimes extending down oesophagus. Forms a special disorder in infancy — the thrush : in adult ag"e, aphthae often pi*o- duced in course of prostrating disease. — Two microscopical parasitic plants — Leptothrix huccalis and Oidium albicans — developed in large quantity, in and between epithelial cells of mucous membrane; filaments and spores of these fungi render epithelium friable, loose, and swollen.
Symptoms. Restlessness. Debility. Cough. Difficulty in swallowing. Vomiting. Diarrhrea. Where aphthous spots are abundant they may coalesce, forming a dirty diphtherial-looking membrane.
Trkatment. Application of borax and glycerine, 2.50. Application of sulphite of soda (gr. 60 to water fl. oz. j) or carbolic acid. Mild astringents. Bark and port wine. Chemical food, 40.5. Cod-liver oil. Chlorate of potash. Pure milk. Liebig's food, 4. Restorative soup, 2. Beef-tea.
APOPLEXY. — From Arto, by means of; Ttx-qaaui, to strike — because, in typical cases, those attacked fall down, as if from a blow. — A state of coma, occurring suddenly, presumably from pressure on the brain, the com- pressing power having its seat within the cranium. There is sudden loss of sensation, thought, and power of voluntary motion ; with more or less severe disturbance of respiration and circulation.
Warnings. Apoplexy seldom occurs without some previous threaten- ings, such as : — Headache and giddiness, experienced particularly on stooping; feeling of weight and fulness in head; noises in ears, temporary deafness ; transient blindness, or sometimes double vision ; repeated epistaxis ; fits of nausea ; occasional sense of numbness in limbs ; loss of memorj' ; great mental depression ; incoherent talking; drowsiness; indis- tinctness of articulation; and partial paralysis, affecting a limb, or muscles of face, or eyelids.
Certain individuals predisposed': — Those whose ancestors suffered from it; men of a peculiar habit of body, of sedentary habits, accustomed to high living, with protuberant bellies, large heads, florid features, and short, thick necks ; and individuals advanced in life, beyond fifty. A predisposi- tion to hemorrhage. Apoplexy is also engendered by disease of kidneys, heart, or cerebral bloodvessels; by gout ; by intemperance ; and by cessa- tion of habitual discharges. Embolic apoplexy, by heart disease.
Varieties. The coniatose condition may cease in one of three ways : — • It may gradually pass off, leaving patielft"=WBi7^'''?n'~ttr-mTcy'i^Tl'ntifate in incomplete recovery, mind being impaired, and some parts of body paralyzed ; or it may end in death. In latter case, on examining the brain, we find either no appearance whatever of disease ; or extravasated blood is discovered in ventricles, or pons^Varolji, or to large amount in centrum ovale majus, or in sac'dLiiracLnoid ; or there is copious effusion of serum into ventricles or beneath arachnoid, with or without cei-ebral soften- ing. That which is fatal without leaving any traces, which is very rare, has been called nervous or simple apoplexy; the second, sanguineous apoplexy, or cerebral hemorrhage ; the third, serous apoplexy. In serous apoplexy so called, the serum is often simply present from semle cerebjal -atrophy, and has no relation to the attack. Apoplexy may also result
44 APOPLEXY.
frooi embolism. During' life it may be impossible to distinguish by the symptoms these varieties.
Modes of Skizurk. Commences in three different ways: — In first, patient falls down suddenly; deprived of sense and motion; lies like a person in deep sleep. Face generally flushed. Breathing stertorous. Pulse full and not frequent, occasionally l)elow natural standard. Some- times convulsions; or rigidity and contraction of muscles of limbs, perhaps only on one side (Abercrombie).
•Jn second form, coma not the first sjniiptom. Complaint made of sudden pain in head. Pallor, sickness, faintness. Sometimes vomiting. Fre- quently, patient falls to ground in a state resembling syncope. Occasion- ally, instead of falling, the sudden pain is only accompanied by slight and transient loss of consciousness. After a few hours, headache continuing, he becomes heavy and oppressed and forgetful : gradually sinks into complete coma, from which recovery is rare. A large clot usually found in brain.
Third variety begins by symptoms of cerebral hemorrhage. 'I'here is an attack of paralysis of one side ; sometimes deprivation of power of speech, but no loss of consciousness. 'J'he paralysis maj' pass into coma; or it may remain without further urgent symptoms ; or it may slowly go off and patient recover ; or it may pass off and death occur suddeidy some houi's or days subsequently, from return of hemorrhage (see Cerebral Hemor- rhage).
Phenomena during Fit. Duration of apoplectic fit varies from two or three hours to as many days. Partial or total unconsciousness. Pulse, at first generally small, becomes full and strong, according as system recovers from shock; it is usually slower than natural, sometimes intermitting. Resjji ration slow, embarrassed, often accompanied by stgrtor ; froijix^aliva about mouth. — In bad cases, body covered with coldj clammy sweat ;'Tkce paie-; eyes dull and glassy, with dilatation of one or both pupils according as pressure is on one or both sides ; "teeth firmly clenched, and all power of deglutition lost, or much impeded; stertorous breathing. Rowels torpid, or motions passed involuntarily. Involuntary micturition ; or retention of urine, until bladder becomes extended and overflows, causing urine to be constantly dribbling away. When patient recovers incompletely, hemiplegia often remains.
Treatment. Prophylactic: — Where predisposition is suspected, it is necessary to warn patient against strong bodily exertion ; venereal excite- ment; stimulus and irritation or any approach to drunkenness; heavy meals; violent mental emotion ; exposure to extremes of temperature ; constipation and straining at stool ; long-continued stooping; tight neckcloths ; and hot baths. Diet to be moderate. Bed-room to be cool and well-ventilated ; to sleep on a mattress, with head high. Daily exercise in open air. Head to be washed in morning with cold water. Where there is giddiness, or epis- taxis, or headache, or throbbing of arteries of head, a few do^Tof an active purgative will be useful; perhaps, blisters or seton to nape of neck. Leeches to sides of anus, where the threatening seems due to the suppression of some accustomed discharge. — Where there is aiisemia. bark and mineral acids, or small doses of steel ; with good easily digested food, and plenty of milk. — Arsenious acid (gr. 1,^0-1^2 twice daily) in combination with liquor potass^ has been recommended.
Curative: — The rule is, after an, attack, " to obviate the tendency to death" (CuUen). If tendency be towards death by coma; if pulse_be full, hard, or thrilling ; if vessels of neck are congested ; if face be flushed'and turgid, — general bleeding, or cupping from nape of neck, may be called for. When there is stftor the p alien t to be turned on his side. Contrariwise, if patient be dying from syj\cgp.e, with a feeble or almost imperceptible pulse, and a colcf clammy skin — then bleeding will only ensure a speedily fatal termination. Bleeding sometimes employed to prevent increase of extrava-
: ASCITES. 45
satioii; but this renierly must be resorted to with p-roat caution, since it is not always easy to distinjiuish hemorrhage from embolism.
Patient to be removed into a cool and well-ventilated room. Head to be raised. All tight parts of dress to be loosened, especially cravat and shirt collar. Cold to the head by means of pounded ice in a bladder. If power of swallowing remain, calomel and jalap, followed by common black draught, 140. Where deglutition is impossible, two or three drops of croton oil on back part of tongue. Stimulating and purg'ative enemata, 189, 190, 191. Pediluvia containing mustard. Blisters to scalp, or nucha, seldom of benefit in any stage and never at early period. Emetics only useful where attack is due to over-loaded stomach.
In event of recovery : — Great care needed to prevent a second fit. Strong medicines, great excitement, severe mental occupation to be avoided. Sim- ple, but nutritious diet : fish ; meat in moderation ; milk. Light French, German, or Hungarian wines.
ASCITES. — From 'Ao;c6j, a wine-skin or leather bottle; because of the swollen condition of the belly. Synon Hydrops Abdominis ; Hydro- jyeritoneum ; Dropsy of the Peritoneum. — (Consists of a tense swollen con- dition of abdomen, owing to presence of a watery fluid in cavity of serous lining.
Cirrhosis of liver and renal disease, most common causes; but may arise from — chronic peritonitis; cancer; amyloid degeneration of liver, obliteration of portal vein ; causing obstruction to free passage of blood through system of vena portte ; disease of heart or aorta; disease and enlargement of spleen ; malignant affections of omentum ; and a few more simple disorders, conges- tion of kidneys, functional derangement of heart, anaemia.
Symptoms. Characteristic appearance of patient. Upper part of body ■wasted, features pinched, countenance very anxious: abdomen greatly enlarged, integuments shining, superficial veins dilated. Fluctuation and vibration : shifting resonance on percussion. In advanced stage, dyspnoea : respiratory murmur cannot be. heai'd as low down as in health : tubular bi'eathing in interscapular regions, especially towards left: apex of heart elevated, and rather pressed to the left. Commonly, anasarca of lower extremities : more rarely, and chiefly in renal drojisy. oedema of face and arms. Urine scanty, often loaded with urates : in ascites from cirrhosis it generally contains bile ; in that from I'enal disease, albumen. Increasing deterioration of general health. Weakness and emaciation. Loss of appe- tite. Sleeplessness. Inability to lie down. Exhaustion : ending fatally ■when the dropsy is due to organic disease.
Treatment. Compound po^wder of jalap. Acid tartrate of potash. Pill of colocynth and hyoscyamus. Elaterium, 1.57. Resin of podophyllum, 160. Croton oil, 168. Gamboge with aloes and blue pill, 174. Calomel and jalap, 159. Acetate of potash, scpiills, and broom, 219. Solution of potash, nitrous ether, and digitalis, 220. Spirit of juniper, nitrous ether, and winter- green, 221. Digitalis and squills, with blue pill or taraxacum, 219, 224. Urea. 225. Copaiba or its resin. Nitric acid, nitrous ether, and taraxacum, 147. Acid tartrate of potash and bnchu, 222. Nitrate of potash and nitrous ether, 212. Conium, digitalis, and calomel, 230. Hydrochlorate of ammo- nia, 60. Iodide of potassium, 31. Iodide of iron, 32. Corrosive sublimate, 27. Nitro-hydrochloric acid, 378. Colchicum, 46. 'I'inuture of perchloride of iron. Phosphate of iron, 405. Quinine and steel, 380. Steel and ammonia, 401, 403. Warm baths. Vapor baths. Turkish bath. Tapping. Acupuncture. Issues.
As a rule, in dropsy from renal disease, all preparations of mercury are injurious, and diuretics must be employed cautiously; baths especially use- ful. Mercurials pernicious where there is anajmia : compound jalap powder, hot air baths, and preparations of steel very valuable. — See Dropsy.
46 ASTHENOPIA— ASTHMA. ^
ASTHENOPIA.— From 'A, priv. ; aeim^, strength ; ^■^, the eye. Weak- siohtedness, from fatigue of muscular system of accommodation. Synon. Muscular Ajnaurosts.
Symptoms, The eyes appear normal. Inability to read or write for any length of time : letters become indistinct, and words seem to run into each other. The eyes ache or get very tired. Museas volitantes. Headache. If unrelieved, the eyes become useless for continued work.
Treatment. When dependent on hypermetropia may be cured by proper use of convex glasses. If due to anseinia, ferruginous tonics, sea air, good food, cold water douche, and spectacles of sufficient power. Work to be interrupted every half-hour by rest, so long as fatigue is induced.
ASTHMA. — From 'AaO/xd^ui, to gasp for breath. Synon. Spasmus Broncliialis. — -A nervous disease: phenomena dependent on tonic contrac- tion of circular muscular fibres of bronchial tubes. Paroxysms induced by direct or reflex mechanism, i. e. — the stimulus to contraction may be cen- tral, in medulla oblongata ; or it will be in pulmonary or gastric portion of pneumogastric, or in some other part of nervous system besides the vagus, and being transmitted to medulla oblongata by incident, is thence reflected by motor filanients.
Symptoms. A fit of asthma may be preceded by headache and sleepiness, or by various digestive or other disturbances, or it occurs suddenly without warning. Patient awakes two or three hours after midnight with sensation of suffocation or constriction about chest: dyspnoea increases, until there is a most painful struggle for breath. Yarious postures assumed to facilitate respiration. Chest gets distended to utmost limit : there is evidently some obstruction to entrance and exit of air. On auscultation, no respiratory murmur audible ; but sibilant rhonchi, loud wheezings, or shrill whistlings are heard. Pulse becomes small and feeble. Eyes staring. Countenance anxious. Lips purple. Temperature of surface often falls to 82° F. ; but after a time the fatigue causes the skin to be bathed in a hot sweat. After a long period, relief comes. Cough, with expectoration of little pellets of mucus. Paroxysm ceases, and sufferer falls asleep.
During interval between attacks, moderately good health enjoyed, with quiet breathing. Most asthmatics thin and round shouldered : countenance expressive of attacks of suffering; cheeks hollow; voice rather hoarse; slight cough. Interval varies in length from twenty-four hours to twelve months. Attacks sometimes periodic. Asthma very capricious : kept off by certain climates, but only experiment can decide which air is suitable for each case. More common in men than women. Often hereditary. In idiopathic or spasmodic asthma, the disease is uncomplicated. In symp- tomatic or organic asthma, the suffering is complicated with, or sympto- matic of, some disease of nervous system, of alimentary canal, of heart, of lungs, or even of skin.
Treatment. During paroxysm :■ — If stomach contain undigested food, a stimulating emetic, 232. If rectum be loaded, an enema of castor oil and assafoetida and rue, 189. Croton oil and turpentine enema, 191. — Great object is to i-elax bronchial spasm. A dose of iodide of potassium (grs. 10), with ammonia or ether, and tincture of belladonna (min. xx-xxx), often succeeds. Subcutaneous injection of atropine, 314. Opium or mor- phia often injurious: if given, only a full dose will be of any avail, but the author's experience leads him to forbid it. A cup of strong coff'ee. A glass of strong brandy, or whiskey, or rum punch. Inhalation of chloroform, or ether, of doubtful value : patient usually gets relief, while inhalation is continued, but wakes up as bad as before. Iodoform, 338. Tobacco useful in some cases, especially in women : when it produces nausea and collapse, the attack often ceases. A pipe of Latakia sufficient for those unaccus- tomed to smoking. Stramonium cigars. Stramonium seeds smoked in a
ASTIGMATISM— BALANITIS. 47
pipe. Patura Tatula cigars. Cigares Aiiti-Asthmatiques de M. Joy. Stranioiiiuin with henbane, 323. Conium with henbane, 335. Fumes from stramonium leaves prepared like nitre-paper. Nitre-paper fumes. Tur- pentine stupes. Hot water stupes. Sinapisms. Hemlock poultice.
In interval : — Improvement of general health by tonics ; regular mode of life; use of cold shower or sponge bath. Removal of dyspepsia. Meals to be taken at such times that digestion may be completed before retiring to bed. Selection of a climate the opposite to that in which attacks come on.
When mucous membrane about fauces is relaxed, — Tannin or catechu lozenges. Atomized spray of astringent fluids, 262. Sponging with solu- tion of nitrate of silver. — If digestion be weak, — Nitro-hydrochloric acid, 378. Pepsine, 420. Ammonia and bitters, 361. Quinine and rhubarb, 385. Steel and citrate of potash, 403. — If periodic,- — Quinine. Phosphorus. Arsenic. — If cause be obscure, — Iodide of potassium with aconite, or with ammonia and belladonna, 31. Inhalation of oxygen gas. Respiration of compressed air.
Kemedies sometimes employed: — Garlic (Allium sativum). Bulb of common onion (Allium cepa). Carbonate of ammonia. Ammoniacum mixture. Compound squill pill. Assafoetida. Nitrate of silver. Arsenic. Camphor. Musk. Galbanura. Ipecacuanha. Dilute hydrocyanic acid. Indian hemp. Petroleum. Senega. Strychnia. Storax. Compound tinctui'e of benzoin. Sumbul. Oxide of zinc. Valerianate of zinc or am- monia. Sulphate of zinc. Blisters to spine or nucha. Ointment oftarta- rated antimony to chest-walls. Issues. Galvanism.
ASTIGMATISM. — From A,priv. ; on-'y^ua, a point — signifying that rays derivedjfrqm one point do not again unite into one point. — An inequaltTy in the refractive'po\vel""Of the several meridians of tlie eye. Usually the cornea is more convex from above downwards than from side to side, or would in section presenf a segmeTif of asmaiter circle.™ The-asymmetry ou which astigmatism depends is proper to all eyes. Usually it exists in so slight a degree, that the acuteness of vision is not essentially impaired by it (normal astigmatism). But exceptionally it becomes considerable, and occasions an aberration of the rays of light, which interferes with the sharp- ness of sight (Ponders).
ATELECTASIS. — From 'A-ta'krii, imperfect; tWacns, dilatation. — A con- genital non-expansion of air-cells of lungs. — See Pidmonary Condensation.
BALANITIS. — From Bdr.o.voi, the glans penis ; terminal -itis — signifying inflanmiatiou when added to the Greek name of an oi'gan. Synon. Exter- nal Clap ; Gonorrhoea Prceputialis. — Consists of inflammation, with red- ness and patches of excoriation, of the glans penis and internal surface of the prepuce. Sometimes the affection is termed balanitis when only the glans is affected ; balano-posthitis (Ba'?iai'oj 7i6a0-q, the skin covering the glans, terminal -2Y/.s) being applied when the lining of the prepuce is also involved. This refinement unnecessary : the two conditions are rarely seen apart.
Symptoms. Heat and itching about the glans. A muco-purulent dis- charge. On denuding the ^lans, patches of redness and excoriation per- ceived, perhaps with flakes of curd-like matter. If there be oedema of fore- skin, or the orifice of this covering be contracted, retraction may be impos- sible—phimosis. Necessity of drawing back the foreskin, — there may be a chancre, or an abscess, or mortification may be threatening. Symjjathetic bubo may arise. Sometimes complicated with gonorrhoea. Balanitis from inoculation with secondary syphilitic discharge, may cause constitutional infection.
48 BARBADOES LEG— BILIARY CALCULL
A similar disorder — vulvitis — occasionally met with in women, or female children.
Treatment. Great cleanliness. Lightly touching of inflamed surface with nitrate of silver. Astringent lotions — alum, subacetatc of lead, sul- phate of zinc, etc. Mere washing and drying of parts, twice in twenty-four hours, with separation of glans from prepuce by a thin layer of cotton-wool. Circumcision. Slitting up of prepuce. Dilatation of preputial opening with sponge tents. After retraction of foreskin it is again to be drawn forwards, to avoid paraphimosis.
BARBADOES LEG. — Synon. Elephantiasis Arahum ; Glandular Disease of Barbadoes ; Bucnemia Tropica.- — Characterized by great swelling and induration of true skin, or derma. Produces most marked de- formity. Sometimes subjacent ai'eolar and adipose tissues are implicated. Most frequently attacks lower extremities : swelling so great that limb be- comes double its natural size. Hardness, severe pain, and thickening; with an appearance resembling the leg of an elephant, whence the disease has un- fortunately derived one of its names (ETiicjiaj, the elephant). The scrotum not an uncommon seat of it. Rarely met with in Europe ; occurs principally in West Indies. Generally continues for life; is accompanied by periodical febrile attacks; neither contagious nor hereditary; attacks males and fe- males, rich and poor, indiscriminately. When confined to one foot and leg, amputation has been resorted to with advantage. Ligature of main artery of limb. The success which has followed removal of large scrotal tumors in India is very I'emarkable.
BED CASE. — A not uncommon form of hysteria. Subjects of it live in bed; they are tranquil, cheerful, have good digestions, and like the kind attentions of sympathizing friends. Often impressed with belief that there is serious disease in spine or in womb ; there are certain movements which they think cannot be made without " horrible" pain. Menstruation fre- quently attended with suffering; leucorrhoea. Uterine displacement, or any other abnormal condition to be remedied ; moral suasion to be applied. Each example varies in regard to important mental peculiarities, and tact is needed to persuade patient to get well. — See Hysteria.
BERIBEBI. — From Beri, the Singalese for weakness, by iteration im- plying great weakness. Synon. Bad Sickness of Ceylon. — A form of general dropsy almost unknown to pathologists in this country. It is very fatal to European and native troops at Ceylon.
Symptoms. Increasing weakness. Marked anasmia. Anxiety. Numb- ness of the surface. Stiffness and oedema of lower extremities. Dyspnoea. Paralysis. Suppression of urine. Effusion of serum into pleurse and peri- cardium. Exhaustion. Generally death.
'J'reatment. Elaterium. Calomel and squills. Squills and digitalis. Treeak Farook, an electuary much esteemed in parts of India, the ingre- dients of which are unknown, but which acts as an aperient and mild diure- tic when combined with rhubarb : the dose is from grs. 5 to 15. Oleum nigrum, regarded as a valuable preparation in India ; having stimulant and diaphoretic properties in doses of ten minims. 'I'onics. Tincture of perchloride of iron. Effervescing draughts. Opium. Nux vomica. Spirit of nitrous ether. Nourishing diet. Wine.
Bleeding. Cupping over spine. Blisters. Friction, with stimulating liniments. Galvanism.
BILIARY CALCULI.— From BiUs, bile: Calculus (dimin. of calx), a
small stone. — See Gall-Stones.
BITES OF RABID ANIMALS— BLACK LEG. 49
BITES OF RABID ANIMALS.— The immediate treatment is as fol- lows : — The tissues around seat of injury are to be compressed by a ligature or otherwise, to prevent absorption. Then the wounded part is to be ex- cised as soon as possible ; taking care to remove every portion touched by animal's teeth, and to obtain a clean raw surface. 'I'he wound should next be thoroughly washed by a stream of water, long poured over it: lunar caustic afterwards to be applied. Mr. Youatt prefers nitrate of silver freely used, to every other caustic : he recommends that after its application the wound be quickly healed. Some authorities advise that the wound be kept open by irritating ointments. Chloroform maybe given to prevent pain of knife. Subsequently, patient to be assured that all has been done to pre- vent any after mischief. To afford him greater confidence, administer for some days the sulphite of magnesia in bark, 48. — See Hydrophobia.
BITES OF VENOMOUS REPTILES.— The poisonous reptiles pro- vided with fangs are the ophidia or serpents. Chief foreign serpents: — ■
(1) Cerastes or Horned Serpents, allied to vipers, and much to be dreaded.
(2) Crotali or Rattle Snakes, provided with long poison fangs, and a reservoir of some size. In human subject, the poison is fatal in two or three minutes. (3) Bothrops or Javelin Snakes, inhabitants of Martinique and St. Lucia. The most formidable species is the yellow viper of Martinique. M. Guyon saw several soldiers perish from its bite. Death may occur almost immediately ; or in the course of twenty-four hours, preceded by exhaustion and coma. And (4) Naia, or Spectacled Serpents, or Hooded Snakes, Avhich are met with in Arabia and India. This group contains the coluber haje, the true asp of the ancients : also the cobra di capello.
The only poisonous reptile indigenous to ihis country is the Common Viper or Adder. It is found on the heaths and in the di'y woods of all parts of Great Britain. Poison apparatus consists of a gland placed by side of head, a duct, and a fang or pointed curved tooth moulded in form of a tube. The bite rarely proves fatal. The wounded part becomes the seat of severe pain ; great swelling, redness, and lividity. Faintness : rapidity and feebleness of pulse. Bilious vomitings. Dyspnoea. Profuse cold sweats. Jaundice. Delirium, or convulsions.
Treatment. Locally : — The wound to be immediately sucked freely and perseveringly. If patient is too faint to do this for himself, a bystander can fearlessly help him : it is well known that these poisons may be swal- lowed, or smeared upon the lips and tongue (provided there is no abrasion), with impunity. At same time a ligature is to be placed around the limb, above the wound ; or if this be impossible from its situation, the textures around are to be compressed. Then, the bitten part to be excised ; or it may be destroyed by actual cauterj', nitric acid, strong liquor ammoniac, or nitrate of silver.
Constitutionally : — Remedies derived chiefly from class of diffusible stimulants. No agent more generally recommended than ammonia. Com- pound tincture of ammonia (Phar. Lond.) formerly known as eau de luce, in half-drachm doses well diluted; or aromatic spirits of ammonia, two drachms to an ounce-and-a-half of water. Supposing no ammonia is at hand, brandy will prove an excellent substitute. Injection into a vein (the radial or saphena) of liquor ammonia; (from min. 20 to 30) diluted with two or three times its quantity of water (Halford of Melbourne). This treatment fails in bites of Cobra and other snakes of India (Fayrer and Brunton). Transfusion of blood has been recommended. 'J'he patient is to be kept I'oused by walking him about, administering strong coffee, etc.
BLACK LEG. — A form of Purpura, which occurs amongst the lumber- men on the Ottawa or Grand River of Canada. It is produced by the use of pork packed in nitrate of potash. — See Purpura. 4
50 BLENNORRHAGIA— BRONCHITIS.
BLENS'OE.RIIAGIA.— From (SXiwa, mucus or slime ; Ij-qyvvijn, to burst forth. A discharge from the mucous membrane of the urethra or vagina, usually contracted in sexual intercourse.— See Gonorrlioea.
BLEUNOBRHCEA.— From pxswa, mucus; 'pico, to flow.— See Gonor- rhcea.
BLOWS ANB BBUISES.— Seldom necessary to do more than relieve pain and prevent discoloration. To be accomplished by: — Arnica lotions, 275. Aconite lotions, 265. Spirit and ammonia lotions, 273. Poultices of black bryony root (Bryonia nigra), used by pugilists. Glycerine. Oil of turpentine. Expressed juice of leaves of Milkania Guaco. Dilute solu- tion of subacetate of lead.
BOILS. — A boil or furunculus (from Ferveo, to burn) is a circumscribed bard tumor, small but very painful, produced by inflammation of the true skin and subjacent areolar tissue. Morbid process terminates in suppura- tion and ulceration.
Treatment. Poultices. Fomentations. Painting with iodine. Peru- vian balsam ointment. Incisions? Jalap and senna, 150. Sulphate of manganese, 172. Quinine, 379. Peroxide of hydrogen. Mineral acids and bark, 376. Liquor arsenicalis, 52. Yeast. Liquor potassa;. Tar, 36. Nourishing food. Wine or beer. Change of air.
BEASS-EOTJNDER'S AGUE.— A peculiar form of intermittent fever, which affects brass-founders and other workmen exposed to the fumes of deflagrating zinc. Observed in the Birmingham foundries, etc.
Symptoms. The paroxysms occur irregularly. Constriction or tightness about chest. In the evening, shivering ; an indistinct hot stage ; profuse sweating.
Treatment. Emetics and milk, as prophylactics. Avoidance of the fumes of zinc. Tonics, quinine, etc.
BBIGHT'S DISEASE.— A term indiscriminately applied to all renal diseases accompanied by albuminuria and dropsy. — See Nephritis ; Renal Degenerations.
BRONCHITIS. — From B^ioyx^i- ^he windpipe; terminal -^^;^s. Synon. Pulmonary ■ Catarrh. — Inflammation of mucous membrane of bronchial tubes. May be acute or chronic, and in larger or smaller tubes : affects one or both lungs throughout, or only a portion of these organs — usually the upper lobes. Symptoms of hay-asthma often of a bronchial character.
1. Acute Bronchitis. — A dangerous disorder : inflammatory action often spreads to vesicular texture of lungs.
Symptoms. Fever. A sense of tightness or constriction about chest. Hurried respiration, with wheezing. Cough. Expectoration of viscid glairy frothy mucus, and afterwards of purulent secretion. Frequent, and often weak, pulse. Foul tongue. Headache and lassitude. Sickness. Great anxiety.
Inflammation of larger and medium-sized tubes, attended by less severe symptoms and results than general and capillary bronchitis. Latter, rare in adults ; chiefly seen in very young and old. It is recognized by tendency to cause asphyxia ; paroxysms of dyspnoea or orthopnoea ; congestion of surface ; perpetual coughprT^eSir^^i^^Ug^iess ; increasing prostration ; and in fatal cases, sorK^^iree, mutteriTfgOSMfijmm, and coma. — Sometimes, during progress ofy^jtre bronchitis, one or w^»^tubes become choked up with viscid Tphlegmf- pulmonary collapse resulq^f^fc— a portion of lung being
BRONCHITIS. 51
emptied of air. One frequent result of collapse is vesicular emphysema; so that loss of function in airless part of lung is compensated for by increase of volume in non-obstructed portion.
In early stage of bronchitis, auscultation often detects two dry sounds — rhonchus and sibilus. Rhonchus belongs to larger bronchi : sibilus bespeaks more danger, as denoting that smaller air-tubes and vesicles are affected. After inflamed membrane has poured out fluid, the dry are displaced by moist sounds — large and small crepitation. Rhonchus and large crepita- tion are tlie dry and moist sounds of larger air-passages: sibilus and small crepitation, of the smaller branches. No marked alteration in resonance of chest to be detected ; with exception of increased resonance in emphysema, and dull percussion note in collapse.
Treatment. Confinement to bed. Temperature of room 65° to 70° F. Air to be moistened by steam. Beef-tea; milk arrowroot or grnel ; tea with milk ; soda water and milk. Mucilaginous drinks, 19. Sarsaparilla, squills, and barley-water, 238. White- wine whey, 10.
If there be constipation, castor oil ; or sulphate of magnesia and senna, 139. Saline draughts, 348. Salines with ipecac, and hyoscyamus and morphia, at first coup sur coup. Ammonia and senega, 235. Carbonate of ammonia, 361. Citrate of potash, ammonia, and aconite, 211. Dry cupping, turpentine stupes, sinapisms or poultices to walls of chest. Inha- lation of steam.
Remedies somet-imes advised : — Bleeding. Blisters. Friction with croton oil, or tartarated antimony ointment. Emetics. These sometimes most useful when asphyxia threatened by accumulation of mucus in the tubes. Tartarated antimony. Calomel. Colchicum. Hydrocyanic acid. Chlorate of potash. Laurel-water. Malt (Byne). Carbolic acid. Oxalic acid. Inhalation of chlorine.
2. Chronic Bronchitis. — Very common in advanced life.
Symptoms. Two chief forms : (1) without expectoration, tending to em- physema ; (2) with copious expectoration, more likely to lead to bronchiec- tasis. Latter, indicated by habitual cough, shortness of breath, copious expectoration : aggravated by exposure to cold and damp, bad living. Cases of " winter cough" in old people, mostly examples of bronchial inflammation of a low lingering form. — Impaired resonance on percussion, especially low down posteriorly : on auscultation, feeble vesicular murmur, mingled with rhonchus and sibilus and moist crepitation. — Dilatation of bronchi, with condensation of surrounding lung tissu?, occasionally results : sometimes bronchorrhcea — excessive and foetid muco-purulent secretion. — Seldom directly fatal : may be indirect cause of death by leading to other diseases.
Treatment. Carbonate of ammonia. 361. Citrate of ammonia, 362. Ammonia and senega, 235. Chloride of ammonium, 60. Ammoniac mix- ture and opium, 237. Squills with ammonia and morphia, 239, or with nitric acid and bark, 236, or with tincture of iron, 236, or squills and conium, 243, squills and sarsaparilla, 238, squills and turpentine, 50. Ipecacuan and Indian sarsaparilla, 241. Nitrous ether, ipecacuan. and conium, 244. Stramonium and dulcamara, 245. Sarsaparilla and squills, 238. Compound squill pill. Benzoate of ammonia. Cod-liver oil. Wine. Nourishing food. Milk.
Locally: — Inhalation of simple vapor. Turpentine or creasote inhala- tions, 260. Inhalation of ipecac-wine or other atomized fluids, 262. Counter-irritation to thoracic walls by sinapisms; turpentine stupes; stimu- lating liniments, 277, 278. Warm, pitch, galbanum, or chalybeate plasters. Respirator to be worn.
Remedies sometimes reca^.meiidecl : — Emetics of antimonial wine, or sulphate of zinc. Tartar^t^d* 'antimony. Compouild tincture of benzoin. Copaiba. Cubebs. Creasote. Guaiacum. Digitalis. Chlorate of potash.
52 BRONCHITIS.
Storax. Sulphur and acid tartrate of potash. Sumbul. Nitrate of silver (locally). Balsam of Peru (locally). Blisters, ointment of tartarated anti- mony, or crotou oil (to chest walls).
3. Catarrhus Senilis. — A peculiar and dangerous form of chronic bron- chitis, occurring in old people. Has been descriljed ?i?, peripneumonia notlia (bastard peripneumony) ; catcu-rhus senilis ; or subacute bronchitis. — Consists of a subacute attack of general or capillary inflammation of tubes. Symptoms insidious : catarrh ; more or less dyspnoea ; excessive secretion of opaque frothy mucus. Febrile condition often much relieved by remedies which produce copious expectoration. Sometimes causes fatal prostration : or patient dies from suffocation, unable .to expel accumulated mucus : or deficient oxygenation of blood leads to coma.
Treatment. Ammonia and senega with ether. Stimulant emetics if asphyxia threatened. Stimulants and nourishing fluids from the first.
4. Plastic Bronchitis. — -Rare form of bronchial disease. Characterized by formation [Uxdaaut, to form or figure, to make an image, etc.) of solid or tiibular concretions of exudation-matter within bronchi.
Symptoms. Expectoration of casts of tubes. Small fragments expelled easily. Expulsion of moulds of notable size preceded by dyspnoea ; dry cough ; haemoptysis. Sometimes, excessive haemoptysis : fibrinous concre- tions detached, but not easily expelled from tubes. Occasionally casts con- sisting of decolorized coagulated blood due to aneurismal or some other form of hemorrhage. Cases of plastic bronchitis may last for years, with occasional acute seizures.
Treatment. Remedies very ineffectual. Carbonate of ammonia, 361, 371. Iodide of potassium with ammonia. At time of hemorrhage, gallic acid, 103 : turpentine, 102 : iron-alum, 116 : tannin and nitric acid, 99. Nourishing food. Sea air.
5. Mechanical Bronchitis. — Due to inhalation of different particles which irritate bronchi. For example, grinder's rot, or knife-grinder's dis- ease : carbonaceous bronchitis, or black phthisis, occurring in miners, from inhalation of lamp smoke and coal dust in pits: and cotton pneumonia, or cotton phthisis, met with amongst operatives in cotton mills. To be pre- vented by proper respirators. — Larch or Venice turpentine (Terebinthina laricea), in doses of gr. 15-20 made into pills with liquorice powder, and taken thrice daily, often serviceable.
6. Secondary Bronchitis. — Bronchitis occurring secondarily in blood- diseases, often troublesome. Tj-jphoicl bronchitis, may greatly aggravate danger in enteric fever. — Gouty, or rheumatic bronchitis, will require colchicum and iodide of potassium. — Syphilitic bronchitis, occurs in system poisoned to secondary or tertiary degree. Causes excessive muco-purulent expectoration; night sweats ; wasting; great debility. Maybe cured by iodide of potassium, 31. Compound pill of calomel. Mercurial vapor bath, 131. Iodine inhalations, 259. Atomized iodine, or corrosive sublimate, spray, 262.
7. Hay-Asthma, — Synon. Hay-Fever ; Summer Catarrh. — May be described as a severe catarrh, with asthmatic symptoms superadded. Pro- bably due to inhalation of pollen of grasses.
Symptoms. Conjunctival, nasal, faucial. and bronchial mucous mem- branes are each affected. Headache. Suffusion of eyes. Sneezing. Irri- tation of nose and fauces. Dry harassing cough. Paroxysmal attacks of asthma.
Treatment. May be cut short by removal from cause; residence at sea- side especially. Susceptibility sometimes destroyed by quinine and steel ; arsenic ; nux vomica.
During attack : — Nasal douche or inhalation of atomized solution of
BRONCHOCELE— BUBO. 53
quinine (262) or of carbolic acid (2G2). Tinctnre of lobelia, 88. Ammonia and assafoetida, 86. Valerian and assafoetida, 94. Ether and opium with camphor, 85. Belladonna and zinc. 410. Stramonium. Indian hemp, Coilee. Subcutaneous iujections of atropine, 314. Creasote inhalations. 261. Pipe of tobacco.
BRONCHOCELE. — From Bpoy;^oj, the windpipe ; xr;Xyi, a swelling. Synon. Thyrocele ; Wen; 6-'o?Yre by the Swiss ; and in this country /9er- bi/shire Neck from its prevalence in some parts of Derbyshire. — An enlarge- ment of the thyroid gland.
Symptoms. The whole gland may be swollen, or only the centre, or either side — especially the right. Sometimes no inconvenience beyond the de- fornlitJ^ In other cases, throbbing of vessels, palpitation of heart, mental depression, dyspepsia, and other manifestations of attenuated blood, or dif- ficult respiration and deglutition from pressure of tumor, or irregularity of uterine functions ; scanty menstruation : profuse leucorrhoea.
A cystic form, in which cysts are developed in the gland. Their lining membrane very vascular : brown-colored serous contents. Cystic broncho- cele more uncommon than simple hypertrophy of thyroid gland.
Exophthalmic goitre. Protrusion of eye-ball (proptosis oculi) ; strong pulsations in thyroid body; palpitation of heart, with a bruit.
Treatment. Removal from locality in which it is endemic. Regular establishment of menstrual functions. Iodide of ammonium, 38. Iodide of potassium, 31. Cod-liver oil. Iodide of iron, 32. Quinine and iron, 380. Bromide of iron. Steel and aloes, 393. Digitalis. Liquor potasste. Bro- mide of potassium. Strychnia. Bromide of ammonium. Nourishing food. Cold bathing. Sea air.
Locally: — Ointment of red iodide of mercury, 302. Compound iodine ointment with cod-liver oil, 308. Diluted iodine liniment. Ointment of iodide of ammonium. Ointment of iodide of potassium. Ice. Setons. Ligature of thyroid arteries. Electro-puncture. Injection with solution of perchloride of iron, or with tincture of iodine, or with solution of iodide of potassium, not free from danger. Introduction of drainage tube into cyst, after withdrawal of contents by tapping and injection of iodine. Free incision into cyst and plugging with oiled lint; so as to cause alteration or destruction of lining membrane and subsequent granulation. Excision of the cyst a dangerous proceeding. Extirpation of the gland, unjustifiable. — See Graves' Disease.
BUBO. — From 'Qov^ujv, a tumor of the inguinal glands. Synom. Adeno- phyma Tngninalis. — Consists either of a simple or of a specific inflamma- tory enlargement of a lymphatic vessel, or of one of the glands in connec- tion with such vessel. Term " bubo" especially applied to inflammation of the inguinal glands. Superficial glands alone affected.
There are several varieties : —
(1) Simple Sympathetic Bubo. — Whatever causes lymphatic irritation may give rise to simple inflammatory adenitis. Hence it may arise from balanitis, gonorrhoea, excessive venery. etc. The action may end in reso- lution, or go on to suppuration. — Requires rest. Warm bathing. Tonics. Cod-liver oil. Evacuation of pus. — See Adenitis.
(2) Primary Bubo. — Said to form from the direct absorption of syphilitic matter, without the occurrence of any chancre or sore. Very rai'e. De- scribed as bubon cVemhUe by the French.
(3) Amygdaloid Indolent Bubo. — Comes on simultaneously with induration in cases of infecting chancre. Suppuration only occurs from some accidental complication.— Treatment the same as for constitutional syphilis.
(4) Virulent or Inoculable Bubo. — Due to absorption of virus from a
54 BULIMIC DYSPEPSIA— BURNS AND SCALDS.
soft or from a phagedenic chancre. Affected gland suppurates : walls of resulting abscess form a chancrous sore, the pus from which is inoculable. — Requires free incisions. Potassa fusa. Soothing dressings. Frequent syringing. Quinine and iron. Nourishing food.
BULIMIC DYSPEPSIA.— Bo{;, abbreviation of /Soiij, as an augmentative particle ; ^i^aoj, hunger, — SorXt/ioj, excessive hunger : Auj, difficult}' ; rtlrti'co, to digest. — In some cases of nervous gastric disturbance, the appetite is exaggerated : is scai'cely appeased by food. Digestion takes place easily and naturally ; or is accompanied with acid eructations and pyrosis. Stomach often dilated.
Symptoms. Desire for food returns immediately after a meal. Constant hunger. Faintness and mental depression. Painful sense of sinking about prajcordia.
Treatment. Cod-liver oil, 389. Raw minced meat, 2. Pepsine, 420.
BURNS AND SCALDS. — Synon. Amhustio [Amhuro, to burn around). — The danger varies according to the extent of surface injured, the degree of tissue disorganization, the importance of the organ implicated, and the age and constitution of patient. Slight burn of large area, more dangerous than deep burn of small extent.
Symptoms. Shock to system, sometimes so severe as to produce fatal syncope. Pallor and coldness of surface and extremities ; shivering. Rapidity and feebleness of pulse. Imperfect reaction and exhaustion : or violent reaction Avith fever, and congestion or inflammation of lungs or brain or bowels : or hectic fever from tedious cicatrization, exhausting discharges, etc. In few cases can the danger be said to be over until after the lapse of nine days. Where recovez'y ensues, there is the fear of deformity from con- traction of cicatrices.
Treatment. To bring about reaction and relieve pain administer a full dose of opium, with mulled port wine or brandy and water ; repeat the dose if necessary. Chloroform inhalation, where pain is excessive : the injured part to be dressed while patient is insensible. After reaction is well estab- lished, a dose of castor oil or a purgative enema if there be constipation. Simple salines, where internal organs are congested or inflamed. Ice. Ammonia and bark, port wine or brandy, milk and raw eggs, beef-tea with pounded meat, cod-liver oil, where there is depression. In all cases, perse- verance with opium or chloroform to remove pain and nervous irritability.
Locally: — Chief object to prevent access of air to injured surface. Immersion in cold water for many hours where only a portion of a limb is burnt. Free application of lime liniment (Carron oil) on cotton-wool. Cotton-wool alone, with gentle bandaging. Lint soaked in carbolic acid diluted with olive oil, one part to six. Dusting with flour, rice flour, pre- pared chalk, or equal parts of starch and carbonate of lead. Crusts formed by the applications not to be removed until loosened by discharges. Dress- ing with sulphur ointment, or turpentine ointment, subacetate of lead ointment, carbonate of zinc in ointment or powder, zinc ointment, turpentine ointment, creasote, glycerine, sulphate of zinc lotion, solution of gum, collodion, treacle, etc. Dressing to be covered with sheets of gutta percha, or oiled silk, or tinfoil to exclude the air.
Patient to be kept in an easy position, between blankets, and on a water bed if necessary. AH vesicles to be pricked, so that tension may be relieved by escape of contents ; but the raised cuticle not to be displaced. When granulations form, skin grafting to promote healing and prevent contractions. The prevention of deformity to be attempted by attention to position, by movements of joints where practicable, and by lubricating cicatrix freely with oil.
CJECITIS— CANCER. 55
CJECITIS. — From Ccecns, blind; terminal -His. Synon. TypliUtis ; Tiipldo-enteril/s. — liiflammatiou of the csecuni or its appendix. — May be due to accumulation of hard fecal matter, skins or stones of fruit, biliary and intestinal concretions, balls of lumbrici and oxyurides, etc.
Sy.mi'toms. In acute form: — Fever; nausea; constipation. Fulness and tenderness about right iliac region : pain, rendered exquisite by pressure. Position on right side selected, with trunk somewhat bent and knees drawn up, to relax painful tissues. If peritoneal coat get involved, may have evidence of general peritonitis. Areolar tissue round cascum may also become inflamed (perityphlitis) : suppuration and abscess.
When inflammatory action begins in veriform apioendix from constitu- tional causes, or escape into this part of morbid matter, symptoms are very acute. Excruciating tormina ; tympanites ; hiccup ; violent sickness. Ob- struction of bowels. Great pain, extending to right ovary or testicle and shooting down inside of thigh. Gangrene and general peritonitis may follow, and cause death. Or a portion of large intestine and caecum with appendix may slough off, be passed with stool, and yet recovery ultimately ensue. In tuberculous typhlitis, ulceration occurs more frequently in appendix than in ciecum itself.
In chronic caBcitis : — Symptoms come on slowly and insidiously. Failing health; weakness; loss of flesh. Colicky pains in right iliac region. Flatulence; loss of appetite. Diarrhoea alternating with constipation. If mucous coat ulcerates, — mucous discharges; attacks of hemorrhage. When fatal, exhaustion generally the cause. Perforation rare.
Treatment. If acute: — Opium. Opium and belladonna, 344. Olive oil enemata, 188. Mucilaginous drinks, 19. Chlorate of potash drink, 350. Lemonade. Ice : iced water. Prolonged hot hip baths. Fomentations. Linseed poultices. Most perfect quiet in bed. Milk diet. — If si/mptoms of suppuration set in : — Ammonia and barlv, 371. Quinine and ammonia, 386. Brandy and egg mixture, with opium, 318. Milk or cream. Raw eggs. Essence of beef. Port wine.
Chronic form : — Mineral acids with quinine, 379. Iodide of ammonium and bark, 38. Cod-liver oil. Warm bathing. Application of belladonna, 265. AVet compress with belladonna, 297. Simple nourishing food. Sea air.
CANCEE.. — Synon. Carcinoma (KapxtVoj, a crab). — Now generally ap- plied to tumors having clinically the character of malignancy, i. e., tendency to invade progressively and indiscriminately adjacent parts, to ulcerate, to recur when removed, to disseminate' like growths in glands and internal organs.
Cancer has long been considered to be a blood disease, but some authori- ties now assert that the disease is at first local, though at an early period it becomes general.
There are two great classes of cancer or malignant disease. The Sarco- mata, having a connective tissue type of structure, small, round or spindle cells, with no stroma but many vessels. Varieties — -round-celled and spindle- celled Sarcoma (recurrent fibroids), Glioma.
The Carcmo?nai!a, consisting of fibrous stroma with large cells of epi- thelial type in interstices, yield cancer juice in which the cells are seen. Varieties : —
Scirrhus, or Hard Cancer. . Medullary, or Soft Cancer. Epithelial Cancer.
Colloid, Gelatiniform, Alveolar, Cj^stic, or Gum Cancer.
Melanoid, or Black Cancer (often a Sarcoma).
Osteoid Cancer.
Hsematoid Cancer, or Fungus Hcematodes.
Villous Cancer.
56 CANCRUM ORIS— CARBUNCLE.
Symptoms. A separable tumor, or an infiltration ; which alters the orig'inal texture of organ in which it is seated, invades surrounding parts, extends to lymphatics, and involves system generally. Softening and disintegration of the growth. Ulceration of skin or mucous membrane. A foul, excavated, spreading ulcer. Sanious, fetid discharges. Hemorrhages. Progressive debility and emaciation. Nausea and vomiting. Diarrhoea. Complete prostration. Exhaustion. Death.
The cancerous cachexia : — Dirty yellow hue of skin. Contracted fea- tures. General wasting. Loss of strength and energy. Mental irritability.
Treatment. General indicattons : — Maintain the constitutional powers by tonics, nourishing food, pure air. warm clothing, removal of offensive discharges, and mental occupation as long as possible.
Relief of Pain: — Extract of opium, 343, 345. Opium with belladonna,
^^44. Liquid extract of opium. Morphia. 315, 329, 343. Conium, 336.
Henbane. Codeia. Indian hemp, 317, 337. Ether. Chloroform. Extract
of hop. Subcutaneous injections of morphia, 314. Aconite. Atropine,
326. Iodoform, 338. Opiate enemata, 339. Opiate suppositories, 34(1.
Improvement of the Blood: — Liquid extract of yellow cinchona. Bark and ammonia, 371. Bark and mineral acids, 376. Iodide of iron. 382, 390. Reduced iron, 394. Amraonio-citrate of iron, 40l, 403. Phosphate of iron, 405. Quinine and iron, 380. Lemon juice and chiretta, 377. Salicin, 388. Sarsaparilla. Sulphite of magnesia, 48. Chlorate of potash, 61. Cod-liver oil, 389. Pepsine. 420.
Animal food. Milk and cream. Raw eggs. Brandy. Wine. Beer. Vichy or soda water. Wenham lake ice.
Abatement of loccd groivth and systemic contamination : — Belladonna and opium, 344. Quinine and belladonna, 383. Zinc and belladonna, 332.
Loccd Remedies : — Bel'adonna, 265, 293. Opium and belladonna, 297. Extract of poppies. Extract of conium. .Iodoform. Carbonic acid gas. Oxygen g'as. Charcoal poultice. Yeast poultice. Hemlock poultice. Chlorine poultice. Linseed poultice, with or without belladonna or opium incorporated. Carrot poultice. Logwood, 82. Chlorate of potash lotion. Iodide of potassium lotion. Citric acid lotion, 264. Permanganate of potash. Friction with solutions of iodide of lead, or iodide of potassium, or bromide of potassium. Perchloride of iron. Cotton-wool.
Opercttive Treatment : — Free excision. Union by first intention not de- sirable. Excision, followed immediately by sponging entire surface of wound with solution of chloride of zinc (gr. 50 to fl. oz. j). Excision, fol- lowed by prolonged administration of belladonna, 383, 410. Ligature of nutrient arteries. Electricity. Methodical compression. Congelation. Actual cautery. Galvanic cautery. Friction and palpation.
Removal by caustics : — Chloride of zinc, 197. Chloride of zinc and puc- coon. Chloride of bromium, 196. Dried sulphate of zinc. Supersulphate of zinc, 198. Arsenical paste, 199. Manganese cum potassa. Strong mineral acids. Concentrated alkalies. Vienna paste, 204.
Subcutaneous injection of acetic acid into substance of growth : one part of strong acid to six or seven of water.
Remedies often tried and found Valueless: — Calomel. Corrosive sub- limate. Iodine. Iodide of potassium. Iodide of mercury. Iodide of lead. Bromine. Bromide of potassium. Arsenic. Iodide of arsenic. Iodide of methyl. Sanguinaria Canadensis, or puccoon. Chloride of lime. Hydro- cyanic acid. — Milk diet. — Leeches. Venesection Blisters. Syphilization.
CANCE,TJM ORIS. — Sloughing phagedsena of the mouth. Occurs in young children. — See Stomatitis.
CAE,BUNCLE.^Diniin. of Carbo, " a live coal." Synon. Anthrax (from ' A^■0ptt|, a coal). — Consists of severe inflammation of a circumscribed portion of skin and subjacent tissue, with infiltration of unhealthy lymph.
CARDIAC ANEURISM— CARDIAC ATROPHY. 57
Symptoms. Flattened circular swelling. Throbbing or dull aching pain. Suppuration. Bloody purulent discharge. Slough of areolar tissue. Viti- ated state of the blood. Constitutional disturbance. Prostration. Fear of pyaemia.
Treatment. Poultices. Anodyne fomentations. Opium plaster. Cru- cial incisions. Subcutaneous incisions. Potassa fusa, rubbed into the centre until an eschar is formed, with avoidance of incisions and poultices. Congelation. Acid nitrate of mercury. Nitrate of silver. Turpentine ointment. Iodine, 20.5. Warm bathing to remove the discharges. Cotton- wool.
Podophyllin, 160. Jalap and senna, 151. Colocynth and blue pill, 172. Saline aperients with colchicum, 152. Castor oil. Chlorate of potash and steel, 402. Arsenic, 52. Tar capsules, 36. Mineral acids and bark, 376. Ammonia and bark, 371. Quinine, 379. Peroxide of hydrogen. Opium. Morphia and Indian hemp, 317. Nourishing food. Milk. Alcoholic stimulants.
CAEDIAC ANETJEISM.— From KapSJa, the heart: 'Avivpvvu, to di- late.— Two forms of aneurism of the heart: — (1) 'llie acute variety, depends on a laceration of endocardium and muscular tissue, through which the blood passes and makes a pouch. In this pouch fibrin is deposited, while at its entrance is a fringed margin of endocardium with vegetations attached. (2) The chronic form, results from some inflammatory condition of muscular fibre, or of endocardium. Walls of sac consist of endocardial and pericar- dial membranes unbroken, while the muscular fibre seems to be replaced by a fibroid tissue. — Either kind of aneurism gives rise to obscure and uncer- tain symptoms. Passage of blood into sac may cause a murmur. Death usually occurs suddenly from rupture, but rupture sometimes prevented by adhesion of pericardium.
Aneurismal dilatation and rupture of coronary arteries not a frequent event. No symptoms during lite to allow of correct diagnosis.
CARDIAC ATROPHY.— From KapSJa. the heart : 'A, priv. ; -r-pf^co. to nourish. — Two lorms» — (1) That in which the heart wastes and dwindles in all its parts. (2) The texture of the muscular walls suffers a more or less complete conversion into fat.
1. Simple Atrophy. — Occurs in connection with many exhausting dis- eases,— cancer, tuberculosis, diabetes, etc. The whole heart diminishes in size : after death weight found reduced from 9 to 5 oz. Minute examina- tion detects the muscular fibres pale and soft, but otherwise healthy. The treatment must be that demanded by the constitutional state, of which the atrophy is merely a symptom.
2. Fatty Degeneration of Heart. — Muscular fibres infiltrated by fatty granules. Occurs alone ; or in conjunction with fatty disease of liver, kid- neys, cornea, etc. Valvular disease may or may not coexist : when it does, aortic more generally affected than mitral valves.
Symptoms. Feeble action of heart : slow pulse, sometimes as low as fifty or forty-five. General debility. Transient attacks of giddiness or faintness. Nervous exhaustion, and loss of tone. Heart's sounds weak, first short and sharp ; impulse feeble. Attacks of dyspnoea. Sometimes pulmonary apo- plexy, dropsy, etc. Many oF the symptoms of angina pectoris. Perhaps an arcus senilis. — Occurs more frequently in men than women. Most common at advanced period of life. May cause sudden death, — perhaps from rupture.
Treatment. Nourishing animal food. Milk. Cream. Cod-liver oil. Mineral acids. Mild preparations of steel. Attention to digestive organs. Residence in pure air. Early hours. Gentle exercise. Avoidance of ex- citement. Tepid saltwater sponge baths.
58 CAEDIAC FUNCTIONAL DERANGEMENT.
3. Fatty Growth. — Eat normally deposited upon the heart increased on and amongst the muscular fibres to a morbid extent. May occur alone ; or in conjunction with general obesity ; or in association with fatty degenera- tion.
Symptoms. When existing alone the chief features are those of a heart enlarged and impeded in the performance of its functions. Pulse perma- nently quickened above normal standard, while its force is diminished.
Treatment. Animal food. Light French, German, or Hungarian wines. Avoidance of sugar, vegetables, oily and starchy substances. — See Obesity.
CAB-DIAC CANCER. — Primary cancer of heart extremely rare. This organ is secondarily involved more frequently. Right auricle most fre- quent seat : sometimes perforated by the malignant growth. Disease occa- sionally extends along coats of large veins. It may occur as an infiltra- tion in muscular tissue, or as a deposit in form of tumor.
Cancer of pericardium almost invariably the result of secondary and general deposits. Medullary more common than scirrhus.
CARDIAC DILATATION".— May occur under three forms :— (1) Hy- pertrophy of heart with dilatation : known as active dikitation, when the expansion predominates over the hypertrophy. (2) Simple dilatation, where thickness of walls is normal. (3) Passive or attenuated dilatation, the walls being thinned. Often combined with malnutrition of heart, and fatty degeneration of muscular fibres. May arise from exhausting disease, endocarditis, valvular disease, or perhaps from pericardial adhesion. The chief symptoms are, a small weak pulse; coldness of extremities; giddiness and deranged digestion. Attacks of fainting ; paroxysms of asthma ; rest- less nights ; palpitation; perhaps, anasarca, followed by ascites; physical signs : weak impulse more like a tap than a push ; first sound loud, short, and sharp, second usually weak. — Aperients. Antispasmodics, ferruginous tonics, and agents to aid digestion are the only remedies. Digitalis may deserve a cautious trial.
CARDIAC FUNCTIONAL DERANGEMENT.-May closely simu- late organic disease of heart. Occurs in cases of hysteria, ovarian or ute- rine irritation, neuralgia, anajmia ; not uncommon in women at " change of life." May be due to nervous exhaustion from over-study, anxiety, sexual excesses, etc. ; to gout, rheumatism, or chronic kidney, or liver disease ; to use of tobacco or strong tea ; to dyspepsia.
Symptoms. There may be irregular pulse, palpitation, fluttering; with a cardiac murmur and subcutaneous oedema in anajmic subjects. Dull weary- ing ache in prascordial region: occasionally, lancinating pains. Inability to lie on left side, owing to tenderness. Mental depression. Dyspepsia : flatulence and acid eructations. Globus hystericus. Occasional attacks of giddiness, faintness, headache, noises in ears, flushings of face, violent pulsa- tions in aorta, etc.
Treatment. Allay symptoms while removing their source. Explain cause of suffering to patient. Antispasmodics and sedatives to quiet circu- lation.— Ether and ammonia, etc., 85. Assafostida and ammonia, 86. Sumbul and ether. 95. Henbane, camphor, and hop, 325. Codeia and assafcetida, 328. — Where there is any connection with rheumatism, — Aconite and guaia- cum, 330. Potash and ammonia, 67. — In gouty subjects, — Potash and aloes, 71. Citrate of lithia, 64. Stramonium, colchicum, and digitalis, 94. Ool- chicum, 46, 351, 352. Saline draughts, 348. — If there be constipation with unhealthy secretion, — Aloes and jalap, 145. Rhubarb and gentian, 146. Phosphate of soda and aloes, 149. Pepsine and aloes, 155.- — If there be dyspepsia. — Carbonate of magnesia, 62. Ammonia and chiretta, 63. Potash
CARDIAC HYPERTROPHY— CARDIAC RUPTURE. 59
and ammonia, 67. Soda, morphia, and hydrocyanic acid, 70. Ammonia in efTervescence, 362. Bismuth, 65. Nitro-liydrochloric acid, 378. Pepsine, 420. — If there be nervous exhaustion and anainiia, — Citrate of steel and ammonia, 401, 403. Reduced iron and pepsine, 394. Phosphate of iron, 405. Steel and aloes, 404. Quinine and iron, 380. Iron and dio-italis.
In all forms,— Attention to diet. 'J'obacco and tea to be forbidden. Malt liquors usually disagree. Brandy and soda water. Light French, German, or Hungarian wines. Exercise in pure air. Sea bathing.
CARDIAC HYPEETEOPHY.— From KapSt'tt. the heart :'Trt£p, in excess; rpf't", to nourish. Synon. IJijpertrophia Cordis. — The heart is roughly said to be about the same size as the closed fist. Its average weight in adult male is 9^ oz. : in female 8^. After sixtieth year, the weight is somewhat greater, owing to the thickness of walls of left ventricle having increased.
The muscular walls of one or more cavities may become thickened without any diminution in size of chamber, — simple liypertropliy. Or, the walls may be thickened and the chamber enlarged, — eccentric hypertrophy , or hypertrophy with dilatation. Or, the increase in thickness may be accom- panied with diminution of size of cavity, this doubtful — concentric hyper- trophy.— Hypertrophy often beneficial : it counter-balances some impediment to tiow of blood through heart, or to free play of this organ. — Hypertrophy of left ventricle is usually due to aortic valvular disease; or to chronic Bright's disease, in which there is resistance to the passage of the blood through the capillaries and arterioles ; sometimes caused by adherent peri- cardium. Hypertrophy with dilatation of right ventricle, generally due to disease in the mitral valve causing obstruction to the pulmonary circulation, or to some chronic disease of lungs.
Symptoms. Will depend on extent of hypertrophy and on degree of com- pensation of valvular or other lesions. Symptoms attributed to hypertrophy often due to valvular lesion. Frequently, there are palpitations ; dyspnoea ; difficulty in walking quickly ; uneasiness and pain about cardiac region ; headache ; repeated attacks of vertigo. First sound heard less distinctly than in health. Extent of pulsation and degree of impulse increased. AVhen left ventricle hypertrophied, apex displaced downwards to sixth space ; when right, to left beyond nipple-line. Murmurs in valvular disease.
Treatment. Circulation to be kept tranquil. If there be much debility, — ■ Quinine and steel, 380. Steel and pepsine, 394. Steel and ammonia, 401. Phosphate of iron, 405. Bark and ammonia, 371. Mineral acids and bark, 376. Nitro-hydrochloric acid and chiretta, 378. — If heart's impulse be very great, — Aconite, 330. Digitalis, 334.-^When Dyspnoea is urgent, — Ammo- nia and ether, 364. Indian hemp, aconite, and ether. 342. Lobelia and ether, 322.
Remedies sometimes employed : — Bromide of potassium. Iodide of potassium. Hydrocyanic acid. Calomel. Acid tartrate of potash. Ace- tate of lead. Henbane. Morphia. Digitaline. Camphor. Spirit of nitrous ether. Hydrosulphuret of ammonia. Blisters.
CARDIAC RUPTURE.— Rupture of the heart may occur spontaneously from previous disease, or may be caused by external violence. In former case, more frequent on left than right side ; in latter, the reverse. Lacera- tion of walls of ventricles most common. Rupture of valves or their tendons, generally the consequence of prior attack of endocarditis : laceration of muscular wall ft-equently due to fatty degeneration, or to rupture of aneurism in ventricular wall.
When death does not result immediately, there is great orthopnosa ; in- tense prostration ; syncope; convulsions. In liceration of valves, of chordae tendineiE, or of musculi papillares, — great oppression about prsscordia, with
60 CARDIAC VALVULAR DISEASE.
a loud endocardial bruit. If wound gets plugged with coagula, patient may live for even some days.
CAHBIAC VALVULAR DISEASE.— Most of the alterations in internal lining membrane of heart result from inflammation, either acute as in rheumatic^fever, or chrpnic as in goiit, or from overstrain, etc., ^AHlTch gives rise to~ar deposit of lymph upon or beneath the serous membrane. The valves lose their delicacy and transparency : become thick, puckered, and adherent to each other, and the tendinous cords contracted. Independently of inflammation, the valves get covered with warty^vegetations or excres- cences ; or they may become the seat of atheromatous or other deposits ; or they may be os^^ed.
Effects twofold : — Either to contract and narrow the orifice and so obstruct the passage of the blood — valvular obstruction; or by thickening and shortening the valves, to prevent them from closing the orifice and hence permit of regurgitation of blood — valvular insufflcienc.y. regurgitant dis- ease of valves, etc. There may be only valvular obstruction, or valvular insufficiency; often, these conditions coexist.
Symptoms. Shortness of breath on exertion ; in advanced stages, dyspnoea which may amount to most severe orthopnoea. Palpitation and irregular action of heart, with sounds and murmurs discoverable by auscultation. Alterations in pulse. Congestion of lungs; bronchitis; pneumonia; pul- monary hemorrhage. Hemorrhages from nose, bronchi, or stomach. (Edema of lower extremities, sometimes of arms and face ; ascites ; hydrothorax. .^Dropsy more common in affections of right than of left cavities. Headache, T]oise5_ju ears, vertigo, syncope, cereloral congestion, and cerebral hemor- rhage : mo§t urgent in aortic disease. Broken rest, startings during sleep, frightful dreams. Enlargement of liver and spleen. Disordered digestion. A peculiar appearance of countenance, — face puffed ; cheeks flushed and of purple hue; lips congested ; eyes bright and watery. ~~ — ^
As disease becomes aggravated, patient gets weak and very nervous. Suffers immediately from over-exertion, mental emotion, improper food, exposure to cold and wet. Subsequentlj^, death : either suddenly from syncope; or gradually from progress of secondary affections.
Physical signs: — Either or Ijoth sounds of heart accompanied or sup- planted by a bello\vs-mui'mur (bruitde soufflet). A murmur may be harsh, or rough, or cooing, or whistling, or musical, — modifications of but slight importance. Of whatever character, a murmur is caused either by alter- ations of the valves or orifices or great vessels producing an organic murmur; or by an altered state of blood, or a clot in one of heart's cavities, giving rise to an inorganic, ov functional, or hce.mic murmur.
Lining membrane, valves, and orifices of left side of heart much more frequently diseased than those of right. Signs of disease of aortic and mitral valves may be thus briefly given : —
Aortic obstruction. — Systolic murmur, often r^ugh, at rigJit_se£Qiid jnter- costal space and along great arteries. Pulse regular, small, and long. Aortic regurgitation. — Diastolic murmur, usually smooth, at right second space, and downwards along sternum or towards apex. Pulse regular, jerking, and collapsing. Most commonly there is also obstruc- tion, and the murmur is double.
In aortic disease the left ventricle becomes hypertrophied, and the apex-beat is displaced dowinvards. Mitral regurgitation. — (The most comniQii form of valvular disease.) Systolic murmur at and to the left of the^lTpex-beat. Pulse irregular in force and frequency, soft and weak. ""*
Mitral obstruction. — Presystolic murmur (often absent) at inner side of apex, frequently accompanied by thrill. First sound sharp. Pu]*e usually regular, but soft and weak. ''^'*~*
1
CARDIALGIA— CATALEPSY. 61
In mitxal disease the riffht veniricle becomes hypertrophied in con- sequence of obstruction to the passage of blood throuoh the lungs, and the apex-beat is displaced to the left of its normal position.
Tricuspid regurgitation. — (Usually secondary to mitral obstruction or regurgitation.) Systolic murmur near ensil'orm cartilage. Pulsation in jugular vein.
Semilunar valves of pulmonary artery may be supposed to be diseased when the boilow^Mnurmur can be traced from middle of left edge of sternum up tmvarcTS~t&l't clavicle ; and when this murmur cannot be heard in sub- clavian or~carotH3 arteries. Pi^lse remaining unaltered.
To determine systolic or diastolic character of a murmur, the apex-beat . . or the puJs^iji-JJie. ^carotid slTould be carefully noted during auscuTration : ' ^if^ '^H^ if systolic, the bruit musTTSe synchronous with caroticLpulse ; if diastolic, .''^ "• . after it; if presystolic, just befofe it, and running up^U) the apex-beat.
Treatment.'' Three indications to be followed : — (1) To abate inorclinate_ ,'
action by cautious use of sedatives. Di grUUiS; Bel 1 adpj \\a. Hycfrocyanic -^
acid. Aconite. Conium. Henbane. Hop. Opium, or morphia, especially the first two. (2) To ward off" or relieve results of cardiac disease, — as pulmonary congestion, pneumonia, hemorrhage, congestions of liver and kidney, dropsy, etc. A nutritious diet. Mercurial and saline purgatives. Blue pill, col&hi'cum, and colocynth (46). Blue pill, ipecac, and rhubarb or colocynth (111). Gamboge~and blue pill. 174. Sulphate of soda, 144. Cream of tartar and buchu, 222. Cream of tartar and taraxacum, 228. Diuretics,— squills and digitalis, 219, 224. Potash and digitalis, 220. Urea, 225. Elaterium, 157. Resin of podophyllum, 160. Digitalis and calomel, 230. Small punctures at various parts of anasarcous legs. (3) To impart strength and tone to heart. Nourishing food. French, German, ,^_^ or Hungarian wines' Warm clothing. Cod-liver oil. Ferruginous tonics, —quinine and steel, 380. Steel and glycerine, 392. Steel and pepsine, 394. Saccharated carbonate of iron, 396. Steel and ammonia, 401. Phosphate of iron, 405. Tepid salt-water sponge baths, 127.
CARDIALGIA. — From KapSt'a, the heart ; ca.yoi, pain. Synon. Hearf- burn. — The uneasiness is popularly believed to be around the heart. — See Gastralgia.
CARIES. — From Caries, rottenness. Synon. Ulceration of Bone. — A disease of bone, characterized by an unhealthy inflammation, softening, and molecular disintegration ; accompanied by suppuration of surrounding soft tissues. Most frequently attacks the vertebrae, short bones, or cancellated extremities of long bones (as tibia). Frequently due to sci'ofula, syphilis, abuse of mercury. AVhen caused by syphilitic taint, cranial bones often affected.
Symptoms. Commonly obscure at first; apt to be attributed to rheuma- tism. Deep-seated pain. Redness and swelling of tissues over affected part. Abscess, which on bursting discharges a fetid sanious pus loaded with bony granules. On introducing a probe, it easily passes to the bone and sinks into it. Fistulous openings. Constitutional disturbance.
Treatment. Eradication of constitutional disorder. Tonics; nourishing- food ; cod-liver oil ; sea air. Iodide of potassium and bark, 31. Iodide of iron, 32. Chemical food, 405. Locally : — Great cleanliness. Astringent lotions and injections. Other remedies failing, removal of diseased portion of bone. Escharotics (potassa fusa, chloride of zinc), where use of knife is contra-indicated.
CATALEPSY. — From Kara^anlidvu, to restrain, or hold firmly. Synon. Hysteria Cataleptica. — A sudden suppression of consciousness and voli- tion ; patient remaining during attack in same position in which she hap-
62 CATAEACT— CATAERH.
pens to be at commencement, or in wliicli she may be placed during its continuance. Seizure may last a few minutes, several hours, or one or two days. Eecovery occurs suddenly as from a deep sleep, without recollection of what has occurred. Nervous and hysterical women suffer from these attacks more frequently than other persons. Danger absent ; very rarely the disease ends in apoplexy or insanity, possibly when connected with chronic softening or with tumor of brain.
Absence of mind a slight form of catalepsy. True mesmerism another variety. The disease has sometimes been endemic.
For treatment see Hysteria.
CATAKACT. — From Karap/jaocrco, to confound ; because the sense of vision is confounded or obscured, if not destroyed (Mayne). — Consists of an opacity of the crystalline lens, or of its capsule, or of both ; the effect being to inter eei>t -t-lTeT'ays of light on thtltlvay to tlre^Tetina. Three forms usually recognized, according to situation of opacity — viz., lenticular, cap- sular, and capsulo-lenticular. " '^ Symptoms. Hard or lenticular cataract of old people, the most common form. Met with in men and women, betweeirfifty and seventy years of age. Causes objects to appear as if obscured by a thick cloud or gauze : allows vision to be most clear when pupil is dilated, as by use of atropine or bella- donna, or by light being dull and subdued. In advanced cases vision reduced simply to perception of light from darkness. Commonly one eye first affected, and then the other. Movements of iris natural : when pupil is dilated by belladonna, cataractous opacity can be distinctly seen with a convex glass of about one inch focus. In commencing cataract, letrticular opacities not otherwise perceptible may be seen with the ophthalnioscci'pe as opaque strife, occupying either the anterior or posterior segment of the lens, and springing from the centi-e of the crystalline, or converging towards the centre from the circumference.
Soft or lenticular cataract of young people may occur at any time of life. Conge15Tfal~CKt-aract of this kind. Due to disintegration of whole substance oTlens, which becomes opaque and swollen. Symptoms much the same as of hard kind, except perhaps that vision is more imperfect. There appears to be some connection between diabetes and soft cataract.
Capsular cataract may result from chronic inflammation. Opacity of a dead white color ; commonly affects part or whole of anterior wall of cap- sule, or it may perhaps be confined to posterior portion.
Opacity of capsule always leads to opacity of lens, so that capsulo-len- ticular cataract is common.
Treatment. One of three operations: — (1) Depression, displacement, or " couching," a clumsy and generally inefficient proceeding by which the lens is pushed from its natural position, so as to allow rays of light to pass through pupil to retina. (2) Solution or absorption, in which the body of lens is .broken up, at several sittings, so that it may undergo absorption. Only suitable for soft cataract. (3) Extraction, in which opaque lens is removed entire through an incision in the cornea.
CATARRH. — From Karap/jS", to flow down little by little. Inflamma- tion of mucous membrane ; usually applied to inflammation of mucous membi-ane of some portion of air-passages. Known as coryza, if it affect Schneiderian membrane of nose ; gravedo, if frontal sinuses suffer ; hron- cliitis, when stress of disease falls on trachea and bronchial tubes. Aural catarrh, intestinal catarrh are also spoken of. — Catarrh as affecting mucous lining of nose and throat, one of the commonest of diseases.
Symptoms. Lassitude; pains in limbs; aching of back ; sense of tight- ness across forehead ; excessive discharge from nostrils ; profuse lachryma- tion ; hoarseness ; sore throat ; furred tonarue ; more or less feverishness
CELLULITIS VENENATA— CEREBRAL HEMORRHAGE. 63
thirst; loss of appetite ; quick pulse. An eruption of herpes appears upon lips ; most frequently about angles or middle of lower lip. — At end of some forty-eight hours symptoms begin to subside ; or disease passes into a more severe affection, — acute tonsillitis, bronchitis, pneumonia, etc.
Treatment. Warm bath. Foot bath. Turkish bath. Powder of ipc- cacuau and opium. Aconite. Warm clothing. An extra glass or two of wine. White wine whey at bed-time.
CELLULITIS VENENATA. From Celbda. a little cell: terminal -I'tis ; VenoLuvi, poison or venom. Synon. Diffuse Cellular Inflamma- tion.— Diftused inflammation of the areolar tissue ; arising from punctures received in dissecting the dead body, or from bites of venomous reptiles, etc. May occur without septic inoculation in unhealthy states of system, from breathing vitiated air, etc.
Symptoms. Erysipelatous inflammation of areolar tissue and absorbents. Skin secondarily involved. Sometimes pleuro-pneumonia. Redness and tenderness of lymphatics. Rigors. Fain. Offensive perspiration. Sup- puration. Gangrene. Delirium. Jaundice. Dyspnoea. Stupor. Fatal exhaustion.
Treatment. Withdrawal of poison by suction or cupping glass. Liga- ture between wounded part and trunk. Caustic. Bark, 371, 376. Quinine in large doses, 379, 386. Sulphite of magnesia, 48. Chlorate of potash, 61. Tincture of perchloride of iron and glycerine, 392. Brandy and Qgg mixture, 17. Fomentations. Poultices. Incisions. Leeches? — See Iclwr- licemia.
CEPHALALGIA. — From Kf(5)aX-/7, the head ; a^yoj, pain. Synon. Cepha- lodynia ; Dolor Gapitia. — See Headache.
CEPHALOH^MATOMA.— From Yi(^a%^, the head; cd/xdtco^a, a san- guineous tumor. Synon. Gephalcemaioma ; Ecchymoma Capitis Recens Natorum ; Thrombus Neonatorum. — A bloody tumor, developed immedi- ately after birth, between bones of skull and pericranium. It is probably caused by long-continued pressure upon foetal head during a difficult labor.
Symptoms. Tumor varies in size from that of a hen's Qg^ to that of a large orange. Is generally formed on one or other of parietal bones : on right more frequently than left ; and occasionally on both. — Swelling soft, circumscribed, and fluctuating : its base often becomes encircled by a hard ring, probably caused by coagulation of the plasma exudation which is poured out by irritated pericranium.
Treatment. Generally best to leave the case alone : effusion becomes absorbed in course of two or three weeks. In some instances, absorption may be hastened by use of evaporating lotions. Avoid the practice some- times recommended of incising tumor, removing blood, and applying com- pression. Should suppuration take place, the pus must be evacuated, and case treated as a dangerous abscess.
A kind of false cephalohajmatoma sometimes produced by effusion of blood into areolar tissue between aponeurosis of scalp and pericranium. It requires no treatment.
CEREBRAL HEMOREHAGE.— From Cerebrum, the brain: Al^a, blood; lAyvvfxi, to break out. — Not synonymous with apoplexy. There may be symptoms of latter, but not necessarily. Main feature, more or less paralysis on side of body opposite to that on which- clot is formed. May come on in various ways; with apoplectic phenomena, on the subsidence of which hemiplegia remains. -2. During sleep, patient waking up hemiplegic. 3. Patient loses use of one side, falls or staggers, feels faint, is giddy and confused but does not lose consciousness. May vomit later, gradually
64 CEREBRAL INFLAMMATION.
becomes comatose (this form generally fatal). 4. Simply turns suddenly hemiplegic. Sensation may, or may not be affected.
Most common seat of hemorrhage, corpus striatum, next thalamus, then hemisphere. It may also occur on surface, in cerebellum, crura, pons, or medulla. The special symptoms attending meningeal hemorrhage when considerable are convulsions, coma, irregular form of paralysis. Hemorrhage into pons or medulla is generally rapidly fatal. May give rise to various kinds of crossed paralysis ; when pons 'affected, pupils greatly contracted. Many cases of cerebral hemorrhage recover, provided recourse be not had to active treatment. Patient rarely seen until after the effusion, when blood-letting and purgatives powerless to remove clot, or to prevent further escape of blood. Rest in sitting posture, with a nutritious but unstimulating diet, aperients, treatment of special constitutional conditions, will effect all that is possible.
CEREBEAL INFLAMMATION.— The study of brain diseases is hardly sufficiently advanced to permit of a certain diagnosis between inflammation of substance of brain [cerebritis), and that of membranes [vieningitis) . Distinction not of great importance. In only a few instances does menin- gitis, or cerebritis occur alone. In majority of cases the two affections ai'e combined {encej)lialitis).
1. Simple Meningitis. — From Mj^wyl, a membrane; terminal -itis. Synon. Encephalitis Memhranof^a. — Inflammation of arachnoid and pia mater may arise without apparent cause ; or may be produced by a fall or blow, by extension of disease from ear or nose, or by exposure to the sun. May also arise from syphilis or rheumatism ; from tubercle (see Tttbercular Meningitis).
Symptoms. Fever. Temperature not very high. Acute pain in head. Irritability, with early and violent delirium. Frequent flushings of face, followed by pallor. Rapid pulse. Muscular twitchings. Prostration and coma.
Inflammation of membranes over convexity of brain .- — First, a rigor;
or in children, a convulsion. Then, skifi gets not aiid'cli'y ; pulse hard and
rapid ; usually vomiting comes on : bowels confined. Intense headache,
increased by sound or movement. Face alternatelj' flushed and pallid: con-
junctivEe injected, eyes suffused and staring. Noisy and violent delirium
sets in early. Great restlessness ; muscular twitchings ; strabismus. At
end of three or four days, fever lessens ; pulse flags, often slow but readily
1 V i accelerated ; tongue gets brown and dry ; pupils sluggish and dilated ;
P iv^JtxaL^ excitement diminishes; delirium apt to paiss 'into coirrar — T!r"tr"fevri}ays
1 ■ '^f^^,,,..'^'^ tnore, intense prostration. When disease ends favorably, improvement very
"' gradual : no critical sweat or diarrhoea.
Meningitis confined to bff'Se: — Diagnosis difficult. Sometimes convulsions or delirium at commencement; fever; contracted pupils; optic ischajmia or neuritis ; frequent pulse ; clenching of teeth ; and retraction of head. Coma. In other cases, pain in temples ; vomiting, constipation ; wry-neck ; loss of appetite; a desire for repose. After a few days, vacant look; dejection; intelligence clear; pulse and skin natural. Headache unrelieved. Coma, ending in death.
Inflammation of dura mater: — Frequently the result of violence: of disease of cranial bones, particularly of petrous portion of temporal or of ethmoid. Chronic affections of ear and nose iu children, regarded as trifling, may end fatally by rapid extension of morbid action to dura mater.
Treatment. See Acute Encephalitis.
2. Cerebritis. — From Cerebrum, i\\Q brain; terminal -/^i's. — Partial or general inflammation of brain substance without meningitis. Of rare occur- rence. ~
^^U^'
CEREBRAL INFLAMMATION. 65
Symptoms. Persistent deep-seated pain in head ; general malaise and vomitincr; impairment of vision and hearing; confusion of ideas, with failure of memory ; convulsive paroxysms, ending in paralysis or coma. Mental disturbance varies considerably according to part of brain affected. After three or four days there may be a copious effusion of serum : symptoms of compression. Sometimes, inflammation ends in abscess; suppuration occur- ring witliout exciting any suspicion.
Treatment. See Acute Encephalitis.
3. Acute Encephalitis.— From 'Eyx£|)aXos, that which is in the head; terminal -/(^/s. Syiion. Meningo-cerehritis ; Plirenitis. — 'I'he inflammation gives rise to more or less complicated phenomena during life, according to degree and extent to which brain and its membranes are involved. Post- mortem appearances : meningeal congestion, with effused lymph or serum or pus ; vascularity, varying from bloody points, or a scarlet tinge, to a dusky redness of brain sub?tanceliO'ffecTgtf^)af t ; with occasionally soften- ing, or suppuration.
Symptoms. Earliest indications, fever; vomiting; acute headache; i "^aJ
sharp and hard and irregular pulse ; constipation ; impatience of light and ' ^^r ." , sound ; watchfulness; a look of oppression or sulienness; suffusion of eyes; ■^" hypersemia of optic disks; confusion of thought or even delriTam. ~ These symptomTTiTOst markecr^when meningitis predominates. — After from twelve ■' ^ , « hours to two days, second stage of the complaint sets in — period of collal^se. ' ^_„-^— State of stupor ; articulation difficult or indistinct ; vision and hearing dull ; pupil" — irolri having been contracted to a pin's point — becomes dilated ; optic neuritis; perhaps squinting, and paralysis of muscles of eyelids; frequent twitchings of muscles ; ghastly countenance ; sordes on gums and teeth ; cold sweats ; relaxation "oT-sptftficters ; convulsive paroxysms, paralysis, and profound coma, which usually soon ends in death. — Occasion- ally the first symptom, a sudden attack of convulsion ; perhaps occurring without previous illness, or preceded by headache and slight complaints which have passed on unnoticed. Convulsion generally long and severe : may be followed immediately by coma, which is soon fatal ; or it may recur frequently at short intervals, and pass into coma at end of twenty-four hours. When nausea and vomiting are earliest symptoms, disease has probably had its origin in cerebral pulp ; when attack begins with a convulsion, the inflammation has started from arachnoid or pia mater (Watson).
In all forms of this dangerous complaint, symptoms variable. Caution necessary against insidious character which many cases assume, and deceitful appearances of amendment. Disease rare. May end fatally in a few hours, - or patient may struggle on for two or three weeks.
Treatment. Calomel and jalap, followed by sulphate of magnesia, 140. Jalap and senna, 151. Calomel and scammony, or jalap, 159. Antimony and sulphate of magnesia, 152. Croton oil, 168. Castor oil and turpentine enema, 190. " More recoveries from head-affections of the most alarming aspect take place under the use of very strong purging than under any other mode of treatment" (Abercrombie). Mercury as calomel or blue pill or gray powder. Iodide of potassium (grs. 3 to 8 every four or six hours). Bromide of potassium, gr. 10-15, every four hours. Tincture of aconite. Milk diet. Head to be shaved. Pounded ice in a bladder, to scalp ; or cold evaporating lotions, 273. Excess of temperature reduced, and excite- ment calmed, by pouring cold water in a stream upon vertex of head. It must be remembered that cold to head exercises a very depressing influence : hence, case must be carefully watched. As soon as extreme collapse sets in from exhaustion of nervous force, stimulants will be needed. Ammonia. Spirit of ether. Brandy or wine. Strong beef-tea. Milk or cream.
Remedies sometimes employed : — Ceueral and local bleeding. Drastic 5
66 CEREBRAL INFLAMMATION.
purgatives, long continued. Antimony. Digitalis. Opium combined with antimony. Blisters, or ointment of tartarated antimony to scalp, after shaving. Mustard pedihivia.
4. Tubercular Meningitis. — Synon. Acute Hydrocephalus ; Water Brain Fever. — Acute inflammation of brain not uncommon in children under five years of age. The disease may occur in those previously healthy ■when it is a form of simple encephalitis. Most frequently the children ai'e scrofulous ; the inflammation being a result of tubercular deposit in brain or membranes. It is then known as tubercidar meningitis. Formei'ly named acute hydrocephalus.
Post-mortem Appearances. — Tubercular meningitis almost always basic. Exudation of yellow lymph or serum at interpeduncular space and adjacent parts, minute granulations (tubercular) in membranes here ; often well seen in fissures of Sylvius. Much fluid in ventricle and frequently softening of surrounding brain substance. Tubercles nearly always present in other organs.
Symptoms. Various and uncertain. Premonitory stage : — Indications of mal-nutritiou ; loss of flesh. Signs of strumous diathesis. Short, dry cough ; peevishness ; occasional headache, giddiness, and other warnings of cerebral congestion ; feverishness, with exacerbations and remissions ; capricious appetite ; tongue furred, and breath offensive ; sickness and constipation. Child drowsy, yet restless; moans or grinds his teeth; wakes iu alarm and screams. These symptoms may be present for weeks or even months, and are considered to indicate the presence of tubercles.
When inflammation sets in three stages are described.
First stage; stage of excitement or of quick pidse. — Child wishes to be left quiet. Countenance alternately flushed autLpale, expressive of sufl'er- ing ; eyes closed and eyebrow^ knit. Fu^Is^xmtracted, intolerance of light and sound ; purposeless vomiting ; bowels usuaTIy, confined. If old enough to reply to questions, complaint made- of headache and weariness and sleep- lessness ; frequent exclamations — " Oh my head." Sometimes delirium ; pulse frequent. Abdomen retracted. Tdches Cerebrates.
Second stage ; stage of depression or of sloio pulse. — Pulse less frequent, perhaps falling from 140 to 80 ; irregular; made more rapid by exertion or excitement. Remission of all symptoms. Amendment of short duration. Stupor and heaviness come on. Squinting. Child lies insensible, probably picking his nose and lips with tremulous fingers. Convulsions ; perhaps paralysis. Urine and feces passed unconsciously.
Transition to third stage, at end of a week or two, effected gradually by drowsiness passing into profound coma. Pupils dilated and insensible. Pulse gets very feeble and frequent ; extremities lose their warmth, cold clammy sweat breaks out. Paralysis, perhaps convulsions. Sometimes death does not occur for several days.
In tubercular meningitis characteristic appearances of ischsemia or neu- ritis may generally be observed at fundus of eyeball, by ophthalmoscope, before convulsive period sets in. These are, — (1) Peripheral congestion of papilla, with spots of congestion in retina and choroid. (2) Dilatation of retinal veins around papilla. (3) Yaricosity and flexuosity of these veins. (4) Thrombosis of same. And (5) in some instances, serous infiltration with retinal hemorrhages from rupture of veins (Bouchut).
Tuberculur meningitis in adidt usually preceded by history of previojfls lung affection. Amelioration of chest disease. "Symptoms may early as- sume an apoplectic or a convulsive form. More frequently they come on gradually with vomiting, slight fever, acute pain in head ; patient seems unable to collect his thoughts, is peevish and irritable, desires only to be left quiet; there may be mutism and somnolence; pulse irregular and feeble. In second stage, depression increases ; greater mental dulness or
CEREBRAL INFLAMMATION. 67
delirium ; clonic or tonic spasms. In third stage, sphincters relax ; increas- ing stupor ; paralysis ; death.
Treatment. Bowels to be cleared out by calomel and jalap. Iodide, or bromide of potassium, or both, with small doses of tincture of aconite, according to age. Cold evaporating lotions to head, 273. If child be teething, employ gum lancet when gum is tender and hard and swollen. Where there is depression of vital powers use stimulants, — ammonia, ether, port wine. If symptoms be subacute, hypophosphite of lime or soda and park. Cod-liver oil. Sea air. Pui'e milk.
5. Chronic Encephalitis. — May follow acute inflammation : more fre- quently an independent primary disorder.
Symptojis. Of a subacute character. Very diversified : allied to those which mark commencement of insanity. Great mental excitement, or de- pression. Delusions. Hesitation in speaking, or slight stammering. Stiff- ness of some muscles. Slight headache. Loss of appetite. Constipation. Irregularity of pulse. Subsequently, symptoms become more marked ; memory fails, external senses get impaired, paralysis, break up of general health. Disease may last for only a few months, or for years.
Treatment. Attempts to combat symptoms as they arise. Hygienic measures to improve general health. Attention to digestive and uterine organs. Cod-liver oil. Small blisters behind ears, often repeated. A seton in nucha. Sometimes, inunction of shaved scalp with iodide of potas- sium, or red iodide of mercury, ointment.
6. Induration of Brain.— Termination of acute or chronic inflamma- tion. Indurated portion of small extent : presents appearance of wax, or white of egg boiled hard. Symptoms obscure.
7. Abscess of Brain. — Usually due to injury, or to disease of internal ear and petrous bone, more rarely of nose and ethmoid. Maybe acute, when symptoms those of severe cerebritis, pain in head, vomiting, fever, delirium ending in coma ; or chronic, when very insidious, headache, dul- ness of intellect, etc. ; sometimes hemiplegia gradual in access ; occasionally convulsions and death from bursting of abscess into ventricle.
Treatment. Mercury or iodide of potassium.
8. Softening of Brain. — Softening, or Ramollissement may be inflamma- tory, but is more commonly atrophic, and caused by imperfect blood-supply due to arterial degeneration. General symptoms of chronic cerebral soften- ing .•—More or less severe and persistent pain in head. Sudden and short attacks of vertigo. Diminution of intellectual j)Ower, slow and hesitating speech, embarrassment in answering questions, depression of spirits, tend- ency to shed tears on any excitement. Prickings and twitching in limbs, perhaps pain or numbness. Tendency to sleep, especially after meals. More or less impairment of vision and hearing. While mental faculties impaired, appetite often goocj, and patient may get fat. In inflammatory softening, headache more acute than in other forms ; limbs become the seat of painful cramps, stiffness or contractions ; paralysis with spasm not un- common ; permanent contraction of flexor muscles of one or both extremi- ties ; general sensibility more acute. — In second stage of either inflammatory or non-inflammatory form : — Paralysis of a limb, or of one-half of body, coming on suddenly without loss of consciousness. Patient easily confused ; has a difSculty in answering questions, and in making himself understood. Feebleness ; weak and intermitting pulse. Vomiting and constipation. Difficulty in emptying bladder. Involuntary escape of stools. Respiration labored ; at last becomes stertorous. Coma, ending in death. Disease most common after fiftieth year.
Acute Ramollissement (from Ramollir, to make soft), or red softening of brain, formerly considered inflammatory, usually from embolism or other
68 CHAPPED HANDS— CHICKEN-POX.
obstruction in a cerebral artery. Affected portion reduced to consistence of cream ; if of limited extent, absorption may take place.
Symptoms. Vary with part affected; usually hemiplegia coming on suddenly without loss of consciousness ; later, some of symptoms described in previous paragraph.
White softening occurs from conditions the opposite to those of inflam- matory form. Met with in aged persons. Insufficient supply of blood to brain ; owing to disease of cerebral arteries, or obstruction by fibrinous masses. Probably leads to fatty degeneration of brain tissue. Portions most frequently affected,— gray matter of convolutions at base, optic thalami, corpora striata.
Softening of cerehellum: — Attended with fixed pain at back of head, especially on diseased side. Occasionally, amaurosis ; hemiplegia or para- plegia ; a tendency to walk backwards ; tottering gait ; vertigo ; semi-con- vulsive agitation of limbs; obtuse hearing ; aphonia. No two cases exactly alike. Abscess of cerebellum sometimes due to disease of ear and mastoid cells.
9. Tumors of Brain. — Simple or malignant; glioma, syphiloma, scrofu- lous, or tubercular tumors ; hydatids.
Symptoms. Often obscure. The most constant are pain in head, vomiting, and double optic neui-itis. Other symptoms according to situation of growth ; if on surface, convulsions ; if in motor ganglia, hemiplegia ; if involving crus cerebri, pons, or medulla oblongata, some form of cross paralysis; if cerebellum, unsteady gait, loss of energy, etc.
Simple and malignant tumors, deposits of tubercle, syphilitic gum- matous growths, and hydatids have been found in brain. Indications of such very obscure. Most frequent symptoms, — headache, sickness, giddi- ness, mental depression with confusion, partial paralysis, epileptiform convulsions.
10. Hypertrophy and Atrophy of Brain. — Hypertrophy of cerebral hemispheres has occurred in children: more common between 20 and 30 years of age. Increase of volume due to connective tissue. If skull increases as brain gets over-developed there may be an absence of symp- toms, until a sudden attack of convulsions ends in death. When bony case does not enlarge, there are necessarily indications of compi-ession : mental disturbance, varying from slight duhiess of intellect to complete idiocy. Headache ; vertigo ; loss of muscular power or paralysis ; unaltered or very slow pulse ; severe epileptic convulsions. Death in latter, or from subsequent coma.
Atrophy may vary from a complete absence of cerebral hemispheres incompatible with extra-uterine life, to a simple incomplete development of certain convolutions above ventricles. When atrophy affects one side only, life may be uninterfered with for some time.
CHAPPED HANDS. — May be due to imperfect drying after washing ; to use of irritating substances, — common yellow soap, etc. ; to cold ; to wearing coarse woollen gloves which fret the hand when moist from perspiration.
Treatment. Thorough drying after washing. Dusting with powdered starch ; spermaceti ; white bismuth ; oxide of zinc ; carbonate of zinc. Glycerine soap. Glycerine and starch. Pure honey soap. Glycerine and water — equal parts. CoUodium. Ointment of oxide of zinc. Ointment of carbonate of lead. Ointment of subacetate of lead. Ointment of spermaceti. Diluted citrine ointment, .305. Ointment of balsam of Peru and spermaceti, 306. Lotion of nitrate of lead (gr. 10 to fl. oz. j).
CHICKEN-POX, — Synon. Varicella. — A trifling infectious complaint almost peculiar to infants and young children. Runs through all its phases
CHILBLAIN— CHLOROSIS. 69
in six or eight days. Consists of an eruption of pimples, whicli on second day become converted into transparent vesicles surrounded by slight red- ness. Rash commences on shoulders and back, and afterwards affects the scalp, but usually spares the face : about fourth day the vesicles form small scabs, which rapidly desiccate. No constitutional disturbance of impor- tance : accompanying pyrexia slight.
Occurs but once to same person. Has a variable period of incubation. Requires no treatment beyond attention to bowels, and restricted diet. Quinine, bark, steel wine, or cod-liver oil, often needed during convales- cence.
CHILBLAIN. — From the Saxon Cele, cold ; hlegen, a boil or ulcer ; i. e. a blain caused by chilliness or cold (Mayne). Synon. Pernio. — A subacute inflammatory swelling, due to cold and the premature restoration of the circulation by heat.
SyiMptoms. a feeble circulation,- — cold feet and hands. In the first stage, swelling and slight redness and pain or itching ; in the second, vesication ; in the third, ulceration or sloughing. Parts most exposed, and where circulation is weakest, most prone to suffer. Occurs in weakly con- stitutions, strumous children.
Treatment. Bark and port wine. Milk; nourishing food. Cod-liver oil. Chemical food, 405. Avoid quickly exposing hands and feet wlien cold to heat. Fire in bed-room. Warm stockings and gloves. Avoidance of tight shoes. Fi'iction with compound camphor, arnica, soap, opium, or turpentine liniment. Painting with tincture of iodine. To relieve itching, lime liniment or glycerine. Sulphurous acid spray in early stage. When vesication or ulceration occurs, water dressing or poultices ; collodion and castor oil varnish, 285 ; resin or turpentine ointment. Diluted nitrate of mercury ointment. Nitrate of silver.
CHIMISrEY-SWEEPER'S CANCER.— A rather uncommon form of epithelial cancer. Very rare in Scotland, France, etc. Produced by irritation of soot lodged in folds of scrotum, in individuals predisposed to cancer. Sometimes hereditary.
Symptoms. Commence as a tubercle or wart. After a variable interval, a fungous sore with ragged edges forms ; whicli spreads and causes great pain, and presents all the frightful characters of malignant ulceration. Superficial inguinal glands do not invariably become secondaiily affected. General health breaks down. Death sometimes hastened by hemorrhage.
Treatment. Destruction of the soot-wart by chloride of zinc, or super- sulphate of zinc, or chromic acid. Extirpation. When disease is more advanced, excision may retard its progress ; provided inguinal glands have not become involved. Sooner or later a return is to be feared. — See Cancer.
CHLOASMA, — From X^oalw. to be of a greenish, yellow color. Synon. Pityriasis Versicolor; Macula Hepatica ; Liver Spot. — A parasitic cutaneous disease. — See Tinea.
CHLOROSIS.— From X?Lwp6?, green. Synon. Pallor Virginum ; Green Sickness. — A peculiar form of auajmia, affecting young women about the age of puberty. The red blood corpuscles are pale, small, and diminished in number. The serum is in excess.
Symptoms. Wax-like hue of face, yellow pallor of skin, whence popular name of "green-sickness." Deficient or depraved appetite. Constipation. Abundant limpid urine. Weak quick pulse. Hysteria. Pale scanty men- strual discharge. Leucorrhcea. Listlessness. Headache. Palpitations.
70 CHOLiEMIA— CHOLERA.
Backache. Cardiac and vascular murmurs. Occasionally enlargement of thyroid and protrusion of eyeballs.
Treatment. Good living. Pure air. Sea-bathing. Chalybeates. Alo- etic aperients. — See Anmmia.
CHOL^MIA. — From 'Kox-q, bile ; al^a, blood. — The morbid state in which bile exists in the blood, owing to its re-absorption after having been formed by the liver. — See Jaundice.
GHOLEE.A. — From XoTtaj, the bowels, and |jlco, to flow ; or, according to some authors, from "KoXri, bile, and pso. Synon. Epidemic, Malignant, Asiatic, or Algide {Algeo, to be cold) Cholera. — An epidemic disease ; con- veyed from place to place by human intercourse ; not directly contagious in a high degree ; probably spread by contamination of drinking water by choleraic discharges.
Symptoms. Sometimes preceded by simple diarrhoea : more frequently comes on suddenly without warning. Presents three stages : — (1) Diarrhoea and vomiting. (2) In addition, contracted pupil, spasms, cramps, coldness of body, and intermitting pulse. (3) Supression of urine: collapse.
In detail these symptoms are copious vomiting, and purging in most cases, at first painless and without effort ; stools consist of an abundance of water, flocculi of coagulated albumen (imparting a rice-water appearance), a trace of biliary matter, and a large amount of salts (especially chloride of sodium). (2) Yery shortly, severe cramps in lovrer extremities and abdomen, render- ing muscles as hard as wood, or drawing them into knot-like masses. (3) Perhaps albuminuria, followed by suppression of urine. Urgent thirst. Diminished circulation and impeded respiration : hence, intense prostration, icy coldness of surface and tongue and breath. Lividity or blueness of lips and skin generally. Unnatural and whispering voice. Shrinking of whole body. Pinched features : muddy-looking complexion : sinking of eye, with contracted and immoble pupil, and flattening of cornea : — the whole so pecu- liar that the expression is spoken of as the fades clioleritica. Noth with- standing coldness of surface, complaint is made of oppression : patient often likes to lie uncovered. There soon follows a gradual lessening of breathing ; a thread-like pulse ; a clear intellect ; and a complete arrest of circulation. — Patients who survive eighteen hours frequently show signs of amendment: occasionally get well rapidly ; pulse rising, and rice-water evacuations being replaced by stools containing bile. But often, improvement only transient : stools, though less frequent, are free from bile ; suppression of urine con- tinues ; and death is preceded by headache, drowsiness, tonic or clonic spasms, vomiting, stertor, and coma. In more favorable cases, a mild febrile ex- acerbation follows and subsides gradually in a few days : or this consecutive fever is of a more severe type, and a low typhoid condition follows.
Treatment. Prophylactic :■ — Sanitary laws to be strictly obeyed. Avoid- ance of all doubtful food and impure water ; of too long abstinence from food ; of purgative medicines ; of over-fatigue ; of intemperance, unclean- liness, and of breathing vitiated air. > Any tendency to diarrhoea to be checked by recumbent position ; warm bath ; sinapisms or linseed poultices to abdomen ; mucilaginous drinks ; very plain food ; and simple astringents, ether, or spirit of chloroform.
Curative : — Only three points seem certain : — Except during the premoni- tory stage the purging is not to be checked ; opium is most injurious ; and the patient is to have cold water, or soda water, and ice ad libitum.
Dr. William Stevens' plan was more successfully used than any other, on a large scale, in the prison of Coldbath Fields, during 1832 : — Patients pre- senting premonitory symptoms were removed into an observation ward, where an even temperature was constantly maintained. A Seidlitz powder was immediately given : if sinking were felt without purging, three or four
CHOLERA. 71
teaspoonfuls of sulphate of magnesia were addccl to powder. These agents acting freely, plenty of thin and well-salted beef-tea was given: thirst was relieved with seltzer, soda, or pure water without stint: if there were any pains a sinapism was applied over gastric region. Most of the cases were thus cured. — If, however, cramps, coldness, or sinking of pulse came on, the following was given about every half hour : — Chloride of sodium, gr. 20 ; carbonate of soda, gr. 30; chlorate of potash, gr. 7; — dissolved in water. If much irritability of stomach existed, a large sinapism was applied ; if much heat or burning pain, an additional quantity of carbonate of soda was added to mixture. — lu cases in stage of collapse, a strong solution of same salts, dissolved in hot water (100° P.), was thrown into rectum, and repeated every two or three hours. Sinapisms to stomach and between shoulders. Frictions with warm towels. Air of ward kept perfectly pure.
Dr. A. C. Macleod, after twenty years of Indian practice, recommends : — Calomel, in ten grain doses, every half or even every quarter of an hour. A large blister to loins. Diffusible stimulants, regulated by state of pulse. Draughts of cold water ad libitum. Hot water bottles to feet. Assiduous rubbing, by three or four attendants, of abdomen and extremities with caju- put oil : while in intervals of friction, the abdomen is to be covered with spongio-piline sprinkled with the oil.
According to the Cholera Report of the Royal College of Physicians (London, 1854) no appreciable effects followed the administration of calomel, even after a large amount in small and frequently-repeated doses had been administered. For the most it was quickly evacuated by vomiting or purging, or if retained was afterwards passed from bowels unchanged.
All authorities agree that patient should be isolated as far as possible. To be surrounded with pure air. To be kept in the recumbent postui-e. ^J'o avoid all water drawn from a well near any sewer. To have excretions received in a pan containing some disinfectant fluid, and immediately thrown away. Great caution with regard to diet during convalescence. Broths and farinaceous substances, without any solids whatever, until the biliary and renal secretions have been fully re- established, and all symptoms have vanished.
Remedies which have had advocates: — Bleeding. Cupping. Dry cupping. Exhausting apparatus of M. Junod. Blisters. Emetics. Pur- gative enemata. Astringent and opiate enemata. Injections of warm water, or of saline solutions, into veins. Inhalation of oxygen gas : of nitrous oxide. Sulphur. Sulphuric acid. Nitric acid. Nitro-hydrochloric acid. Quinine. Ipecacuanha. Indian hemp. Opium. Belladonna. Sub- cutaneous injections of atropine: of morphia: of sulphate of quinine: of camphor and turpentine : of curare. Injection into veins during hopeless collapse, of warm water to the extent of several ounces : of warm water containing 4 per cent, of phosphate of soda and same quantity of common salt: of artificial serum. Brandy. Cajuput oil. Castor oil. Croton oil. Creasote. Carbolic acid. Chloroform. Nitrite of amyl. A dilute alco- holic solution of liquor potassce. Charcoal. Permanganate of potash. A highly concentrated solution of camphor in alcohol (the " Rubini" specific). Saturated solution of camphor and chloroform. Ether. Sugar. Arsenic. Chloride of potassium. Sulphate of copper. One single large dose of calomel (30 grains). Acetate of lead. Logwood. Nitrate of silver. In- fusion of Mikania Cuaca. Petroleum. Phosphorus. Sumbul. Turpen- tine. Inoculation with quassia. Wet-sheet packing. Cold affusion. Hot baths, followed by cold affusion. Hot air baths. Vapor baths. Hot water baths. Mustard baths. Ice to spine. Galvanism. Actual cautery along spinal column. Vesication with boiling water. Acupuncture of heart.
The treatment most worthy of further trial is subcutaneous injection of morphia or atropia. Medicines taken by the mouth have little chance of absorption.
72 CHOLESTER^MIA— CHYLOUS URINE.
CHOLESTER-ffiMIA. — From XoXrj, bile ; otfpibi, solid ; and al,«a, blood. — Blood-poisoning, owing to the non-elimination of cholestei'iue by the liver. — See Acliolia.
CHOREA. — XopfJtt, a dancing or jumping ; from Xopo^, a dance accom- panied with singing. Synon. Chorea Sancti Viti ; St. Vitus' Dance. — ■ A disease chai'acterized by irregular, and often ludicrous actions of volun- tary muscles, especially those of face and limbs ; there being incomplete subserviency of affected muscles to the will. Has been called " insanity of the muscles." — Mostly attacks girls between sixth and fifteenth years, though not uncommon in boys.
Symptoms. At the commencement, slight clonic spasms of facial muscles, or of limbs on one side. By degrees almost all voluntary muscles affected. Child cannot keep quiet, though movements are to some extent under con- trol of will : constant restlessness of hands and arms, perhaps of legs, most marked when patient sees she is watched. Features curiously twisted and contorted : vacancy of countenance. Articulation impeded. Temper irri- table. Irregular appetite. Perhaps constipation. One-half of body usually more affected than the other : disease may be confined entirely to one side — hemichorea. During sleep, irregular actions cease.
During progress, endocarditis or pericarditis may supervene. An ansemic murmur sometimes audible at base of heart. Or an organic murmur at apex. Sometimes sugar present in the urine. Rheumatic fever may pre- cede, accompany, or follow chorea. Rarely terminates in epilepsy. Rarely dang'erous to life except after puberty, or when secondary to endocarditis.
Treatment. Nourishing food and general care will cure many cases. Regulation of bowels and of uterine functions if patient has reached the age of puberty. Saccharated carbonate of iron, 396. Steel and ammonia, 401. Steel and arsenic, 399. Quinine, steel, and arsenic, 381. Steel and zinc, 414. Oxide, or sulphate of zinc, 415. Chemical food, 405. Hypophos- phite of soda or lime, with bark, 419. Cod-liver oil, 389. Nutritious diet; milk. Ether spray along spine. • Cold shower bath. Sea bathing. Exer- cise in pure air. Gymnastic exercises. Avoidance of mental excitement, long lessons, etc.
Remedies sometimes recommended : — Velerianate of ammonia. Iodine. Calabar bean. Nitrate of silver. Sulphate of copper. Belladonna. Atro- pine. Indian hemp. Stramonium. Strychnia. Bromide of potassium. Hydi^ate of chloral. Turpentine. Assafoetida. Salts of cerium. Inhala- tion of chloroform. Sulphur baths. Galvanism. Blisters to spine.
CHOROIDITIS. — From Xdptoi', skin; ^ifioj, shape; terminal -ttis. — In- flammation of the choroid, — the second, or vascular and pigmentary, tunic of the eyeball. Rarely or never seen alone : inflammation rapidly spreads to neighboring textures of eye, producing disorganization, etc.
Symptoms. Intolerance of light, lacrymation, dimness of vision, and supra-orbital pain. Engorgement, more or less extensive, of conjunctival vessels. Displacement of pupil. Thinning of sclerotic, so that choroid is seen through it (staphyloma scleroticfe). Opacity of cornea. Enlargement of globe : sometimes suppuration and formation of fungous growths.
TeeatmeiNt. Aperients. Calomel and opium. Arsenic. Warm baths and fomentations. Blisters to nape of neck. Leeches. Tartar emetic ointment to temples.
CHYLOUS URINE. — From Xvxbi. the nutritive juice formed by di- gestion,— chyle. Synon. Chyluria ; Galacturia ; Chylodiahetes ; Chy- lorrhcea Urinalis. — The excretion of urine of a milky appearance from the presence of fatty matter in a molecular state. In addition, there is gene- rally pi"eseut one or more of following, — blood corpuscles, fibrin, albumen,
CIRRHOSIS OF LUNG— CLUB-FOOT. 73
and an imperfect albumen (albnminose ?) The urine, after standing a short time, and sometimes whilst in the bladder, coagulates into a trembling mass resembling blancmange or common size. Mostly met with in natives of East and West Indies, Mauritius, Brazil, etc. Found by Dr. T. R. Lewis to be associated with presence oifilarue in blood.
Symptoms. Lassitude. Pains about loins and epigastrium. Mental anxiety. Debility, and loss of fiesh. Attacks intermit : urine healthy for months, an3 then chylous for months.
Trratment. Gallic acid (gr. 20-80 thrice daily). Decoction of man- grove bark (Rhizophora recemosa) Tincture of perchloride of iron. Qui- nine and steel. Ammonio-citrate of iron. Cod-liver oil. Opium. Turkish baths. Salt-water baths. Tight belt worn round loins. Change of air — a bracing temperate climate. Nourishing diet.
CIRRHOSIS OF LUNG.— From Ktp/joj, yellowish or tawny.— A consoli- dation or contraction of more or less of pulmonary tissue, accompanied with dilatation of bronchi. — See Pulmonary Condensation.
CLITORITIS.— From K7.ritrjp, one who calls or invites ; terminal -itts. Synon. Injlammatio Penis Muliebris. — The clitoris occasionally attacked with subacute inflammation ; leading to great hypertrophy, or to cystic de- generation. May also be excessively developed, from some congenital mal- formation. Sometimes, the seat of cancerous infiltration. Entire organ found diseased, or only its prepuce.
Clitoris occasionally becomes indurated, with or without enlargement. Said to be due to self-abuse. The organ frequently amputated to cure this practice, but with very doubtful benefit.
CLUB-FOOT. — Synon. Talipes; from TaMpedo (talus and pedo), to walk on the ankles. — A gradual change in the form and positions of the tarsal bones, owing to undue action or paralysis of certain muscles, or con- traction of tendinous structures. May be congenital or acquired. ' One or both feet affected. Four principal varieties : — ■
1. Talipes Equinus. — A rigid contraction of tendo Achillis, so that the heel cannot be brought to the ground, and the patient walks on the meta- tarsal bones. Horse-heel sometimes occurs during first dentition. When congenital — i. e. not caused by irritation of teething, worms, etc. — a cure is generally effected by subcutaneous division of tendo Achillis.
'2. Talipes Varus. — The heel is raised, inner edge of foot drawn upwards, and outer edge rests on the ground. In extreme cases, patient walks on dorsum of foot and outer ankle. There is contraction of muscles of calf and adductors of foot. The tendons of tibialis anticus and posticus, as well as that of flexor longus digitorum, have to be divided ; and subsequently the tendo Achillis.
3. Talipes Valgus. — The reverse of T. Varus. Outer edge of foot drawn upwards, so that patient rests on inside of instep and inner ankle. Chiefly due to contraction of tendons of peronei muscles, which have there- fore to be cut.
4. ^'alipes Calcaneus. — Elevation of toes with a falling of heel, so that patient walks on latter. Owing to paralysis of muscles of calf, there is no counteraction to contraction of those of anterior tibio-fibular region. Ten- dons of tibialis anticus, long extensors of toes, and peroneus tertius may all need section before the foot can be brought to proper position.
Mixed or compound varieties of foregoing not uncommon. Their nature explained by the names : — Talipes equino-varus, T. equino-valgus, T. calcaneo-valgus.
The principle on which subcutaneous tenotomy is resorted to, is simple. The cut surfaces of the tendons heal by connective tissue, w'hich lengthens
74 COCCYODYNIA— COLOR-BLINDNESS.
the tendon and admits of considerable extension while recent. Li many cases a cure can be obtained without operation when treatment adopted early. — By removal of sources of irritation ; fomentations and frictions of rigid muscles ; tonic, good food, sea-bathing, etc. ; anti-rheumatic remedies ; and the proper application of wood or gutta percha splints, stiffened boots, India-rubber bands, bandages, and other mechanical appliances.
COCCYODYK'IA.— From Kd%a:u|, the cuckoo, because the coccyx is said to resemble the beak of this bird; and dbvv/], pain. Synon. Goccyalgia ; Coccygodynia. — Pain or tenderness about coccyx. After a fall or blow, child-birth, violent horse exercise, etc, inflammation may be set up in fibrous tissues around, and muscular attachments to the coccyx.
Symptoms. Fain on sitting down or rising from chair, on walking, on defecation, etc. Can only sit on one hip in many cases. Any movement which stretches coccygeal ligaments, or Jjrings sacro-coccygeal articulation into play, causes suffering : sometimes this is most severe. Often aggra- vated by sexual intercourse, by menstrual flow. Tenderness on pressure. Occasionally an accompaniment of uterine or ovarian disease, when it is sympathetic or neuralgic. Disease very chronic.
Treatment. Removal of any uterine or ovarian disease. Improvement of general health. Nervine tonics, — Quinine, iron, arsenic, zinc. Warm hip baths. Leeches. Friction with equal parts of belladonna and mercurial liniments. Subcutaneous injection of morphia, 314. Subcutaneous division of muscles and ligaments and fasciae connected with coccyx, so as to set the bone at rest. Complete removal of coccyx, or a portion of it.
COLIC. — From KwTioi/, the large intestine. — Characterized by severe twisting or griping pain in belly, especially about umbilicus, occurring in paroxysms. Pain generally relieved by pressure ; never aggravated by it. Often, vomiting. Generally, constipation. An absence of inflammation and fever. While attack continues, pulse is lowered ; surface of body cold ; countenance anxious.
Attacks of colic due to: — (1) Indigestion, accompanied with flatulence. Relieved by vomiting or purging, or eructation, or explosion of wind by anus. — See Flatulence. (2) The irritation of intestine by morbid secretions, accumulation of fecal matter, etc. Cured by hot brandy and water with spice : castor oil. (3) Fright, cold, hysteria, gout : demanding anti-spas- modics like ether, chloroform, belladonna, opium ; fomentations ; perhaps colchicum and opium. (4) Mineral poisons, such as copper, lead, etc. — See Cupper Colic; Lead Colic.
Colic not to be confounded with pain of gastrodynia or gastralgia, ente- ritis and csecitis ; peritonitis ; perforation of bowel ; strangulated hernia, or ileus ; passage of hepatic, or of renal, calculi ; spasm of bladder ; uterine colic ; or with that produced by aneurismal or other tumors of abdomen, disease of spine, etc.
COLLOID CANCER. — From KoVka, glue. Synon. Alveolar Cancer {Alveolus, a little trench) ; Cystic Cancer {Kvani, a bladder). — A variety of cancer, consisting of a clear viscid substance somewhat resembling soft gelatine or gum. Most frequent primary seats — the stomach, intestinal canal, omentum, breast, and peritoneum ; secondarily, it affects lymphatic glands, lungs, etc. A section of a colloid cancer presents to naked eye a clear, soft, gelatinous mass, intei'sected and surrounded by tough fibrous- looking tissue ; the intersections, when numerous, forming small cysts or cavities filled with colloid matter. Such a cancer often attains considera- ble size. — See Cancer.
COLOR-BLINDNESS. — Synon. Acliromotopsia ; Acritochromacy ; Cliromato Fseudopsis ; Daltonism. — The inability to discriminate between
COMA— CONCUSSION OF BRAIN. 75
certain colors is a defect which is quite compatible with perfect vision in other respects.
Color-blindness may exist in three forms: — (1) Inability to discern any color, properly so called, so that black and white — i. e. light and shade, are the only variations of tint perceived. (2) Inability to discriminate between nicer shades of more composite colors, as browns, grays, and neutral tints. (3) Inability to distinguish between primary colors, red, blue, and yellow ; or between these and secondary and tertiary colors, such as green, purple, orange, and brown (Dr. G. Wilson).
Defect upon which false perception of colors is due, consists probably of some peculiar organization of retina and that part of brain which is essen- tial to vision. Generally congenital : cases known where it has been induced by disease or injury. Quite incurable. Care should be taken that railway servants are not afflicted with color-blindness, since mistakes in nature of signals might lead to a serious accident.
COMA. — From Kw^a, sound sleep. — A state of stupor with loss of con- sciousness, from which patient roused with difficulty. In cams (from Kcipoj, heavy sleep) or ■intense coma, there is not only loss of perception and voli- tion, but usually stertorous breathing, flaccid limbs, and dilated pupils : patient cannot be roused.
Coma may be due to a recent epileptic attack, to urcemia (preceded or not by convulsions), to apoplexy/, to opium, to alcohol, to injury. Usually the diagnosis is made clear by the history, but when coma present, and no account of mode of access, or previous history can be obtained, there may be a difiSculty in attributing it to the correct cause.
Epileptic coma is temporary, and the insensibility is rarely absolute, except during status epilepticus. Patient can be roused. Respiration natural. Pulse frequent and full. Temperature normal.
In tircemic coma, patient can generally be roused, except near termina- tion. Muscular twitchings. Urinous or ammoniacal odor of breath. Re- spiration not stertorous. Pulse different in different cases. Temperature below normal.
In apoplectic coma, patient roused with difiBculty, or not at all. Respi- ration stertorous (unless patient placed on his side). Sometimes irregular. Pulse full. Face flushed or pale. Temperature above normal. Hemiple- gia can generally be made out. Pupils dilated, or unequal, or in lesion of pons contracted.
In opium poisoning patient can at first be roused. Breathing slotv and stertorous. Pulse weak and soft. Pupils contracted to pin points. Coun- tenance livid. Clammy sweat. Temperature normal or lowered.
In alcoholic coma, insensibility often complete. No stertor. Pulse fre- quent. Pupils contracted, or more often dilated. Temperature 2 or 3 degrees below normal. Odor in breath.
Numerous cases of apoplexy occurring in the streets have been mistaken for examples of drunkenness. Practitioner cannot be too cautious in his diagnosis, — See Apoplexy ; Poisoning ; Alcoholism.
COMPRESSION OF BRAIN.— From Comprimo, to squeeze together. — May be produced by extravasation of blood or serum ; fracture of skull, with depression of bone ; bony excrescence ; some foreign body, — a bullet, portion of spike, etc. ; by abscess and tumor of brain. Symptoms are essentially those of apoplexy.
CONCUSSION OF BRAIN.— From Conditio, to shake.— Signalized by fainting, sickness, stupor, insensibility, and loss of all muscular power, suc- ceeding immediately to some act of external violence. Patient may rally quickly, or not for many hours ; or he may die suddenly, or at end of some
76 CONCUSSION OF SPINAL CORD— CONJUNCTIVITIS.
days. After death, no lesion may be detected (?), or a laceration of some part of brain, or disseminated ecchymoses, or a general softening of cerebral substance.
Symptoms. Vary according to degree of concussion. When shock has been slight, state of unconsciousness soon i-ecovered from : complaint only made of confusion of ideas, faintness, sickness, chilliness, drowsiness, ring- ing noises in ears. In more severe forms, insensibility continues longer. Patient lies as if in deep sleep; pupils insensible to stimulus of light; sur- face pale and cold ; muscles flaccid ; pulse fluttering or feeble ; sphincters relaxed ; breathing often scarcely perceptible. When, after variable inter- val, partial recovery ensues, there is confusion of thought; inability to articulate distinctly; often, severe vomiting; sometimes, paralysis of one or other extremity. In worst cases, individual is felled to ground by the shock, and dies on the spot.
Whole nervous system now and then receives a jar by railway accidents, without immediate symptoms being developed. In coux-se of a few days there may be diminution of power of motion ; one or more fits of epilepsy ; squinting, or impairment of sight ; deafness, or troublesome noises in ears. These symptoms, after a variable duration, may pass off: occasionally they are precursors of serious cerebral or spinal disease.
Treatment. Patient to be watched carefully. Make sure that there is no fracture or dislocation. If, on recovery from shock, there be excessive reaction, cold to head. Two or three drops of croton oil on tongue. Where no attempt to rally is made, a little wine or brandy and water. Warmth to surface of body and extremities : blankets, bottles of hot water, hot bricks, etc. In after-treatment, a mild unstimulating diet; absolute rest from all mental occupation ; bodily repose and cpxiet; gentle bitter aperients.
CONCUSSION OF SPINAL CORD.— May arise from any shock,— as fall, jump, severe blow, etc.
Symptoms. At first slight and obscure. Peculiar tingling (sense of pins and needles) in extremities. Increasing weakness. Difficulty in passing urine. Coldness and numbness of legs ; gradually increasing difficulty in walking. Perhaps, irremediable paraplegia.
Treatment. Cases become serious from neglect. A cure usually to be effected by perfect rest in bed until all symptoms have passed off. Nourish- ing food. Attention to bowels and bladder.
CONJUNCTIVITIS. — From Conjunctiva {Conjimgo, to join together"), the membrane which lines the eyelids and covers anterior surface of eyeball; terminal -t'tis. Synon. Ophthalmia. — Inflammation of mucous membrane of eye, 'a common affection. Some authors divide the ophthalmiae into several classes : for practical purposes it suffices to remember the varieties to be presently mentioned.
During violent fits of coughing, vomiting, etc., blood sometimes extra- vasated beneath conjunctiva, owing to rupture of a small vessel. Whether patch of ecchymosis be small, or so abundant as almost to conceal sclerotic, absorption soon takes place. If patient be anxious for some application, a piece of linen dipped in cold water containing a few drops of tincture of arnica, may be laid over eye.
Effusion of serum into areolar tissue between conjunctiva and sclerotic is called chemoszs. When oedema is abundant, conjunctiva becomes quite elevated, so that cornea looks as if it were sunk in a deep depression. Swell- ing subsides as disease which causes pressure on conjunctival veins disappears.
1. Catarrhal Ophthalmia. — A mild form of inflammation of the con- junctiva and Meibomian follicles. Most common of all eye diseases : caused lay exposure to cold and wet, sudden changes of temperature, etc.
CONJUNCTIVITIS. 77
Symptoms. Slight pain, or sense of scalding. Stiffness and drjmess : a feeling of pricking or roughness about the eye, as if sand or broken glass were under upper ej'elid. This sensation caused by rubbing of sensitive eyelids over enlarged vessels of sclerotic conjunctiva. These vessels seen to be of a liright scarlet, and irregularly arranged ; can be moved by finger ; differing from appearance of vessels in sclerotitis, in which they are of a pink hue, immovable, disposed straight and regularly like radii in a circle. Natural secretion from conjunctiva and Meibomian follicles increased in quantity : often becomes puriform.
Treatment. Yields readily to simple treatment: often terminates favora- bly, without any remedies. At outset, if there be obstinate constipation, calomel and jalap, 140, 1.59 ; or a dose or two of some milder aperient, 141. If general health be bad, stimulants or tonics, with beer or wine, and meat. Where there is plethora, contim;e purgatives for two or three days, while diet is restricted. In troublesome cases, a blister behind ear. Arsenic, 52. Iodide of potassium, 31. Affected eye can be rested by wearing a shade ; to be bathed several times in day with warm water. Astringent applica- tions rarely needed : occasionally, a drop or two of vinum opii, or of solution of nitrate of silver (gr. 2 to fl. oz. j), may cut short an attack. When dis- charge is abundant, edges of eyelids should be smeared with some simple ointment at night, to prevent their adhering in the morning.
2. Purulent Ophthalmia. — Three kinds : — Purulent ophthalmia of adults, or contagious ophthalmia, or Egyptian ophthalmia; gonorrhoeal ophthalmia; and purulent ophthalmia of infants.
Symptoms. In purulent ophthalmia of adults, inflammation very intense, runs a rapid course, attended with violent pain, and leads to formation of large quantities of thick and yellow purulent matter. Eyelids swell so that they cannot be separated sufficiently to expose cornea ; chemosis ; discharge adheres to eyelashes in thick drops. Severe pain in eye and forehead. Generally much constitutional disturbance, fever, prostration. Where dis- ease does not yield, inflammation increases, attacks cornea, and occasionally internal textures of eye ; extensive sloughing takes place ; and when suf- ferings terminate it is found that sight is completely lost. — It is contagious, frequently epidemic, and common in hot climates. Military life appears to predispose to it. Both eyes often affected ; sometimes simultaneously.
Gonorrhoeal ophthalmia differs from the preceding in a few points only. Thus, it is the most severe ; rarely limited to one eye, but one organ usually attacked two or three days before the other ; caused by contact of gonor- rhoeal— or even leucorrhceal — discharge with conjunctiva. Frequently ends in sloughing of cornea.
Purulent ophthalmia of infants, or ophthalmia neooiatorum, generally commences about third day after birth, with inflammation of that part of conjunctiva lining palpebrse. Edges of eyelids adhere; on separating them a drop of thick white fluid escapes. As inflammation extends to conjunctiva covering eyeball, eyelids sw'ell; purulent discharge increases; child becomes very feeble and restless and fretful. Disease may remain in this stale for eight or nine days ; if not then relieved, ulceration of cornea occurs, and very destructive consequences ensue. Both eyes commonly suffer ; either at same time, or within an interval of a few days. Discharge contagious.
Treatment. In purulent ophthalmia of adults, and gonorrhoeal ophthal- mia, no need for violent measures. Result to be dreaded is ulceration and sloughing ; morbid processes which are more likely to be encouraged by bleeding and antimony and mercury and starvation, than by any other agents. At commencement, when tongue is thickly coated, an active pur- gative, 140, 151. If there be debility,— Ammonia and Bark, 371 ; quinine, StO; cod-liver oil. Animal food. Beer or wine. To combat restlessness at night, — Henbane ; camphorated tincture of opium ; ether ; morphia and Indian hemp, 317. Locally : Injections of solutions of alum (gr. 8 or 10
78 CONSTIPATION.
to water fl. oz. j), under eyelids, every hour ; or solution of nitrate of silver (gr. 2 to fl. oz. j) may be employed, in same way, about every eight hours. If there be ulceration of cornea, it may sometimes be checked by early ap- plication of solid nitrate of silver. Pain arising from application must be relieved by warm narcotic fomentations, and opium. To prevent lids from adhering, smear their edges at night with diluted citrine ointment, 305.
To cure purulent ophthalmia of infants, — Magnesia ; castor oil ; mercui'y and chalk, 35. Small doses of ipecacuan and opium powder. Iodide of potassium. Examination of mother's milk : if it be poor or deficient in quantity, a healthy wet-nurse. Goat's or cow's milk. Liebig's food, 4. Locally : — Bathing of eye with tepid water : injections of a solution of alum (gr. 5 to water fl. oz. j) beneath lids, every six or eight hours. Injections of sulphate of zinc (gr. 2 to fl. oz. j') in severe cases.
3. Strumous Ophthalmia. — A disease of scrofulous and other children, occurring generally between time of weaning and ninth or tenth year.
Symptoms. Slight conjunctival and sclerotic redness; with formation of little phlyctenulaj or pustules, sometimes of ulcers, on cornea. Copious lachrymal secretion ; irritability of nasal and buccal mucous membranes. Great intolerance of light {photophobia), with spasmodic contraction of eyelids. Swelling of lips, eruptions behind ears, disordered intestinal secre- tions. Both eyes usually aff"ected. Hot tears flowing over cheek often produce an eruption resembling crusta lactea.
Treatment. Good nourishing food. Milk. Beer. Warm clothing. Pure air. Occasional doses of mild laxatives. Tonics, — Quinine, arsenic, steel, etc. Cod-liver oil. Locally : — Warm fomentations. Use of a green shade : a green or blue veil. Drops of wine of opium. Sulphate of zinc or alum (gr. 2 to fl. oz. j). Spermaceti ointment to edges of lids. Blisters behind ears, or to nape of neck. Flying blisters to temples.
4. Granular Conjunctiva. — Sometimes epidemic in workhouse schools, contagious. The conjunctiva, particularly palpebral portion, is found red and uneven and granular. So-called " granulations" or "' sago-grains" con- sist of inflamed mucous follicles and papillae : when they cause much irrita- tion, opacity of cornea may i-esult.
Treatment. Quinine. Arsenic and steel, 399. Good diet. Dabbing granulations gently with undiluted liquor potassse, previously everting lids. Sulphate of copper. Nitrate of silver. Ointment of nitrate of mercury. Sulphur ointment. Hygienic measures. Prevent contagion by separating sufferers and forbidding use of towel in common.
CONSTIPATION.— From Constipo, to crowd thickly together. Synon. Ohstipatio ; Alvus Adstricta ; Torpor Intestinorum. — Maybe an idio- pathic affection, or may arise during progress of any acute or chronic dis- ease. By habitual costiveness is meant a prolonged departure from the standard natural to the individual. As a rule, most people have a daily evacuation ; but some only go to stool every second or third day.
Symptoms. Functions' of stomach, liver, and pancreas imperfectly per- formed. A sense of mental and bodily oppression. Sallow and pasty com- plexion. Foul breath. Dry skin. Scanty urine. No stools : or only scanty motion, pale, clay-like, and very offensive. — In obstinate cases : — A loss of all power for exertion. Headache. Palpitation. Neuralgia. Hypochon- driasis.
Treatment. Temporary constipation : — Sulphate of magnesia, manna, and senna, 139. Sulphate and carbonate of magnesia, 141. Sulphate of soda and taraxacum, 144. Aloes, senna, and jalap, 145. Resin of podo- phyllum, 160. Castor oil, 164. Calomel and jalap, 159. Rhubarb and magnesia, 165. Croton oil, 168. Rhubarb and blue pilj, 171. Gamboge, aloes, and blue pill, 174. Simple enemata, 188. Castor oil and turpentine
CONTUSIONS OF ABDOMEN— CONVULSIONS. 79
enema, 190. Croton oil enema, 191. Purgative electuaries, 194. Officinal ■purgatives : — Confection of pepper. Confection of scammony. Confection of senna. Confection of sulphur. Compound decoction of aloes. Decoction of taraxacum. Elaterium. Enema of aloes. Enema of sulphate of mag- nesia. Extract of Barbadoes aloes. Extract of Socotrin.e aloes. Com- pound extract of colocynth. Extract of jalap. Purified ox bile. Calomel. Mercury and chalk. Blue pill. Infusion of rhubarb. Infusion of senna. Resin of jalap. Carbonate of magnesia. Sulphate of magnesia. Scam- mony mixture. Croton oil. Castor oil. Pill of Barbadoes aloes. Pill of aloes and assafoetida. Pill of aloes and myrrh. Pill of Socotrine aloes. Compound pill of gamboge. Compound pill of colocynth. Pill of colo- cynth and hyoscyamus. Compound rhubarb pill. Eesin of podophyllum. Tartrate of potash. Acid tartrate of potash. Compound "powders of jalap ; of rhubarb; of scammony; of liquorice. Tartrate of soda and potash. Phosphate of soda. Precipitated sulphur. Syrup of senna. Tincture of aloes. Tincture of jalap. Tincture of rhubarb. Tincture of senna. Com- pound tincture of benzoin. Wine of aloes.
HahitiLol constipation : — Olive oil. Almond oil. Castor oil, ] 64. Ehu- barb and magnesia, 165. Syrup of senna. Sulphate of soda, 143, 144, 148. Pepsin and aloes, 15.5. Steel and aloes, 154, 404. Nitric acid, senna, and taraxacum, 147. Sulphates of magnesia and iron, 166. Seidlitz powders, 169. Purified ox bile, 170. Glycerine. Factitious Cheltenham waters, 180. Factitious Carlsbad waters, 182. Simple enemata, 188. Supposi- tories of soap, or cocoa butter. Quinine, 379. Quinine and nux vomica, 387. Zinc and nux vomica, 409. Strychnia and steel, 408. Sulphate of zinc, 177. Compound tincture of benzoin. Extract of nux vomica, 175. Belladonna. Belladonna and rhubarb pill. Valedanate of zinc and bella- donna, 410. Tar capsules or pills, 36. Cod-liver oil. Pepsine, 420. Nitro-hydrochloric acid, 378. — Diet : — Wholesome and digestible food. Ripe fruits in morning. Figs or prunes soaked in olive oil. Oatmeal por- ridge. Brown bread. Aerated bread. Tobacco. Tumblerful of spring water at bed-time. General remedies : — Daily exercise. Avoidance of too much sleep. Sponge or shower baths. Wet compress over abdomen. Friction of abdominal walls. Galvanism. Gentle kneading of abdominal walls. Bowels to be solicited to act at a regular hour daily. — See Intes- tinal Obstruction.
CONTUSIONS OF ABDOMEN.— From Contundo, to bruise, to crush to pieces. — May be produced by kicks, blows, a fall upon some prominent object, or a squeeze between buffers of two railway carriages, etc. Conse- quence often very serious. A blow sometimes causes death immediately, owing to syncope from shock to solar plexus of sympallietic. In other instances there may be laceration of some internal structure, with hemor- rhage : injured individual often dies at end of a few hours, from combined effects of shock and loss of blood. — Occasionally, contusion causes rupture of an internal oi'gan, with extravasation of contents. There may be no external symptom of injury ; and yet gall-bladder, liver, spleen, stomach, intestinal canal, bladder, or pregnant uterus be torn through. Patient either dies shortly from collapse, or hemorrhage : surviving these dangers, from peritonitis after a longer interval. Instances have occurred of lacera- tion of liver or kidney, where sufferers having got over first effects of suc- ceeding inflammation have subsequently fallen victims to blood-poisoning from absorption of extravasated fluids. Lastly, a contusion may only set up inflammatory action in a limited portion of the abdominal wall, this action going on to suppuration. — See Abscess of Abdominal Walls.
CONVULSIONS, — From Convello, to overthrow, to annihilate, etc. Syuon. Eclampsia; Hyperspasmia ; Spasmus. — Convulsions consist of
80 COPPEE COLIC.
violent and involuntary contractions of muscles of whole body ; occurring in paroxysms, and usually attended with unconsciousness. Sometimes, con- tractions partial, of considerable duration, and attended with hardness of affected muscles [tonic spasms or spastic contractions), e. g. common cramp and tetanus. Sometimes, quickly alternating contractions and relaxations [clonic spasm).
Convulsions may be due to organic disease of nervous system, especially tumor of brain ; to meningitis ; to an insufficient supply of healthy blood to nervous centres ; to irritation about gums or alimentary canal (as in teeth- ing, indigestion, intestinal worms, etc.) ; to renal disease and albuminuria (as in uraemia and pregnancy) ; to a morbid state of the blood (as in hydro- phobia, eruptive fevers, hooping-cough, etc.) ; to certain poisons; as well as to strong and sudden mental emotion.
Symptoms. There are premonitory symptoms, or an absence of any warning. All the voluntary muscles attacked; or there may be only spasms of features, one-half of body, or a single limb. Consciousness gene- rally lost but not always. During a general paroxysm there is distortion of features, pallor or lividity of face, staring eyeballs, insensibility of pupils to light, grinding and gnashing of teeth, protrusion of tongue, etc. In- voluntary evacuations. Laborious respiration. There will be only one attack, or several. Followed by a tendency to sle-ep. Seldom a fatal result unless connected with severe disease. Convulsion of one limb, or of one half of face, or of one half of body, not attended with loss of consciousness, is usually indicative of organic disease of opposite cerebral hemisphere.
Treatment. General remedies : — Patient's dress to be loosened, espe- cially clothing about neck. To be placed so that he may breathe pure and cold air. Cold to head if there be much heat and flushing. Cold affusion to head, while body is in a warm bath. Sinapisms, or hot bottles to ex- tremities. Mustard footbaths. Purgative and antispasmodic enemata, 190, 191. Croton oil, one or two drops on tongue. Emetics of ipecacuanha, if patient can swallow and there be evidence of gastric irritation, 231, 233. Blisters, dry cupping to nape of neck. Venesection ? Leeches ? Bromide of potassium. Opium, where there is no cerebral disease. Hypodermic injection of morphia, 314. Belladonna and camphor, 326. Ether. Chloro- form in draughts, and by inhalation, 313. Sulphate of aniline (gr. 1 twice or thrice daily). Benzoic acid, 49. Lemon juice. Yinegar.
Puerperal convulsions : — Purgative and antispasmodic enemata. Inha- lation of chloroform. Induction of labor when patient is undelivered ; convulsions often cease as soon as liquor amnii is evacuated. When convul- sions occur during parturition, expedite delivery by forceps or turnuig, patient being previously placed under influence of some anaesthetic. Vene- section ? In convulsions after delivery, hypodermic injection of morphia ; chloroform, or ether, inhalation. Benzoic, or acetic, acid.
Infantile convulsions : — Attention to diet. Cold to head, while body is in a warm bath. One or two grains of calomel placed on tongue. Ipecac- uanha emetics, if stomach be loaded. Lancing gums, where they are in fault. Magnesia or soda in dill water, if there be acidity of secretions. Calomel and scammony, oil of turpentine, liquid extract of fern root, san- tonin, decoction of pomegranate root, if there be intestinal worms. — See Chorea.; Epilepsy; Hysteria; Tetanus; Urcemico, etc.
COPPER COLIC. — Paroxysmal twisting or griping pains in the belly, due to chronic poisoning by copper. Affects copper-plate printers.
Symptoms. Attacks of abdominal pain, coming on suddenly ; aggravated by pressure. Nausea and vomiting. Constipation may be absent. Pecu- liar sallow hue of complexion : countenance anxious : eyes sunken and lips livid. A purple line around gums.
Treatment. Sulphate of magnesia and sulphuric acid, 142. Sulphate of
CORNEITIS. 81
soda and sulphuric acid, 143. Castor oil. 164. P^nemata of warm water. Morphia, chloroform, and Indian hemp, 817. Ether and opium, 8.t. Iodide of potassium, 31. Hot baths. Sinapisms. Turpentine stupes. Linseed poultices. — See Colic.
CORNEITIS. — From Cornea [Cornu, a horn), the transparent and nearly circular external tunic of the eyeball, forming the anterior sixth of the globe ; terminal -itis.
1. Acute Inflammation. — Corneitis, or preferably Keratitis (Kspaj, a horn), renders the polished and transparent cornea hazy, dim, and rough. May cause it to look like ground glass.
Symptoms. A crescentic plexus of minute vessels can be seen passing from edge of cornea. A zone of pink vessels in adjacent sclerotic. Hazi- ness of cornea with opacity. Abundant secretion of tears. Intolerance of light. Strumous children and subjects under twenty years of age most liable to it. One or both eyes may be affected : sometimes one eye attacked, just as the other is getting well. Morbid action may last for months and leave cornea permanently cloudy. Occasionally ends in suppuration, and pus gets infiltrated between fibres of the membrane. Softening generally takes place posteriorly ; pus makes its way into anterior chamber, to bottom of which it sinks ; where it assumes a crescentic form — hypopyon. When an opening occurs anteriorly, a perforating ulcer of cornea is produced through which iris protrudes — staphyloma iridis.
Treatment. Attention to biliary and intestinal secretions. Rhubarb and magnesia, mercury and chalk, calomel, or castor oil. Iodide of potas- sium and bark, 31. Iodide of iron, 32. Cod-liver oil. Chemical food, 405. Quinine. Tincture of perchloride of iron. Nourishing diet, with milk. Small blisters to temples, or behind ears. Warm fomentations ; steaming the eyes. Tincture of iodine to skin of lids. Avoidance of irritating collyria.
2. Syphilitic Keratitis, — Sometimes spoken of as " chronic interstitial keratitis." 'J'he result of inherited constitutional syphilis. Affects children and young persons, especially females. Is very chronic.
Symptoms. A diffused haziness beginning at centre of one cornea. Tissue gets to resemble ground glass. No tendency to ulceration. After a few weeks both corneEe become affected. Subjects of this disease have a coarse and flabby skin, pits and scars on face and forehead, cicatrices of old fissures at angles of mouth, sunken bridge to nose, and permanent upper central teeth peculiar for smallness and bad color and vertically notched edges (Hutchinson).
Treatment. Cautious use of mercury, avoiding salivation. Corrosive sublimate and compound infusion of gentian. Mercurial inunction behind' ears. Iodide of potassium. Iodide of iron. Ferruginous tonics. Liberal diet. Cod-liver oil.
3. Opacity of Cornea. — May result from inflammation, giving rise to effusion of fibrin into substance of cornea, or between it and conjunctiva ; or it may be the consequence of a cicatrix following an ulcer.
When opacity is cloudy and diffused, as from keratitis, appearance called a nebula : a limited white patch, such as results from a cicatrix, is known as albugo and leucoma. Employment of acetate of lead collyria, when there has been an abrasion of cornea or conjunctiva, has led to formation of a permanent white deposit. This may sometimes be gently scraped away.
4. Ulcers of Cornea. — Occur in individuals of all ages where powers of life have been lowered by illness, insufficient food, strumous disease, etc. May lead to perforation of cornea with escape of aqueous humor, oblite- ration of anterior chamber, and prolapsus iridis. To be cured by attention
6
82 CORYZA— COUGH.
to general health. When the ulcer is very indolent, local use of nitrate of silver. Avoidance of irritating coUyria.
5, Conical Cornea. — Synon. Keratoconus ; Staphyloma Cornew Pel- lucidttm.—A rare malformation. Cornea found exceedingly convex, giving a peculiar sparkling or brilliant appearance to eye. Both eyes usually affected, though often unequally. In consequence, vision very indistinct. Causes of this deforniity not known. In the few cases which have been examined after death, apex of cornea has been found thinner than natural. — All kinds of treatment have been fruitless. But patient's vision may some- times be partly assisted by a deeply concave glass ; or by use of a black plate with a transverse slit along its middle, fixed in spectacle-frame with or without glass.
6. Ar CHS Senilis. — Synon. Leucoma Gerontotoxon ; Macula CornecB Arcuata ; Fatty Degeneration of Peripheral Portion of Cornea. — A gradually increasing opacity of circumference of cornea, owing to fatty de- generation. Generally occurs in the aged. Indicative of fatty degenera- tion of heart?
CORYZA. — From Ra'pa, the head ; ti's'td. to boil. Synon. Rhinitis; Gra- vedo ; Stillicidium Narium ; Cold in the Head. — Catarrhal inflammation of Schneiderian membrane of nose.— Often quickly relieved by full dose of opium. Iodine vapor, 259. — See Catarrh.
COUGH. — Synon. Tussis. — A symptom of numerous and varied dis- eases. Frequently an effort to expel irritating matters from bronchi and air-cells. Sometimes an idiopathic affection. — See Asthma; Bronchitis; Croup; Hooping-Cough ; Laryngismus Strididus ; Laryngitis; Phthi- sis; Pleurisy; Pneumonia, etc.
Treatment. General Remedies: Mucilage of gum Arabic. Mucilage of tragacanth. Decoction of Iceland moss (Cetraria). Decoction of barley. Infusion of dulcamara. Infusion of linseed. Infusion of marsh mallow. Liquorice jujubes (consisting of gum and sugar and gelatin). Ammoniac mixture, 237. Balsam of Peru with mucilage. Syrup or tincture of tolu. Ammonia and senega, 235. Antimonial wine, 240. Ipecacuan wine, 241. Powder of ipecacuan and opium. Tincture or syrup of squills, 236, 247. Compound squill pills. Spirit of nitrous ether. Spirit of ether. Spirit of chloroform. Rectified pyroxylic spirit. Dilute hydrocyanic acid. Laurel water (Aqua laurocerasi, min. v to xxx). Morphia, 315, 317, 346, 347. Opium, 213, 316, 324, 338, 345. Camphorated tincture of opium, 235, 319. Syrup of poppies. Conium, 335. Henbane. Stramonium, 323. Aconite, 330, 332. Belladonna, 326, 344. Indian tobacco, 88, 242. Almond oil. Cod-liver oil, 389. Inhalation of steam, tar vapor, medicated vapors. Spray, or atomized fluids, of weak solutions of tannic acid, perchloride of iron, sul- phate of zinc, alum, opium, conium, etc., 262. Locally to chest walls: Mustard poultice. Turpentine stupes. Blisters. Opium, belladonna, am- moniac and mercury, chalybeate, galbanum, pitch, or warm plasters. Lini- ment of chloroform, or opium, or belladonna, or iodine, properly diluted. Compound liniment of camphor. Liniment of croton oil, 207. Ointment of tartarated antimony. Tartar emetic embrocation, 206.
Cough from Intestinal Irritation, etc. : — Lancing gums. Remedies against intestinal worms. Remedies against dyspepsia, gastric catarrh, constipation, etc.
Cough from Relaxed Uvida, Enlarged Tonsils, etc. : — Astringent gar- gles, 248, 249, 252, 257. Quinine, 379, 386. Steel, 380, 392, 395, 403. Phosphate of iron, 405. Iodide of iron. 382, 390. Iodide of ammonium. Phosphate of zinc, 414. Cod-liver oil, 389. Application of nitrate of sil-
COUP DE SOLIEL— COW-POX. 83
ver. Excision of tonsils. Amputation of elongated uvula. Potassa fusa has been applied to enlarged tonsils, but its use requires great caution.
Ear-cough: — Due to irritation or disease of some portion of the meatus auditorius.
Nervous and Hysterical Cough : — Valerian, 87. Valerianate of qui- nine or zinc, 93, 410, 411. Assafoetida, 89. Phosphate of zinc. Nux vomica. Compound mixture of iron. Citrate of iron and quinia. Galba- num : compound pill of assafoetida. Nitrate of silver to glottis. Attention to uterine functions. Horse exercise. Sea bathing. Shower baths. Nourishing food.
COUP DE SOLIEL. — Synon. Sun-strnl-e ; Insolatio ; Heat Apoplexy ; Erethismus Tropicus. — A disease allied to simple apoplexy. In perfect form, only met with in the tropics. Often fatal to European soldier, at seasons when heat is very oppressive.
Symptoms. Generally, faintness ; thirst ; considerable heat and dryness of skin ; high temperature ; great failure of nervous energy. Often ver- tigo and a sense of tightness across chest. Pulse sometimes quick and full, sometimes so thin and feeble it can hardly be felt. As case progresses, heart's action becomes violent ; patient can scarcely be roused ; face gets pallid ; perhaps an attack of vomiting ushers in deep coma. While coma- tose, there is heat of skin; dyspnoea; contracted pupils, with congested conjunctivae ; action of heart intermittent. Just prior to death, dilatation of pupils ; gasping respiration ; perhaps vomiting.
In some instances, symptoms very insidious. Mere listlessness and stu- pidity ; head is said to be a little queer. Yet in twelve hours, death. — Often, after exposure to sun, the individual has suddenly fallen down insen- sible ; made one or two gasps ; and died in a state of syncope.
If recovery take place, convalescence apt to be retarded by deranged secretions, continued fever, some pulmonary complication, partial paralysis, or great prostration. — Patient not free from immediate danger until skin gets cool and moist. Many months after apparent cure, symptoms of paralysis or of insanity may be developed : in any case, the individual is seldom the man he was prior to attack.
Treatment. Curative : — Mortality very large where bloodletting has been resorted to. Most reliable remedies, such as bring down the tempera- ture.— Cold to head, and stimulants. A continuous stream of cold water to be poured over head and neck and spine and chest, provided pulse be not very weak and skin cold. Evaporating lotions to scalp. Blisters, or liniment of cantharides, to nucha. Ammonia. Ether. Brandy. Tea, well sweetened. Ipecacuanha emetics, if stomach be loaded. Sinapisms or turpentine stupes to extremities. Stimulant enemata. Ice to spine. Frictions of surface.
Prophylactic : — AVhen a march is undertaken in India during hot sea- son, weak and sickly to be left behind. Costume to be suitable to early morning houi-s before sunrise, as well as for scorching heat which follows. Flannel shirts, as safeguards against sudden chills : flannel belts advan- tageous, save in hottest weather. Shirt collars to be open. Light knap- sacks, without cross-belts over chest. Troops to march easy : halts when men are exhausted, with longer halt half-way, so that each man may have coffee and biscuit. To arrive on neiu ground about an hour after sunrise. Camp to be formed on as high and open ground as possible. Men to have an ample supply of water. Rations of spirits to be discontinued (Aitken).
COW-POX,— Synon. Vaccinia. — The comparative immunity against smallpox, conferred by vaccination, was discovered by Jenner towards close of eighteenth century.
When vaccination has been successfully performed on a healthy child,
84 CRAMP— CRETINISM.
an elevation may be felt over puncture on second day, accompanied by slight redness; on fifth, a distinct vesicle is formed, having an elevated edge and depressed centre ; on eighth, it is of a pearl color, and is distended with a clear lymph. An inflamed areola now forms round base of little tumor, and increases during two succeeding days ; about eleventh day it fades ; and the vesicle, which has then burst and acquired a brown color, gradually dries up, until by end of second week it has become converted into a hard and round scab. This falls off about twenty-first day ; leaving a circular, depressed, striated cicatrix, which is permanent in after-life. First vaccination affords protection for ten years, perhaps for longer ; a safe proceeding to revaccinate after this lapse of time.
Four or five separate, good-sized vesicles should be produced. — When variola occurs after vaccination, it is known as varioloid, or modified small- pox.
CRAMP. — Synon. Myospasmus ; SiJasmus 3fuscularis ; Tetanus Do- lorificus. — A spasmodic and involuntary contraction of one or more muscles, of short duration, attended with rigidity and great pain ; most common in muscles of lower extremities, especially the gastrocnemius, or one of the plantar muscles; but muscular fibres of internal organs— as of stomach, intestines, bladder, uterus, pharynx, etc. — not infrequently affected.
May arise from disease in nervous centres : morbid state of blood, — gout, rheumatism, anaemia, etc. ; dyspepsia, colic, cholera, pregnancy, tetanus, etc. ; sometimes cannot be traced to aerangement of any organ. Not an uncommon cause of drowning, even where the bather is an accomplished swimmer.
Symptoms. Fibres of affected muscle are gathered into a hard knob ; appreciable to touch, and often to vision. Pain most severe. Spasm may cease in a few seconds, or not for hours : it commonly leaves more or less tenderness, which remains for some hours. The same muscle may be affected over and over again : or the contractions may shift from one part to another. Cramp from dyspepsia often occurs at night ; rousing the victim suddenly from sleep
Treatment. Prophylactic : — Removal of all sources of indigestion. Correction of debility, anaemia, constipation, gouty or rheumatic state of system. Attention to condition of nerve centres. Bitter tonics. Chaly- beates. Antispasmodics. Pepsine. Quinine, especially if attacks inter- mit. Sulphur. Tar water. Tepid sponge baths. Sleeping on a mattress, so inclined that the foot of the bed is twelve inches lower than the head.
Curative : — Friction with naked hand, flesh-brush, or flannel. Anodyne liniments, — especially such as contain aconite, belladonna, chloroform, cam- phor. Forcible extension of limb. Hot bath. Inhalation of ether or chloroform. Full doses of carbonate of magnesia or soda, with ether and tincture of cardamoms.
CRETINISM. — Perhaps, according to Dr. Mayne, from Cretira ; old Italian for a poor creature. Synon. Idiotismus Endemicus ; Fatuitas Alpicolarum ; Micrencephalon. — A form of idiocy, accompanied by de- formity of the bodily organs. Has a close, but ijl-understood connection with goitre. In English Cretins thyroid has been absent, and glandular masses seen on each side of neck.
Symptoms. Diminutive stature. Large head, flattened at top, and spread out laterally. Countenance vacant and void of intelligence. Mouth gap- ing and slavering. Tongue protruding. Goitre. Disgusting habits. Per- haps squinting, deaf-mutism, blindness.
Treatment. Pure mountain air. Plenty of exercise. Simple nourishing food, with milk. Cod-liver oil. Carbonate of iron. Phosphate of lime. Chemical food. Valerianate of zinc. Moral control. Judicious mental training.
CROUP— CYANOSIS. 85
CROUP. — Synon. Tracheitis ; Cynanche Tracliealis ; Angina Tra- chealis. — An inflammatory disease of mucous linincr of trachea, or often of glottis and larynx, and trachea. Fever and inflammation accompanied by exudation of false membranes on affected surfaces. A question much debated is whether membranous croup is not always diphtheritic. — Most common during second and third years of childhood. Often complicated with bron- chitis or pneumonia. May end fatally from exhaustion, suffocation, convul- sions, or thrombosis. Mortality very largo.
Symptoms. In early stage, those of catarrh. Slight fever; cough; hoarse- ness ; drowsiness ; suffusion of eyes, and running at nose. In course of eigh- teen hours, wheezing respiration ; fits of hoarse coughing ; occasional spasms of laryngeal muscles. Then, characteristic symptoms: alteration in cough, which is attended with a peculiar ringing sound, rendering it " brassy." Inspirations prolonged : accompanied with crowing or piping noise. Red- ness and swelling of tonsils and uvula, less marked than in tonsillitis. In- creased fever. I3reathing becomes more hurried and impeded. Cough frequent. Depression with weakness and irregularity of pulse. Thirst. Irritability and restlessness. Features expressive of alarm and distress: patient grasps at his neck, or thrusts his fingers into mouth, as if to remove cause of suffering. Nocturnal exacerbations : remissions towards morning. — As disease subsides, cough loses peculiar twang, becomes moist : crowing inspirations lessen, or cease. — When tending to death, drowsiness gets extreme, though sleep is uneasy : child starts and wakes in terror. Breath- ing becomes gasping and interrupted : suffocation seems imminent. Con- gestion of lungs. Skin cold ; covered with clammy sweat. Perhaps death directly after an inspiration : asphyxia, coma, convulsions, or fatal dyspnoea from thrombosis.
Treatmext. — Under use of bleeding, tartarated antimony, and mercury, half the cases attacked die. For this cause alone, a different plan ought to be tried. Blisters most injurious.
Confinement to bed. Flannel clothing. Temperature of room 70° F. ; air to be moistened with steam. Continuous fomentations to throat ; sponges dipped in water as hot as can be borne. Emetic of ipecacuan, 231. Calo- mel as a purgative, or castor oil, if there be constipation. Lessen excessive heat of skin by warm bath, 137. If skin be dry, wrap patient in a blanket wrung out of warm water, and cover all with two or three dry blankets, 136. Painting of throat with belladonna, — diluted extract, liniment, or tincture — if distress arise chiefly from spasmodic contractions of laryngeal muscles. Iodide of potassium with assafoetida and senega, 31. Ammonia and senega, 23.5. Quinine. Inhalation of spray of hot water or saline solutions, or hot saccharated solution of lime, 262. Inhalation of oxygen gas. Beef-tea. Lime-water and milk. Cream. Wine, or brandy. — Tracheotomy, if pre- dominant symptoms are those of asphyxia : inhalation of chloroform, so that operation may be performed deliberately and cautiously. After operation trust to warm moist air, nourishment and stimulants : abandon medicines.
Remedies of ten recommended : — Leeches. Bleeding. Purging. Blis- ters. Tartarated antimony. Calomel. Mercurial inunction. Digitalis. Hydrocyanic acid. Squills. Veratrum viride. Sanguinaria Canadensis. Quinine. Sulphate of copper. Sulphurated potash. Nitrate of silver, locally. Glycerine, locally. Tincture of iodine, painted over outside of neck.
CYANOSIS. — From Kuttj/of, blue ; fdcyoj, disease. Synon. Hcematocya- no sis ; Morbus Cceruleus ; Blue Disease. — A condition characterized by a blue or purplish discoloration of skin ; arising generally in connection with some deficiency in construction of the heart.
Chief mcdformations : — Permanence of foramen ovale, allowing a passage of blood between the auricles. Abnormal apertures in some part of septum
86 cynanchp: laryngea— deafness.
of auricles or ventricles. Origin of aorta and pulmonary artery from a single ventricle. Transposition of origins of large vessels from heart ; aorta arising from right, and pulmonary artery from left, ventricle. An extreme contraction of pulmonary artery. Continued patescence of ductus arteri- osus, permitting a mixture of blood of aorta and pulmonary artery.
Symptoms. Discoloration of skin. Coolness of body : temperature of mouth sometimes reduced to 77° F. Palpitation. Fits of dyspnoea. Syn- cope on excitement. Tips of fingers and toes become bulbous ; nails incur- vated. Generative organs often imperfectly developed. Congestion of in- ternal organs, and dropsical effusions. — Infants affected generally die very early : occasionally, life prolonged to adult age. Males more prone to cyanosis than females. Under exceptional circumstances it may not come on until somewhat late in life.
Treatment. Must be simply palliative. Nourishing food. Occasionally, mild tonics. Warm clothing. Avoidance of fatigue, or mental excitement. Residence in pure mild air.
CYNANCHE LAEYNGEA.— From Kv^v. a dog; ay;};co, to strangle,— because dogs were supposed to be especially liable to sore throat : Aapryl, the windpipe. Synon. Angina Laryngea ; Inflammation of the Larynx. — See Laryngitis.
CYK'ANCHE PAROTIDEA.— From napa. near: otj, the ear. Synon. Parotitis Contagiosa ; Angina Externa; Alumps ; Branks ; Inflamma- tio'H of the Parotid Gland. — See Parotitis.
CYNANXJHE TONSILLARIS. -From Tonsilla. the tonsil. Synon. Amygdalitis ; Angina Tonsillaris ; Inflaimnatory Sore Throat ; Quinsy. — See Tonsillitis.
CYNANCHE TRACHEALIS.— From Kucov, a dog ; ayxco, to strangle.
Synon. Suffocatio Stridula. ; Angina Memhranacea; Lary-ngotracheitis ; Inflammation of the Trachea. — See Croup.
DEAFNESS. — Synon. Cophosis ; Surditas ; Hardness of Hearing. — May be the result of rheumatism, gout, hereditary syphilis, disease of the menibrana tympani, disease of the ossicula auditus, obstruction of the Eu- stachian tube, or some diminution of nervous force. — See also Otorrhoea ; Otitis ; Eustachian Tube.
1. Rheumatism of Ear. — Most frequently occurs after subsidence of rheumatic inflammation of joints.
Symptoms. Tenderness of scalp, temple, mastoid process, jaw, and teeth on affected side. Distressing tinnitus. Nightly exacerbations, with acid perspirations. An acute attack may prove most destructive by producing periosteal inflammation and caries. Sometimes obstinate otorrhoea results : may lead to exfoliation of a portion of bone.
'Preatment. Alkaline salts. Iodide of potassium. Opium. Hot bath- ing. Fomentations. When great tenderness exists over mastoid process, much relief may be given by an incision over this part down to the bone, so as to free tense inflamed periosteum.
2. Gout of Ear. — A common cause of deafness. Ear seldom attacked until small joints have been frequently invaded. Deafness generally pre- ceded by severe headaches.
Symptoms. Gout affecting external ear often sets in soon after midnight. Tearing or twisting pain : burning heat ; beating noises or singing in ear; swelling, with redness. — Minute articulations of bones in the middle ear may suffer. Pain very acute. Sometimes loss of consciousness, delirium,
DEATH CAUSES— DELIRIUM TREMENS. 87
or convulsions. Concretions and deposits of urate of soda found after death (Harvey).
Treatmknt. Same as for o;ont in other parts of body. Purging with neutral salts. Alkalies. Colcliicum. Fomentations. When apparently due to metastasis, mustard pediluvia, or other local stimulants, to recall disease to less important joints.
3. Nervous Deafness. — Somewhat analogous to amaurosis. More or less deafness owing to some lesion of nervous system ; whether the mischief have its seat in nervous tissue expanded in labyrinth, at origin or in course of seventh pair, or in brain itself. — In some cases no relief can be given; as in senile deafness, arising from insensibility of nervous tissue due to old age. Ear-trumpets. Marshall's Double Reflecting Ear-trumpets possess great advantages as regards the ease and distinctness with which they convey sounds of voice, witliout any necessity for speaker doing more than articu- late clearly. Singing noises and deafness sometimes due to decayed teeth.
DEATH CAUSES. — Life can only be maintained by the circulation of arterial blood. If no blood circulates through arteries, or only venous blood, the result is death. Death by cessation of circulation of blood may be of two kinds. (1) Death by anannia ('A, priv. ; al^a, blood), in which there is a want of due supply of blood to heart. The anaemia may be due to loss of blood or to its impoverishment and diminution by disease. (2) Death by asthenia ('A, priv. ; oQivoi, strength), where there is a failure in con- tractile power of heart. This may arise from disease of the cardiac walls or valves ; or from ari'est of the heart's action through the nervous system, as in apoplexy ; disease of medulla oblongata, shock, etc., or by certain poisons. When, either from anaemia or asthenia, the death is sudden it is said to be due to st/ncope (Sfyxortrw. to be affected with sudden prostration of strength). Sometimes life fails partly from anaemia and partly from asthe- nia ; as in cases of starvation, phthisis, dysentery, etc.
Death by circulation of venous blood may happen in one of two ways: — (1) By apnoea ('A, priv.; rti'sw, to breathe), asphyxia, or suffocation, where access of air to lungs is stopped; as in drowning, strangulation, many laryn- geal and lung diseases, tetanus, section of phrenic and intercostal nerves, etc. (2) By coma (KiL^a, deep sleep), in which muscular movements required for respiration cease owing to insensibility produced by cerebral disease. — In apnoea there are successively impeded respiration, circulation of venous blood, and insensibility. In coma the order is reversed. — -insensibility, cessa- tion of thoracic movements, and stoppage of chemical functions of lungs,
DELIRIUM TEEMENS.— From Deliro, to be crazy : Tremo, to trem- ble. Synon. Delirium Ebriositatis ; Mania a Potu ; Delirium Vigi- lans. — Delirium characterized by hallucinations, fear, trembling of muscles of extremities, weakness, and watchfulness. Natural tendency of the disorder to terminate in a critical sleep, at end of from forty-eight to seventy-two hours from commencement of delirium.
Symptoms. Sleeplessness. A busy, but not violent, delirium : aggravated towards night. Constant talking or muttering. Hallucinations of sight and hearing. A dread or suspicion of every one: a belief that strangers are under the bed, or listening at door. A generally excited and eager manner. Mental with bodily prostration. Tremulous motions of hands : constant twitching of facial muscles. Loss of appetite. Nausea. Consti- pation. Pallor and moisture of skin ; frequent weak pulse.
In fo.vorahle cases, critical sleep, lasting twelve or more hours; from which patient wakes cured, though weak. \\\ fatal examples, watchfulness continues; muttering delirium, subsultus tendinuni, and exhaustion ; great prostration, coma or convulsions or fatal syncope ; syncope sometimes induced by struggles. Death usually between third and seventh days.
88 DENGUE— DIABETES MELLITUS.
Treatment. Critical sleep to be brought about as soon as possible. Ice to cool irritable stomach. Salines, 348, 349, 356. Milk, raw eggs, beef- tea. Brandy and egg mixture, 17. Ammonia and bitters, 361, 371. Ether, brandy, and bark, 367. Sumbul and hop, 369. Bromide of potassium, morphia, chloroform, and Indian hemp, 317. Indian hemp in doses of half a grain to one grain. Subcutaneous injection of morphia, 314. Chloral. Tincture of digitalis, in half-ounce doses, once or twice repeated. Patient to be restrained by one or two good attendants. Apartment to be kept quiet and dark. All sources of mental irritation to be removed. Cold affusion, or cold shower bath, sometimes very useful.
Avoidance of over-stimulation, and excessive doses of opium. Use of strait waistcoat very rarely advisable, as it increases irritation. — See i)^j7- somania.
DENGrUE.— Synon. Scarlatina Rheumafica ; Eruptive Epidemic Fever ; Eruptive Rheumatic Fever ; Dandy Fever ; Break-hone Fever. — • In certain parts of East Indies, Southern States of America, as well as in Philadelphia and New York, occasional extraordinary epidemics of a pecu- liar infectious fever, in which an eruption like that of scarlatina is combined with severe rheumatic pains in limbs and joints. Sometimes, throat is implicated ; occasionally testicles enlarge ; often, lymphatic glands of neck and groin swell. Pains about shoulders and arms, loins and hips, thighs and legs; great soreness of muscles and bones; headache and flushing of face; rapid pulse and coated tongue; nausea and vomiting; prostration. The disease generally lasts about eight days. Demands the use of antacid aperients, salines, colchicum with opium, and bark or quinine.
DIABETES MELLITUS.— From Ati, through ; l^aJw, to move ; Mi%t, honey. Synon. Melituria ; Paruria Mellita ; Glucosurict; Giucnhcemia; Saccharine Diabetes. — A complicated chronic disease, due to inefficient performance of some important function. Characterized by secretion of a large quantity of urine containing glucose or grape sugar.
Syjiptoms. Come on insidiously. Muscular weakness. Malaise : sense of feverishness. Excretion of large quantities of urine, having a faint apple- like odor, and a high sp. grav. 103.5-1050. Dryness and harshness of skin. Constipation: hard dry feces. Constant thirst. Failure of genei'al health; loss of sexual power. Pain about loins. Coldness of extremities, with sense of burning in hands and feet. Increasing debility, diminution in weight, shrinking of frame, oedema of legs, and sometimes albuminuria. Chloroform- like smell of breath. Sponginess of gums, with decay of teeth. Mental depression and irritability. Constant sense of sinking at stomach, with voracious appetite. Tendency to double cataract: to boils. — Often becomes associated with phthisis after a time. In confirmed cases death from some intercurrent low form of inflammation — bronchitis, pleurisy, pneumonia, or peritonitis ; from gangrene of legs ; phthisis ; or from gradual exhaustion.
Sugar to be detected in urine by fungus, potash, copper, or fermentation tests.
Treatment. Diet : — To be nutritious, yet free from saccharine and amylaceous materials. Meat, poultry, game, ham or bacon, white fish. eggs. Weak beef-tea, mutton broth. Milk, or preferably cream. Neufchatel, Stilton, or cream cheese. Butter. Greens, green leaves of lettuce, spinach, waterci'esses. Bran loaf, 9. Almond rusks and biscuits. Gluten bread. Stale well-fermented bread thoroughly toasted. Skim milk in large quantity as sole food has been recommended. Spring water, iced water, soda water, Vichy water. Tea sweetened with glycerine. Dry sherry : Bordeaux wine: dry Hungarian wines : Burgundy: weak brandy and water: whiskey and water. — Forbid: — Sugar. Pastry. Fruit. Confectionery. Potatoes. Carrots. Parsnips. Beetroot. Turnips. Radishes. Macca-
DIARRHCEA. 89
roni. Rice, sago, tapioca, arrowroot. Liver. Oysters, lobsters, crabs, mussels. Beer ; raw spirits ; liqueurs. Coffee.
Drugs: — Opium (gr. ^-1, tlirice daily). Codeia. Opium, ipecacuan, and nitre, 324. Citrate of ammonia or potash, with steel, 403. Reduced iron, aloes, and nux vomica, 404. Strychnia. Quinine and opium. Crea- sote, 41. Cod-liver oil; or suet boiled in milk. Peroxide of hydrogen. Oxygenated water. Pepsine, 420 : Castor oil : Seidlitz powders : Com- pound powder of rhubarb and magnesia : Aperient enemata.
General remedies: — AVarm clothing: flannel or chamois leather next the skin of trunk and extremities. Hot water or vapor baths. Turkish bath, 130. Mineral springs of Vichy, Carlsbad.
Remedies which have been employed : — Carbonate of soda. Acetate of potash. Tartrate of potash and soda. Carbonate of ammonia. Indian hemp. Permanganate of potash. Alum. Lime-water. Yeast. Large quantities of sugar. Potato bread. Iodine. Nitric acid. Phosphoric acid. Sulphur. Turpentine. Permanganate of potash. Inhalation of oxygen gas.
DIAR.B,H(EA. — From AtaiJijEco, to flow through. ^ Synon. Coprorrhoea ; Catarrhus intestinalis ; Summer or Bilious Diarrhoea; English Cho- lera; Purging. — A relaxed state of bowels, i. e. the frequent evacuation of loose or liquid stools.
Symptoms. Purging. Nausea. Furred tongue. Foul breath. Flatu- lence and griping pains. Acid eructations. Tenesmus. Stools unhealthy : consist either of liquid feces, or a watery feculent mucus, or thin frothy serum, or of pale yeast-like matter. In severe summer or English cholera, evacuations often consist chiefly of bile : violent abdominal pains, cramps in legs, chilliness, and depression.
Treatment. Expulsion of offending matter from intestinal canal : — Castor oil, 164. Castor oil and opium, 114. 164. Tincture of rhubarb. Compound powder of rhubarb. Blue pill and rhubarb, 171. Warm water enema. Calomel.
Suhsequevtly, or at first luhen cause has been removed by spontaneous -purging : — Ether and opium, 8.5. Chloroform, morphia and Indian hemp, 317. Chalk mixture, with catechu and opium, 97. Rhatany, 96. Matico and rhatany, IO.t. Aromatic sulphuric acid and opium, 100, Liquid ex- tract of bael, ,58, 97. Kino and logwood, 108. Compound powder of catechu. Aromatic powder of chalk and opium. Powder of kino and opium. Powder of ipecacuan and opium. White bismuth, 6.5, 112. Astrin- gent enemata, 113. Enema of opium. Morphia suppository. Vegetable charcoal, 98. — Careful diet. No solid food. Mucilaginous drinks. Muci- lage of gum Arabic. 1'apioca, sago, or milk arrowroot. Saccharated solution of lime and milk, 14. (!ustard or rice puddings. White fish. Pepsine. 420. Port wine. Brandy and cold water. Ice.— Linseed poul- tices. Turpentine stupes. Wearing a flannel belt or bandage round abdo- men. Avoidance of damp and cold.
Remedies sometimes used: — Nitrate of silver. Chloride of silver. Sulphate of copper. Aminonio-sulphate of copper. Tannate of bismuth. Alum. Cinnamon. Oxide of zinc. Iron-alum. Tincture of perchloride of iron. Acetate of lead. Ergot of rye. Dilute sulphuric acid. Blisters. Ice to spine, etc.
Infantile diarrhoea : — Often attended with great danger. In early stage, castor oil, or calomel, or gray powder with rhubarb and soda to re- move offending matters. Later, minute doses of laudanum with dill water or bismuth.
No milk or other food to be given for 12 or 24 hours, but water, toast water. Sweetened barley water, or rice water. This alone often sufficient with warmth.
90 DIPHTHERIA.
DIPHTHERIA. — From At^^tpa, a skin or membrane. Synon. Angina Maligna; Cynanclie Membranarea ; Putrid Sore Throat; Malignant Quinsy. — An epidemic and contagious sore throat of great severity, due to toxaemia ; attended with much prostration, and characterized by exudation of false membranes on tonsils and adjacent structures. — When followed by recovery, it often leaves an altered state of voice, and may be followed by partial paralysis of muscles of deglutition, weakness of extremities, im- paired vision, and other secondary nerve affections.— Children more ob- noxious to this specific blood-disease than adults. Most common amongst poor, or such as reside in damp situations and badly drained houses.
Symptoms. Commence gradually : feelings of depression and muscular debility, headache, nausea, slight diarrhoea, chilliness, drowsiness, and sense of stiffness about neck, or sometimes with high fever, quick pulse, flushed face, and hot skin. Then, tonsils get inflamed and swollen : swelling and tenderness of glands about angles of lower jaw. Inflammatory action spreads to velum, uvula, posterior part of pharynx. Perhaps difficult deglutition. — If resolution do not occur, characteristic feature becomes manifested, — effusion of a plastic fibrinous material. This may first appear in nasal fossfe, or on soft palate, on one tonsil, or on back of pharynx. Exudation looks like ash-colored specks ; which, enlarging and coalescing, form large patches resembling damp dirty M'ash-leather. As disease spreads, false membrane increases in thickness and extent : firmly attached to mucous membrane beneath : if forcibly removed, a new patch soon forms : may spread to cheek and gums, oesophagus, or through glottis into larynx and trachea. When membrane begins to separate and decompose, horribly fetid breath : when thrown off, there may be left ulceration, sloughing, or gan- grene ; or tissues gradually assume a healthy appearance. True diphthe- ritic membranes sometimes form on abraded cutaneous surface, conjunctiva, mucous coat of vagina or rectum, etc.
Constitutional symptoms perhaps slight at first. Soon, prostration and restlessness. Only moderate fever. Pulse increases in rapidity. Saliva often dribbles away. Breath fetid. Disinclination for exertion or food. Dysphagia often absent. Attacks of hemorrhage occasionally from nose, fauces, or bronchi. Albuminuria present in most cases from early period. Sometimes purpura. — Death from exhaustion, hemorrhage, ichorhtemia, uraemia, gangrene, or asphyxia— consciousness remaining till close. Some- times, fatal event due to thrombosis. — In event of recovery, convalescence tardy. Anaemia. Secondary nerve affections : paralysis, neuralgia, defec- tive vision.
Treatment. No specific known. By remedies of a supporting nature, patient may be often guided through the great danger, which is present in every case.
Locally : — External applications — leeches, blisters, poultices, fomenta- tions— to throat, useless or injurious. At commencement, inhalation of acid vapor — three ounces of vinegar to pint of boiling water, hot-water spray. When pellicle has formed, — spray of hot atomized lime-water. 262, or solu- tion of phosphate of soda ; sulphurous acid spray. Iodine inhalation, 259. Painting with tincture of perchloride of iron and glycerine; turpentine; strong solution of nitrate of silver; solution of chlorinated soda. Hydro- chloric acid gargle, 248. Borax gargle, 250. Chlorinated soda gargle, 254. Creasote gargle, 255. Gargle of hot saccharated solution of lime. Avoidance of solid nitrate of silver, nitric acid, hydrochloric acid, and other caustics. Tearing away of exudation, injurious.
General remedies : — In early stage, emetic of ipecacuan and ammonia, 233. Cream of tartar drink, 356. Chlorate of potash drink, 360. If there be depi'ession, hemorrhage, or albuminuria, commence with tincture of per- chloride of iron, 392. Quinine and iron, 1-^80. If thrombosis be feared, ammonia and bark, 371. Chlorate of potash, 61. Iodide of potassium, 31.
DIPLOPIA— DIURESIS. 91
Sulphurons acid. Sulphite of soda, or masfnesia, 48. Opium. Essence of beef, 3. EfrS's, cream, and beef-tea, .5. Ijime-water and milk. 14. Brandy and e<jgs, 17. Brandy. Port wine. Champagne. Milk, or cream. Ice, to suck very freely.
Patient to be kept in bed. from commencement ; flannel clothing' often advantageous. Air of room to be pure and warm (70° F.) ; to be kept moist by evaporation of boiling water, Sinapisms to epigastrium, if there be sickness. Simple enemata or castor oil, if there be constipation. Lin- seed poultices to loins, or hot fomentations, if suppression of urine come on. Chloroform inhalation, where attacks of dyspnoea are paroxysmal. Tra- cheotomy or laryngotomy, when exudation obstructs larynx. AVhen swal- lowing is prevented, nutrient enemata, 21. 22, 23. — Directly convalescence is firmly established: — Sea air. Very generous diet. Cod-liver oil. Quinine and steel. Strychnia, or nux vomica. Faradization.
DIPLOPIA. — From AiTfkoo^, double : oTt-toixai. to see. Synon. Amhi- Ofia; Dittopsia ; Double Vision. — Arises from some derangement in the visual axes by paralysis or spasm of muscles of one eyeball, or some irregu- larity in density or curvature of dioptric media or some disease of retina or optic nerve. — See Arncourosis.
DIPSOMANIA. — From At4'a, thirst ; ftai'ta, madness. — An intense craving for intoxicating liquors; attended with a protracted state of gene- ral depression and restlessness. An unphilosophical and dangerous view to regard a dipsomaniac as in every case an irresponsible being. Hard drink- ing a degrading vice : difficult to discontinue, the more it is indulged in.
Excessive use of alcoholic stimuli leads to : — Induration of portions of nervous centres. Congestions of respiratory organs. Amyloid and fatty degeneration of liver. Chronic inflammation and thickening of walls of stomach. Disease of substance of heart, and of kidneys. Cirrhosis or gin- drinker's liver. Dropsy. Tuberculosis.
Treatment. Total abstinence from intoxicating drinks. Henbane, hop, bromide of potassium, chloral, or small doses of opium, to avoid sleepless nights. Bark and mineral acids, 376. Quinine, 379. Quinine and nux vomica, 387. Phosphate of iron, 405. Phosphate of zinc, 414. Oxide of zinc, 41.5. Hypophosphite of soda or lime, 419. Pepsine. 420. Nourish- ing food. Milk. Fruit syrups in soda water. In almost hopeless cases it may be justifiable to substitute opium for alcohol. Opium-eating much less injurious than alcohol to general health ; while the subject of it is not an intolerable nuisance like the drunkard. — See Delirium Tremens.
DIURESIS. — From Ata, through; otlpEw, to pass urine. Synon. Dia- betes Insipidus. — A condition in which an excessive quantity of pale limpid urine is secreted, free from sugar or other abnormal ingredient.
Symptoms. Insatiable thirst (polydipsia), with excretion of large quan- tities of urine. Watery constituents of latter alone increased ; total amount of urinary solids not greater than in health : in exceptional cases, however, the solids and particularly the urea have been above the average (polyuria). General health usually suffers : annoying thirst and frequent micturition cause bad nights. Sometimes, dropsy sets in.
If there be an excess of urine over amount of liquid taken, one of three explanations must be adopted: — (1) Either the body becomes poorer in water, and so loses weight. (2) Or, water is absorbed by skin and lungs. (3) Or, water is formed in system by direct union of its elements — oxygen and hydrogen (Parkes).
TreatmeiVT. Tincture of perchloride of iron, 101. Phosphoric acid and nux vomica, 376. Iron alum, 116. Gallic acid, 103. Opium. Valerian. Warm baths. Cod-liver oil. Enforced abstinence from fluids useless.
92 DRACONTIASIS— DEOPSY.
Remedies sometimes employed : — Ergot of rye. Mineral acids. Tannic acirl. Oxide of zinc. Iodide of potassium. Green iodide of mercury. Assafoetida. Camphor. Nitrate of potash.
DRACONTIASIS. — From Apdxuv, a serpent. Synon. Mcdus Drarun- culus ; Helminthoncus Medinensis. — Dracunculus medinensis, Filaria me- dinensis, or Guinea-worm, has a slender cylindrical body, sometimes nearly as thick as a crowquill, and from one to twelve feet in length. Usually found in human body in subcutaneous areolar tissue of feet and legs. — En- demic in some parts of Asia and Africa, especially in marshy districts : individuals returning from these countries occasionally bring this nematode helminth with them.
Symptoms. May be absent for some months : then a feeling of irritation in affected part, when a cord-like ridge may be felt. Constitutional dis- turbance : fever, headache, nausea, colic, debility. A kind of boil forms : sometimes pustule breaks, and head of worm protrudes.
Treatment. Curative: — When head protrudes, a thread to be placed round it and rolled on a piece of stick or bougie ; day by day drawing worm out, and winding it round the stick until extraction is complete. When worm does not protrude, it may be exposed by incision ; parasite being removed in a loop, or a wedge of wood being inserted around which it is to be wound without fracture.
Prophylactic : — Feet to be well protected, when travelling in districts where Guinea-worm is found. Thorough drying of feet after bathing, or wading through marshy districts. Avoidance of lying on the ground with any part of body exposed to the soil.
DROPSY. — Formerly correctly called hydropsy, from "TSwp, water, and o-^ii, an appearance. An accumulation of watery or serous liquid in some one or more of the natural serous cavities of the body, or in the meshes of the areolar tissue, or in both, often occurring independently of inflammation.
May be due (1) to obstruction to venous return causing over-distension of the veins and their capillaries, which may arise from many different conditions. 'I'he most common are : — Valvular or other disease of heart. Retarded circulation with increased fulness of veins, in pulmonary emphy- sema, bronchitis, etc. Structural disease of liver, impeding return of blood through the portal system of veins. Pressure of tumors, enlarged glands, gravid uterus, etc., on veins. (2) To kidney disease giving rise to imper- fect elimination of urea and water which therefore accumulate in the blood ; and (3) anemic or watery blood. — See Anasarca ; Ascites ; Hy- drocephalus ; Hydrothorax ; Hydropericardium ; Hydrocele, etc. (4) Inflammatory hyperaemia, as is seen in pleuritic effusion, strumous ascites, hydrocele, etc.
Treatment. Remove or relieve diseased condition, of which dropsy is a symptom. To carry off fluid. — Purgatives. Diuretics. Diaphoretics. Emetics. Alteratives. Tonics. Tapping. Incisions or acupunctures. Issues.
Purgatives : — Calomel, 159. Jalap, 140, 1.59. Compound jalap powder. Compound scammony powder. Compound pill of gamboge. Eiaterium, 157. Croton oil, 168. Black hellebore. Tobacco. Oil of turpentine, 190. Acid tartrate of potash, 228. Rhubarb. Colocynth. Resin of podophyllum.
Diuretics: — Acetate of potash, 219. Digitalis, 219. Squills, 219. Copaiba, or its resin. Nitrate of potash, 212. Bachu, 222. Senega, 214. Compound spirit of horseradish. Spirit of nitrous ether. Tincture of cantharides. Oil or spirit of juniper, 229. Infusion of uva ursi. Benzoate of ammonia and digitalis. Liquor potassse. Fomentations to loins. Cup- ping or leeches to loins. Dry cupping over the kidneys.
DROWNING— DUODENAL DISEASES. 93
Diaphoretics: — Tartarated antimony, 210, 213. Antimonial powder. Opium. Powder of ipecacuan and opium. Elder-flower water. Guaiacum, 43. Hot-water baths, 119. Hot-air or vapor baths, 130. Wet-sheet packing', 136.
Emetics : — Ipecacuanha, 231, 233. Sulphate of zinc, 232. Mustard.
Alteratives: — Corrosive sublimate, 27. Compound pill of calomel. Mercury and chalk. Blue pill. Colchicum, 46. Liquor arsenicalis, 52. Chlorate of potash, 61. Iodide of potassium, 31.
Tonics: — Nitric acid, 147. Nitro-hydrochloric acid, 378. Tincture of perchloride of iron. Citrate of iron and ammonia. Citrate of iron and quinia. Iodide of iron, 32. Tartarated iron. Cod-liver oil.
DROWNING. — For the restoration of the asphyxiated from submersion, see Suspended Animation.
DUODENAL DISEASES.— From Duodeni, twelve ; because this por- tion of bowel was said by the ancients to be as long as the breadth of twelve fingers. — Great difficulty in diagnosing diseased conditions of duodenum from those of small intestines generally.
1. Duodenitis. Synon. Dod,ecadactylitis. — Acute inflammation seldom limited to duodenum : generally complicated with similar disease in stomach, jejunum, or ileum ; or with inflammation of gall-bladder, or under surface of liver, accompanied by jaundice.
Symptoms. Probably pain about epigastric and right hypochondriac regions ; perhaps only becoming severe about three hours after taking food. Well marked tenderness about right hypochondrium ; partly owing to in- flamed condition of intestine, and partly to sympathetic ii'ritation about liver, 'i'hirst. Unaltered or even increased appetite. Nausea and vomit- ing. Diarrhoea, with unnatural and off'ensive stools. Weakness, mental anxiety, and loss of flesh. — When complicated with inflammation of the biliary apparatus, or when due to the irritation set up by a gall-stone (which may cause inflammation, ulceration, and perforation of the walls of the gall-bladder and intestine, so as to allow of its escape into the duode- num), there will be jaundice with the usual results. If there be also pan- creatic disease the liquid stools will contain fatty matters.
Treatment. Castor oil, or calomel as an aperient. Opium. Solution of acetate of ammonia. Mucilaginous drinks. Milk diet. Linseed poultices. Poppy-head fomentations.
2. Duodenal Dyspepsia. — Either the result of chronic or subacute in- flammation, or simply of impaired function.
Symptoms. Pain about duodenum some three hours after food has been taken. Nausea. Attacks of faintness. Occasionally, jaundice ; especially when the disease is caused by abuse of alcoholic drinks.
^^REATMENT. Mcrcury and chalk. Mercury and chalk with opium, 34. Rhubarb and blue pill, 171. Nitric acid, senna, and taraxacum, 147. Nitro-hydrochloric acid, 378. Quinine and rhubarb, 178, 370, 38.5. Ipe- cacuan. rhubarb, and oxide of silver, 179. Ammonia and ox bile, 170. Ammonia and chiretta, 63. — See Dyspepsia.
3. Perforating' Ulcer of Duodenum. — Presents, in a mitigated form, many of the symptoms of ulcer of stomach. There may be diarrhoea with bloody stools; nausea and vomiting; great prostration, etc. Fatal per- foration sometimes occurs suddenly where premonitory symptoms have been mild. A sloughing ulcer is liable to form in upper part of duodenum within a few days of a severe burn. — See Gastric Ulcer.
4. Cancer of Duodenum. — As a primary affection very rare. Not unfrequently the duodenum is secondarily involved in progress of hepatic
94 DYSENTERY.
cancer, and in malignant disease of pancreas or neighboring lymplmtic glands. Colloid form most common. When the diseased mass presses on the ductus communis there will be jaundice. — Death may occur from inanition, or from peritonitis the result of perforation, or from obstruction of the bowel. — See Gastric Cancel'.
DYSENTEEY. — From Adj, difficulty or badness ; htf^ov, intestine. Synon. Colitis; Colorectitis ; Bloody Fhix. — A specific inflammation and ulceration of mucous lining (occasionally also of other tissues) of the colon, especially perhaps of lower part of this gut and rectum ; attended with febrile disturbance, severe griping pains, mucous and bloody stools, and great prostration. Has been improperly termed colitis [Colon, th& large gut; terminal -itis) ; cases occurring where ulceration does not stop at ilio-caecal valve, but extends several inches up small intestines.
Severe dysentery rare in this country. Sometimes breaks out in un- healthy localities. In tropics often very fatal. — Has been ascribed to wet and cold, contagion, malaria, polluted water, intemperance, deprivation of fresh fruit and vegetables, bad or insufficient or salt food, insufficient clothing, etc.
Symptoms. Acute form : — Uneasiness and pain in abdomen of a griping character {tormina, from Torqueo, to torture), with frequent inclination to go to stool. As ulceration commences, desire to empty bowel becomes more frequent, and is followed by shorter interval of ease. Evacuations scanty, thin, mucous, bloody ; mixed with small hard lumps of feces [scyhala, from 1,xv3a\ov, excrement). The scanty stools produce great distress ; griping, and straining without any evacuation [tenesmus, from TftVcd, to strain); peculiarly fetid and dark-colored motions, mixed with blood and purulent matter and shreds of lymph ; and frequent micturition. Urine high-colored ; gives rise to scalding. Sometimes constant desire to micturate, only a few drops coming away at a time [strangury, from Srpayl, a drop ; olpov, urine). Great constitutional disturbance and pros- tration.
Often associated with hepatitis and hepatic abscess. May end in per- foration of bowel and fatal peritonitis : in rupture and fecal abscess : in ichorhsemia and secondary abscesses : in fatal exhaustion. After healing of ulcerations in favorable cases there may be troublesome constipation from contraction of cicatrices.
Chronic variety : — Most intractable. Often causes atrophy of mucous membrane with degeneration of intestinal glands : or imperfectly cicatrized ulcers remain in tissues of caecum, colon, or rectum. Most cases recover. Sometimes, however, patient gradually wastes : skin gets dry and scaly : improvement one day with relapse the next : discharges of fecal matter, mixed with thin pus and blood, most offensive: the exhaustion, pains, tenesmus, etc., render death welcome.
Treatment. Acute : — Perfect rest in bed, in well-ventilated room. Demulcent drinks. Ice. " Farinaceous food : milk or cream : thin broths. Warm bath. Fomentations: linseed poultices: wet compress. A few doses of castor oil (164) if there be lodgment of scybala. Ipecacuanha often most valuable, given thus :— Interdict use of fluids for three hours ; apply a large hot linseed poultice, containing two or three tablespoonfuls of mustard, over epigastrium : a full dose of opium in form of enema or suppository : thirty or forty-five minutes subsequently give from thirty to sixty grains of ipecacuaa powder in form of bolus, in mucilaginous draught, or wrapped up in wafer-paper ; repeating dose, if necessary, at end of six or twelve or twenty-four hours. Subsequently: — Opiate suppositories or enemata, 339, 340. If there be weakness and anaemia, salicine ; quinine ; bark and ether; cascarilla; or some mild preparation of steel. If stools continue numerous and frothy and bloody, bismuth ; gallic acid ; kino ;
DYSMENORRHOEA. 95
logwood; sulphate of copper. In scorVjutic cases, lemon or orange juice. Generous diet ; milk or cream, raw eggs, strong broths, ripe grapes, perhaps stimulants. Restorative soup, 3.
Remedies sometimes employed: — Bloodletting. Leeches to anus. Emetics. Calomel. Compound powder of jalap. Sulphur. Acid tartrate of potash. Nitrate of silver. 'J'artaric acid. American hellebore (Ve- ratrum viride). Belladonna. Hydrocyanic acid. Narcotine. Infusion of linseed. Mucilage of Iragacanth. Tobacco fomentations. Turpentine stupes.
Chronic or subacute : — Residence in a mild, dry, equable climate. Sea voyage. Warm clothing. Constant use of flannel roller round belly. Plain animal food : milk or cream: raw eggs. Grapes: oranges. Morphia. Chloroform, morphia, and Indian hemp, .317. Liquid extract of bael, 58, 97. Sumbul and ether, 9.5. Pill of lead and opium (officinal). Sulphate of copper and opium, 106. Nitrate of silver and opium, 107. Kino and logwood, 108. Matico and rhatany, 105. Gallic acid. 103. Australian red gum. Alum and sulphuric acid, 115. Tannic acid lozenges. White bismuth, 65, 112. Vegetable charcoal, 98. Iron alum, 116. Tincture of perchloride of iron. Reduced iron. Nitro-hydrochloric acid, 378. Pepsine, 420. Cod-liver oil. Quinine, rhubarb, and hop, 370. Enemata of acetate of lead and liquor opii.
DYSMENORRHCEA. — From Avj, difficulty; /xr^v, a month; ^t'co. to flow. '6y\\on. Paramenia Diifficilis ; Menstrua Dolorosa ; Amenorrhcea Partialis; Laborious or Zhjficult Menstruation. — Three distinct varie- ties : —
1. Neuralgic Dysmenorrhcea. — Afflicts nervous women, in delicate health, about time of puberty : or may come on after some years of painless menstruation, especially in those who have never been pregnant.
SymptOiMs. Malaise, headache, with pain about sacrum and lower part of abdomen for a few days prior to period. Soreness of inner and upper part of thighs. Bearing-down, with sense of pelvic weight. If discharge comes on freely, relief experienced. Commonly, flow is scanty — slight gushes : suffering becomes acute. Pain lessens and returns. Hysteria. Flatulence and constipation. Pain probably in ovaries, rather than in uterus. No swelling or heat of parts.
Treatment. During paroxysm .-—Hot hip bath for thirty or forty-five minutes. Bath, with extract of poppies and carbonate of soda (an ounce of each). Pessary of oxide of zinc and belladonna, or of iodoform, or of conia, 423. Indian hemp, aconite, ether, and juniper, 342. Morphia, chloroform, and Indian hemp, 317. Opium and henbane, with hot gin and water, 343. Hypodermic injection of morphia, 314. Linseed, or hemlock, poultice to abdomen and vulva.
During interval: — Quinine and mineral acid, 379. Bark, phosphoric acid, and aconite, 376. Salicin, 388. Hypophosphite of soda and sumbul, 419. Cod-liver oil, 389. Compound rhubarb pill. Effervescing citrate of magnesia. Taraxacum juice. Pepsine, 420. Iodide of lead and belladonna pessaries, 423. Chamomile tea. Nourishing food : substitution of milk or cocoa for tea and coffee. Wine ; weak brandy and water ; bitter ale. Avoidance of sexual intercourse. Warm sea baths.
2. Congestive Dysmenorrhcea. — Synon. Membranous Dysmenorrlioea. Generally occurs at later period of life than neuralgic form.
Symptoms. Suffering begins four or five days before each period. Backache ; weariness and restlessness ; sense of pelvic weight ; irritability of bladder. Haemorrhoids; frequent flushings; throbbing uterine pain. Discharge comes on gradually: scanty at commencement; relief follows abundant flow. Clots, and shreds or flakes of membrane expelled : some-
96 DYSPEPSIA.
times, pear-shaped casts of uterine cavity, formed of epithelial lining of uterus, analogous to decidua. Uterus found congested, lips oedematous, on examination ; sometimes displaced : ovaries tender. Swelling and tender- ness of breasts.
Treatment. During paroxi/s7n : — Same as for neuralgic form. Three or four leeches to labia uteri. Scarification of labia.
During interval: — Mercury and coniura, or iodide of lead and bella- donna or conia pessaries, 423. Corrosive sublimate, 27. Iodide of potas- sium, 31. Bromide of potassium, 42. Mercurial vapor baths, 131. Col- chicum,46. Cod-liver oil. Plain living: absence of stimulants. Avoidance of sexual intercourse. Cold salt water hip baths. Moderate exercise in open air. Sea air.
3. Mechanical Dysmenorrhoea. — That form in which there is stricture of internal or external os uteri; or a narrowing of entire canal of cervix; or some uterine tumor; or uterine displacement — retroflexion or anteflexion. Ensuing remarks apply only to the variety due to stricture of internal or external os, or to narrowing of entire cervical canal ; conditions causing sterility as well as dysmenorrhoea
Symptoms. Indicative of obstruction to escape of menstrual fluid. A scanty flow : discharge escapes in gushes ; each gush attended by pain. Backache. Irritability of bladder. Congestion and tenderness of ovaries. Examination reveals a very small os uteri : or an orifice of normal size, stricture being detected by uterine sound at internal os. Sometimes, os uteri only slightly smaller than natural ; but under influence of menstrual molimen spasmodic contraction occurs, with all the suffering of organic stricture.
Treatment. Incision of uterine canal with hysterotome (Routh's or Simpson's) ; followed by plugging with oiled lint, or introduction of a spring stem pessary (Greenhalgh's). Dilatation, by sea-tangle or sponge- tents, less likely than incision to eff'ect permanent cure ; and more apt to be followed by pelvic cellulitis, metritis, or ovaritis. Dilatation by bougies, useless.
DYSPEPSIA. — From Ad5, difficulty ; rtErtr'co, to digest. Synon. Apepsia; Digestio Dijficilis ; Conrodio Tarda ; Indigestion. — Anything which interferes with the healthy action of stomach and intestines may give rise to indigestion.
Symptoms. Variable in nature and severity. Loss of appetite. Pain, weight, and fulness at epigastrium, especially after eating. Flatulence. Nausea and vomiting. Costiveness alternating with diarrhoea. Furred tongue and foul breath. Palpitation. Headache. Pains in loins and limbs. Heartburn. Cramp in stomach. Water-brash. Hypochondriasis.
In sloio digestion from scanty secretion of gastric juice, — a feeling of fulness and distension in left hypochondrium, and at pit of stomach, after food. Flatulence; sour eructations; constipation; coated tongue; palpi- tation and irregular action of heart; headache and mental depression, etc.
Treatment. General Directions : — Digestion to be improved by means which invigorate system generally : — Rest and early hours. Relaxation from severe studies, or from harassing cares and anxieties of business. One day's holiday in every seven. Change of air : sea-bathing. Cold or tepid sponging. Wet compress over stomach, 136. Horse exercise : brisk walk- ing. Disuse of tobacco. Alcoholic stimulants in great moderation.
Regidation of Diet : — Plain food in small quantities. Gruel ; sago ; arrowroot. Milk and water. Lime water and milk. Stale, or unfermented, or aerated bread. White fish, — especially sole, whiting, brill, turbot. Poultry ; sweetbread ; tripe ; mutton ; venison ; pheasant ; hare. Dry sherry : dry Ruster, Ofner, Auslese, Carlowitz, Szamarodnya, Muscat, or
DYSPHAGIA— DYSPHONIA CLERICOEUM. 97
other white rTungarian wines. Weak cold brandy and water. Simple aerated water; soda water. Coffee, without chicory, but not after dinner. Avoidance of: — Vegetables, save cauliflower, asparagus, vegetable mar- row : of raw fruit— save grapes and oranges ; of pastry, cheese, tea, beer, port wine, and undiluted spirits ; of rapid mastication and hurry at meal times.
Dnnjs : — Pepsine, 420. Pepsiiie and aloes, 15.5. Pepsine and steel, 394. Rhubarb. Ipecacuanha and rhubarb, 179. Quinine and rhubarb, 178. Rhu- barb and blue pill, 171. Rhubarb and magnesia, 165. Ammonia and rhu- barb, 161. Purified ox bile, 170. Nux vomica, 175. Nux vomica, or strychnine and steel. Steel and hydrochloric acid, 397. Steel and citrate of potash, 403. Quinine, rhubarb, and hop, 370. Carbonate of ammonia, 361. Nitro-hydrochloric acid, 378. Salicin, 388. Nitrate of silver. Ox- ide of silver. White bismuth. Bicarbonate of potash. Ipecacuanha. Blue pill. Mercury and chalk. Taraxacum. Nitric acid. Saccharated solution of lime. Wood charcoal. Oxalate of cerium. Hydrocyanic acid. Lactic acid. Tannic acid. Gentian. Quassia. Hop. Kino. Serpentary. Chiretta. Cascarilla. Calumba. Compound tincture of cardamoms. — See Gastralgia ; Gastrodynia ; Pyrosis.
In dyspepsia with constipation, the waters of Carlsbad, Friedrichshall, Marienbad, Frauzensbad. In dyspepsia from debility, Spa, Fachingen, Schwalbach.
DYSPHAGIA. — From Av?, difficulty ; ^ayco, to eat. Synon. Deglntitio Jmpcdita ; Difficulty of Deglutition. — Difficulty in swallowing is a promi- nent symptom in disease of pharynx and oesophagus, — as inflammation, ulceration, stricture, spasmodic contraction, polypus, or cancer. It may also arise from glossitis, acute or chronic tonsillitis, diphtheria, croup. From erysipelatous or other inflammation of areolar tissue of neck. Retro- pharyngeal abscess. Glosso-laryngeal paralysis ; paralysis of muscles of deglutition; progressive paralysis of insane; progressive muscular atrophy ; paralysis agitans. Tetanus. Myelitis. Malignant, syphilitic, and tubercu- lar ulcerations about epiglottis. Syphilitic ulceration of velum and fauces. The pressure of aneurismal or other tumors. Spasm of pharynx and oesopha- gus, as in hydrophobia. Inflammation, ulceration, or oedema of larynx. And rarely, from disease of laryngeal cartilages.
DYSPHONIA CLEEICORUM.— From Arj, difficulty or pain ; fpc,v^, the voice : Clericus, a clergyman. Synon. Follicular disease of Pharyngo- laryngeal memhixme. — Frecjuently, a nervous complaint; unattended in early stage by any organic lesion, but consisting of hyperassthesia or irri- tability of investing membrane of fauces. Subsequently, congestion or in- flammation or relaxation of mucous membrane ; enlargement of tonsils ; elongation of uvula ; irritation, inflammation, morbid deposit, and ulcera- tion of mucous follicles about isthmus faucium. — Clergymen, barristers, public speakers, actors, singers, etc., most liable to this disease.
Symptoms. Uneasy sensations in upper part of throat, with frequent in- clination to swallow, as if there were something in oesophagus. Coughing, hawking, and spitting of phlegm. Uneasiness or pain about larynx. Di- minution in power of voice: hoarseness, especially towards evening: some- times aphonia. Unhealthy, granular appearance of fauces. Mucous folli- cles seem to be filled with yellowish matter. A viscid muco-purulent secre- tion adhering to palate and velum.
Treatment. Early stage .-—Quinine and iron, 380. Steel and pepsine, 394. Quinine and nux vomica, 387. Phosphate of iron, 405. Iron alum, 116. Sulphurous acid. Cold shower baths, or sea bathing. Rest of voice. Temporary change of scene and occupation.
Confirmed stage: — Iodide of potassium, 31. Iodide of iron, 32, 390. Iodide of ammonium, 38. Bromide of ammonium, 37. Corrosive sublimate, 7
98 DYSPNOEA— ECSTASY.
27. Phosphate of zinc, 414. Strychnia and steel, 408. Steel and chlo- rate of potash, 402. Quinine, steel, and arsenic, 381. Phosphoric acid, nux vomica, and bark, 376. Cod4iver oil, 389. Nourishing food. Sea air. UndercliflF, Torquay, Pan, Malaga, Algiers.
Local applications : — Inhalation of atomized alterative or astringent fluids, 262. Sulphurous acid inhalation. Sponging diseased parts, in- cluding interior of larynx, with solution of nitrate of silver (gr. 40-60 of crystals to fl. oz. j). Outside of throat to be protected : beard to be worn. Excision of tonsils, if they be affected with chronic enlargement and indu- ration.
DYSPNCEA. — From Adj, difficulty; ftviic, to breathe. Synon. Pseudo- Asthma; Respiratio Difficilis ; Short Breath. — May be Pharyngeal, from inflammatory swelling of fauces, tonsils, etc.
Laryngeal in croup, laryngitis, oedema of glottis, syphilitic, tubercular, or malignant diseases of larynx, foreign bodies or growths ; laryngismus stridulus ; spasm or paralysis from pressure on laryngeal nerves by intra- thoracic aneurism, tumor, etc.
Tracheal. From ulceration and narrowing, or from pressure by aneu- rism or tumors.
Pulmonic. From bronchitis, asthma, effusion into pleura, disease of lungs.
Cardiac. From valvular, or other disease, causing obstruction to entry of blood into heart from pulmonary veins. "
Other causes are, arrest of respiratory movement by spasm (tetanus), or paralysis of thoracic muscles and diaphragm. Pressure on diaphragm by ascitic fluid, abdominal tumor, pregnant uterus.
Simple shortness of breath may be caused by anaemia, debility, obesity, nervousness.
ECLAMPSIA NUTANS. From 'E;£7ia>7tw, to emit brilliant light; Nido, to nod. Synon. Scdaam Convidsions of Infancy. — A rare disease of in- fants ; attended with a frequent bowing of the head. Probably a form of epilepsy. Sometimes leads to impairment of intellect.
Symptoms. A peculiar, involuntary, rapid bowing forward of the head, and occasionally of the body. Bowings repeated in rapid succession : attacks come on in paroxysms several times in day. Most severe seizures usually occur in morning, on awaking from night's rest. After a time, — cerebral symptoms ; convulsions ; pure epilepsy ; hemiplegia or paraplegia ; general" wasting. In favorable cases, symptoms remit at end of some months ; bodily health completely restored in two or three years.
'1'reatment. Intestinal secretions to be kept healthy by mild alteratives, — mercury and chalk, rhubarb and soda, syrup of senna. Tonics, — bark and ammonia ; quinine ; phosphate of iron and lime, etc. 405. Cod-liver oil, 389. Nourishing food. Warm clothing. Sea air. Tepid salt water baths. As palliatives, — chloroform inhalation : small doses of hydrocyanic acid. Opium aggravates the attacks.
ECSTASY. — "Exfffaffts, a deep trance ; from 'E^iatfrjixi, to put a person out of his natural state. Synon. Catalepsia Spuria ; Trance. — A condi- tion analogous to the cataleptic. Patient insensible to all external impres- sions : absorbed in contemplation of some imaginary object. Eyes immov- ably fixed : impassioned sentences, fervent prayers, psalms, and hymns are recited with great expression. Religious fanatics, by encouraging some pre- dominant idea, fall into a state resembling incipient stage of monomania. " Gift of unknown tongues" mostly manifested by nervous women in a mor- bid condition. Faith, imagination, enthusiasm, and especially an irresis- tible propensity to imitation, will explain the origin of tarantism, dancing mania, convulsionaii'es of St. Medard, etc. — For treatment see Hysteria.
ECTHYMA— ELEPHANTIASIS GE^CORUM. 99
ECTHYMA. — From 'ExOvut, to break out in eruptions. Synon. Furun- culi Atonici ; Dartre Crastac6e ; Phlyzacia ; Papulous Scall. — Anon- contagious inflammation of the skin ; characterized by large, round, promi- nent pustules, occurring upon any part of the body. Pustules usually dis- tinct ; seated upon a hard inflamed base ; terminate in thick dark-colored scabs, which leave superficial ulcers followed by cicatrices. — May be acute, and preceded by lancinating pains with fever : more commonly chronic, and due to bad living, syphilis, etc. Often met with on scalp of badly nourished infants. In ecthyma cachecticum, ulcers assume an unhealthy appearance ; general health much deteriorated.
Treatment. Internally : — Mineral acids and bark, 376. Nitrohydro- chloric acid, 378. Quinine and steel, 380. Quinine, steel, and arsenic, 381. Steel and aloes, 154. Steel and sulphate of magnesia, 166. Iodide of potassium. Opium. Henbane. Cod-liver oil. Nourishing food. — Locally: — Warm or tepid baths. Gelatine baths, 132. Water dressing, dilute solution of subacetate of lead, oxide of zinc ointment, or subacetate of lead ointment to the scabs or ulcers.
ECTROPION. — From 'Exfpsrtco, to turn from. Synon. Blepharotosts ; Divaricatio Palpebrarum. — Eversion of the eyelid may be due to long-con- tinued conjunctivitis, or to the contraction of one or more cicatrices on the cheek, or to dropping of lower lid from paralysis. More common with lower than with upper lid.
ECZEMA. — From 'Ex^fw, to break forth in pustules. Synon. Running Scall ; Humid Tetter. — A very common non-contagious skin disease. Usually classified with vesicular diseases, but this questioned. A portion of skin becomes red, inflamed, and stiff; cuticle desquamates; a discharge of serum takes place from follicles and sebaceous ducts of skin ; and supei'- ficial moist excoriations, or patches of ulceration, covered with scabs or crusts, result. General health depressed : loss of appetite, irritability, rest- lessness. The disease may be acute or chronic. ■
Treatment. Internally : — Efl'ervescing citrate of magnesia, 169. Rhu- barb and magnesia, 165. Rhubarb and blue pill, with henbane, 171. Steel and sulphate of soda, 180, 181. Saline aperients and tartar emetic. Quinine and steel, 380. Phosphate of iron, 405. Steel wine. Pill of carbonate of iron. Arsenic, 52. Quinine, steel, and arsenic, 381. Steel and arsenic, 399. Cod-liver oil, 389. Corrosive sublimate, 27. Red iodide of mercury, 54. Red iodide of mercury and arsenic, 55. Opium. Henbane. Indian hemp. — Animal food : milk or cream : sherry, claret, etc. Exercise in pure air.
Locally : — Warm baths. Conium and starch bath, 122. Thin gruel, barley water, or simple water dressing. Subacetate of lead and glycerine lotion, 264. Glycerine and water (equal parts). Carbonate of soda and glycerine lotion, 268. Lime liniment. Saturation of scabs with washed lard or olive oil, and removal by linseed poultices. Oxide of zinc ointment. Diluted nitrate of mercury ointment, 305. Creasote and red oxide of mer- cury ointment, 301. — In eczema capitis, the hair to be cut off" close to scalp.
ELEPHANTIASIS GR^CORTJM.— From 'E^£>aj, the elephant,— owing to the terrible nature of the disease, and its causing the skin to re- semble that of the elephant. Synon. Elephantiasis Ancesthetica ; Lazari Malum ; True Leprosy. — A terrible and dangerous constitutional disease : gradually becoming more and more rare. Norway, Spain, and Portugal only European countries in which it is now common. It is endemic : affects the poor and badly nourished in preference to the well-fed : non-contagious, hereditary, and generally incurable. Tuberculated or not.
Characterized by patches of a purplish color ; which are succeeded by
100 EMBOLISM— EMPHYSEMA.
elevated tumors, irregular in shape and size, soft and smooth and insen- sible to touch, and which generally become the seat of unhealthy ulceration. Skin of face often affected ; an elongation and thickening of lobes of ears ; and a spreading out of alis of nose. When face beset with tubercles, fea- tures become puffed out and traversed by deep lines ; lijis thicken ; whis- kers and eyebrows and eyelashes fall off. Gradually, tubercles extend over the limbs ; sensibility of mind and body becomes greatly blunted until there is mere animal life. After some years, tubercles ulcerate ; there is oz^na ; fingers and toes become gangrenous ; body exhales a loathsome fetor. Death occurs from exhaustion, diarrhoea, or erysipelas.
Treatment. Arsenic. Nitro-hydrochloric acid. Nitric acid. Iodide of potassium. Iodide of iron. Bromide of potassium. Powdered bark of root of Mudar (Calotropis Gigantea ; Asclepias Gigantea). Bevilacqua (Asiatic Pennj'-wort; Hydrocotyle Asiatica) internally, and locally to ulcerations. Frictions with oil. Phosphorus. Cod-liver oil. Sudorific drinks. Turkish baths. Sulphur baths. Sea water baths. Sea air. Nourishing food : avoidance of salt meats. The Jews of Morocco are said to employ, as a prophylactic remedy, brandy distilled from raisins, pears, figs, and dates,
EMBOLISM. — From "E^^o^oj, a plug. — A term used to designate the obstruction of an artery by a fibrinous concretion detached and transported from the interior of the heart or of some vessel, and carried onwards by the blood until the calibre of the vessel becomes too small to allow of further progress. The migratory substance is called an embolus.
Symptoms. They depend upon the organ in which the embolus is arrested. A large clot from an inflamed vein fixed in pulmonary artery will induce immediate asphyxia ; or if able to pass on into lung, may be the cause of haemoptysis, pleuro-pneuraonia, or even gangrene. Obstruction of the chief vessel of a limb will induce mortification. Plugging of cerebral artery may cause hemiplegia and softening of portion of brain ; of renal artery albuminuria.
Treatment. See Thrombosis.
EMMETROPIA.— From 'E^fietpo^, in regular measure ; u>4'. the eye. Synon. Normal-siglitedness. — The emmetropic eye can distinguish the presence of an object the 600th of an inch in size at a distance of six inches. Can read Snellen's types at indicated distances.
The power of vision often injured by use of single eye-glasses. Light blue spectacles — "conservative spectacles*' — do harm, the retina being benefited by the stimulus of white light. It would be as wise to employ " conservative" crutches to spare the muscles.
EMPHYSEMA. — From 'E^^ixra'w, to inflate. Synon. Pneumatosis Palmdnimi ; Pneutnectasis. — Two varieties : — One consisting of enlarge- ment and coalescence of air-cells, atrophy of their walls, and obliteration of their vessels [vesicular or pulmonary emphysema). The other due to infiltration of air into interlobular areolar tissue, or into sub-pleural areolar tissue [interlobular emphysema). Both forms produce habitual shortness of breath ; occasional paroxysms of asthma ; and such distress, that sufferer is unfit for any active occupation. They often lead to disease of I'ight cavities of heart, with venous congestion and dropsy.
L Vesicular Emphysema. — May affect one lung or both, or a part of each — especially anterior edges and apices.
Symptoms. Dyspnoea, increased on any exertion. Feeble cough. Ex- pectoration of frothy sputa. Dusky appearance of countenance. Weakness of voice. Stooping gait. Loss of flesh and strength, lowered temperature
EMPYEMA— ENDOCARDITIS. 101
of body. Constipation. Weak and slow pulse. Attacks of asthma. Chest, barrel-shaped ; little respiratory movement of chest walls. On percussion, — unnatural clearness and extent of resonance. On auscultation, — very indistinct vesicular murmur. Occasionally, a moist rale, like sub-crepitant rattle of bronchitis. Heart's sounds feeble : often cardiac displacement. Diseased side of thorax unduly prominent and rounded.
Treatment. Invigorating diet, with attention to digestive organs. Rest. AVarm clothing. Carbonate of ammonia, 361, 371. Ammonia and ether, 8.5, 364. Lobelia and ether, 88. Sumbul and hop, 369. Quinine, 379. Quinine and steel, 380. Steel and pepsine, 394. Cod- liver oil, 389. Steel and cocoanut oil, 391. Phosphate of iron, 405. Stramonium smoking. Raspail's camphor cigarettes. Use of respirator. Warm climate.
2. Interlobular Emphysema. — Generally due to sudden rupture of air-cells by violent strain. Very rarely associated with vesicular emphy- sema. Can only be relieved by antispasmodics. When extensive may at once prove fatal.
EMPYEMA. — From 'Ev. within; rtvov, pus. Synon. Pyothorax ; Hydrothorax Purulentus. — The formation and accumulation of pus in the cavity of the pleura. Some physicians speak of true and false empyema : the first form being that in which pus is secreted by pleura in consequence of inflammation ; the second, that in which pus finds its w^ay into thoracic cavity from rupture of an abscess of lung. — See Pleui'isy.
ENDOCAEDITIS.— From "'Ev8ov, within ; xap^M, the heart ; terminal -itis. Synon. Internal Carditis. — Inflammation of the serous membrane which lines the interior of the heart, and which by its reduplications assists to form the valves. — Endocarditis usually associated with acute rheumatism, sometimes associated with pericarditis.
Symptoms. In severe forms, a sense of oppression and uneasiness at pragcordial region. Fever. Small and feeble and intermittent pulse. Patient prefers to lie on his back ; is restless and anxious. Cold sweats. Oppressive dyspnoea. Jactitation. Syncope.
In ulcerative endocarditis which may come on in depressed constitution, in addition to above symptoms there will be irregular high temperature, evidences of general distribution of emboli, petechise on the skin and fever of typhoid character.
When endocarditis is of limited extent, or of subacute character, as is most commonly the case, symptoms milder and more obscure. During rheumatic fever, it sometimes occurs without being recognized ; though its power is manifested by the structural changes which remain after apparent /-./A,, *X». recovery. — Endocarditis of Jeft. more common than of right side of heart. ^7 »' / ♦ That portion of membrane' covering valves and lining orifices most fre- /
portion of membrane covermg _^^ ^ ^
quently attacked. Seldom directly 'FataTTTmnote efifects^most to be dreaded.
Physical signs : — Palpation may detect a vibratory thrill. Doubtful if there is ever increased dulness on percussion, owiiigt^Tumtfaction of heart's walls. A soft mitral or aortic bellows-murmur detected by auscultation, but not always pTE^elTt'TirearIy"sTageT^=^SFe» Cardiac Valvular Disease.
Terminations : — Permanent valular disease, with implication of heart's substance, and all their combined consequences. Systemic loss of tone ; impoverishment of blood ; obstruction to circulation ; dropsy. Perhaps sudden death. — See Embolism.
Treatment. Perfect rest of body and mind. Sulphate of magnesia, or sulphate of soda, if there be constipation, 141, 144, 150, 152. Carbonate
]02 ENDOMETRITIS— ENTERITIS.
of ammonia, 361, 362. Aromatic spirit of ammonia, 349. Bicarbonate of potasli drink, 355. Linseed poultices over the cardiac region. Light diet. Remedies sometimes employed : — Tartarated antimony. Calomel. Mer- curial inunction. Digitalis. Opium. Colchicum. Blood-letting. Leeches. Blisters.
ENDOMETRITIS.— From "EvBov, within ; fir^tpa, the womb : terminal -ttis. Synon. Uterine Leucorrlicea ; Uterine Catarrh. — Catarrhal or croupy inflammation of mucous membrane lining uterine cavity.
Symptoms. Aciote variety : — Dry hot skin ; general irritability ; sallow complexion ; loss of appetite. Pain about lower part of abdomen, sacrum, groins, inside of thighs. Sense of heat and fulness about pelvis : bearing- down. Frequent micturition : urine loaded with urates or uric acid. Tenes- mus and diarrhoea ; subsequently constipation. Haemorrhoids. Tenderness of ovaries and uterus on pressui'e. Thick and tenacious discharge, after two or three days : subsequently, muco-purulent secretion tinged with blood, imparting a greenish-yellow or yellowish-red stain to body linen.
Chronic form: — Runs a tedious course. Obstinate dyspepsia; flatu- lence ; constipation ; mental depression. Wearying pains about sacrum, groins, etc. Discharge of abundant glairy mucus, resembling white of Qgg or mucilage. Increasing debility. Hysterical or convulsive affections, severe nausea, tympanites, tenderness of breasts, and menorrhagia, if lining of fundus be involved.
Treatment. Acide variety: — Rest in bed. Diet of fish, milk, tea, mucilaginous drinks. Castor oil. Calomel and compound jalap powder, 1.t9. Podophyllin, 160. Warm hip baths. Warm water vaginal injec- tions. Mercury and belladonna pessary, 423. Linseed poultices to lower part of abdomen and vulva. Four or six leeches to lips of uterus. Avoid- ance of sexual intercourse.
Chronic form: — Corrosive sublimate, 27. Green iodide of mercury, 53. Red iodide of mercury, 54. Donovan's triple solution, 51. Iodide of potas- sium, 31. Mercury, or iodide of lead, and belladonna pessaries, 423. Pep- sine, 420. Cod-liver oil. Leeches to labia uteri, or scarifications, only if there be congestion and no tendency to menorrhagia. Division of os uteri with hysterotome, if there be consti'iction. Application of solid nitrate of silver up cervical canal, or astringent uterine pessaries (424), in endometritis limited to cervix. Injection of tincture of iodine, but only after dilation of OS uteri by sponge-tents. — Animal food, milk, raw eggs. Avoidance of malt liquors. Gentle exercise in open air. — Subsequently, — Mineral acids with bark, 376. Quinine, 379. Nitro-hydrochloric acid, 378. Steel and pepsine, 394. Phosphate of iron, 405. Mineral waters of Spa, Homburg, Carlsbad, Marienbad, Kissingen.
ENDOSTEITIS. — From "Evhov, within ; occfaov, a bone ; terminal -itis. — Inflammation of medullary membrane lining central canal of long bones, as well as cells of flat and irregular bones. — See Osteomyelitis.
ENTERITIS. — From ^Evti^ov, an intestine ; terminal -itis. Synon. Intestinorum Inflammatio ; Ileocolitis ; Enterophlogosis. — Inflammation of the small intestines varies much in severity. Results sometimes very slight. There are no signs by which the morbid action can be positively diagnosed as existing only in duodenum, or in jejunum, or in ileum. All the coats of the bowel may be involved, or only the mucous lining.
Symptoms. Maco-Enteritis, or acute intestinal ccdarrh, a form of diar- rhoea, with bilious, and mucous or later serous stools. When the muscular coat involved, rigors ; hot skin; thirst; hard and frequent pulse. Abdo- minal pain, especially around umbilicus; increased by pressure. Nausea and vomiting. Position on the back assumed, so as to relax abdominal parietes. Great restlessness ; high fever ; prostration ; anxiety of counte-
ENTOZOA. 103
nanoe ; obstinate constipation ; rlelirinm. Wiry and almost imperceptible pulse. Vomited matters liis'bly offensive : sometimes stercoraceons.
Trkatment. Perfect quiet in bed. Opium and belladonna, 344. Ene- mata of warm water, to empty lower part of intestines. Ice or cold water. Aconite. Calomel. Demulcent drinks. Broth ; beef-tea ; farinaceous substances ; milk. Hot linseed poultices. Fomentations. Application of belladonna and opium, 297. Turpentine stupes. Sinapisms. Blisters. — Where there is a disposition to collapse : — Ammonia and ether, 364. Brandy and egg mixture, with opium, 318. Brandy and ether, 367. — During convalescence : — Ammonia and bark, 371. Cod-liver oil. Steel and cocoa-nut oil, 391. Steel and glycerine, 392. Phosphate of iron, 405. Simple animal food ; milk ; raw eggs.
ENTOZOA. — From 'Evroj, within ; fwov, an animal. The parasitic animals which infest the human body are very numerous. Helminthologists are well acquainted with upwards of thirty perfectly distinct forms. The fol- lowing are those of importance : —
(1) Fasciola Hepatica. — Synon. Distoma hepaficum ; Liver-fluke. — Of the order Trematoda, or flukes. Common in all varieties of grazing cattle, producing the Rot. It has been found in the human gall-bladder, etc. Usually rather less than an inch in length, and rather more than half an inch in breadth : body flat, covered with minute spines, of an oval form, and capable of contraction like that of a leech : has an oral and a ventral sucker : androgynous, the orifices of the male and female organs being placed side by side near the ventral sucker : oviparous. Bile forms its nourishment.
(2) DisTOMA Lanceolatum. — Synon. Fasciola lanceolata. — This Treraa- tode is smaller than the preceding, and less common. Body flat, smooth, and of a lanceolate form : androgynous : circular oral and ventral suckers. Most frequently found in liver of ox : only three cases recorded of its oc- currence in human subject (Cobbold).
(3) Distoma Ophthalmobium. — Synon. Distoma oculi-humani. — Of the order Trematoda. Four specimens have been found in the eye of an infant with congenital cataract (Gescheidt). Body very minute, and of a lance- olate oval form : two circular suckers.
(4) Distoma Crassum. — Synon. Distoma BusJcii. — Of the order Trema- toda. Body varies in length from an inch and a half to three inches : about half an inch in breadth. In 1843, fourteen of these flukes were found in duodenum of a Lascar who died in the Dreadnought Hospital ship (Busk).
(5) Distoma Heterophyes. — A very small trematode helminth, scarcely one line in length. Found on two occasions in small intestines of boys (Bil- harz). •
(6) Distoma H^MATOBTUM. — Synon. GyncBcophorus hcematobius ; The- cosoma hcematohiam ; Bilhai'zia hcematobia. — A cylindrical trematode worm, nearly half an inch in length. Males and females distinct : former the largest, and having on under surface of abdomen a longitudinal groove in which the slender female is lodged during copulation. Gives rise to hsematuria, — intermittent hsematuria of Egypt, the Cape, etc. ; ova fo.und in urine. — See Hasmatozoa.
(7) Tetrastoma Renale. — Has an oval flattened body, about five lines long, and provided with four suckers. Said to be found in the tubuli urin- iferi. Very little known about it.
(8) Hexathyridium Pinguicola. — Synon. Linguatula pinguicola ; Polystoma pinguicola. — A flat trematode, about eight lines in length. Been found in a small tumor of ovary (Treutler).
(9) Hexathyridium Venardm. — Synon. Polystoma venarum ; Lingua- tula venarum. — See Hceviatozoa.
(10) TiENiA SoLiuM.^ — Synon. Tcenia commum's, etc. — A large cestode helminth, which in its sexually mature or strobile condition may measure
104 ENTOZOA.
from twenty to thirty feet in leno^th : breadth, at widest part, nearly half an inch. Head (scolex) small and flattened, provided with a projecting papilla, armed with a double circle of hooks, and with four suckers : the neck long and narrow, continued into imperfect segments (sexually immature), which gradually merge into distinct segments (proglottides or sexually-mature joints). The generative apparatus consists of a ramified canal or ovarium containing the ova, and of a minute spermatic duct, both occupying the centre of each proglottis. Impregnation occurs by contact of one proglot- tis with another. The cysticercus cellulosfe, or pork measle, is the larva or scolex of this tapeworm. — See lyitestinal Worms.
(11) T^xiA Mediocanei.lata. — A cestode worm, attaining a greater length, and having larger segments than the preceding. Head furnished with large sucking-discs, but destitute of a rostellum and hook-apparatus. The "measles" or cysticerci which produce this helminth are found in the muscles of cattle. This bookless tapeworm is as common in this country as the Taenia solium, for which it is often mistaken (Cobbold). — See Intestinal
Worms.
(12) T^NiA Marginata. — Synon. Tcenia ex cysticercotenuicolli ; Tcenia tenuicollis ; Tcenia globosa. — Infests man only in the immature or cysti- cercal condition, the full-grown tapeworm (strobila) being found in dog and ■wolf (Cobbold). The larva (Cysticercus tenuicollis) only been found once or twice in human body.
(13) T^NiA EcHiNocooous. — A very small cestode helminth, infesting only the dog and wolf. Often met with in its larval condition in man, form- ing the well-known hydatids (echinococci, or acephalocysts). Hydatids are found in the following organs, enumerated according to their frequency : — • Liver; subperitoneal areolar tissue; omentum; female breast; muscles of heart ; brain ; spleen ; kidneys ; lungs ; bones, especially shaft of tibia. — See Hepatic Tumors.
(14) BoTHRiocEPHALUS Latus. — The largest cestode helminth ever met with in human subject ; sometimes attaining a length of more than twenty- five feet, and a breadth of nearly and inch (Cobbold). This broad tape- worm is almost peculiar to the inhabitants of Switzerland, Russia, and Po- land. Each joint or segment possesses its own ovary and male organs.
(15) AscARis LuMBRicoiDEs.— Synon. Lumbricas teres hominis. — A nematode helminth, in size and appearance like the common earth worm only white instead of red. Males about six inches long : females, double this length. — See Intestinal Wo7'ms.
(16) AscARis Mystax. — A nematode worm, especially characterized by the pi'esence of alaform appendages, one being placed on each side of the head. The male acquires a length of two inches and a half: female, twice as long. Yery common in the cat. In a few instances it has been found in human intestine (Cobbold).
(17) Tricocephalus DisPAR. — Synon. Trichuris ; Ascaris tricliiura. — The long thread-worm is a small nematode helminth, usually found in cajcum and large intestines. Male measuring about eighteen lines in length, female reaching two inches. — See Intestinal Worms.
(18) Trichina Spiralis. — See Tricliiniasis.
(19) FiLARiA Sanguinis Hominis. — See Hcematozoa.
(20) Strongylus Bronchialis. — Synon. Filaria bronchialis ; Filaria lymphatica. — A nematode helminth ; the male measuring about seven lines, the female about an inch. Has been found in the human bronchial glands.
(21) EusTRONGYLUs GiGAS. — Synou. Strongylus gigas ; Strongylus renalis. — A nematode helminth ; the male attaining a length of ten to twelve inches, and the female reaching to three feet. Not very uncommon in the kidneys and ovarian passages of animals, especially weasels. Rare in man. Gives rise to symptoms like those of renal abscess or renal calculi.
(22) ScLEROSTOMA DuoDENALE. — A Small nematode worm : the males measure one-third of an inch in length, the females being rather longer.
ENTROPION— ENURESIS. 105
Yery common in Eo-ypt, its presence in the small intestines of the natives giving rise to severe antemia.
(23) OxYURis Vermicularis. — Synon. Ascaris vermicularis. — This nematode helminth is the smallest of the intestinal worms. Male about three lines in length : female slightly longer. — See Intestinal Worms.
(24) Dracunculus Medinensis. — Synon. Filaria Medinensis ; Guinea- worm. — See Dracontiasis.
(25) Pentastoma T^nioides. — One of the family of Acaricte. No structural connection with true helminths. Adult body, lancet-shaped ; flattened at ventral surface; marked transversely by some ninety rings; four feet or limbs; head, truncated ; general surface smooth, but in larval condition [Pentastoma denticulatum) furnished with many rows of sharp spines. Length of female three to four inches ; of male, eight to ten lines. Oviparous, with a subsequent metamorphosis. In sexually-mature slate, infests nostrils and frontal sinuses of dog and wolf; in pupa and larva state found in human abdominal and thoracic cavities, though it has not been met with in this country. Does not give rise to any functional derange- ments (Cobbold).
(26) Pentastoma Constrictum.— About half an inch in length, and one line in breadth. Differs from larva of Pentastoma tsenioides in not having spines. The cephalo-thorax has four foot claws : the elongated abdomen is marked with twenty-three rings. Has been found in the livers of negroes at Cairo (Cobbold).
(27) PsEUDELMiNTHS. — The following so-called worms are not human parasites-. They have probably been introduced into the excrements or into the viscera for the purpose of deception. They are, — Dactylius ac'uleatus ; Spiroptera hominis ; Diplosoma crena,tum ; Gordiios aquaticus, or common hairworm of ditches, about a foot long, extremely slender, and which coils itself into knots (Cobbold).
EITTEOPIftN. — From 'Ev, in ; irpirtco, to turn. Synon. Inversio Palpe- brarum ; Blepharelosis. — An inversion of the margins of the eyelids. May result from a cicatrix in conjunctiva, neglected purulent ophthalmia, etc. Removal of the eyelashes will give at least temporary relief. Collo- dion to outside of lid : alum coagulum, 289.
ENURESIS. — From 'Ei/oupsu, to urine in bed. Synon. Hyperuresis ; Incontinence of Urine. — May be associated with tendency to renal disease ; disposition to gravel ; excess of uric acid, urates, or oxalates in urine ; stone in bladder ; loss of tone, or tumors, of walls of bladder ; irritation of thread worms in rectum ; haemorrhoids and prolapsus ani ; long and con- tracted foreskin ; stricture of urethra ; enlarged prostate ; vascular tumors of female urethra ; ovarian or uterine diseases and displacements ; paralysis from spinal disease ; nervous debility ; hysteria ; dyspepsia, etc.
Enuresis very common in young children. Its occurrence favored by free use of fluids during after part of day ; by exposure to cold in night ; by lying on back, — a posture unfavorable to retention of urine, especially when natural sensibility of mucous membrane of neck of bladder is increased.
Can usually be cured by making child almost abstain from fluids for three or four hours before going to bed : waking him to empty bladder twice or thrice during night : tying a cotton reel over spinal column, so that when he turns round upon his back he may be awoke: giving strength and tone to system, by administration of the tincture of perchloride of iron, phosphate of iron, cantharides and steel, benzoic acid, phosphate of zinc and belladonna, cod-liver oil, etc. Belladonna, or chloral sometimes effectual. Circumcision will be required, if there be a long prepuce with a very small orifice. In inveterate cases, application of succession of small blisters over sacrum. Where bladder is very irritable, belladonna plaster
106 EPILEPSY.
over loins and sacrum : or friction with diluted belladonna liniment. Where walls of bladder are weak, nux vomica ; ergot of rye : galvanism to lower part of abdomen and spine.
EPILEPSY. — From 'ErtiXafxISdvu, to attack unexpectedly. Synon. Morbus Comitialis ; Falling Sickness. — A disease presenting these prominent symptoms : — Sudden loss of consciousness and sensibility, with tonic convulsions lasting a few seconds, and followed by clonic spasms of voluntary muscles. Cessation of fit succeeded by exhaustion and coma. Attack recurs at intervals. — Hereditary taint, and marriages of con- sanguinity, are predisposing causes.
Warnings. Premonitory symptoms of an approaching seizure often not experienced. They differ in duration and character. Sometimes too short to allow sufferer to dismount from horseback, or remove away from fire, or lie down : sometimes many minutes or hours between their occurrence and fit. Spectral illusions, hallucinations of smell, headache, giddiness (epileptic vertigo) , confusion of thought, sense of fear, and that peculiar sensation — the aura epileptica — constitute most frequent premonitory symptoms. Epileptic aura differently compared to a stream of cold water, a current of cold or warm air, sense of tingling, creeping of insects ; the feeling begin- ning at extremity of a limb, or in epigastrium, etc., and gradually ascending along skin towards head. As soon as the aura stops, the paroxysm occurs.
Symptoms. Cadaverous pallor of countenance, with utterance of a shriek or scream ; immediately after which patient falls to the ground, and fre- quently on his face, senseless and violently convulsed. Severe burns, fractures, dislocations, etc., may be produced. Convulsive movements continue violent : usually more marked on one side of body than on the other, or first on one side and then on the other. Distortion of face. Gnashing of teeth. Foaming at mouth ; protrusion of tongue, which is often severely bitten. Eyes partly open and suffused : eyeballs rolling, and pupils insensible to light. Skin cold and clammy. PeT-haps involun- tary micturition and defecation: vomiting. Breathing laborious, seems about to be suspended ; when the limbs are stretched out, a deep sigh is drawn, and attack goes off. Patient left insensible and as in a sound sleep, with stertorous breathing ; from which he recovers with feeling of stupor and exhaustion and headache, but without any knowledge of what he has gone through. Some hours subsequently, small ecchymoses, like flea-bites, often to be detected about forehead and throat and chest. Ecchymosis of conjunctiva sometimes produced.
Average duration of fit from two to three minutes. Occasionally said to last some hours : appearance of this due to rapid succession of seizures, with- out recovery of consciousness in intervals — the status epilepticus. Fit may be very slight (iDetit mal), or very severe [grand or haut mal of the French). Former often only consists of giddiness, confusion of mind, loss of conscious- ness, little or no convulsion, and stupor, and all is over in less than a minute. Seizures recur at very variable intervals : often happen in the night, and for a time without being suspected by patient or friends. Repetition of attacks impairs memory : may produce cerebral hemorrhage, temporary or permanent paralysis, or dementia and idiocy.
In feigned epilepsy, the impostor does not fall violently, but throws him- self down deliberately in such a way as to avoid injury. Eyes are closed ; pupils contract to stimulus of light ; tongue is not bitten ; face is red instead of deadly pale, while skin is hot from necessary exertion ; neither urine nor feces are voided. Proposing to apply actual cautery, or to shave the head, often effects a speedy cure. Blowing snuff up the nostril changes the fit into one of sneezing.
Treatment. During fit : — Patient to be laid on a large bed, or on floor. Air to be freely admitted around him. Head to be raised, and all tight
EPIPHORA— EPISTAXIS. 107
parts of dress loosened. A piece of cork or soft wood to be introduced be- tween tooth for protection of tongue. Cold affusion to head sometimes use- ful where countenance is turgid. Use of snuff, so as to induce sneezing la status eptlepticus inhalation of nitrite of amyl. Where fit is preceded by epileptic aura, application of ligature just above region from which sensa- tion starts, may prevent attack.
During interval : — Improvement of general health necessary. Bromide of potassium in most cases diminishes the frequency and violence of the attacks; sometimes curative ; may require to be continued for a long time, 42. Iodide of potassium when origin syphilitic. Belladonna, or Atropia, 326. Hypodermic injection of atropine, 314. Quinine, 379, 386. .Salts of iron, 380, 390, 394, 405. Salts of zinc, 410, 413, 414. Formiate of ammo- nia, 363. Hypophosphite of soda or lime, 419. Cod-liver oil. Henbane, hop, or Indian hemp, if there be sleeplessness. A full dose of tincture of henbane; or bicarbonate of potash, oz. ^, immediately before expected fit. Nutritious diet ; milk, raw eggs, animal food, wine or beer. Cold shower bath. Tepid salt water sponge bath. Chapman's ice bags to spine. Ee- moval of stumps or decayed teeth ; or of any other source of irritation, as worms, etc. Circumcision, especially in young boys.
Remedies sometimes recommended : — A long-continued course of corro- sive sublimate. Iodide of potassium. Turpentine. Camphor. Yalerian. Assafoetida. Opium. Digitalis, in large doses. Chloroform. Naphtha. Cajuputoil. Nitrate of silver. Ammonio-sulphate of copper. Sulphate of copper. Arsenic. Juice of cotyledon umbilicus. Expressedjuiceof galium album. Galvanism. Stramonium. Sumbul. Oxalate of cerium. Bru- cine. Strychnia in small tonic doses. Inhalation of oxygen ; of chloroform ; of ether; of nitrite of amyl. Tracheotomy. Caustics to larynx. Moxa, or actual cautery, to naj^e of neck, or to part whence aura starts. Setons or issues high up in neck. Repeated blisters over upper cervical vertebra. Sleeping on a bed inclined at an angle of fifty degrees. Excision of clito- ris. Extirpation of testicles.
EFIPIIOB.A. — From 'Ern-^ipo, to convey to. Synon. Lacrymatio ; Weeping.— A. superabundant secretion of tears, so that they run over the cheek. Common in strumous children. May be due to foreign bodies. To be distinguished from stillicidium laclirymarum owing to closure of puncta lachrymalia, or to obstruction of nasal duct.
EPIPHYTES. — From 'Emi, upon ; ^vthv, a plant. Synon. Phi/topara- sites. — Microscopic vegetable growths, belonging to the class Fungi Cryp- togamia. They are found on the skin and mucous membranes, in the stomach, etc.
The chief vegetable parasites are: — (1) Microsporon furfur, found in Tinea versicolor or chloasma. (2) Microsporon mentagrophytes, in Tinea sycosis. (3) Tricophyton tonsurans, in ringworm. (4) Achorion Schon- leinii, in Tinea favosa or honeycomb ringworm. (5) Microsporon Au- douini, in Tinea decalvans. (6) Tricophyton sporidoicles, in Plica Polonica. (7) Oidium albicans, in aphthae. (8) Sarcina ventriculi, in some stomach diseases. (9) Cryptococciis Cerevisice or yeast plant, in the stomach. And (10) Mycetoma or Chio7iyphe Garteri, in Fungus Foot of India. — See Tinea ; Fungus Foot of India.
EPISTAXIS, — From 'ErtccTT'a^w, to drop upon. Synon. Hemorrhagia Narium ; Rhinorrliagia ; Bleeding at the Nose. — Bleeding from the nose is very common in early life, without doing any harm. But it frequently gives rise to anxiety when it occurs in advanced life. If there be tend- ency to apoplexy, or if patient be afflicted with heart-disease, the loss will perhaps prove beneficial. This is not the case when the bleeding sets in
108 EPITHELIAL CANCER— ERUPTIVE FEVERS.
during progress of disorders which injure quality of blood ; as in renal and hepatic diseases, fever, scnrvy, purpura, etc. Exhausting epistaxis may be immediate cause of death in leucocythemia, when approaching a fatal ter- mination.
Treatment. Patient to be seated upright. Collars and neckerchiefs to be removed. Holding one or both arms above the head. Cold to neck and back, or over nose and forehead. External compression of nostril with finger. Swabbing nostril with perchloride of iron. SnufHng of alum, powdered matico leaf, tannin, powdered gum. Spi'ay of Richardson's styptic colloid. Injections of alum, or iron alum, or tincture of perchloride of iron in water. Plugging nostril with cotton-wool saturated with an astringent. Styptic rods of tannin, 424. Plugging posterior nares by pledget of lint, etc., or by India rubber air bag.
Calomel. Corrosive sublimate, 27. Gallic acid, 103, 104. Amraonio- sulphate of iron, 116. Ergot of rja. Mineral acids with bark, 376. Tinc- ture of perchloride of iron, 101. ^i'urpentine, 102. Digitalis. Mild laxa- tives, 142, 143. Nitric acid and taraxacum, 147. Nourishing diet : pota- toes : watercresses : orange or lemon juice.
EPITHELIAL CANCEE.— From 'Ert^, upon; and 6-^%^, the nipple. Synon. Epithelioma; Cancroid of the Shin. — By some pathologists re- garded not as a form of cancer, but as a disease sui generis, consisting of an infiltration of cells of epithelium, scaly if on skin, columnar if affecting some mucous membranes. Hence its synonyms. Resembles cancer inas- much as it returns after excision, is prone to incurable ulceration, affects the lymphatics seated near it, and destroys the patient. Peculiar in being little liable to multiplication in internal organs, and in being apparently produced by local causes. — See Cancer.
EPIZOA. — From 'Erti, upon ; and ^u^ov, an animal. Synon. Ecio -para- sites.— Animal parasites which live upon, or in the structure of the skin.
'J'he epizoa living on the skin are: — (1) lihoi Louise ov Pediculus. (2) Common Flea, or Palex irritans. (3) Chigoe or Jigger, found in Guiana and Brazil. (4) Ticks or Ixodes, which particularly attach themselves to oxen, sheep, dogs, wolves, and occasionally to the human body. (5) Argades, which are allied to the ticks, and are met with in parts of Persia. (6) Com- mon Bed-Bug or Acanthia lectxdaria. And (7) the Harvest-Bug, or Leptus ctutum7ialis.—See Phthiriasis and F. 429.
'J'he epizoa found in the skin are : — (1) The Itch insect, or Acarus scahiei, or Sarcopjtes hominis — See Scabies. And (2) Demodex folliculorum (Owen), or Acarus follicidorum (Simon), or Pimple mite, which is chiefly found in the ducts of the sebaceous glands of the alae of the nose.
EQiITIIflA, — From Equus, a horse. A severe inflammatory disease, due to inoculation with morbid fluids generated in the horse, ass, and mule. — See Glanders.
ERUPTIVE FEVEES.— Continued fevers, with an eruption superadded.
— See Smallpox; Coiv-pox ; Chicken-pox ; Measles ; Scarlet fever ; Ru- beola; Plague.
The principal diseases of this class have these common characters : — A variable amount of time elapses between reception of poison and setting in of symptoms, called the period of incubation ; they are accompanied by fever, which runs a defined course ; are attended by an eruption, which goes through a regular series of changes ; for the most part affect every indivi- dual once, and once only, during life ; and they arise from specific contagion. Of all eruptive fevers, scarlatina is probably that which most frequently occurs a second time.
ERYSIPELAS.
109
The following' table shows the period of incubation, together with date of eruption and time of its disappearance, in the three chief eruptive fevers : —
|
Disease. |
Period of incubation. |
Eruption appears. |
Eruption fades. |
|
Measles Scarlet fever . . Smallpox .... |
10 to 14 days 4 to 6 days 12 days |
On 4th day, or after 72 hours of fever. On 2d day, or after 24 hours of fever. On .3d day, or after 48 hours of fever. |
On 7th day of fever. On 5th day of fever. Scabs form on 9th or 10th day of fever, and fall off about ]4th. |
ERYSIPELAS. — From 'Epuco, to draw ; rtsXaj, near, — expressive of the tendency of the disease to spread. According to German lexicographers, from ''EpvOpbi, red; 7ts%.%oi, livid, livid redness. Synon. Saint Anthony's Fire ; the Rose. — A diffused, spreading inflammatory affection of the skin, and very commonly of the subcutaneous areolar tissue. There are the general phenomena of fever ; while the affected part becomes of a deep red color, hot, painful, and swollen. — It often arises spontaneously, but also due to absorption of a specific poison. The miasm most readily generated by the assembling together, in one ward, of patients with unhealthy discharges or secretions. Epidemic, and contagious.
No portion of the surface exempt from attacks. Integuments of face and head most commonly the seats of idiopathic erysipelas, — that which arises from internal causes ; while traumatic erysipelas — that following wounds, commences at seat of injury. In simple erysipelas, inflammation superficial ; in phlegmonous form, subcutaneous areolar tissue involved, and no surface redness, but great swelling and tension with tallow-like appear- ance of skin.
SyxMptoms. a period of incubation, varying from three to seven days. Then chilliness, rigors, sore throat, fever, and constitutional disturbance, with local signs of inflammation. Urine sometimes albuminous : chlorides diminished. Cerebral disturbance, delirium. Nausea, vomiting, diarrhoea. Swelling of the part : if of face, all traces of natural features quite lost.
Death may occur from extension of inflammation to brain or its mem- branes. Chink of glottis sometimes becomes closed from serous effusion. Failure of vital powers. Erysipelas occui-ring in cases of diabetes, or espe- cially of renal disease with albuminuria, are almost always fatal. Mortality in England averages about 2000 annually. Poison of erysipelas will give rise to puerperal fever in lying-in women.
Treatment. Confinement to bed in a well-ventilated room. Light diet. Cooling drinks. Begin with emetic, which- sometimes seems to cut short the attack, or aperient. — Rhubarb and blue pill, 171. Castor oil. Aloes, senna, and magnesia, 1.50. Compound rhubarb powder, 165. Then car- bonate of ammonia, 361, 371. Tincture of perchloride of iron, 392. Chlo- rate of potash, 61. Quinine. I'urpentine. Colchicum. Port wine. Ale or stout. Brandy. Brandy and &gg mixture, 17.
Locally : — Fomentations. Poultices of linseed ; of yeast ; of hemlock. Water-dressing. Lotions of diluted solution of subacetate of lead with laudanum ; of solution of permanganate of potash ; of carbolic acid — ten grains to each ounce of water ; or of sulphite of soda — ten grains to each ounce. Inunction with lard. Dusting with flour : finely-ground rice pow-
110 ERYTHEMA— EUSTACHIAN TUBE DISEASES.
der. Collodion. Boundary lines to be drawn on sound skin with nitrate of silver or tincture of iodine. Incisions to evacuate pus, or to relieve great tension.
Infantile erysipelas : — Yigorous wet-nurse. Good milk. Beef-tea. White wine whey. Wine and water. Bark.
ERYTHEMA. — From 'Epv^oaVw, to redden, or cause blushing. Synon. Inflammatory Blush ; Efflorescence Gatanie. — A non-contagious affection of the skin. One of the Exanthemata. Characterized by slight superficial red patches, irregularly circumscribed, of variable form and extent. Most frequently seen on face, chest and extremities.
Varieties. Erythema fugax, of a fleeting nature, and generally due to some derangement of alimentary canal. Erythema intertrigo, sometimes produced by friction between folds of skin, where secretions are not re- moved by washing. Erythema pernio, the technical name for that pecu- liar inflammation of skin constituting an unbroken chilblain. Erythema circinatum, in which the round red patches are slightly raised, and ring- shaped. Not of uncommon occurrence in acute rheumatism. Erythema Iceve, which is developed on lower extremities when they become anasarcous. Erythema nodosum, in which the eruption is mainly on fore part of leg, taking the form of one or more oval raised patches, resembling nodes.
Treatment. Effervescing citrate of magnesia. Compound rhubarb pow- der. Pill of aloes and myrrh. Colchicum. Quinine. Compound tincture of bark. Mineral acids. Steel wine. Ammonio-citrate of iron. Pill of carbonate of iron. Subacetate of lead lotions. Glycerine lotions. Yeratria ointment, if there be pain. Warm water or vapor baths. Warm fomenta- tions. Elevation of limb. Puncture of anasarcous limb. Light diet. Cooling drinks, — lemonade.
EUSTACHIAN TUBE DISEASES.— This tube (first described by Eustachius), by which the tympanum communicates with the pharynx, is about two inches long. Composed partly of bone, partly of fibro-cartilagi- nous tissue. It affords an entrance for air into tympanum, and an exit for mucus.
1. Obstruction of Tube. — Permanent obstruction produces exhaustion of air in tympanic cavity : consequently a pressure inwards of membrana tympani, a forcing together of chain of bones, pressure on contents of laby- rinth, and deafness. Conditions giving rise to obstruction are : — Thickening of mucous membrane of faucial orifice, such as often coexists with chronic enlargement of tonsils ; a collection of viscid mucus, or stricture of middle part of tube ; and thickening of mucous membrane, stricture of bony walls, or deposit of fibrin at tympanic opening.
Symptoms. The entrEtnce of air into tympanum, during act of deglutition, can be distinctly heard by the Otoscope, — an elastic tube, eightgyu irichWT' long, having its ends tipped with ivory. One end being inserted into ear of patient, and the other into that of surgeon, the patient is directed to swallow saliva with mouth and nose closed. If tube be pervious, at the moment the patient has a sensation of fulness in ear, practitioner will detect a faint crackling sound, produced by slight movement of membrana tympani. WTiere mucous membrane of the tympanum is thickened, a gentle flapping sound will be heard instead of faint crackling. If the otoscope fail to reveal any sound during deglutition, if no sound be heard when a forcible attempt at expiration is made with mouth and nose tightly closed, and if no other cause can be found for dulness of hearing, then it may be presumed that the tube is obstructed (Toynbee).
Treatment. Attention to general health. Nourishing diet; warm clothing ; exercise in open air ; sea bathing. Cod-liver oil, 389. Iodide of
EXOPHTHALMIC GOITRE— FATTY DEGENERATION. Ill
iron, 32. Iodide of potassium, and bark, 31. Corrosive sublimate in bark, 27. If tonsils be enlarged, or faucial mucous membrane swollen, applica- tion of solid nitrate of silver : swabbing with tincture of iodine. Excision of tonsils. Introduction of Eustachian catheter. Puncture of membrana tympani in irremediable obstruction. Inflation by Politzer's instrument during the act of swallowing with mouth and nostrils closed.
2. An Open Condition of Tube. — The normal condition of this canal is that of closure by apposition of its walls. It acts like a valve, which is opened by muscles of palate and pharynx during deglutition. When per- manently open, — complaint made of buzzing and other noises in ear. Un- easiness about throat. Occurs during attacks of catarrh : in irritable con- ditions of throat. Cure results as cause subsides.
EXOPHTHALMIC GOITRE.— From 'E|, out ; dfOa^nb^, the eye. Pro- trusion of the eyeball (proptosis oculi), accompanied with goitre. — See Bronch oeele ; Graves^ Disease.
EXOPHTHALMOS.— From 'E|. out ; o^eax^h^, the eye. Synon. Proci- dentia Bulhi Oculi; Ophthalmocele ; Proptosis Oculi; Goggle-eyed. — A protrusion of the eyeball, so that the lids cannot cover it. Met with in some forms of anaemia. — See Graves' Disease ; Anosmia.
EXPECTATION OF LIFE.— By this term is meant,— the mean num- ber of years which, at any given age, the members of a community, taken one with another, may expect to live. An easy rule has been established for determining this value : — The expectation of life is equal to two-thirds of the difference between the age of the individual and eighty. Thus, a man is 20 years old ; 60 is the difference between this age and 80 ; two-thirds of 60 are 40, and this is the sum of his Expectation. By the same rule, a man of 60 will have a lien on life for nearly 14 years ; a child of 5 for 50 years (Willich). The results thus obtained correspond very closely with those to be deduced from Dr. Farr's English Life Table, which was constructed with great care from an immense mass of records. — See Parr's Life Table for Males in Appendix to Registrar-General's \2th Annual Report. For Females, 20th Annual Report.
FALLOPIAN TUBE DROPSY.— An uncommon affection. Fimbriated extremity of tube, together with uterine orifice, gets completely obliterated in consequence of chronic inflammation ; the portion of canal between the openings becoming the seat of an accumulation of pus or serous fluid. As many as twenty-three pints of fluid have been found under tliese circum- stances. Only one method of giving relief, — puncture of cyst with a minute trocar and canula through roof of vagina.
FARCINOMA OR FARCY.— From Farcio, to stuff or cram.— A se- vere contagious disease ; accompanied with a pustular eruption or small tumors (Farcy-buds) which soon suppurate, and malignant fever. Arises from inoculation with morbid matter generated in the horse, ass, or mule. — See Glanders.
FATTY DEGENERATION.— The designation o^ fatty degeneration, or fatty metamorphosis, is given to a certain class of cases which during life are marked by anaemia with great prostration ; and which, after death, are found to be distinguished by the more or less perfect transformation into fat of various important textures, but especially of muscular fibres of the heart.
There is no connection between the tendency to form fat around organs,
112 FBBRICULA— FISTULA IN ANO.
or the prodnction of obesity, and the change of tissues into fat. In former case there is a condition which may prove preservative, if confined within due limits. In latter, is to be recognized a process of decay and death, the result of some defect in nutritive functions.
Amongst the causes of this retrograde metamorphosis are old age, intem- perance, inactivity, and cessation of function. Heart, lungs, brain, liver, kidneys, uterus, and arteries may suffer from it. Atheroma of arterial walls is a form of fatty degeneration ; and arcus senilis is caused by same change occurring in cornea. When important organs are involved, it may lead to gradual or sudden death : — in latter case, owing to rupture of organs. — See Cardiac Atrophy ; Fatty Degeneration of Kidney ; Hejiatie Degenera- tion.
FEBE.ICTJLA. — Dim. Febris, a fever. Synon. Ephemeral Fever. — A mild form of fever.— See Simple Continued Fever.
FEVERS. — From Ferveo, to burn. Synon. Febris ; Pyrexia. — Fever may be described thus:— After a preliminary stage of languor, weakness, defective appetite, and some degree of chilliness or shivering, there is pre- ternatural heat of body, acceleration of pulse, great muscular debility, in- creased waste of tissue, and disturbance of most of the functions. This morbid state accompanies many diseases as one of their phenomena — symp- tomatic fever ; but under certain circumstances we meet with idiopathic fevers, which are probably independent of any local lesion.
Much has been written on the classification of fevers. In order to be as clear as possible, the different varieties may be arranged on the following plan : —
I. Continued Fever.
1. Simple Fever, or Febricula.
2. Typhus Fever.
3. Typhoid, Enteric, or Pythogenic Fever.
4. Relapsing, or Famine Fever.
5. Yellow Fever. ■
II. Eruptive Fevers.
1. Smallpox, or Variola.
2. Cow-pox, or Vaccinia.
3. Ch/cken-pox, or 'Varicella.
4. Measles, or Morhilli.
5. Scarlet Fever, or Scarlatina.
6. Dengi(,e. 1. Plague.
III. Intermittent Fever, or Ague.
IV. Remittent Fever.
1. Simple Remittent Fever.
2. Malignant Remittent Fever.
For further information concerning any particular fever, reference must be made to the disease as it is arranged in alphabetical order.
FISTULA IN ANO. — From Fistida, a pipe or reed : Anus, the funda- ment.— A fistulous passage by side of rectum, the result of abscess. — Two forms of anal fistute : — (1) Complete, in which a probe can be introduced from external orifice upwards into the bowel. (2) Blind external fistula, where mucous coat of rectum is not perforated.
Symptoms. External aperture, in either kind, often small and difiBcult to find : generally near the anus, but perhaps one or two inches distant; may be concealed in a furrow, or will be found in centre of a button-like emi- nence. Complete fistula most annoying : flatus, intestinal mucus, and fluid
FLAT FOOT— FLATULENCE. 113
feces pass along its track, causing irritation and painful spasmodic con- tractions of sphincter. — Fistula often coexists witii phthisis : probably due to tubercular inflammation of portion of rectum, followed by ulceration and perforation.
Treatment. Exceptional cases may be cured by attention to general health ; frequent bathing of part with tepid or cold water ; and daily in- jection along sinus of iodine lotion, or sulphate of zinc lotion, etc., 264, 269. Generally it is necessary to divide the tissues which intervene between the external and internal opening, including fibres of sphincter ani ; first clearing out the bowels with aperients, and afterwards insuring constipation for three or four days by the administration of opium. It has been recommended to effect division by elastic ligature, or by a ligature to be tightened daily until parts are cut through ; but it is much better to use the knife, pushing it through the mucous membrane of the bowel if there be no internal opening. Operation not forbidden by presence of tubercles in lungs, unless the deposit be abundant or case otherwise far advanced.
FLAT FOOT. — Synon. Spurious Valgus; Splay Foot. — A sinking of the tarsal arch, from relaxation of the supporting ligaments. Walking is rendered awkward, slow, and somewhat painful. In confirmed cases, lame- ness and deformity. Occasionally associated with talipes valgus (see Club foot). May arise from constitutional debility with too much standing. Often to be remedied, in slight cases, by friction, bandaging, and improve- ment of general health. The sole of boot ought to be considerably thicker on inner than outer side. An apparatus to support ankle and invert foot.
FLATULENCE. — From Flo, to blow up. Synon. Tympanites; Meteorism ; Drum Belly ; Wind Dropsy. — An accumulation of gas in the intestines occurs as an idiopathic disorder, or it may be symptomatic of some other affection. The gas is generally derived from the decom- position of imperfectly digested food ; or it may perhaps be a secretion from the gastric or intestinal mucous membrane ; or it will be merely air that has been swallowed. In the eructation or belching due to dyspepsia, the gas has the offensive odor of sulphuretted hydrogen.
(1) Idiopathic form : — The flatus usually most abundant a few hours after food: little or no derangement of general health. Nervous and hys- terical women especially liable to it. Often produced by green vegetables, pea soup, tea, or any food which quickly undergoes fermentation. — To he cured by : — Avoidance of vegetables, soup, beer, tea. Creasote, 41. Vegetable charcoal, 98. Mineral acids with nux vomica, 376. Quinine and nux vomica, 387. Strychnia and steel, 408. Steel and pepsine, 394. Pepsine, 420. In tympanites from intestinal atony and weakness of abdominal muscles, electricity very useful. — To give immediate relief when distress from flatulence is urgent: — Carbonate of magnesia, opium, and ether, 62. Ether and tincture of castor, 85. Ammonia and chloroform, 86. Dill water. Caraway water. Assafcetida. Cinnamon. Spirit of nitrous ether. Cajuput oil. Spirit of nutmeg. Spirit of juniper. Com- pound tincture of cardamoms. Ammoniated tincture of valerian. Tincture of ginger. Hot brandy and water with spice. Peppermint lozenges. Castor oil and rue enema, 189. Castor oil and turpentine enema, 190. Turpentine stupes. Sinapisms. Linseed poultices.
(2) Sy^nptomatic flat ulence : — An accompaniment of indigestion; in- flammatory disorders of stomach or bowels ; intestinal obstruction ; organic diseases of liver ; peritonitis ; typhoid fever ; uterine or ovarian irritation ; gout, etc. — Remedies : — Of a variable nature, according to the cause. Enemata of turpentine and rue, 189, 190. If quantity of air be excessive, its escape may be aided by passage of stomach-pump tube for several inches
8
114 FOKEIGN BODIES IN AIR-PASSAGES.
up rectum, or the inflated bowel may be aspirated by a fine needle passed through abdominal wall.
FOREIGrN BODIES IN AIR-PASSAGES.— Foreign matters may pass into larynx, trachea, or bronchi of children, — very rarely of adults. They may enter air-passages from tvithin the body : — Worms have passed upwards from stomach, by oesophagus, into larynx. Tubercular deposit, or pus, now and then makes a way by the neck. Retropharyngeal abscess sometimes bursts into larynx or trachea. In attempting to repress vomiting, matters from the stomach have entered the larynx. Portions of necrosed bone, occasionally work a passage into bronchi or trachea. — Those bodies which are accidentally introduced from without are often remarkable for their size, considering the smallness of the chink of glottis. The most common are portions of toys, seeds or beans, fruit stones, buttons, pins, coins, beads, marbles, pebbles, nails, fish bones, masses of meat, sugar plums, etc. Ani- mal and vegetable substances imbibe moisture and swell : sometimes they disintegrate and are expelled piecemeal. ' '
Symptoms. The entrance of a foreign solid body from without usually occurs during a sudden and strong inspiration : it at once causes violent spasmodic cough, dyspnoea, a sense of impending suffocation, perhaps im- mediate death. In a few minutes, symptoms lessen in severity; cough and dyspnoea return at intervals. If the body remain in larynx, there will be harassing and suffocative cough : loss of voice, or inability to speak above a whisper : probably pain in swallowing : tenderness : noisy hissing respira- tion, with more or less dyspnoea. If it descend into trachea it is seldom stationary : can sometimes be felt by application of hand externally to rise and fall ; the change in position gives rise to severe spasmodic attacks of dyspnoea : sometimes a flapping or valve-like sound, owing to foreign body being forced against rima glottidis in expiration. The substance often passes on into one of the bronchial tubes, ■ most frequently the right, being directed to this by the bi'onchial septum. Auscultation and percussion will then show that air does not enter the obstructed lung at all, or only incompletely; diminution or loss of resonance and of respiratory murmur. The fear of bronchitis and pneumonia to be remembered.
When fluids enter the larynx they induce a sense of choking, with con- vulsive and suffocative cough, which usually suffices to expel them ; if very abundant they may cause sudden death.
Treatment. If the body be at entrance of larynx, or between the vocal cords, it may perhaps be seen by laryngoscope and seized with polypus for- ceps. This failing, child should be placed with head downwards, and slapped smartly and quickly on the back. Emetics and sternutatories can be tried : they are generally useless.
When the body remains in larynx, laryngotomy should be performed as early as possible : Mdien it has descended lower, and perhaps always in young children, trachea ought to be opened. The substance may be ejected through glottis, or through artificial opening, directly the latter is made : should this not take place, patient's body must be inverted, and a few smart taps made to dislodge the substance. Inversion rarely followed by bad consequences, because patient will breathe through artificial open- ing : hence the coin, bean, or whatever it may be, will not give rise to that severe spasm of the glottis on touching it, which it would otherwise do. Perhaps this spasm of glottis might be overcome by inhalation of chloro- form, without opening trachea. If tried, the surgeon should be prepared to perform tracheotomy immediately, in case of necessity. — Where extrane- ous body resists all efforts to remove it, the wound in the trachea should be kept open to favor expulsion subsequently. When operation is successful, incision should be immediately closed by strips of plaster or by sutures.
FOREIGN BODIES IN EECTUM— GALL-STONES. 115
FOREIGN BODIES IN RECTUM.-May consist of :-(l) Substances ■wliich liave licen swallowed; such as stones of fruit, fish bones, coins, etc. (2) Concretions formed in intestines, having a gall-stone or some mass of indigestible matter as a nucleus. (3) Articles forced through anus ; as pieces of wood, masses of flannel or sponge, syringe-pipes, gallipots, bottles, ferrules, etc.
In attempting removal of substance, force to be avoided. If sphincter be contracted, relaxation should be procured by lubricating with iodpform (one part to four of lard). Chloroform seldom necessary. Indurated feces to be extracted with a lithotomy scoop or handle of spoon.
FRAMBCESIA. — From Framboise, a raspberry. Synon. Anthracia Euhula; Lepra Fung if era ; Pian ; Yatos. — A tubercular skin disease, said to be common in Africa, parts of America, and West Indies. Without precursory symptoms, portions of skin about face, scalp, axilte, or genital organs are found covered with small dusky-red spots ; which gradually be- come converted into larger tubercles, isolated at summits but collected together at bases, and I'esembling raspberries or mulberries in color and form. Tubercles generally hard, covered with dry scales, sometimes in- flamed. If inflammation spreads, ulceration sets in ; a yellow sanious dis- charge resulting, which forms scabs. Disease continues for years, or even for life.
GALACTORRH(EA.— From ra?ia, milk ; [Jci, to flow. Synon. Galac- toplewrosis ; Superabundant Secretion of Milk. — An excessive secretion of milk in nursing women. Owing to this excess, the milk continually oozes away ; several pints may thus escape in course of twenty-four hours, keeping patient's clothing wet, and weakening her system. Hence result, anaemia; hysteria; dyspepsia ; low spirits ; and even phthisis or dropsy. Milk always found poor in quality, after a time.
Treatment. Infant to be weaned. Compression of breasts, by strapping with belladonna plaster. Belladonna, iodide of potassium, colchicum, cam- phor, etc., 427. Nourishing food. Removal of uterine or ovarian disease. Iodide of lead and belladonna pessaries, 423.
GALL-STONES.— Synon. Chololitlius ; Biliary Calculi.— More fre- quently formed in gall-bladder, than in substance of liver— in branches of hepatic duct. Solitary calculi when found in gall-bladder are globular or oval or pear-shaped; associated stones usually have numerous polished facets, the result of pressure and mutual attrition. Gall-stones formed in branches of hepatic duct are small, rough, or tuberculated. and of a dark color — like black pepper-corns. Gritty sand-like deposits (biliary gravel) are met with in excretoi'y passages of liver ; consisting of minute calculi, or of a powder made up of cholesterine and colochrome. Ingredients of gall- stones,— Cholesterine, principal ingredient; cholochrome or coloring matter ; earthy and alkaline salts — phosphate and carbonate of lime and magnesia ; together with biliary and fatty acids.
Symptoms. Depend on situation in which they are present. In branches of hepatic duct small calculi may give rise to dull pains about liver, per- haps shooting to shoulder ; to symptoms of intermittent fever ; gastric dis- turbance with nausea. As they usually only cause temporary obstruction to flow of small quantity of bile, there is no jaundice.
Hepjatic duct rarely blocked up by a concretion. When it is, symptoms consist of intermittent pains ; attacks of vomiting ; jaundice ; and enlarge- ment 0^ liver owing to escape of bile from all the ducts being prevented. Fatal rupture of duct has occurred.
In gall-bladder calculi may be present without producing morbid de- rangements. Rarely they set up catarrhal or plastic inflammation ; with
116 GASTRALGIA— GASTRIC CANCER.
pains about epigastrium, right shoulder, and hip. Loss of appetite ; indi- gestion ; constipation. Ulceration and perforation have occurred.
When calculi of any size leave the bladder and enter cystic duct, they cause well-marked symptoms— /lepa^ic or biliary or gall-stone colic. Ex- cruciating pain. Great tenderness of right hypochondriac and epigastric regions. Nausea and vomiting. Constipation and flatulence. Perhaps rigors. Slow pulse. If stone recede into bladder, symptoms cease ; if it remain impacted, dropsy of gall-bladder may result, and perhaps ulceration or gangrene pf duct: if it be forced onwards into common duct, there is a sense of partial relief; though pain returns as duodenal orifice is reached. If common duct be long occluded, jaundice must ensue, as there is no outlet for the bile. Where obstruction is permanent, jaundice increases; liver progressively enlarges ; gall-bladder gets much distended. Ultimately, death occurs ; unless the stone be Forced into bowel, or unless it induces adhesive inflammation and gets into intestines or through abdominal walls, after ulceration and perforation have taken place. In event of passing into intestines, care must be taken that it escapes per anum ; otherwise it may form a nucleus for a concretion, and produce complete obstruction at the end of a few months.
Treatment. Relief of hiliary colic : — Hot water, or vapor, or air bath. Fomentations with decoction of poppy heads and camomile flowers. Lin- seed poultices. Poultices, with application of belladonna and opium, 297. — Morphia, chloroform, and Indian hemp, 317. Subcutaneous injection of morphia, 314. Opium and belladonna, 340, 344. Opiate enemata, 339. Inhalation of chloroform, or ether, or of a combination of both. Ice. Copious draughts of hot water containing bicarbonate of soda. Food to consist of fluids, chiefly milk.
Expulsion of calculus and prevention of further formations : — Castor oil. Seidlitz powders, 169. Phosphate of soda and aloes, 149. Sulphate and phosphate of soda, 148. Pill of colocynth and hyoscyamus. Carlsbad waters, Vichy, Ems, Eger. Regulation of diet. Bloodletting and emetics to be avoided. Mixtures of ether and turpentine to dissolve calculi, use- less.
GASTRALGIA. — From raai'»jp, the stomach ; aVtyoj, pain. Synon. Dys- fepsodynia; Cardialgia ; Heartburn. — An unpleasant burning sensation in the stomach and gullet, coming on in paroxysms. A common symptom in indigestion.
Treatment. White bismuth, 65. Carbonate of magnesia, 62. Solution of potash, 69, 73. Bicarbonate of soda. Carbonate of ammonia. Saccha- rated solution of lime, 14. Lemon juice. Nitric acid. Dilute nitro-hydro- chloric acid, 378. Hydrocyanic acid, 86, 377. Phosphoric acid. Ammo- nio-citrate of iron, 401, 403. Ai'senic. Pepsine, 420. — See Dyspepsia.
GASTRIC CANCER. — From raorjjp, the stomach. — Generally primary. May be of scirrhous, medullary, or colloid variety. Most frequent seats, — pyloric aperture ; cardiac orifice ; space along lesser curvature. More common in men than women : rare before fortieth year. Few cases survive beyond two years from commencement of symptoms.
Symptoms. Pain in epigastrium, of a burning, lancinating, or gnawing character ; increased by food and pressure. Retraction of abdominal wall. Eructation of fetid air. Nausea : frequent vomiting of ingesta and glairy mucus, of bloody sanioas fluid, of dark grumous matter having an appear- ance of coffee-grounds. If disease of cardia, a pouch formed at lower end of oesophagus in which food accumulates, returning undigested, together with mucus. If disease of pylorus, food retained longer and more changed by gas- tric juice. Constipation. Debility. Emaciation, which becomes extreme.
GASTRIC ULCER. 117
Occasionally gradual emaciation with little pain or vomiting-. Pulsatino- tumor, when mass lies over aorta : or a firm painful tumor in some part of epigastric, umbilical, or hypochondriac region. Cancerous cachexia. — Per- foration may occur, with escape of contents of stomach into peritoneum. Or perforation, with communication between stomach and outside of abdo- men ; between stomach and colon ; between stomach and duodenum ; or between stomach and pleural cavities, lungs, or pericardium.
Treatment. Opium and belladonna, 344. Subcutaneous injection of morphia, 314. Opiate suppositories, 341. Iodoform, 338. Bismuth and soda, 65. Vegetable charcoal. Hydrochlorate of ammonia (gr. 1.5 every two hours), to relieve nausea and pain. Inhalation of small quantities of chloroform or ether, 313. Cod-liver oil. — Locally: Wet compress. Bel- ladonna and opium, 297. Linseed poultices. Hemlock poultices. Fomen- tations. Ointment of aconitia, cautiously. Ointment of atropia. — Diet : Milk ; cream ; asses' milk. Raw eggs. Essence of beef, 3. Nutrient ene- mata, 21, 22, 23.
GASTRIC ULCER.— From Vaat^p, the stomach. Synon. Simple, Chronic, or Perforativg Ulcer of Stoviach. — More frequent in women than men, and in poor tlian rich. Very rare before puberty. The ulcer is usually round or oval ; seldom smaller than a fourpenny piece or larger than a crown piece ; sometimes with thickened edges, sometimes as if punched out of mucous membrane; and mostly seated on posterior surface, lesser curvature, or pyloric pouch. — May be fatal by hemorrhage, perforation, or exhaustion.
Symptoms. Liable to some variety. Pain in epigastrium, and over lower dorsal vertebrjB : increased by food, especially by warm fluids and sugar. Tenderness over small spot in epigastrium. Violent aortic pulsa- tions. Eructations of sour fluid ; nausea and vomiting. Loss of flesh. Amenorrhoea in young women, particularly if there be hemorrhage. In favorable cases pains diminish as ulcer gradually heals : complete recovery. When a large vessel eroded profuse hgematemesis.
Where perforation happens, which may occur after a large meal, and sometimes, especially in young women, with very slight antecedent symp- toms : — Violent pain, spreading from epigastrium all over belly. Tympa- nites. Great anxiety. Rapidly increasing prostration. Painless collapse in a few hours ; death.
Treatment. Extract of opium (gr. 1 every six or eight hours). Opium and belladonna, 344. Henbane and Indian hemp, 337. Subcutaneous injection of morphia, 314. Bismuth and soda, 65. Bismuth and kino, 112. Powder of kino and opium. Nitrate of silver. Oxide of silver. Oxalate of cerium. Bicarbonate of potash, ammonia, and aconite, 67. Bromide of ammonium, 37. Iodide of potassium. Citrate of ammonia and hydro- cyanic acid, 362. Steel and ammonia, 40L Steel and citrate of potash, 403. Iron alum, 116. Castor oil. Simple enemata, 188.— Loca//?/ ; Hot linseed poultices. Fomentations. Turpentine stupes. Sinapisms. Blis- ters. Ice in a bladder. — Great care as regards diet : — Only small quanti- ties of food at a time. Gruel, or arrowroot, with milk. Saccharated solu- tion of lime and milk, 14. Iced milk. Wenham lake ice. In severe cases, complete rest of stomach : nutrient enemata, 21, 23. Subsequentlj', — White fish. Light puddings. Poultry. Weak brandy and water. Avoidance of :■ — Sugar. Beer. Wine. Coffee. All indigestible foods.— Great caution during convalescence.
When severe hcemateniesis occnr?,, complete abstinence from food, nutrient enemata, ice to epigastrium. — See Hoematewesis.
If ferforation— opium freely to arrest all movements of stomach so as to limit extravasation of contents and permit of adhesion.
118 GASTRITIS.
GASTRITIS. — From rafffj^p, the stomach; terminal -/f?s. — Several im- portant affections of the stomach, more or less closely connected with in- flammation, are included under this head.
1. Acute Gastritis. — Synon. Injiammatio VentricuU. — Acute inflam- mation of mucous membrane of stomach seldom or never arises idiopathically. A frequent result of poisoning by mineral acids, caustic alkalies, arsenic, etc. Sometimes produced by swallowing boiling water, excessive doses of antimony, or use of mustard emetics.
Symptoms. In gastritis due to an irritant poison, — increasing burning pain in epigastrium, aggravated by pressure. Distressing nausea ; violent retchings. Accelerated pulse and breathing. Great thirst : desire for cold drinks, which are vomited immediately. Constipation. Scanty and high- colored urine. Extreme prostration sets in quickly. Commonly death from exhaustion. — In exceptional cases, early symptoms very slight. Disease may not be suspected until a few hours before death.
Treatment. Purgative enemata, 188. Nutrient enemata, 21, 22, 23. Free sucking of ice. Opium and belladonna, 344. Opiate suppositories, 340. Subcutaneous injection of morphia, 314. Linseed poultices. Poppy head fomentations. Mucilaginous drinks: iced milk. — Avoidance of : — Emetics. Stomach pump.
Daring convalescence: — Great care as to diet. Small quantities at short intervals, of farinaceous substances and broths. Milk : cream. Raw eggs. Ice.
2. Gastric Catarrh.- — Catarrhal affections of stomach Avhen slight usually spoken of as "' bilious attacks." — Symptoms ai-e those of indigestion : furred tongue, oppression at epigastrium, vomiting of bile, giddiness, " sick head- ache."— Remedies consist of rhubarb, ipecacuanha, mercury, and chalk. Seidlitz powders. Meagre diet. Soda water. Ice.
3. Chronic Gastritis. Chronic Gastric Catarrh. — A comparatively mild disorder, unless of long duration. May produce thickening and indu- ration of coats of stomach, narrowing of pylorus, or ulceration perhaps going on to perforation.
Chronic catarrh or mucous flux may succeed a bilious attack, or arise independently. Often coexists with chronic bronchitis, whooping-cough, phthisis, and pulmonary emphysema. There is congestion of capillary gastric vessels, with excessive secretion of glairy mucus.
Symptoms. Anorexia. Tenderness at epigastrium and sternum. Pain and sickness after meals. Slowness of digestion. Gastrodynia. Pyrosis. Disordered bowels. Often a craving for food ; only a small quantity can be taken without sense of oppression, vomiting, etc. — Remedies are such as restrain secretion of mucus and restore tone of stomach. Iron and nux vomica. Sulphite of soda, 48. Bismuth, 65, 112. Kino and logwood, 108. Iron alum, 116. Bichloride of mercury with bark or iron. Tannin lozenges. Aromatic sulphuric acid. Calomel (gr. 5). if there be constipation. Milk and saccharated solution of lime, 14. Arrowroot. Gruel. Bread and milk. White fish. Poultry. Sherry and water. Soda water. — See Dys- pepsia.
Severe examples of gastric catarrh sometimes spoken of as " gastric fevers." — Chief symptoms are heat of skin ; quick and full pulse ; vomiting, with epigastric pain ; scanty urine loaded with lithates. Superficial ulcera- tion of mucous coat may result. — Remedies are rest, low diet, demulcent drinks, mild aperients, effervescing salines. An emetic of ipecacuanha at commencement. Hot fomentations. Poultices. Turpentine stupes
4. Induration of Pylorus. — Synon. Fibroid Infiltration of Pylorus ; Plastic Linitis ; Cirrhotic Inflammation. — Consists of an abnormal de- velopment of fibrous tissue in submucous areolar membrane about pyloric
GASTRO-COLIC FISTULA— GASTRODYNIA. 119
portion of stomach. As a consequence there is stricture, perhaps with dila- tation of stomach and hypertrophy of muscular coat.
Symptoms. Resemble those produced by cancer, save that they extend over a longer space of time. Emaciation and progressive debility. Pyrosis. Sickness. Constipation. Mental depression. Appetite may be ravenous : a large meal causes great suffering, as food tries to pass through pylorus. Vomited matters may look like yeast, and contain sarcinse or torute : often consist only of partially digested food. Indurated pylorus can be felt, like a tumor, through abdominal walls. Aortic pulsation. Disturbed sleep. Prostration. Death from inanition ; though by strict attention to diet, life may often be prolonged for some years.
Treatment. Iodide of potassium. Iodide of ammonium. Hydrochlorate of ammonia. Liquor calcii chloridi (Phar. Dub.). Opium. Belladonna. Belladonna plaster. Wet compress. Cod-liver oil. Liquid food, — milk, cream, raw eggs, soups, wine. Nutrient enemata. Warm clothing.
5. Dilatation of Stomach. — Generally due to some affection of pylorus causing contraction, so that food is impeded from passing into duod^tTmw. Dilatation goes on slowly and steadily, until stomach comes to occupy a large portion of abdominal cavity. Occasionally acute or rapid without obvious cause.
Symptoms. Stomach-cramp, heartburn, water-brash, flatulence, constipa- tion, and sometimes attacks of vomiting. Appetite may be voracious. Where there is vomiting, ejected matters are large in quantity, intensely acid, often resemble yeast: microscopically examined, Sai'cinge.veutriculi are -foiuid, and sometinies the yeast fungus — Torulje cerevisite. These vegeta- ble organisms probably result from long detention of food in stomach.
Treatment. Regulation of diet : unfermented or aerated bread. Food not to be too limited, where appetite is large. The author has known suicide committed from not allowing sufficient food to relieve the hunger. — Formation of parasites to be checked by sulphite of soda, 48. Sulphite of potash. Hyposulphite of soda. Washing out stomach with Yichy water by means of stomach pump. — For relief of other symptoms, see Gastralgia ; Gastrodynia ; Pyrosis; Dyspe^psia.
GASTRO-COLIC FISTULA.— A communication between the stomach and colon takes place Avith greater frequency than between stomach and duodenum. More commonly due to cancerous than simple ulceration. Stomach and colon not always closely adherent : a cavity may intervene, as if a mass of cancer or tubercle had connected the two viscera, and been gradually hollowed out. The symptoms are chiefly fecal vomiting, and expulsion of undigested food with the stools.
GASTRO -CUTANEOUS FISTULA —A communication between the stomach and outside of abdomen. May result from suppuration in abdo- minal wall; wounds; from long-continued pressure, voluntarily produced by hysterical women; or from simple or malignant perforating ulcer of stomach, this viscus first contracting adhesions with peritoneum. In either case it is almost impossible to close the opening. A plug must be worn to prevent escape of contents of stomach.
GASTRODYNIA. — From raa-r'jjp, the stomach ; oSw?;, anguish or pain. Synon. Spasmus Ventriculi ; Stomachalgia ; Cramp in the Stomach. — May occur in connection with organic disease of stomach, or from simple indigestion.
Treatment. Subnitrate of bismuth. Carbonate of bismuth. Solution of citrate of bismuth and ammonia. Bismuth lozenges. Mineral acids. Preparations of iron. Oxide of silver. Oxalate of cerium. Morphia.
120 GENERAL PARESIS-GLAUCOMA.
Hydrocyanic acid. Wood charcoal. Creasote. Arsenic. Quinine. Puri- fied oxide of manganese — from ,5 to 15 grains thrice daily on an empty stomach. Aloes. Blisters to epigastrium. Sinapisms. Belladonna, chlo- roform, and camphor liniments. Linseed poultices. Wet compress. — See Dyspepsia ; Pyrosis.
GENERAL PARESIS. — From na'pffftj, want of strength, from ria^irifii, to relax. Synon. General or Progressive Paralysis of the Insane. — See Insanity.
GLANDERS. — Synon. Equinia ; Farcinoma ; Farcy. — A malig- nant febrile and contagious disease ; due to a specific poison received from a glandered horse, ass, or mule. Glanders and farcy are essentially identi- cal, both having their origin in the same poison. But when the eff"ects of the morbid agent are especially manifested in the nasal cavities, the disease is known as glanders; while, when the lymphatic system suffers, it is called /arcy.
Treatment. Prophylactic : — Cauterization of inoculated tissue. Sul- phite of soda or magnesia, 48.
Curattve : — Sulphurous acid. Sulphite of soda or magnesia, 48. Iodide of potassium, grs. 10 to 15 thrice daily. Bark. Quinine. Arsenic. Str^'chiiia. Carbonate of ammonia. Disinfectant washes to nostrils and ulcers. Creasote injections. Vapor baths. Stimulants. Nourishing food. Pure air. Abscesses to be opened.
GLAUCOMA, — From r^auxoj, sky-blue. — A term formerly applied to opacity of the lens. Now used arbitrarily to denote a form of blindness attended with disorganization of the various tissues of the eyeball. The symptoms are the result of excessive intraocular pressure, this being due to an increase in quantity and firmness of the vitreous humor (Hulke). Glaucoma peculiar to middle life and old age : its occurrence sometimes foreshadowed by quickly increasing presbyopia.
Symptoms. The disease may be acute; when the glaucomatous changes take place rapidly, and quickly end in loss of vision. Attack perhaps com- mences suddenly during night, with severe throbbing pain in one eye and temple. Pain continues ; on following morning, sclerotic found discolored and congested. Iris becomes of a dusky hue, and motionless : cornea gets dim : pupil widely dilated, and sometimes of an irregular oval shape : eye- ball felt to be unnaturally hard. Objects or lights surrounded by prismatic colors. Sometimes complaint made of bright flashes of light darting before the eye. Occasionally there is slight temporary improvement, though blindness subsequently results. Both eyes affected; disease usually commences in one a few days before the other.
In chronic glaucoma, same symptoms; but they come on insidiously, with much less pain. Morbid changes spread over many months. Their sequence seems to be as follows : — First, in retina and choroid ; going on, perhaps, to serous effusion between these two coats, which causes a bulging forwards of lens and iris, by pressing from behind upon vitreous body. 'J'hen, congestion and inflammation of iris and cornea. Last of all, opacity of lens, as a consequence of its deranged nutrition (Dixon).
Ophthalmoscope usually shows extravasation of blood in retina and cho- roid; serous effusion between retina and choroid, retina appearing as if raised into folds; small clots in vitreous humor; and an excavation of optic nerve entrance, with pulsation of arteria centralis retinae.
Treatment. Bleeding, blistering, and mercury have invariably done great harm. A'l that the physician can do is to improve the general health. Whether the surgeon can best reduce the excessive tension of the eyeball,
GLOSSITIS— GONORRHCEA. 121
in acute cases, by iridectomy, or simply by evacuating the aqueous liumor, is a disputed point. ""
GLOSSITIS. — From rxwoaa, the tongue ; terminal -itis. Synon. Ivflani- matio Ltnguce ; Ivflammation of the Tongue. — See Tongue Diseases.
GLUCOH.ffiMIA. — From r%vxvi, sweet ; al^a, blood. Sweet blood.— See
Diabetes Mellitus.
GLUCOSOmA.^From rxvxv^, sweet ; olfov, the urine. Sweet urine. — See Diabetes Mellitus.
GOITKE. — Perhaps from Guttur, the throat. — See Broncliocele.
GONORRHCEA. — From Vovri, semen ; ('iw, to flow. Inaccurately used to signify an inflammation, more or less acute, of one or more portions of the geuito-urinary passages, accompanied with a muco-purulent discharge. Synon. The Clap.
1. Gonorrhcea in Male. — Inflammation of the mucous membrane of the urethra, — generally of the anterior portion. It is attended with the flow of a contagious purulent or muco-purulent fluid.
Symptoms. About third day from exposure to contagion, heat and itching of glans penis. Fulness and redness of urethral orifice. Milky purulent discharge, which becomes muco-purulent. Scalding. Pain in groins, irri- tability of bladder, weight and dragging pain about testicles.
Complications : — Painful erections or chordee. Balanitis. Hemorrhage from urethra. Retention of urine. Abscess. Prostatitis. Cystitis. Or- chitis. Gonorrhceal ophthalmia. Gonorrhoeal rheumatism.
Treatment. Balsam of copaiba and cubeb pepper: usually inefficient, nauseous, apt to derange stomach and to produce skin eruptions. May be given in gelatine capsules. Mercury, turpentine, creasote, nitrate of potash, ergot of rye, etc., worse than useless. Oil of yellow sandal wood (Sirium myrtifolium) and Gurjun balsam or wood-oil (product of the Dipterocarpus turbinatus) have been recommended.
Abortive treatment : — In early stage always very dangerous. It consists of injections of nitrate of silver (grs. 5-10 to the fl. oz.), active purgatives, perfect rest, abstinence from stimulating food and drinks, and hot bathing ; followed by mild injections of subacetate of lead, and gentle aperients.
In ordinary cases : — Mild aperients. Moderate rest. Diet free from salt meats, pastry, cheese, coffee, wine, beer, and spirits. Injections — from 1 to 3 grs. to the fl. oz. — of alum, acetate of lead, sulphate of zinc, chloride of zinc, acetate of zinc, nitrate of silver, sulphate of copper, or sulphate of iron ; glycerine of tannin or carbolic acid. Testicles to be supported by a suspensory bandage.
Astringent sticks or sup])ositories, made with cocoa butter and alum, or sulphate of zinc or tannic acid, so as to be introduced into urethra. Strips of lint or linen, moistened with an astringent solution, passed down urethra for two inches. Cauterization of urethra with nitrate of silver. Copaiba mixed with urine as an injection ? Copaiba enemata and suppositories ?
For relief of scalding : — Warm baths. Liquor potassse in camphor water. Opium. Drinking freely of tea with milk, or of plain water. De- mulcent drinks useless, except as vehicles for water.
For relief of chordee: — Camphor (grs. 5) and belladonna (gr. ^) in a pill at bedtime. Spirit of camphor in drachm doses. Sleeping on a mat- tress, without much covering ; towel with a knot over spine, or a cotton reel, to prevent lying on the back.
For retention of urine : — Warm bath and opiate suppository, before re- sorting to catheter.
122 GOUT.
For hemorrhage from urethra : — Application of ice. Pressure by in- troduction of a large bougie. Pressure externally, by pad and bandage.
2. Chronic Gonorrhoea or Gleet. — Transparent mucous discharge. No scalding nor pain. Frequent calls to pass urine, when the prostate or the neck of the bladder is irritable. Pain in perineum.
Treatment. Temperate mode of living. Attention to digestive organs. If there be an organic or permanent stricture, employ dilatation, forcible rupture, or incision.
Where patches of the urethra are contracted and over-sensitive, use bou- gies smeared with some astringent ointment. Solid nitrate of silver, by means of Lallemand's porte caustique. Astringent injections. Suspensory bandage for testicles.
If there be irritation about prostate or neck of bladder, avoid bougies and injections. Employ hot baths, warm bathing of penis and perineum, opiate suppositories and application of extract of belladonna to perineum. Infusions of uva ursi, pareira, or buchu. Iodide of potassium, 31. Paint- ing under surface of urethra and perineum with tincture of iodine. Appli- cation of a blister to penis for one or two hours.
Where there is constitutional debility. — Phosphoric acid and bark, 376. Gallic acid, 103. Iron alum, 116. Steel and cantharides, 400. Nux vomica. Cod-liver oil. Sea bathing. Nourishing diet.
3. Gonorrhoea in Female. — Consists of acute or chronic inflammation of urethra, vulva, vagina, or canal of cervix uteri. Not to be distinguished from inflammations due to other causes than impure sexual intercourse.
Treatment. Hot hip baths. Vaginal injections of warm water. Mild aperients. Rest. Low diet. Astringent injections, 425, Medicated pes- saries, 423. Solid nitrate of silver.
GOUT.— From the Fr. Gotitte, a drop ; because it was thought to be produced by a humor which fell goutte a goutte into the joints. — May be defined as a constitutional disease giving rise to inflammation of specific character usually affecting the smaller joints. There is very great tendency to hereditary transmission of this disease. It is accompanied by great pain and swelling of the affected joint, fever with general disturbance, and espe- cially by some disorder of the digestive organs. The disease has a tendency to recur again and again, after variable intervals.
Causes. — Over indulgence in nitrogeftized food and malt liquors or strong wines ; lead poisoning, etc.
Symptoms. The aeute attack maybe preceded by warnings, — heartburn, flatulence, dull pain in left side of chest, irregularity of heart's action, dry skin, urticaria, and urine loaded with urates. It may come on suddenly in the night, with, — acute pain in great toe, heel, or instep ; a rigor followed by heat, tenderness and swelling of affected part ; fever, irritability, and restlessness; constipation with furred tongue ; and urine loaded with urates, phosphates, or containing albumen. The attack passes off: an interval elapses, of length proportionate to. the care taken ; and then another attack follows. In chronic gout, tophi or chalk-stones ^form round the joints, con- sisting chiefly of urate of soda ; small deposits on auricle of ear.
Compltcat-ions : — In retrocedent gout metastasis occurs froiu the joint to some internal organ, — to the stomach, heart, membranes of the brain. Often caused by application of cold to gouty limb.
Gouty diathesis without local manifestations, causing neuralgia, dyspepsia, palpitation, syncope, congestion of liver, urticaria, piles, pains about the head, toothache, tonsillitis, etc.
The diathesis or chronic form of the disease also a common cause of dis- ease of the kidneys, arteries, and heart, and indirectly of apoplexy.
Treatment. Acute stage: — Bleeding to four or six ounces, where the
GRAVBDO— HiEMATEMESIS. 123
constitution is sound, to relieve overloadecl lieart and congested vessels. Saline aperients, sulphate and carbonate of magnesia, 141. Mild laxatives containing aloes, senna, rhubarb, jalap, etc., 144, 145, 14G, 148, 149, 151 Calomel, colchicum, aloes, and ipecacuanha pill, 46. Acetate, citrate, or bicarbonate of potash. Emetics. Opium. Hot air or vapor bath. Col- chicum,— in Vichy water, or with sedatives and alkalies, or iodide of potas- sium, 31, 46, 212, 351, 352. Hellebore and colchicum, 163. Carbonate of ammonia. Liquor potassae. Liquor sodoe. Sulphur. — Locally: — Cotton- wool and oiled silk. Anodyne lotions, 265, 281, 297. One or two leeches. Poultices, with extract of belladonna or opium. Ointment of veratria. Small blisters in chronic cases. — Diet: — Milk. Arrowroot. Tapioca. Tea. Diluents. Soda water. Vichj' water. Avoid animal food too soon.
Chronic stage : — Maintain proper action of bowels and skin. Colchicum. Alkalies. Iodide of potassium. Taraxacum. Guaiacum. Extract of the physalis alkekengi. Quassia. Calumba. Bark. Mild ferruginous tonics, 394, 402, 403. Arsenic, with colchicum or iodide of potassium or steel, 52, 399. Phosphate of soda. Avoid opening chalk stones. Friction with liniments of iodide of potassium or iodide of ammonium, 280. Regulate diet :— Animal food in small qunntity ; white fish ; milk and eggs. Avoid- ance of malt liquors, port, and sherry ; sugar to be used sparingly.
In irregular or misplaced attacks : — Salines and colchicum. Ether. Ammonia. Chloroform. Brandy. Mustard pediluvia. Warmth to the joints. Sinapisms. Turpentine stupes.
To prevent repetition of attack: — Well regulated diet. Food from which healthy chyle can be extracted. Claret. Hock. Hungarian wines (Ofner or Carlowitz). Brandy and water. Soda water. Vichy water. Infusion of leaves of common ash. Mild aperients. Carbonate or citrate of lithia, 64. Moderate mental and bodily exertion. Avoidance of too great sexual indulgence. Hot air or water baths. A visit to Bath, Bux- ton, Cheltenham, Harrogate, or Leamington; Wiesbaden, Vichy, Carlsbad, Aix-la-Chapelle, Fachingen, Kissingen, Geilnau.
GRAVEDO. — From Gravis, heavy. Catarrhal inflammation of mem- brane lining frontal sinuses. — See Catarrh.
GRAVES' DISEASE.— Synon. Exophthalmic Goitre. This name has been given to a singular combination of three symptoms, — palpitation, protrusion of eyeballs, and enlargement of thyroid gland. More common in females than in males : there is often some obscure connection between it and disturbance of the uterine functions. Generally believed that a neurosis of the cervical sympathetic nerve is the cause of the affection. The cases run a chronic course. The remedies to be resorted to will depend on the condition of the system ; — i.e., whether there is any syphilitic taint, or tuberculosis, or simply a state of anaemia.
H^MATEMESIS.— From Al^a, blood; f>£to, to vomit. Synon. Gas- trorrhagia ; Hcemorrhoea Ventriculi ; Vomiting of Blood. — Hemorrhage from the stomach may be either acute or chronic : latter most dangerous, as indicative of some disease of abdominal viscera.
Causes. Simple or malignant ulcer : cirrhosis of liver : very rarely aneurism of one of the branches of abdominal aorta : vicarious menstrua- tion : scurvy.
Symptoms. Blood vomited in considerable quantities. Blood not frothy : of a dark color. Blood mixed with food. Melsena very common. Gastric or duodenal symptoms.
Treatment. In acute form : — Abstinence from food. Perfect rest in horizontal posture. Cold to the epigastrium, 118. Ice or cold acidulous drinks. If necessary, enemata of beef-tea and brandy, 21, 23. Gallic acid,
124 HEMATOCELE— HEMATURIA.
103. Turpentine, 102. Sulphuric acid and opium, 100. Tincture of per- chloride of iron, 101. Lead and acetic acid, 117. Alum and sulphuric acid, 116. Ergot of rye. Ipecacuanha.
In chronic form : — Mineral acids with bark, 376. Quinine and iron, 380. Ammonio-sulphate of iron, 116. Cream ; raw eggs ; essence of beef. Cod- liver oil. — See Hcemoptysis.
H.XMATOGELE. — Effusion of blood into cavity of tunica vaginalis testis. May arise from injury, straining, rupture of varicose veins of cord.
Symptoms. Swelling coming on rapidly, pain and weight. Tumor pyri- form, soft or hard, not transparent ; hiding testicle.
Treatment. Rest. Cold lotions. Suspensory bandage. Sometimes it is necessary to make an incision and let out the extravasated blood.
HJEMATOCELE, Pelvic or Retro-Uterine— See Pelvic Bcematocele.
H^MATOID CANCER.— From Al^a, blood ; terminal -ides. Synon. Fungus Hcematodes. — This disease is probably a soft medullary or other cancer, the substance of which has become more or less infiltrated with blood. When it protrudes through the skin it forms a large vascular mass, somewhat resembling a clot of blood. — See Cancer.
HEMATOMA AURIS.— From Alfxatoio, to convert into blood : Auris, the ear. — A sanguineous tumor about outer surface of auricle of ear. Often symmetrical. Especially affects insane. The explanation of its oc- currence is : — (1) The states of the circulation, nutrition, and development of tissues which make up the ear-lobule, and cover the helix, very commonly coincide with similar conditions of the encephalic tissues. (2) Development of cartilages of external ear, and their several parts, is in relation with en- cephalic and cranial development of individual (Laycock). — See Insanity.
H^MATOZOA.— From Alua, blood ; C^ov, an animal. — The following entozoa have been found in human blood : —
(1) FiLARiA Sanguinis Hominis. — A worm of microscopic dimensions, discovered by Dr. Lewis in the blood of sufferers from chyluria.
(2) DisTOMA H^MATOBiuM. — An entozoon with a flat elongated body and a cylindrical tail ; inhabits the vena portse, and the veins of the mesentery, liver, bladder, and intestines. It is very common in Egypt, and especially infests the bodies of those who drink the unfiltered waters of the Nile, etc. It is probably the cause of a peculiar form of hematuria somewhat preva- lent in Southern Africa and in the Mauritius. — Chief remedies : — Calomel. Turpentine. The efficacy of either very doubtful.
(3) Hexathyridium Venarum. — About three lines in length. Has been found in venous blood, and in sputa of patients with haemoptysis.
(4) Fasciola Hepatica. — Has been discovered in the vena portae. This fluke and the Distoma lanceolatum are often found in the gall-ducts and bladder of the sheep, producing the Distemper or Rot. — See Entozoa.
HJEMATURIA. — From Al^ua. blood ; ojpov. urine. Synon. Hwmiiresis ; Sanguis in Urina ; Bloody Urine. — Haemorrhage from the mucous mem- brane of the urinary passages, — the kidneys, bladder, or urethra.
Symptoms. Urine smoky, or of a black hue, or of a port wine tint. Al- bumen present. When from kidney, the blood equally diff'used through the urine. When from bladder or urethra blood comes away after passing clear urine. Blood casts of renal-tubes ? Cancer cells? Renal calculi ?
Urine not unfrequently found to be bloody during the fit in ague.
Paroxysmal hcematuria is induced by exposure to cold. Patient is chilly, shivers, and passes urine more or less loaded with blood; iii a few
HJEMOGASTRIC FEVER— HAEMOPTYSIS.
125
hoars the urine becomes healthy. No blood-corpuscles are found, they are disintegrated ; whence the disease has been caWed jjciroxysmal hcematolysis. Oxalate of lime crystals often present. The subjects of this affection are pale, weary, and incapable of exertion in cold weather.
Endemic hcematuria of Egypt, Southern Africa, and Mauritius due to the Distoma haematobium. — See Hcematozoa.
Treatment. In malignant disease or calcidus : — Gallic acid, 103. Tincture of perchloride of iron, 101. Sulphuric acid and opium, 100. In- fusion of matico. Ruspini's styptic. Turpentine. Creasote. Krameria. Ergot of rye. Opium. Rest in recumbent posture. Sinapisms. Turpen- tine stupes. Application of ice to loins.
In renal disease, or some morbid poison in the blood : — Hot air baths. Warm water baths. Compound jalap powder. Ferruginous tonics, — espe- cially tincture of perchloride of iron, and iron alum. Quinine.
From disease of urethra: — Application of ice. Use of a large bougie for some hours.
Vesical hemorrhage : — Injections of alum or tannin, grs. 30 to water fl. oz. X. Ice to pubes. Ammonio-sulphate of iron, 116.
For paroxysmal hcematuria change to a warm climate is desirable. Quinine. Arsenic. Phosphorus. Iron.
HiEMOGASTRIC FEVER.— From Al.aa, blood; yafffjjp, the stomach.
Synon. Febris Flava ; Pestilentia Hcemagastrica ; Pestis Intertropica / Typhus Icterodes ; Synochus Icterodes ; Mcdignant Pestilential Fever. — See Yellov) Fever.
HEMOPTYSIS.— From AI,ua, blood; rtrvw, to spit. Synon. Emoptoe ; Sputum Sanguinis ; Hcemorrhagia Pulmonis; Pneumorrhagia. — The escape of blood through the mouth — from larynx, trachea, bronchial tubes, or air-cells of lungs. Of little consequence comparatively when due to some accidental and transitory cause. An important indication of bron- chial, pulmonary, cardiac, or aortic disease, when of frequent recurrence at variable intervals.
Symptoms. Blood coughed up in mouthfuls. Blood frothy, and of a florid red color. Blood mingled with sputa. Absence of melsena. Bron- chial or pulmonary symptoms. Tubercular deposit ? Aortic aneurism ?
Distinction between haemoptysis and hsematemesis : —
In hoimoptysis : — Dyspnoea; pain or heat in chest. Blood coughed up in mouthfuls. Blood frothy.
Blood of a florid red color. Blood mingled with sputa. Absence of melsena. Bronchial or pulmonary symptoms.
In hcematemesis : — Nausea ; epigastric tenderness. Blood vomited profusely. Blood not frothy. Blood dark colored. Blood mixed with food. Melsena very common. Gastric or duodenal symptoms.
Treatment. Strict mental and bodily repose. Rest in bed. Head and shoulders to be elevated. Unstimulating diet. Ice and cold drinks. Blis- ters. Turpentine stupes. Sinapisms. Dry cupping. Ice to chest.
Gallic acid, 103. Mineral acids, 99, 100, 115. Sulphate of magnesia, sulphate of iron, and sulphuric acid. Acetic acid. Ammonio-sulphate of iron, 116. Acetate of lead and opium, 117. Creasote. Common salt ? Ergot of rye. Turpentine, 102. Alum. Infusion of matico. Hydrocyanic acid. Morphia. Emetics of ipecacuan. Antimony? Digitalis? Leeches? Venesection? A ligature round the limbs. Inhalation of atomised fluids, medicated with tannic acid, alum, perchloride of iron, or turpentine, 262.
126 HAEMORRHAGE— HEMORRHOIDS.
H-ffiMORRHAGE. — Synon. Sanguifluxus ; Hcemorrhoea ; Loss of Blood ; Rupture of a Bloodvessel. — 'J'he escape of blood from the vessels in which it is naturally contained constitutes hasmorrhage [hcemorrhagia, from Alixa, blood ; p^ywixv, to break out).
Varieties. Ilie chief subdivisions are these : — (1) Traumatic when a vessel has been directly divided, -and spontaneous when the bleeding has resulted from some constitutional cause. (2) Sympytomatic when clearly a result of some disease, as tubercle, cancer, etc., and idiopathic or essential, when no such connection has been perceptible. Or, (3) active hasmorrhage when congestion or inflammation has preceded the flow, and passive when there have previously existed signs of debility, with poverty of blood. Moreover, heemorrhages have been termed constitutional when they occur at intervals, and seem to be of service to general health, as in the bleeding from piles in plethoric people : vicarious when supplemental of some other htemorrhage, as where a woman has periodical bleeding from nose in place of usual catamenial discharge ; and sometimes spoken of as critical when they occur during progress of some disease, and produce marked good or bad effects.
The seat of the haemorrhage is likely to vary with the patient's age. Bleeding from the nose is most common in youth; from the lungs and bronchi, stomach, urinary passages, and uterus in adults; and from the cerebral vessels and rectum in old age.
Treatment. Cool apartment. Repose. Freedom from excitement. Simple and unstimulating diet. Position such as to prevent afflux of blood to bleeding organ. Application of cold. Turpentine stupes. Blisters. Ligatures.
Ice. Gallic acid. Tannin. Mineral acids. Ammonio-sulphate of iron. Tincture of perchloride of iron. Creasote. Ipecacuanha. Acetate of lead. Ruspini's styptic. Oil of turpentine. Nitrate of silver. Oxide of silver. Alum. Kino. Matico. Rhatany. Corrosive sublimate. Calomel. Ergot of rye. Opium. Tenesection. Digitalis. Aperients. Transfusion. — See Apoplexy; Epistaxis ; Hcematemesis ; Hcematuria; Hcemoptysis ; Men- orrhagia ; Melcena ; Otorrhagia ; Stomatorrhagia.
HiEMORRHAGIC DIATHESIS.— Synon. Hcemophilia. Usually con- genital, or may perhaps be induced by insufficient food. Perhaps sometimes connected with diseased spleen. Due to absence of coagulable constituent of blood.
Symptoms. Ecchymoses. Dropsy. Painful swellings round joints. Bleeding from umbilicus a few days after birth ; from nose or gums in youth ; from urinary passages or rectum in after-life. Fatal loss of blood after leech bite, extraction of a tooth, rupture of hymen, etc.
Treatment. Avoidance of surgical operations. Caution after accidents. Nourishing food. — See Hoimorrhage.
HEMORRHOIDS.— From Alixa, blood; pIco, to flow. Synon. Proc- talgia Hcemorrhoidalis ; Piles. — Small tumors situated within or at verge of anus. Two varieties: — (1) External, or those outside sphincter muscle. (2) Internal, or such as are within sphincter. Often, the two kinds coexist.
1. External Haemorrhoids. — Consist either of a knot of varicose veins, or of one or more cutaneous excrescences. In first case, the veins may con- tain fluid blood : more frequently their contents have coagulated, forming one or several tense and purple swellings. The excrescences consist chiefly of hypertrophied skin and areolar tissue.
Symptoms. When indolent, only troublesome from their bulk. If they become congested or inflamed considerable pain arises ; with heat and throbbing, tenesmus, backache, irritability of bladder, perhaps retention of urine, and uterine irritation in women.
HEADACHE. 127
Treatment. Daily action of bowels to be procured. Confection of pepper. Confection of senna. Confection of snlphur. Compound electua- ries. 194. Simple enemata, 188. Sulphur and magnesia, 158. Pepsine and extract of aloes, 1.55. Castor oil. Mercury and chalk. Taraxacum. Pullna water. Anus to be sponged with cold water after every stool. Sponging parts round anus, when relaxed, with lotions of alum or tannic acid. Ointment of galls. Ointment of galls and opium. — Plain nourishing food ; free from highly seasoned dishes, coffee, and alcoholic stimulants. — Hot bathing and poultices where there is inflammation. — Incision, with evacuation of contained clot, when tumor is swollen and tender. — Excision of growths with curved scissors.
2. Internal Hsemorrhoids. — May be simple or multiple. Of three kinds: — (1) Spongy vascular growths, having a red granular appearance, and soft elastic texture like that of erectile tissue. (2) Made up of lower branches of the plexus of haemorrhoidal veins. Branches dilated : often plugged with coagula. (3) Pendulous tumors, composed of fibro-areolar tissue.
Symptoms. The piles only protrude during defecation at first. After- wards, as sphincter gets dilated by their pressure, and relaxed by attacks of hemorrhage, they are constantly down save when patient is in I'ecum- bent posture. Loss of blood, from a mere tinging of feces to escape of many ounces. Uneasiness about rectum ; tenesmus. Irritability of blad- der, and of uterus in women. Muco-purulent discharge. Loss of flesh. Ansemia. Sallowness of complexion. Derangement of functions of liver, stomach, and bowels, etc.
Treatment. Daily action of bowels to be insured by remedies recom- mended for external piles. Improvement of general health. Attention to functions of liver, digestive organs, etc. Nitro-hydrochloric acid. Digi- talis. Quinine. Arsenic. Sulphur. Cold water enemata. Enemata of solutions of gallic acid, alum, animonio-iron alum, or of tincture of per- chloride of iron to check hemorrhage. When protruding piles cannot be I'eplaced, it may be necessary to reduce their size by applying ice, or by puncturing, before making further attempts. If, from constriction .of sphincter, protruded piles have become strangulated and more or less gangrenous, they must be poulticed, and pain relieved by opiates, till they slough off.
Radical cures .•—By cauterization with nitric acid. Simple excision dangerous, owing to probability of hemorrhage. Excision with ecraseur. Use of clamp and excision; applying actual cautery, or nitric acid, before removing clamp. Operation hy ligature the safest and most to be recom- mended.
HEADACHE, — Synon. Cephalalgia [KiipaXr], the head ; oXyo^, pain.) — Of common occurrence during progress of most acute and many chronic diseases. Affects adults more than young or old : inhabitants of towns more than country folk : nervous and delicate more than robust : higher classes of society more than lower.
Varieties. Four principal forms may be noticed : — (1) Organic head- ache, due to disease of brain or membranes, and especially of such in early stage. Accompanied by vertigo ; sometimes by vomiting, convulsions, confusion of mind, noises in ears. Pain, sharp or dull or lancinating or throbbing: more severe in diseases of meninges than of brain substance. When due to inflammation, pain intense, increased by warmth or noise or movements, and lessened by elevating head. — In valvular disease of heart, the interrupted supply of blood to nervous system causes headache. — Some- times headache is the only symptom of constitutional syphilis.
(2) Plethoric headache, dependent on congestion of cerebral vessels.
128 HBMERALOPIA.
Sense of pulsation in ears : giddiness on stooping. Constipation. Those who live too freely, take but little exercise, rise late in morning, etc., are subject to it. It may arise from sudden suppression of accustomed dis- charge, as of catamenia.
(3) Bilious headache, temporary or constant. When temporary, pro- duced by some error of diet, any excess in food or wine. Most severe in morning, after restless night. Passes away with cause. Constant siclf headache occurs in persons with weak stomachs, and in the gouty. Sto- mach and duodenum out of order ; gastric catarrh. Tongue coated, breath offensive, flatulence, low spirits, nausea. Hepatic functions ill-performed : stools clay colored. Urine scanty and high colored.
(4) Nervous headache, often owing to debility and exhaustion. Poverty of blood from renal disease, hemorrhage, etc., may induce it. Irritation of decayed teeth, or offensive stumps, a frequent cause. — In hemicrania or brow-ague, symptoms are intermittent, recurring with regularity of an ague fit. — The megrims is a form which affects delicate women, especially if exhausted by over-lactation. — AVhen hysterical young women suffer from nervous headache it is often confined to a single spot, resembles the pain of driving a nail into the part, and is known as clavus hystericus.
Treatment. The indications are to relieve congestion of head and dyspeptic symptoms, while tone is given to general system. Diet to be regulated ; often beneficial to discontinue tea and coffee, though in some instances the latter is beneficial. Milk taken at night may be injurious. Tobacco in all forms to be forbidden. In organic headaches, attention to be paid chiefly to cerebral mischief.
Sulphate of soda and taraxacum, 144. Aloes, gentian, and liquor potassse, 148. Pepsine and aloes, 155. Rhubarb and magnesia, 165. Rhubarb and blue pill, 171. Nux vomica and rhubarb, 175. Colchicum, 46. Phosphate of iron, 405. Effervescing citrate of magnesia. Hydro- chlorate of ammonia, 60. Aconite. Belladonna. Camphor. Iodide of potassium where there is a suspicion of syphilitic taint. Nitro-hydrochloric acid, 378. Where there is albuminuria, iron alum, 116 : tincture of per- chloride of iron and hydrochloric acid, 101. Quinine or arsenic in hemi- crania, 52, 379, 381. Zinc or steel in hysterical forms, 394, 403, 410, 414. Stramonium. Shower baths. Mustard pediluvia. Holding arms high above the head sometimes palliative, owing to effect on cerebral circulation. Compression of temporal arteries with pads and a bandage round forehead. Pulvermacher's galvanic chain-band. Ether spray to forehead in frontal headache. Juuod's boot. Cold lotions, sponge dipped in cold water, eau de Cologne, etc., to forehead and crown. Hot water bag, or hot sponge to nucha. Dry cupping, or blisters, or sinapisms, or setons, to nape of neck. Extraction of bad teeth. Change of air.
HEMERALOPIA. — From 'H^tepa, daylight ; orttojXM, to see. Synon. Visus Diurnus ; Dt/sopia Tenebrarum; Night-blindness; Day-vision. — That condition in which vision is only distinct during daylight. Long- exposure to strong light, such as that of the tropics, temporarily exhausts the sensibility of the retina, so that this delicate structure ceases to be affected by twilight. Soldiers and sailors in hot climates often suffer from night-blindness : when so affected they are incapacitated for duty after sunset. In scurvy, there is sometimes the same symptom : retina is weak- ened like the other tissues. Rest of the eyes, use of dark-blue glasses, quinine or steel, cod-liver oil, and nourishing food will generally effect a cure.
In another distinct class of cases, night-blindness is a much more serious condition, being due to structural changes in choroid and retina. Ophthal- moscope shows the presence of masses of black pigment on surface of choroid and in the degenerating retina. Tissues of choroid become atrophied :
HEMICRANI A— HEPATIC ATROPHY. 129
ultiiTiately, the retina undergoes similar change. Total and irremediable blindness gradually ensues.
HEMICRANIA. — From "H^ktuj, half; xpafi'oi/, the skull. Synon. Hemi- cephalcea; Nuaralgia Cerebralis ; Megrims. — Headache affecting one side of brow and forehead. — See Neuralgia; Headache.
HEMIOPIA. — Fom "H/utffuj, half; co>l/, the eye. Synon. Visus Dimidi- atus ; Amaurosis Dimidiaia. — That form of faulty vision in which only half an object is seen. May be temporary or permanent. — See Amaurosis.
HEMIPLEGIA. — From "H^touj, half; 7tXyi6st^, to strike. Synon. Semi- plegia : Semisideratio. — Paralysis limited to one sidepf the body, — See Paralysis.
HEPATIC ATROPHY.— From 'Hrtan^roj, affecting the liver : 'A, priv. ; rpEijicd, to strengthen or support. — See Acholia.
1. Acute Atrophy of Liver. — Synon. Yellow Atrophy of Liver ; Acute Wasting of Liver ; Softening of Liver; Diffused Hepatitis; Fatal 4 Jaundice. — A most remarkable disease; consisting, as a rule, of a ranid 'i\l''', .\v i\ and complete destruction of the hepatic cells through every part of the ,-, _^,„„,.^ glandT'" women more obnoxious to this rare affection than men ; pregnancy
seems to predispose to it. Among other alleged exciting causes are, — grief or anxiety, sudden alarm, fits of passion ; venereal excesses, syphilis, exces- sive use of mercury ; druukenngss and dissolute habits ; poisons of malaria and typhus ; phosphorus poisoning. Maitypo^TnTs of resemblance between acute atrophy and yellow fever.
Symptoms. Preliminary stage: — Headache, loss of appetite, thirst, drowsiness, mental and bodily depression, irregularity of bowels, tenderness of abdomen. Then, conjunctiva3 become yellow: skin gets slightly^ atra^/, dice'97"^ These precursory symptoms may last from a few days to three or-' four weeks ; or may be altogether absent.
Confirmed stage: — Jaundice; perhaps with petechise and large ecchy- moses. Vomiting; at first of mucus, afterwards of matter like coffee-grounds (altered blood). Irritability, great despondFncy ; soon folTowed by wander- ing merging into noisy delirium and convulsions, stupor and deep coma. — Toifigtre' and teeth coated with black sordes. Pains about epigastric and right hypochondriac regions. DiiJmmtion of hepatic dulness (may be in- creased at first): increased area of splenic dulness. Obstinate constipation: purgatives bring awayjiard claj-colored stools ; at later "period^, evacuations black from presence of blood. Difficult micturition : urine loaded with bile pignTent, perhaps albuminous, and containing tyrosine and leucine. — In- crease of jaundice Bedsores, if life be prolonged beyond eight or nine days. Hemorrhages from nose, stomach, bowels, bronchi, etc.
Death usually occurs within a week from commencement of confirmed stage : sometimes within eighteen or twenty-four hours.
Treatmknt. Empirical and probably useless. Usual remedies: — Drastic purgatives; then mineral acids, with diffusible stimulants as prostration increases. Large doses of quinine and mineral acids. Ice. Cold drinks.
2. Chronic Atrophy of Liver. — This disease is ijiji^ojn^ay connected with acute atrophy. It results from all those conditions which tend to arrest the capillary circulati^TRi'ough the gland, and hence to lessen its nutrition.
Symptoms.^ 15eveloped slowly and insidiously. Imperfect digestion : flataleuce, diarrhoea alternating with constipation, pale-colored stools. Dry sallow skin. Loss of flesh and strength. ATisemia: persistelft wasting : perhaps ascites or general dropsy : finally, there may be fatal exhaustion.
Treatment. Light nourishing food : avoidance of rich dishes, sugar, 9
130 HEPATIC CALCULI— HEPATIC CONGESTION.
fermented drinks, coffee. Warm clothing. Over-fatigue to be guarded against. — Pepsine, 420. Purified ox biie with ammonia, 170. Quinine and ipecacuanha, 44, 384. Quinine aud rhubarb, 385. Bark and mineral acids, 376. Harrogate waters. Spa. Kissingen. Marienbad. — If dropsy set in : — Purgatives, elaterium, jalap, etc. Diuretics, squills, digitalis, aud broom, 219. Buchu and acid tartrate of potash, 222. Nitre, juniper, and ether, 221. Tapping, to afford temporary relief.
HEPATIC CALCULI. — From 'HrtaT'lxoj, affecting the liver : Calculus (dimin. of calx), a small stone. — See Gall-Stones.
HEPATIC CANCER.— From 'Hrtart^oj, affecting the liver.— Every variety of cancer has been met with in the liver. Medullary more common than scirrhus.
Symptoms. In addition to general indications of malignant disease : — En- largement of gland : loss of regular form : detection of uneven bulging_pro- linences. Nodulous masses often give rise to partial peritonitis." Daily increasing lass.-of-flesli_and strength. Diffused abdominal pain and tender- ness. Indigestion. Irritability and mental depression. Jaundice occurs more frequently than ascites : occasionally both present. Formation of gall-stones not uncommonly adds materially to the suffering.
Duration, except in scirrhus, short. Life seldom prolonged for two years, sometimes only for six months, from onset of symptoms.
Treatment. Opium. Belladonna. Conium. Ammonia and bark. Mineral or vegetable acids. Light nourishing diet. — See Cancer.
HEPATIC CONGESTION.— From 'Hrtanxb?, affecting the liver. Synon. Hy-peroimia of the Liver ; Congestion of the Liver. — Two varieties to be described : — ^
1. Passive Congestion. — Simplest form. Results from some obstruction to circulation through hepatic and portal veins. Occurs in valvular affec- tions of heart ; in morbid states of lungs impeding passage of blood through pulmonary artery ; in diseases which" 'diminish capacity of thoracic cavity ; temporarily, from violent exercise, etc. Leads to diminished excretion of bile : ducts become gorged with bile — biliary congestion.
Symptoms. Sense of constriction and weight in riglitjiypochondrium. Often, slight jaundiceTnaXTseail^d^yspepsia: urine scanty, high-colored, per- haps-contains bile-pigment, with traces of albumein' constipation and hiemor- rhoids. Area of hepatic dulness found to be increased on percussion, and liver felt to descend below ribs and extend across epigastrium. Symptoms of cardiac or pulmonary disease, etc.
Treatment. Sulphate and carbonate of magnesia, 141. Sulphate of soda and sulphuric acid, 143. Aloes, senna, and sulphate of magnesia, 150. Antimony and magnesia, 152. Nitric acid, senna, and taraxacum, 147. Ammonia and rhubarb, 161. Sulphates of magnesia and iron, 166. Leeches to anus. Harrogate waters. Carlsbad. Kissingen. Marienbad. Simple diet. Avoidance of stimulants.
2. Active Congestion, — Capillaries of hepatic artery chiefly affected. Produced by morbid matters in' blood ; suppression of habitual discharges, z. e., hsemorrhoidal, catamenial, etc. ; long residence in hot climates ; de- ranged nervous influence ; atony of bloodvessels from disease of coats ; excessive eating and drinking, alcohol, etc. ; sedentary habits.
Symptoms. Fulness and sense of tightness about right hypochondrium. Slight enlargement of gland. Pains about right shoulder. Headache ; loss of appetite ; mental depression ; nausea ; irregularity of bowels, bilious stools, etc. These symptoms soon pass off, unless the congestion be kepFup
HEPATIC DEGENERATIONS. 131
by non-removal of the cause ; in which case structural disease may ulti- mately result, with jaundice, perhaps suppurative fever, perhaps dropsy, etc. Treatment. Removal of cause. Horse exercise, walking, etc. Simple diet : white fish, fresh vegetables, rice, weak tea, etc. Aloes, gentian, and solution of potash, 148. Sulphate of soda and taraxacum, 144. Aloes, senna, and jalap, 145. Resin of podophyllum. Sulphate of manganese, 172. Nitro-hydrochloric acid, 378.
3. Apoplexy of Liver. — Extra vasated masses of blood sometimes found in hepatic tissue, or beneath the capsule. Results of great congestion induced by morbid changes in the blood. Occur in scurvy, purpura, icho- rhaemia, and especially in malarious fevers of tropical climates. Extrava- sations often numerous : vary in size from a pea to a hen's egg : or blood may be infiltrated through parenchyma, converting the tissue into a pulpy mass.
HEPATIC DEGENERATIONS.— From 'HTtatixbi, affecting the liver: Degenero, to degenerate. — Three varieties : —
1. Fatty Degeneration of Liver.— Synon. Hepar Adzposum ; Fatty Liver. — A great increase in the quantity of oil naturally contained in the hepatic cells; so that on minute examination, the latter are found gorged ^ -x-Pc with oil-globules, diminishing the normal granular matter, and quite ob-^I'V^-^Q^' scuring the nucleolated nuclei. Liver large, pale, smooth, and greasy, oftenyi-^^^g^^v' /" burning like fat. -«— —
Of frequent occurrence in phthisis, and in fatty degeneration of other _< important organs. May affect those who live too freely, who lead indolent* lives. Has been observed in constitutional syghjlis ; as well as after death from ichorhsemia, typhus, smallpox, erysipelas, etc.
Symptoms. Often distinguished with difficulty from those of associated dis- ease. If cells be excessively loaded, they may impede capillary circulation and obstruct excretion of bile. Gastric catarrh, dyspepsia, constipation, alternating with diarrhoea, pasty-looking complexion, anaemia, haemorrhoids, etc. may be present. Liver found to be enlarged on physical examination. Possibly, ascites ; complete acholia ; or fatal exhaustion.
Treatment. Regulation of diet : plainly cooked animal food, fresh ripe fruits. Avoidance of alcohol, sugar, amylaceous matters, and fat. Daily exercise. Sulphate of soda and taraxacum, 144. Alkaline aperients, 148. Rhubarb and magnesia, 165. ' Hydrochlorate of ammonia, 60. Iodide of potassium, 31. Harrogate waters. Carlsbad Kissingen. Selters.
2. Amyloid Degeneration. — From Amylum, sta^^. Synon. Waxy, Albuminous, Lardaceous, or Scrofulous Liver. — May coexist with fatty liver, cirrhotic induration, syphilitic cicatrices and gummatous nodules, or be alone present. The glandular structure is gradually~c6nverted into a dense material. Minute bloodvessels first thickened, then lobules invaded from without inwards ; hence, destruction of hepatic cells with abolition of their functions. After death, liver found increased in weight and size: may _ average 8 or 9 lbs. avoir, instead of 3 or 4 lbs. Substance firm, glistening J on section, resenibling yellow wax : cut surface presents only faint traces of lobules. Iodine and sulphuric acid stain it dark blue or black.
Chief predisposing causes, — Caries and necrosis in strumous subjects; constitutional syphilis ; prolonged suppuration ; tubercular disease of lungs and intestines ; and perhaps intermittent fever.
Symptoms. Enlargement of liver. Sense of fulness in right hypochon- drium. Enlai'gem^htof spleen. Loss of appetite. Dyspepsia : flatulence, attacks of diarrhoea with pale stools, nausea. Anaemia with sallow look. AJbuminuria, from coexistence of same disease in kidneys. Very rarely, acute pain ; jaundice; ascites. Disease slowly but steadily advances to fatal termination.- '
132 HEPA'riC HYPERTROPHY— HEPATIC TUMORS.
Treatment. Unsatisfactory. Attempts to be made to relieve the cause, and prominent symptoms. Iodide of potassium. Iodide of iron. Ferrugi- nous tonics. Warm or tepid sea-water baths. Digestible food. — See Amy- loid Degeneration.
3. Pigment Liver. — Synon. Melancemic Liver. — After death from severe intermittent, remittent, or continued fevers, the liver is sometimes found to present a blackish or chocolate color. This is due to accumulation of pigment matter in vascular apparatus of the gland (Frerichs). The loading of the hepatic capillaries with this melanotic matter, leads to their destruction, and consequent atrophy of the gland. The resulting gastric catarrh, diar- rhoea, and severe cerebral symptoms or ascites, are incurable.
HEPATIC HYPERTROPHY.— From 'Hrtartxoj, affecting the liver: %-^ 'Trtfp, in excess ; fpE-j^to, to nourish. — Hypertrophy of liver characterized by ^ rt^>y^_,^V^Man increase in the secreting cells, causing general enlargement-'oftlTe' 'gland. •C^^"^^ , ^ffepatic cells may be increased in size, or multiplied in number.
Arises from long-contiTTuT^t!"~Ttfrtfestion, sucB^as "occurs in residents of tropical climates or ormalarious districts. Sometimes found in leucocy- themia, phthisis, dysentery, saccharine diabetes, etc. Partial hypertrophy may be ot'^a compensatory natureY^- «., a portion of gland having been rendered uselessTiy'-St^tcse, the healthy part has its cells enlarged so as to prevent systemic derangement.
HEPATIC TUMORS.— From 'Hrtafixo?, affecting the liver: Tximor (tumeo), a tumor. — The most significant new formations having their seat in the liver are the hydatid tumors and cancerous infiltration (see Hepatic Cancer). There are/'MW'e^'eT,' two or three other growths which may be met with.
1. Cystic Tumors. — Encysted knotty tumors, containing a clieese-like substance, are found in the glandular substance, varying in size from tTiat of a laxge pea to a small potato. They have their origin in inflammation of mucous lining of hepatic ducts. Steatomatous contents composed of irregular granules, free oil globules, and occasionally plates of cholesterine.
Simple serous cysts, with clear watery contents, are sometimes scattered through the liver. Seldom larger than small beans.
Sacculated cysts, containing a glairy fluid, may be met with. Very rarely, the liver has been crowded with such' cavities.
2. Cavernous Tumors. — Commonly found on upper surface of the gland, especially in bodies of aged persons. They are developed in the hypertro- phied connective tissue. Ori^tlie surface, they look like dark blue colored spaces, varying in size from that of a pea to a fowl's egg : on cutting into them, a tissue is found resembling that of the corpora cavernosa of penis, containing dark blood.
3. Tuberculosis. — Tub^rcular^deposits very rare in liver: probably never occur primarily, but always in connection with far-advanced tuberculosis of other organs — especially of abdominal viscera. Deposit tnkes place over all parts of the gland, in shape of semi-transparent miliary granules, or as yellow adipose deposits. Patient usually succumbs to constitutional affec- tion before stage of softening sets in.
4. Hydatid Tumors. — From 'xSartj, a vesicle. Synon. Echinococci of the Liver. — Hydatid tumors occur in the liver more frequently than in other organs. They are occasionally-met with, however, in subperitoneal areolar tissue, spleen, omentum, muscles of heart, brain, kidneys, lungs, ovaries, and bones — particularly the tibia.
These growths consist of a sac formed by condensation of surrounding tissue, lined by a bladder or cyst, and filled with a limpid salt fluid ; floating
HEPATITIS. 133
" hydatids." The echinococci are immature__tapeworms — the scolices of embryos of the Tajriia echinococcus wlucli iiTfests uTe^g and wolf.
SyxMptoms. a hydatid tumor in the liver jjrows slowly. May give rise to little inconvenience beyond a sensation ofweTgTrfT When large, it is easily detected : volume of liver increased. Occasionally, fluctuation : in exceptional cases, a peculiar vibratory sensation — ^hydatid fremitus. If the cyst inflame, violent pains ; sometimes compression of portal vein or vena cava, causing ascrE95''afi9 oedema of legs. — Cyst may burst into peritoneum, causing fatal peritonitis ; or into base of lung'rhydatids and puriforhi matter being expectorated ; or into he_patic.duct, whence contents may pass through common duct into duodenum. "STore fortunately it sometimes bursts directly into intestines, or through abdominal wall. May also undergo spontaneous cure, without rupture ; by death of hydatid, when cyst may contract and contain thick putty-like matter.
Treatment. Iodide of potassium, 31. Calomel. Common salt. Sul- phur baths. Efficiency very doubtful. Electrolysis. Removal of fluid contents by tapping. This generally sufficient. If not, injection of solution of iodine; or or diliited alcohol; or of weak solution of carbolic acid after tapping ; insertion of drainage-tube after tapping. Careful incision, pi"o- vided cyst be adherent to integuments.
HEPATITIS. — From "Hrtap, the liver; terminal -itis. Inflammation of the liver has to be considered under five heads : — (1) Hepatitis, or inflam- mation of peritoneal investment, or of substance of the gland, or of both combined. (2j (Jirrhosis, or that slow form ot inffSmnialofy action which affects the areolar or connective tissue. (3) Syphilitic hepatitis. (4) In- flammation of the bloodvesseTsT^^^Inflammation of biliary ducts and gall- blad4er. "^ -
1. Hepatitis. — Synon. Suppurative Inflammation of Liver. — Occa- sionally, only the coats of liver and Glisson's capsule become inflamed [Peri- Hepatitis). INlore commonly, substance of gland attacked. The morbid action may be diffused over whole organ [Hepatitis diffusa parenchyma- tosa) ; and it may lead to softening and acute atrophy, or to induration. Generally, inflammation more circumscribed [Hepatitis vera circimiscripta, suppuratoria) ; and then abscess is a frequent I'esult.
Sy.mptoms. Tenderness over gland : most marked if peritoneal investment be affected. High fever, sometimes assuming a low form. Fulness of right hypochondrium : increased dulness on percussion. Pain increased by pres- sure, cough, deep inspirations: inability to lie on left side. Yellow tinge of conjunctiva : rarely jaundice. Dyspnoea, cough, vomiting, headache, hic- cup. Pains in rigBtcIavicle and shoulder : probably, when left lobe of liver suff'ers, pains in left shoulder.
Formation of abscess signalized by chills, or distinct rigors. Hectic fever. Gastric disturbance. Pain and great tenderness. Tension of abdo- minal muscles on palpation. Feeling of weight about liver. Emaciation. Prostration. Diarrhoea or dysentery.
Treatment. Sulphate of soda and taraxacum, 144. Aloes, gentian, and potash, 148. Small doses of blue pill and ipecacuanha, chloride of ammo- nium. Acid tartrate of potash. Salines, 348. Opium. Opium and ipe- cacuanha, 324. Opium and belladonna, 344. Ipecacuanha, morphia, and astringents where there is dysentery Fomentations. Compress with dilute nitro-hydrochloric acid and water. — Restricted diet. Indian sarsaparilla and barley-water drink, 20. Acid tartrate of potash drink, 356. Complete rest in bed.
,><*•
134
HEPATITIS.
If supfuration occur: — Bark and ammonia, 371. Mineral acids and bark, 376. Niti'ohydrochloric acid, 378. Quinine, 379. Quinine and steel, 380. Opium. Wine. Nourishing food. — If surface of abscess have become adherent to abdominal parietes, puncture with trocar and caaiula, after exploratory puncture with grooved needle. Aspiration has been found very successful. Some authorities prefer allowing abscess to burst sponta- neously.
Remedies sometimes employed : — Tartarated antimony. Calomel. Iodide of potassium. Oolchicum. Digitalis. Bloodletting. Leeches. Blisters. Issues.
2. Cirrhosis. — From Kt/'po?. yellowish : because on slicing the liver it presents the grayish-yellow color of impure beeswax. Synon. Interstitial Hepatitis ; Granular Induration of Liver ; Hoh-nailed Liver ; Gin- dri7iker's Liver.— Chrouic inflammation and hypertrophy of areolar tissue pervading and coverin~g"lTvief.' The gland becomes abnormally firm,' aiTd subsequently contracted ; the contraction of thickened connective tissue causing the caji^nle to be drawn in, so that the surface of the liver has a
: '• hob-nailed" appearance" 'KsH is a common result of spirit-drinking, it is sometimes known as Gin-drinker's liver. Sometimes occurs in young, and independently of alcohol.
Symptojis. Few and obscure until effused fibrin begins to interfere with flow of portal blood, and secretion and escape of bile. Slight enlargement of gland : Ts""Bbrous tissue contracts and lobules atrophy, the gland dimin- ishes in size. Hypertrophy of spleen. Pain in right hypochondrium : in- digestion, flatulence, coiisfipation : occasional feverishness : dry and rough skin : unhealthy sallow look. After an interval, — debility with loss of flesh. An increasing contraction of eff'used lymph obstructs portal circulation, — ascites. Jaund]c^,_x)eeasional_but not common. DiLatation of v^jjis in abdominal walls. Haemorrhage inTo~stomach and intestines. Sometimes an attack of hsematemesis has constituted one of earliest symptoms, and caused death before disease has been suspected. Incr^se of dropsical effu- sion. Death from exhaustion ; or from some intercurrent attack of pneu- monia, peritonitis, jaundice and toxaemia, or diarrhoea.
Treatment. At commencement : — Disuse of all alcoholic drinks, coffee, curry, and highlj seasoned dishes. Plain animal food, milk, fish, etc. Sul- phate of magnesia, 141. Sulphate of soda. 143. Resin of podophyllum, 160. Acid tartrate of potash aud taraxacum, 194. Factitious Carlsbad waters, 181. Waters of Carlsbad, Marienbad, Kreuznach. Iodide of potassium, 31. Quinine and iodide of iron, 382.
Whe7i degeneration of hepatic cells has far advanced : — Nitro-hydro- chloric acid, 378. Pepsine and nux vomica, 420. Ox-gall. Rhubarb and bitters, 370. Inunction of hepatic region with compound iodine ointment : red iodide of mercury ointment.
For checking hcemorrhage : — Gallic acid, 103. Turpentine, 50, 102. Cinnamon and nitric acid, 104. Aromatic sulphuric acid aud opium, 100. Cold drinks : ice. Bladder of ice over abdomen.
For ascites: — Squills, digitalis, and juice or decoction of broom, 219. Buchu and cream of tartar, 222. Nitre, juniper, and nitrous ether, 221. Solution of potash and digitalis, 220. Benzoate of ammonia, 21.o. Elate- rium, 157. Calomel and jalap, 159. MorphiaTcTiToroform, and Indian hemp, 317. Tapping. Nourishing food : milk, raw eggs, stimulants.
3. Syphilitic Hepatitis.— Generally accompanied with other tertiary symptoms of venereal infection. Three varieties : — (1) Simple interstitial hepatitis and peri-hepatitis. (2) Hepatitis gummosa; in which white de- pressions, like cicatrices, are found to contain yellowish nodules of a rounded form aud dried appearance, varying in size from a linseed to a bean. And
HEPATITIS. 135
(3) as waxy, amyloid, or lardacoous den^eneration. — All three forms may co- exist, or ^tlier may be present independently of the others (Frerichs).
SvMPTOMS. Those produced by first and second varieties seldom very striking : while one portion of g-land becomes unfit for its functions, the cells of healthy part get hypertrophied. Syphilitic cachexia. Enlargement of spleen. Sometimes albuminuria.
Treatment. Iodide of potassium, 31. Corrosive sublimate, 27. Green iodide of mercury, 53. Red iodide of mercury, 54. Mercurial vapor bath, 131. Nourishing food. Rest from mental and bodily labor: country air. Where there is renal disease, — iodide of iron, 32. — See Hepatic Degenera- tions.
4. Diseases of Bloodvessels, — Hepatic artery and its branches may be involved in liver disease, — in cirrhosis, cancer, tubercle, etc. ; or canal of artery may become obstructed ; or there may be atheroma of the coats, or aneurismal dilatation.
/jor(aZ_jifii2iLJnay_iiave its channel obstructed by coagula. — Sometimes ruptured, from fatty degeneration of coats. — Inflammation, ulceration, or suppuration of viscera in which the roots of this vein.have their origin, may produce suppurative disease of vein itself. Chief features of suppurative portal phlebitis are headache, violent fever, great prostration, rigors, pro- fuse sweating, pains in epigastrium or right hypochondrium, bilious diar- rhoea, jaundice, enlargement of liver and spleen ; followed frequently by symptoms of peritonitis, occasionally by metastatic purulent deposits in liver or lungs or joints; and terminating in fatal exhaustion or coma. Remedies of little avail : quinine and opium to subdue rigors and pain. Milk »j ,
and raw eggs. Solution of beef, 2. Demulcent drinks, 19. . , Ml-''''
Hepatic veins usually found enl^arged after death from valvular disease i/^'' jL^ of heart. — Rarely tliSTfeSToTa^dTiesive inflammation.- — Suppurative hepatic / /^-- ■^■- ''^^|^_^ phlebitis more common, as a consequence of abscess of liver. Blood-poison- ing generally ensues. ' /' / -.r.^'
5. Inflammation of Biliary Passages, — The biliary ducts and gall- / <), bladder may be attacked by different forms of inflammation : — (1) Catarrhal - — -.- inflammation, in which secretion of mucus is increased and soon becomes
viscid or muco-purulent. Sometimes the cystic or common duct becomes temporarily obstructed by a firm plug of mucus. The morbid action gene- rally has its origm_iii catarrh of stomach and duodenum. (2) In exudative or p/ffs^TcTnHa^rnmation there is either a firm fibrinous or a croupal product. This forms casts of the tubes, blocking them up and leading to dilatation. (3) Suppurative inflammation leads to formation of pus and a thick kind of mucus tinged with bile. Ulceration may occur : ulceration of gall-bladder often found, together with gall-stones : may be induced by decomposing bile, where there are no calculi.
Symptoms. Very variable in severity. Gall-bladder, cystic, and common ducts more obnoxious to inflammation than hepatic ducts, because the former are-more likely to be irritated by gall-stones and unhealthy bile. — In catar- rhal inflammation, there is slight tenderness, tightness about epigastricaii^ right liypdchondriac regions, nausea, mild fever, and constipation. ila.u^(^cfi. if viscid mucus choke up many of the ducts ; ending with salutary diarrhoea as pent-up bile finds its way into duodenum. — Undue retention of bile in gall-bladder, from any cause, may lead to decomposition : hence irritation and inflammation, perhaps ending in suppuration and ulceration and even perforation.
Dilatation of biliary passages may occur from their origin in plexiform network in which hepatic cells lie, to termination of common excretory duct of liver and gall-bladder in duodenum. Generally, expansion only partial. In any case, it may arise from habitual accumulation of inspissated bile; compression of ducts by tumors or by disease of the parenchyma; inflam-
136 HERNIA,
matory swelling of mucous lining diminishing calibre of tubes, and so lead- ing to retention of their secretions as well as of bile ; and from obstruction A ^' ^y calculi, catarrhal or croupj' exudations, etc. Owing to obstruction of '^■'%ii\jt/ y^' duodenal orifice, the ductus communis cliolcdoclius has become as large as small intestine. When~ttre" gaTT^ljladder cann()t~get~rid"6T'n's"'bontents in r^*'^'^' ^ -consequence of occlusion of cystic duct, the residuary bile may be absorbed ; «-..— ""^ but if lining membrane continue to secrete mucus, dropsy of cyst must re- sult. If obstructing substance act like a valve, permitting ingress of bile i i \ but preventing egress, a large pear-shaped or globular tumor may form con- JfO^lly'^^l)'*' "'• '^)''^i'''i'"'g some pints of fluid. Rupture of bladder h^s been prevented by tajj-^ ' } bingl can be safely performed i5rovide3~niere'"are adhesions to abdomiaaL»=
( ' . /rVall, or^by means of aspTrator without.
<, — - ' Treatment. Active remedies have probably only an injurious effect. Recovery may be aided by a restricted diet; warm baths; simple aperients if there be constipation ; astringents if.there be undue diarrhoea. Fomenta- tions and sedatives to relieve pain, rubbing with moderate pressure ; simple diluents or salines for fever and thirst; digestible restorative food, with ammonia and bark, if there be exhaustion.
Where catarrhal inflammation becomes chronic, and customary discharge of bile does not occur, — Nitro-hydrochloric acid, 378. Benzoic acid, 49. Benzoate of ammonia, 215. Hydrochlorate of ammonia, 60. Waters of Carlsbad, Marienbad, Selters, Kissingen.
Remedies sometimes employed : — Leeches to anus : to hepatic region. Blisters. Issues. Calomel. Blue pill. Taraxacum. Resin of podophyllum. Tartarated antimony. Iodine. Iodide of potassium. Iodide of zinc. Nitric acid. Purified ox bile. Chlorine baths. Nitro-hydrochloric acid baths. Turkish baths.
HERNIA. — From "Epfoj, a branch or spout ; because in this affection the whole or a part of an organ shoots out from its natural position. Synon. Rupture. — A tumor formed by the protrusion of more or less of a viscus from its normal site. Thus, there may be hernia of the brain, iris, mucous lining of windpipe through rings of trachea, lung, liver, spleen, bladder, uterus, ovaries, omentum, and intestine. When, however, the term "hernia" stands alone it signifies a protrusion of omentum or intestine through some abnormal opening in abdominal walls; in which sense it is here considered. I'he viscera most liable to protrusion are, — small intestines, omentum, and arch of colon. The most frequent sites are those points where muscular and tendinous structures are weakened to allow of exit of spermatic cord in male and round ligament in female, or of large vessels to lower extremity, — inguinal and crural canals.
A hernia is composed of a Sac and its Contents. The sac consists of the parietal layer of peritoneum : is always present save in hernias following penetrating wounds, in some cases of congenital umbilical hernia, and in cases where viscus protruded is only partially covered by peritoneum (as the caecum); and it has a neck which is often the seat of constriction in strangulated herniee, and a hody which is usually pyriform or globular. When the sac only contains intestine, the rupture is termed an Enterocele; when only omentum, an Epiplocele; when both, an Entero-epiplocele.
A hernia is at first Reducible, — the contents of the sac can generally be pushed back into abdominal cavity, though the sac itself rapidly becomes adherent to areolar tissue. After reduction, protrusion is to be restrained by a proper truss, — a pad kept over the seat of protrusion and the canal along which it passes by a steel spring round the body. Amongst the best trusses are those of Mr. John Wood ; contrived so as to exert flat and level pressure at sides of hernial opening instead of in the axis. Bigg's convolute spring truss sometimes very useful in oblique inguinal rupture. A radical cure may be desirable : operations for effecting this, eitlier aim at in vagi-
HERNIA, 137
nating the skin and superficial fascia and sac, so as to plug the opening through which the hernia passes (WUtzer's) ; or, after invaginating sac and fascia, the sides of the aperture are brought together by subcutaneous stitches, and held so until sufficient adhesive inflammation has been set up (John Wood's).
Irreducible hernia, — protrusion generally large, of long standing, and often consisting of thickened omentum and of intestine and mesentery. If left alone, there is a tendency to gradual increase: to prevent this, if hernia be not too large, it may be supported and protected by a truss with a large concave pad ; if of great size, a suspensory bandage ought to be worn. In- flammation, simulating strangulation, sometimes occurs in these herniaj ; the treatment must consist in use of opium, fomentations, and perfect rest.
Incarcerated hernia is an irreducible hernia which has become tempo- rarily obstructed, from accumulated flatus or some undigested matters in an angle of the gut. The constipation is to be removed by purgative eneraata, 189, 191 : ice may be applied : the taxis to be used to empty incarcerated gut of its contents, or the aspirator may be employed.
In strangidated hernia the portion of protruded ome*ntum or intestine is so tightly consti'icted that it cannot be reduced ; consequently the passage of feces is arrested, the return of blood from the strangulated portion is prevented, and gangrene soon occurs if relief be not afforded. The symp- toms are those of obstruction of the bowels. The treatment consists in recourse to the taxis, — the attempt to return the protrusion by manipula- tion, without undue force. This may be assisted by placing the patient in a hot bath ; by inducing anaesthesia with chloroform ; by a full dose of opium ; by application of bladder of ice ; by aspirating the hernia ; or by inverting the patient, so that the gut may be emptied of its fluid contents, (" He may, if occasion I'equire, be carried to and fro upon the back of a strong man with his head downwards, by which the prolapsed bowels are often reduced.") Some practitioners relax the muscular contraction by bleeding, nauseating doses of antimony or tobacco, large enemata to empty the lower bowel, etc. If the symptoms continue after reduction they may be due to,- — the hernia having been pushed back en masse, sac and all ; or there may have been a double strangulation, the taxis having failed to relieve the stricture within the sac ; or the constriction may have been so great that gangrene has been set up. But the taxis failing to effect reduc- tion, one of two operations becomes necessary without delay: — -an incision is made over the neck of the tumor, the sac exposed and opened, and the stricture divided from within ; or the sac is to be left entire, the stricture being divided outside.
The special herniie are : — (1) Oblique inguinal hernia, in which the pro- trusion originates at internal abdominal ring, traverses entire length of inguinal canal, and usually passes out at external ring. — (2) Direct inguinal hernia passes through a triangular space on the inner side of epigastric vessels, bursting through or pushing before it the conjoined tendon of internal oblique and transversalis muscles, and presenting at external ring gradually makes its way into scrotum or labium.— (3) Congenital hernia descends inside the tunica vaginalis, which forms its sac. Always oblique, following the course of spermatic cord. The tendency to the protrusion is congenital, but the actual hernia may not occur for some years after birth. — (4) Femoral or crural hernia is that which escapes under Poupart's ligament through the crural ring, and enters the sheath of the vessels internal to the femoral vein. After passing through the saphenous opening of the fascia lata it turns up over the falciform process, instead of descend- ing on the thigh. — (5) Umbilical hernia protrudes through the umbilical aperture. Not uncommon in infants, and in women who have borne many children, — (6) Ventrcd hernice are such as protrude through any part of the abdominal parietes, except the inguinal or femoral or umbilical apertures.
138 HEEPES— HICCOUGH.
Most frequent throng'h the linea alba, lineae semilunares, etc. — (7) Obturator hernia passes through the opening in obturator ligament which gives exit to the artery and nerve. Very rare, and very difficult to diagnose during life. — (8) Iscliiatic hernia escapes through the sciatic notch. — (9) Perineal hernia descends between rectum and bladder, forming a proti'usion in peri- neum.— (10) Vaginal hernia gives rise to a tumor which protrudes through the posterior or upper wall of vagina. — (11) Labial hernia presents a tumor in one of the labia and along the side of vagina. — (12) Diaphragmatic hernia results from a wound or from congenital deficiency of a portion of the diaphragm. The stomach or transverse colon, with a large portion of omentum, may escape through such an opening and form a large tumor in thoracic cavity.
HERPES.' — From "Eprfu, to creep. Synon. Tetter. — A transient non- contagious skin disease, consisting of clusters of vesicles upon inflamed patches of irregular size and form. Eruption runs a definite course ; with one exception, rarely continues for more than three or four days; it is not usually severe, and leaves no scar.
Varieties. Herpes^ labialis, often forms on upper lip during a cold. — Herpes preputialis, ocGViYS on foreskin; vesicles run into each other, pro- ducing an excoriation covered with a scab. — Herpes zoster, zona, or shingles, sometimes very troublesome: frequently attended with severe stinging pain. Inflamed patches with their clustered vesicles following the course of a nerve, most commonly one or more of the intercostals, and arranged in form of a band, encircling half the circumference of the body. — Herpes ophthalmicus, not uncommon. Groups of vesicles along branches of superior division of fifth nerve. If nasal branch affected, the eyeball to which it supplies branches will be inflamed. May resist treatment for a few weeks. Often followed by neuralgia, especially in old people.
Treatment. Attention to bowels. Regulation of diet. Vesicles may be pricked, and sponged with warm water or dilute solution of subacetate of lead. Oxide of zinc, or subacetate of lead ointment. Painting with belladonna or aconite liniment, where there is pain. In obstinate forms, quinine and arsenic, 52. For neuralgia following shingles, — Steel and arsenic. Quinine. Iodide of iron. Nourishing food.
HICCOUGH. — Synon. Singultus; Hiccup. — A short convulsive and noisy inspiration, followed immediately by expiration. It is due to the sudden and involuntary and momentary contraction of the diaphragm, with the simultaneous narrowing of the glottis. Frequently a warning of great danger in severe diseases : often a symptom of irritation or inflammation of the digestive organs : occasionally a product of hysteria : sometimes a mild idiopathic affection. Most common during infancy and old age. The con- vulsive inspirations produce pain about the prtecordia. Paroxysms of hic- cough recurring at short intervals, and continuing for some days, are occa- sionally the cause of great exhaustion.
Treatment. Idiopathic : — In mild cases hiccough may perhaps be checked by taking a set of deep inspirations and then holding the breath as long as possible, so as to keep the diaphragm contracted. A belt firmly applied i-ound epigastrium. Use of sternutatories to provoke prolonged sneezing. — In severe forms, — Ammonia. Musk. Peppermint. Camphor. Ether. Mulled port wine, or hot brandy and water with spice. Cajuput oil or chloroform on sugar. Extractof Indian hemp. Aconite. Belladonna. Tincture of nux vomica. Inhalation of chloroform or ether. Opium. Hen- bane. Hydrocyanic acid. Ice, or iced water. Blisters ; sinapisms ; turpen- tine stupes; dry cupping; wet compress; belladonna, aconite, chloroform, or opium liniment ; either agent to be applied to back and sides, in neighbor- hood of attachments of diaphragm. — Dyspeptic : — Emetics. Mild warm
HOOPING-COUGH. 139
aperients, or enemata of castor oil, etc. Drauoi-hts of ammonia, bicarbonate of potash, and peppermint water. White bismuth. Creasote. Ipecacu- anha. Sinapisms. — Hysterical : — Assafoetida. Sumbul. Musk. Valeri- anate of ammonia, quinine, iron, or zinc. Ferruginous tonics. Shower baths. G^\Y'Ani?.m.— Intermittent : — Quinine. Arsenic. — Infantile : — Di water (aqua anethi). A few drops of brandy in hot sugared water. Warm bath. Attention to quantity and quality of milk or other food.
HOOPING-COUGH. — Synon. Pertussis; Tiissis Convnlsiva ; Bron- chocejjhalitis ; Chincough.— An infectious disease, especially of childhood ; rarely occurring more than once in same individual. Attended with slight fever and vomiting ; and accompanied at first by catarrh, and subsequently by a peculiar cough which occurs in paroxysms at uncertain intervals. — Duration from two or three weeks to as many months. — Probably due to some poison affecting respiratory mucous membrane. Sometimes epidemic.
Symptoms. After a latent period of perhaps six days, a simple febrile stage of eight or ten or twenty days' duration ; sometimes accompanied, but usually followed, by violent paroxysms of coughing. Restlessness from coryza, heat of skin, oppression of chest. As fever remits, the cough as- sumes its peculiar shrill sound or hoop. Child soon learns when each paroxysm is commencing, and is frightened. Series of coughs or expiratory efforts very protracted : suffocation seems about to set in, when relief is afforded by a long respiratory act, the rush of air through glottis causing characteristic crowing or hooping. Directly after fit, patient regains courage ; soon appears well. If paroxysm end in vomiting, there is a crav- ing for food immediately afterwards. There may be two or three paroxysms in a day. or as many in an hour.
Complications : — May coexist with measles, smallpox, etc. With bron- chitis, pneumonia, disordered bowels, some head affection. — Perhaps the urine occasionally contains sugar — pertussal glucosuria. — When cough is very severe, it is sometimes accompanied with hemorrhage from nose or mouth ; or from ears, with laceration of membrane of tympanum. Ecchy- mosis of conjunctivae, common. May prove fatal from exhaustion due to loss of food by vomiting, or by causing pneumonia. Convulsions. Hydroce - phalus. More frequently, by catarrhal inflammation of bronchi, with col- lapse of a portion of the lung.
Treatment. Mild cases : — Warm clothing : flannel or chamois leather jackets next the skin. Light nourishing food. Mucilaginous drinks. Con- finement in-doors. Friction of spine, night and morning, with belladonna and soap liniment, 281.
More severe forms : — Ipecacuan, as an emetic, if bronchi are loaded with mucus, 231. Ammonia, ipecacuan, and senega, 235. Sulphate of zinc and belladonna, 92. Ammonia, ether, belladonna, and hydrocyanic acid, 86. Bromide of ammonium, 37. Bromide of ammonium, with hydrocyanic acid, and stramonium. Chloral hydrochlorate of quinine. Spirit of chloroform. Hydrocyanic acid. Nitric acid, 9L. Tincture of aconite. Belladonna. Morphia. Opium, 333. Hydrochlorate of ammonia. When food vomited, a drop or two of tincture of opium to be given just before meals. Attention to bowels. Belladonna or belladonna and chloroform liniment to spine, 281. Confinement to one room : temperature 68° F. Flannel clothing. Nutritious but easily digested food : milk, cream, fish, eggs. — When chronic : — Saccharated carbonate of iron. Cod-liver oil. Removal to sea-side.
Remedies sometimes recommended : — Tartarated antimony. Ipecacuan. Alum. Arsenic. Assafoetida. Camphor. Coffee. Colchicum. Peroxide of hydrogen. Musk. Lobelia inflata. Saccharated carbonate of iron Quinine. Oxide of zinc. Sulphur. Vaccination. Sponging fauces and glottis with solution of nitrate of silver (gr. 20 to the fl. oz.). Spray of
140 HYDROCELE AND HEMATOCELE.
solution of quinine. Exposure to fumes from lime used for purifying gas. Leeches to spine. Sinapisms to spine. Tartarated antimony ointment. Cold shower bath, in chronic stage.
HOUSEMAID'S KNEE.— Enlargement of bursa over patella, the result of pressure and inflammation from kneeling. If the inflammation be acute, — Leeches, poultices, evaporating lotions, and rest will be needed. In chronic cases, — Iodine liniment, blisters, ammoniac and mercury plaster, diluted red iodide of mercury ointment, etc. Wire setons. Tapping with trocar, followed by seton : the wires or threads to be left in until free suppuration has been set up. If there be sloughing, a free incision must be made through anterior part of bursa.
HYDREMIA. — From "TSwp, water ; al/xa, blood. Watery blood. — See Ancemta.
HYDEOCELE AND HEMATOCELE.- Hydrocele (from "ncop, water; xrj'Kr;, a tumor) consists of an accumulation of serum in the tunica vaginalis, or in the cord. Hasmatocele {Alfxa, blood ; xri'krj) is an extravasation of blood into tunica vaginalis.
1. Hydrocele of Tunica Vaginalis. — Synon. Hydrops Scroti ; Hydror- chis. — May result from injuries, testitis, and many causes.
Symptoms. The scrotum gradually gets distended with serum, until it forms a smooth and pear-shaped elastic and translucent swelling. The testicle maybe felt near the lower and back part: the spermatic cord to be distinguished free at neck of tumor. The fluid consists of pale yellow serum : average quantity ten or twelve ounces. When chronic, the tunica vaginalis becomes thick, dense, and opaque, and swelling may not have pyriform shape.— In congenital hydrocele the communication between the tunica vaginalis and peritoneal cavity has not been obliterated. Apt to be com- plicated with congenital hernia. — In encysted hydrocele there are one or more cysts filled with serum connected with the testis or epididymis.
Treatment. Palliative: — Withdrawal of fluid by trocar. Punctures with a grooved needle : fluid escapes from tunica vaginalis into scrotal areolar tissue, whence it is absorbed. Painting with iodine. Friction with diluted red iodide of mercury ointment. Radical cure : — 'I'apping, with injection of tincture of iodide (fl. drm. j to water iij), allowing the injection to remain. A moderate amount of inflammation is set up, which does not subside for two or three days. This plan failing, a seton may be passed through the sac, — two or three threads, or a fine iron wire. — In congenital hydrocele a truss to be worn, so as by pressure to close vaginal process. Iodine to scrotum. Punctures with grooved needle. Irritating injections inappropriate. — In encysted form, recourse is to be had to tapping with or without injection ; or to seton.
2. Hydrocele of Cord. — Serum accumulates in areolar tissue of cord : not common. In some cases, the fluid is formed in a distinct cyst ; which may either be a new formation, or a portion of unobliterated vaginal process of peritoneum. Where interference is needed, the best remedies are iodine to surface of enlargement. Acupuncture.
3. Haematocele. — Synon. A Blood Tumor.- — May be due to injury : sometimes arises spontaneously. The tunica vaginalis gets distended with blood : perhaps to such an extent as to compress the testicle and produce atrophy. Rest, pressure, and cold lotions sometimes effect a cure. If there be much inflammation it may be necessary to turn out the clot by a free incision, and leave the cavity to granulate.
HYDROCEPITALOID DISEASE— HYDROCEPHALUS. 141
HYDROCEPHALOID DISEASE.— From 'T5cop, water; :>cf(f.tt>.j7, the head; terminal -ides. Synon. Spurious Hydrocephahis. — A form of cere- bral aiifemia. The early appearances somewhat resemble those due to tubercular meningitis. A fatal error to mistake spurious for real hydro- cephalus.
Symptoms. Weakly children the subjects of this affection, especially ■when exhausted by diarrhoea or some acute disease. Heaviness of head. Drowsiness. Great languor. Unhealthy stools. Alarm at strangers and slight noises. Freaks of temper. Irregular breathing. Coolness of skin. Surface of fontanelle depressed, instead of raised as in true hydrocephalus.
Treatment. Pure milk. Strong beef-tea, or finely pounded meat. Raw meat, 2. Port wine. Bark. Steel ; especially chemical food, 405. Strict avoidance of active purgatives, diuretics, and poor diet.
HYDROCEPHALUS.— From "T5cop, water; xs^aX^, the head. Synon. Hydrocranium ; Hydrops Capitis ; Water on the Head ; Dropsy of the Brain. — Met with in children of various ages, as result of many circum- stances. Often congenital, and associated with some cerebral malformation. Sometimes the precursor, sometimes result, of tubercular meningitis : in this case, often spoken of as acide hydrocephalus. When congenital, or when arising slowly from constitutional causes, it is termed chroiiic hydrocephalus.
For acute hydrocephalus see Tubercular Meningitis among cerebral in- flammations.
Head attains a great size : the unossified sutures yield readily to pressure of fluid. One side may be larger than the other. Bones thin and trans- parent : meninges thickened. Serum usually contained in lateral ventricles, which are perhaps expanded into one large cavity ; occasionally collected in sac of arachnoid, compressing brain. Quantity of fluid varies from two or three ounces to as many pints. Essentially a disease of childhood, yet occasionally adults are affected.
Symptoms. Generally commence before infant is six months old : may exist from birth. Child takes food eagerly, but does not thrive : after a few weeks, extreme wasting. Appearance remarkable : emaciated body, small face, with a large globular cranium and overhanging forehead. Head droops helplessly on one side. Intelligence usually enfeebled. Irritability and peevishness; morbid susceptibility to noise and light; liability to epileptic convulsions ; great muscular weakness. Rolling movement of eyeball : perhaps strabismus, or amaurosis. Headache ; nausea ; consti- pation, with dark colored offensive stools. Grinding of teeth. Screams on awaking.
In second stage, more stupor ; pallor ; slow pulse ; dilatation or contrac- tion of pupils ; picking of nose and lips. In favorable cases lethargy and pallid hue and irritability gradually subside. Desire for food. Increase of muscular power. Diminution of emaciation. In unfavorable examples, ex- cessive prostration and rapidity of pulse. Paralysis. Coma or convulsions ending in death.
Treatment. Prophylactic : — Infants with tendency to hydrocephalus to be reared so as to strengthen constitution as much as possible. Nourishing food : plenty of good milk. Salt-water baths : friction of skin. Residence in pure air: sea-side. Cod-liver oil. Only the most gentle attempts at education. — Curative: — Rhubarb and magnesia. Syrup of senna. Castor oil. Mercury and chalk. Plain but nourishing food : pure milk. Cod-liver oil. Glycerine. Iodide of potassium. Iodide of iron. Quinine. Bark and hypophosphite of lime or soda. Chlorate of potash. Sea-air.
Compression of head and tapping have been strongly advocated. Com- pression best effected by bandaging, or by application of strips of soap plaster over whole of cranium, so as to make equal pressure on every part. Where there are no symptoms of active cerebral disease, pressure
142 HYDRONEPHROSIS— HYDROPHOBIA.
will probably do good. — Puncture is performed with a small trocar and canula at coronal suture, about an inch and a half from anterior fontanelle, so as to avoid longitudinal sinus. The fluid is to be evacuated slowly; and as much as will flow be allowed to come away ; and gentle pressure must be kept up both during its escape and afterwards for some weeks. Only to be had recourse to when other means have failed. Has proved successful in very young children.
Remedies sometimes used : — Active purgatives. Leeches. Blisters. Calomel. Corrosive sublimate. Mercurial inunction. Crude mercury, with manna and squills. Tartarated antimony. Iodine. Colchicum. Digitalis. Liquor potassaj. Acetate of potash and squills. Cold affusion. Issue in neck, or on each shoulder.
HYDRONEPHROSIS.— From "T5wp, water ; rs^poj, the kidney. Synon. Hydrorenal Distension ; Dropsy of the Kidney. — Sometimes congenital. May result from obstruction of ureter by calculi, tubercular or malignant deposit, pressure of tumors, etc. Kidney ultimately converted into a large pouch. Occasionally associated with suppuration of lining membrane of pelvis and calyces.
Symptoms. Sometimes altogether absent ; especially if distension be not very great, and other kidney remain healthy. Hydronephrotic tumor found in loin, reaching forwards in abdomen : may be very large, with undulating feel and fluctuation, and tender to touch. Urine often natural in quantity : contains pus if there be associated pyelitis. Suppression of urine and ui-ag- mia where both glands are affected. Attacks of nephritic colic where there is a calculus.
Treatment. Rest. Diluents, to prevent concentration of urine. Gentle and oft-repeated manipulation, if there be an absence of tenderness, so as to force onwards obstructing body. Tapping by aspirator.
HYDRO-PERICARDIUM.— From "TSwp, water ; Tti^ixd^biov, the peri- cardium. Synon. Hydropericarditis ; Hydrops Pericardii ; Hydrocar- dia ; Dropsy of the Pericardium,. — See Pericarditis.
HYDROPHOBIA.— From "rSwp, water ; ^)o|3«co, to dread. Synon. Pho- hodypson ; Rabies; Canine Madness. — A disease caused by inoculation with the saliva of a rabid animal. Period of incubation varies from thirty days to many months. Death often occurs before the end of fourth day from commencement of symptoms.
Symptoms. Cramps of muscles of pharynx and thorax. Spasmodic action of diaphragm. Great dread of fluids. Recurrence of paroxysms of frenzy on attempting to drink, or on exposure to a current of air. A flow of viscid saliva (" hydrophobic slaver"). Restlessness. Anxiety. Delirium. Exhaustion.
Treatment. Prophylactic : — Suction of wound. Excision of bite. Ex- posure of wound to stream of water. Nitrate of silver. Caustic potash. Actual cautery.
Curative : — Chloroform. Chloral. Belladonna. Subcutaneous injec- tions of liquor atropise. Hydrocyanic acid. Indian hemp. Wourali. Ice. Opium. Curari. Calabar bean. Sulphite or hyposulphite of soda or magnesia. Yinegar. Vapor baths. Iodide of potassium. Laying open cicatrix and inducing suppuration. Division of nerves leading to wound. Application of ice to spine. Transfusion of blood. Copious enemata of plain water.
Remedies which have been employed: — Venesection to syncope. Cup- ping at nape of neck. Morphia injections into veins. Vaccination. Strych- nia. Galvanism. Arsenic. Iron. Turpentine. Tobacco. Calomel. In- jections of warm water into veins.
IIYDRORACHIS— HYPOCHONDRIASIS. 143
HYDRORACHIS. — From "rScop, water; ^dx(-i, the spine. Synon. Hy- drorrhachia ; Myelochyais ; Hydrocele Spinalis ; Dropsy of the Spine. — The serous efi'usion is either within the spinal canal, or in a sac — spina bifida.
Usually congenital. When fluid has been present for some time, the pressure produces atrophy of cord. — See Spina Bifida.
HYDROTHORAX.— From "T6wp, water; (9wptt|, the chest. Synon. Hydrops Thoracis; Pleurorrhoea Serosa; Dropsy of the Chest. — -An effusion of serum, or of serum mixed with blood, into the cavity of the pleura. Usually a result of inflammation, but sometimes a true dropsical non-inflammatory effusion. — See Pleurisy.
HYPER.ffiMIA. — From 'Trffp, in excess ; aI|Utt, blood. Synon. Plethora ; Polyiemia. — An excess of blood ; or, a superabundance of red corpuscles, producing superfluous richness, without any increase of the other com- ponents.
Symptoms. Lassitude. Indolence. Desire for sleep. Snoring and dreaming. Vertigo. Hemorrhage. Distended capillaries. Full, strong, resistant pulse. I'urgidity of veins.
Treatment. Restricted diet: non-nutritious substances. Active exer- cise. Saline purgatives, 165, 167, 169. Bromide of ammonium, 37. Liquor potassse, 73. Liquor arsenicalis. Mercury. 'I'artar emetic. Bloodletting. Issues. Mineral waters of Cheltenham. Vichy. Fried- richshall.
Abstinence from : — Beer; wine; spirits; sugar; milk; fatty matters. Lessened amount of sleep.
HYPERMETROPIA. — From 'Tttip, in excess ; ^hpov, measure ; and Ci-^, the eye. Synon. Over-sight. — That condition in which the refractive power of the eye is too low, or the optic axis (antero-posterior axis) too short. Consequently when the eye is in a state of rest, parallel rays are not united upon the retina, but behind it, and only convergent rays are brought to a focus upon the latter (Soelberg Wells).
Symptoms. A sense of heat and fulness about the eyes on reading : the print appears indistinct, and the words seem to run into each other. Dis- tant objects not seen clearly. Eyes look smaller and flatter than in health. Dull frontal headache.
Hypermetropia is one of the causes of asthenopia, as well as of convergent strabismus. Sometimes associated with presbyopia.
Treatment. Carefully-selected convex spectacles. Glasses increasing in power will have to be gradually used until the hypermetropia is com- pletely neutralized.
HYPOCHONDRIASIS.— From 'Tjtoxoi'bpiaxo;, afl'ected in the viscera under the false ribs, — because such affection was regarded as the cause of melancholy. Synon. Hallucinatio Hypochondriaca ; Anathymiasis ; Spleen ; Vapors ; English Malady ; Low Spirits. — May be said to consist prominently of an exaggerated egoism.
Symptoms. Frequently functional derangement, occasionally structural disease, of certain organs, especially of those connected with functions of nutrition and generation. Hypochondriacs writhe under despotism of imaginary evils. They fulfil their duties naturally, at least for a time, but are morbidly sensitive of opinions and actions of others. Constantly dwell- ing on their miserable condition. Dread of internal disease, impotence, insanity, death. Want of resolution. Languid circulation. Decayed teeth. To same extent that hysteria is peculiar to females, is hypochon- driasis to male sex.
144 HYPOSPADIAS AND EPISPADIAS— HYSTERIA.
Treatment. Purgatives injurious as a rule. Action of bowels to be maintained by exercise and proper diet. Narcotics and sedatiA'es increase the mischief, and check secretions. If there be anaemia, quinine and steel. 379. Strychnia, or nnx vomica, 387, 407, 408. Phosphate of zinc and bark, 414. Hypophosphite of soda, or lime, 419. Phosphate of iron, 405. Nitro-hydrochloric acid, 378. Sulphate of majiganese. Bromide of potas- sium. Cod-liver oil. Assafoetida. Musk. Sumbul. Shower bath. Sea bathing. Turkish bath. Nourishing food. Exercise in open air. Riding on horseback. Physical training. Gymnastics.
HYPOSPADIAS AND EPISPADIAS. - Hypospadias ('Trt6, under; (jrtdfco, to draw from) is a congenital malformation, in which the urethra opens on under surface of penis instead of at extremity of the glans. — Epispadias {'F-Tti, upon ; orta^w) is that condition in which urethra termi- nates on dorsum of penis. Either state, when extensive, may call for an attempt at cure by a plastic operation.
HYSTERIA. — From 'Totspa, the womb ; owing to its supposed origin in this organ. Synon. Hyateropathia ; Asthma titer i ; Vaiiores Uterini ; Passi'o Hysterica; Hysterics. — A nervous disorder which occurs in paroxysms, or simulates other diseases. Attacks accompanied with an abundant secretion of urine of low specific gravity : frequently with a sense as of a ball rising in the throat (globus hystericus). Occasionally convulsions. Women from the age of puberty to the decline of menstru- ation most liable to it; though occasionally men are the subjects of it.
Symptoms. Those characterizing hysteric j^aroxysm or fit are : — Con- vulsive movements of trunk and limbs ; beating of breasts with hands clenched, or tearing of hair or clothes ; shrieks and screams, violent agita- tion ; globus hystericus, or feeling of suffocation ; attack ending with con- vulsive outbreaks of crying or laughter, and sometimes with hiccough. Occasionally patient falls to ground insensible and exhausted ; soon re- covering, tired and crying. Perhaps urine is discharged involuntarily during the excitement.
Hysterical paraplegia, or hemiplegia, sometimes occurs. There may be hyperassthesia, or increased sensibility of various parts, perhaps leading to erroneous suspicions of pleurisy, spinal disease, metritis, or ovaritis. The opposite condition- — anaesthesia, or loss of .sensibility — not uncommon; sometimes lasting for many months, affecting left side more than right, and being so deep that pins and needles may be thrust into substance of affected muscles without causing pain. Appetite for food increased, or diminished, or depraved so that most extraordinary substances are eaten.
Hysteria simulates almost all diseases. The favorite are : — Suppression of urine, stone in bladder, pleurisy, consumption, complete loss of voice, paralysis, epilepsy, and affections of spine or joints. Hysterical cough, hiccough, or vomiting may prove very obstinate.
Peculiar expression of countenance : fulness of upper lip, drooping of upper eyelids. Questions answered abruptly. Pains increased by pretended pressure. Catamenia often irregular : more or less profuse leucorrhoea. Hysteric paroxysms sometimes induced by pressure on one or other ovary. — Sufferings not always feigned. Perhaps generally, patient believes she is grievously afflicted. Even where pins are thrust under skin, stones placed in vagina, or food refused unless it can be obtained surreptitiously, the patient is diseased. She resorts to these practices to increase sympathy of friends.
'I'reatment. During paroxysm: — Loosen dress. Prevent self-injury. Surround body with cool air. Ammonia to nostrils. Hand over mouth and compression of nostrils till attempts to breathe become powerful, then suddenly allowing entry of air. If it can be swallowed, a draught contain-
ICHORHiEMrA— IMPETIGO. 145
inc; a drachm of ammoniated tincture of valerian. If apparent insensibility continues, cold water douclie over head and face.
In other forms, or during intervals betiveen Jits : — Aloetic aperients, 1.56, 393, 404. Quinine and steel, 380. Steel and glycerine, 392. Strychnia and steel, 408. Zinc and nux vomica, 409. Valerianate of zinc, or am- monia, or steel, or quinine, 410. Phosphate of iron, 40.5. Hypophosphite of soda, 419. Bromide of potassium, 42. Cod-liver oil. Ammoniated tinc- ture of valerian and bark. Compound pill of assafoetida. Nourishing food, pj.xercise in open air. Moral control. Mental occupation. Shower baths. Sea bathing. Galvanism. Attention to uterine functions ; checking cata- menia if too abundant, promoting them if too scanty.
ICHORH.ffiMIA. — From 'lx<^p, pus ; al,ua, blood. Synon. Septicaemia; Pyoimia ; Fyolicemia. — A morbid condition of the blood, caused by the introduction of ichorous or putrid matters. Sometimes called Septiccemia, when fatal without local formations of pus, and pycemia when secondary abscesses follow.
Symptoms. Shivering. Sweating. Rapid pulse. Sallow look. Epilepti- form seizures. Sweet hay-like odor of the breath. Diarrhoea. Dysentery. Pleurisy. Pericarditis. Peritonitis. Erysipelas. Boils. Secondary ab- scesses. Rapid wasting. Feebleness. Death from prostration. In chronic cases the symptoms come on much more gradually, and are less intense.
Trkatmknt. Calomel? Aperients. Vapor bath. Wet sheet packing, 136. Acid sponging, 138. Perfect ventilation of sick room. Sulphurous acid gas. Beer. Wine. Brandy. Beef solution, 2. Essence of beef, 3. Bark and ammonia, 371. Quinine in large doses, 379, 386. Sulphui'ous acid. Sulphite of magnesia, 48. Mineral acids, 376, 377. Opium. Cold drinks. Wenham Lake ice. Fomentations. Poultices. Incisions. Leeches ? bleeding ?
ICHTHYOSIS. — From 'Ix^vi;, a fish. Synon. Xerodermct Ichthy aides ; Fishskin Disease. — A very rare, non-contagious squamous disease. Gene- rally congenital and most common on legs. Oharacterizod by development, on one or more parts of body, of thick and hard and dry imbricated scales of dirty gray color. Unattended by heat or pain or itching. The scales or shagreen-like flakes give rise to most unsightly appearance.
Treatment. Interncdly : — Arsenic, 52. Donovan's triple solution, 51. Red iodide of mercury and arsenic, 55. Cod-liver oil. Corrosive sublimate. Solution of potash in sarsaparilla.
Locally : — Warm baths. Alkaline baths. Vapor baths. Collodion. Creasote lotions. Glycerine. Cod-liver oil. Neat's foot oil. Friction with olive oil.
ICTEE.TJS. — From "ixi'spoj, a yellow bird (probably the Loriot-Oriolus Flavus) ; because it was thought that patients affected with jaundice were cured by looking at this bird. Synon. Morhas Arcuatus; Morbus Regius; Cholcemia; Fellis Siiper/usio.—See Jaundice.
IMPETIGO. — From Impeto, to attack ; terminal -igo. Synon. Psydra- cia ; Crusted ov Running Scall ; Pustidar or Humid Tetter.- — A severe inflammation of the skin, sometimes contagious by inoculation of purulent discharge; characterized by an eruption of small hemispheroidal, or flat- tened pustules, most frequently grouped in clusters, and forming thick yellowish scabs ar incrustations. From beneath incrustations a discharge flows : ci'usts get thicker and larger, and fall off, leaving raw surfaces.
Varieties. Impetigo figurata occurs generally on face, especially the cheeks. Attended with constitutional disturbance, and swelling of lym- phatic glands. Pustules arranged in round or oval groups : as they burst 10
146 IMPOTENCE AND STERILITY.
and form scabs, heat and itching become intolerable. In children, impeti- ginous eruption sometimes covers head or face like a mask, and is called crusta lactea : sometimes due to pediculi. /mpeif/t/o .sparsa characterized by scattered pustules ; perhaps irregularly distributed over a limb, or even entire body.
Treatment. Internally: — Quinine, 379. Quinine and steel, 380. Arsenic, 52,381. Red iodide of mercury and arsenic, 5.5. Cod-liver oil. Steel and aloes, 154. Steel and sulphate of magnesia, 166. Potash and lime-water, 73- Iodide of potassium. Colchicum. Plain nourishing food.
Locally : — Vapor or warm water baths. Conium and starch bath, 122. Hydrocyanic acid lotion, 263. Subacetate of lead and glycerine lotion, 264. Creasote lotion, 270. Oxide of zinc ointment. Use of linen dipped in melted suet. Lime liniment. Creasote and red oxide of mercury ointment, 301. Diluted citrine ointment, 305. Whatever ointment used careful removal of scabs necessary. Nitrate of silver. Iodine. Borax. Sulphur. Hairs to be cut close to scalp, if head or beard be attacked. Early puncture of pustules.
IMPOTENCE AND STERILITY.— The term Impotence (from hi, neg. ; possum, to be able) may be applied to every morbid state, in either sex, which prevents the seminal fluid of the male coming into contact with the female ovule. — On the other hand. Sterility (from Irnpo^, barren) is that condition in which either no spermatozoa or ovules are secreted, or their vitality is immediately destroj'ed. Another definition of Impotence is incompetence for sexual intercourse ; of sterility, inability to produce offspring.
1. Impotence in Man. — The act of copulation may be rendered impos- sible by many causes : — By absence or want of development, or malformation, or mutilation of penis. — By mental influences, — violent emotion, passion, over-excited desire, want of confidence, anxiety, grief, disgust : this form most curable, by tact and skill on part of physician (see Montaigne's Essays, Book I. chap. xx.). — By fevers and other severe diseases, sexual organs remaining feeble after general health is restored : curable by ferruginous tonics, nux vomica, sumbul, cantharides, Indian hemp, hypophosphite of lime or soda, sea bathing, nourishing food, and stimulating liniments or gentle galvanism to spine. — By injuries to back part of head,^ — from falls, blows, railway accidents, etc. ; there being generally incurable loss of power and wasting of testes and penis. — By injuries and diseases of spinal curd ; ■which remove the power to copulate, though desire remains and semen may be secreted. — By excessive use of tobacco, Avhich impairs digestion and weakens nervous and muscular systems : opium-eating injurious in same way. — By abuse of sexual functions removing the power of erection, — onanism, excessive intercourse (see Spermatorrhoea). — By excessive obesity : large scrotal herniae.
2. Impotence in Woman.— May be due to : — Firm adhesions of labia pudendi. — Excessively developed and persistent hymen. — Absence, mal- formation, or an impervious condition of vagina (see Vaginal Occlusion). — Obliteration of this canal through inflammation. — A double vagina im- pedes but does not prevent copulation. — Supersensitiveness, with spasmodic closure of vagina (see Vaginismus). — Tumors of vagina, or uterine tumors which have passed into vaginal canal. — Uterine cancer, even when vagina is involved, impedes but does not prevent intercourse and fecundation.
3. Sterility in Man. — May arise from : — Certain diseases, as tuberculo- sis, diabetes, albuminuria, some forms of obstinate dyspepsia: in advanced stages, secretion of seminal fluid usually stopped. — Some cerebral defect, owing to which the functions of testicles have never been called into play.
INDIGESTION— INFLAMMATION. 147
— Diseases of testicles, — tumors, syphilitic sarcocele, cancer, repeated attacivsof inflammation, and varicocele ; though as only one gland is usually affected, these conditions rarely produce sterility. — Malposition of testes, these organs being retained in abdominal cavity ; copulation being feasible with these cryptorchics, but the semen ejaculated being destitute of sperma- tozoa.— Obstruction in the e.xcretory ducts of testicle ; such as temporary or permanent obstruction after epididymitis, power of copulating remaining but ejaculated fluid being destitute of spermatozoa. — Obliteration of ejacu- latory canals from abscesses near prostate or from lithotomy, leading to atrophy of testes. — Impediments to escape of semen ; such as stricture of urethra, in which ejaculated fluid regurgitates into bladder. — Abnormal openings in urethra (hypospadias and epispadias), so that the semen is not ejaculated into vagina. — Abuse of tobacco, and opium, and alcoholic drinks, as well as a syphilitic taint, may destroy vitality of spermatozoa.
4. Sterility in Woman. — May arise from: — Elongation of cervix uteri, Engorgement, or induration of labia uteri. Obliteration, obstruction, or great narrowing of os uteri or cervical canal : closure of uterine cavity by tumors, cancer, etc. — Malposition of uterus, — acute retroflexion and ante- flexion.— Inflammatory affections of uterus. — Occlusion of Fallopian tubes: disease of their fimbriated extremities. — Irremediable procidentia of uterus. — Large vesico-vaginal, or recto-vaginal fistulfe. or complete rupture of peri- neum, allowing improper escape of seminal fluid, — Amenorrhcea. — Exhaus- tion or excessive general weakness. — Too frequent or imperfect sexual excitement; self-abuse. — Indiffei'ence to sexual act, or a restraint of the orgasm ? — Absence, arrest of development, or disease of ovaries ; only a relative, not absolute cause, as both glands are seldom diseased at same time. — Leucorrhoea, especially where the discharge is abundant and acrid ; by causing destruction of the spermatozoa before they reach an ovule. — Syphilitic taint occasionally destroys vitality of ovules.
For the ti-eatment of impotence and sterility refer to the different diseases of the sexual organs under their appropriate heads.
INBIGESTION. — From In, neg. ; digero, to concoct or digest. — See
Dyspepsia.
INFLAMMATION.— From Inflammo, to burn. Synon. Phlogosis ; Phlegmasia ; Hyperlioimatosis. — riometinies a destructive, sometimes a formative process ; consisting essentially of local congestion, and stagna- tion (stasis) of blood, with exudation of liquor sanguinis, emigration of white corpuscles, and proliferation of these and of cell elements of part.
Symptoms. Pain. Swelling. Heat. Redness. Blood when drawn be- comes buffed and cupped. Diminution of red corpuscles, and increase of fibrin : Perhaps an increase of colorless corpuscles. Rise in temperature of the blood. Symptomatic fever. Depression. Rigors. Frequency of pulse. Headache. Thirst. Loss of appetite. Furred tongue. Diminution of chlorides in the urine. Increased excretion of urea. Sweating. Hectic fever. Excessive wasting. Prostration.
Varieties and Results. — Adhesive inflammation. Suppuration. Ul- ceration. Sloughing. Gangrene. Hemorrhage.
Treatment. Generally : — Withdrawal of cause. Repose. Well-ven- tilated sick room. Light diet. Ice and cold drinks. Tea. Milk. Bella- donna. Henbane. Aconite. Opium. Salines, 348, 349, 3.51, etc. Ape- rients. Acid tartrate of potash. Citrate of potash. Colchicum. Carbo- nate of ammonia. Wine or brandy.
Locally : — Fomentations. Poultices. Water-dressing. Ice. Evapo- rating lotions. Baths. Sinapisms. Turpentine stupes.
Antiphlogistic remedies : — Bleeding. Leeches. Cupping. Emetics.
148 INFLUENZA— INSANITY.
Drastic pursratives. Antimony. Mercury. Digitalis. Veratrum viride. Blisters. Setons. Issues. Low diet.
INFLUENZA. — From the Italian. Irijiui^iiza ; because the phenomena Avere thought to be due to the influence of the stars. Synon. Rheuma Epidemicum ; Dejluxio Gatarrhalis ; Epidemic Catarrhal Fever ; La Grippe (in France). — An epidemic disorder attended with great depres- sion, chilliness, running from eyes and nose, frontal headache, cough, rest- lessness, and fever. — Probably due to some peculiar condition of atmosphere.
Symptoms. — Shivering or sense of chilliness down the back, followed by heat and dryness of skin. Urgent frontal headache: aching pains about eyes. Coryza, and sneezing. Tenderness of fauces. Hoarseness. Harass- ing cough, and shortness of breath. Fains in back and limbs. Perverted taste, with disordered stomach. In addition, all the signs of nervous and muscular prostration. Occasionally, acute bronchitis, or pneumonia. Runs its course in less than a week : often ends in diarrhoea, or diuresis, or pro- fuse sweating.
Treatment. Rest in bed for first three days, in properly ventilated room. Barley water. Cold infusion of linseed, lemonade, soda water, raspberry vinegar, etc. Tea and milk. Mutton or chicken broths. In mild cases, drugs unnecessary. — If catarrhal symptoms are urgent: — Ipecacuanha and conium. Henbane. Ethereal tincture of lobelia. Powder of ipecacuan and opium (gr. 10 at night). Indian sarsaparilla with infusion of linseed, 243. Spirit of nitrous ether with camphorated tincture of opium, 348. Inhalation of simple vapors. Iodine, lime-water, belladonna, or conium spray, 262. Sinapisms to chest. Vapor, or hot air, bath. — When prostration is a prominent symptom : — Ammonia and bark, 371. Extract of beef, 1. Wine, or brandy. Brandy and egg mixture, IT. — During convalescence: — Bark and phosphoric acid, 376. Quinine and iron, 380. God-liver oil. Nourishing diet : substitution of milk for tea and coffee. A few days' holiday in the country.
INSANITY. — From In, neg. ; sanus, reasonable. Synon. Mental Alienation; Unsound Hind ; Deranged Intellect; Madness. — No useful definition of insanity can be given. Speaking roughly, it may be said, — That it is a general term used to express the mental condition opposed to sanity; sanity being that state of mind which enables a man to discharge his duties to his God, his neighbor, and himself.
Warnings. Indications of impending cerebral mischief often to be detocted by physician some months before they attract notice of patient or his friends. Cerebral affections not developed suddenly : often rendered incurable by neglect of treatment in early stages. Threatenings which should excite alarm are :— Headache, severe and frequent; attacks of giddi- ness and mental confusion ; paroxysms of irritability, and loss of temper without sufficient cause ; unfounded suspicions ; inaptitude for usual occu- pations ; weariness of life ; sleeplessness, or lethargy ; loss of memory ; some marked deviation from usual line of conduct ; defective articulation ; dimness of sight ; fiightiness of manner ; sufferer feels that he is not quite right, but does not like to consult a physician. He shuns his old friends; is tortured with blasphemous or obscene thoughts ; has frightful dreams ; frequently suffers from dyspepsia.
Complications. Mental diseases often accompanied with symptoms of a variety of bodily disorders. Of all forms of insanity those complicated with general paralysis, or with epilepsy, are the most terrible.
Insanity with General Parcdysis: — An affection sui generis. Some- times spoken of as " general paralysis" ; " general paresis" ; or, more appro- priately, as "progressive paralysis of the insane." — Paralytic lunatics seldom live more than from one to three years. — 1'he paralysis may come
INSANITY. 149
on in a person not previously insane, or in the course of any variety of mental disease, increasing as power of mind diminishes. The first indica- tion is exaltation of ideas, the sufferer is rich or high in position, or wonder- fully strong; sometimes great depravity; with mental change there will be usually an impediment to movements of tongue: convulsive trembling of lips ; articulation muffled and imperfect. As this impediment increases, there come on tottering, uncertain, and vacillating movements in walking : sometimes impairment of locomotion precedes other symptoms. FTand- writing gets changed. A heavy vacant look. Intelligence and judgment greatly lessened. Fits of irritability, hallucinations, and illusions. Loss of memory. Debasement of moral character. Pulse gets frequent and feeble. Tongue on being protruded curves tremulously from side to side. Pupils often of unusual size, and their mobility lessened. Pulse small and long, and vascular tension unduly great. Excretions escape involuntarily, either from want of attention, or from paralysis of sphincters. Hemiplegic seizures, attended with convulsions or coma, not uncommon ; though they generally pass off after use of stimulating enemata, and removal of any col- lection of hardened feces.— As disease progresses, patients become unable to articulate a single word ; they continually grind their teeth ; their weak- ness such that they cannot walk or stand; all traces of intelligence get abolished; they remain motionless and insensible, their torp'd existence being reduced to a kind of slow death. — Calabar bean has appeared to be of great service, but generally all that can be done with remedies is to give sleep, relieve painful symptoms, and support strength. Henbane, in twenty-grain doses, may be useful. Nourishing diet. Warmth. Cleanli- ness. Attention to bowels and bladder.
Insanity ivith Epilepf^y : — Always incurable. Conduct of insane epilep- tics most ferocious; homicidal, or suicidal. Filthy and disgusting in their habits. Residence in a well-ordered asylum does much to induce' a certain amount of mental tranquillity. Good diet, and daily exercise, contribute to physical improvement. Bromide of potassium is said to reduce the fre- quency of the fits, and to soothe nervous irritability. If early death do not result, disease usually subsides into incurable dementia.
Varieties. Differences between various forms of insanity always im- perfectly marked. Descriptions in books extraordinarily distinct, compared with medley of symptoms in real cases. Various forms frequently run into each other.
(1) Mania {yiaivofxo.1, io rage), or raving madness : — Characterized by general delirium. Reasoning faculty, if not lost, is disturbed and confused. Ideas abundant, erroneous, absurd, wandering. Manner violent, excited, mischievous.
Rarely comes on suddenly, though it does so more frequently than other varieties. Premonitory symptoms : — Neglect of family and business. Dis- trust of relatives. Causeless attacks of anger and despondency. Insomnia. Constipation.- — Disease sets in with general delirium, and extreme fury. Tendency to suicide. Shouting, howling, laughing, reciting, etc.. for hours together: angry, furious, destructive, ceaseless movements. Weakness, exhaustion, eniaciation. Want of sleep. Aversion to food. Incontinence of urine. — Recovery preceded by sleep, desire for food, with a gradual cessation of agitation and delirium.
(2) Monomania (Mdvoj, alone ; juatVo^at, to be furious, — irrationality on one subject only), or partial insanity : — That form in which the under- standing is deranged to a certain degree, or is under the influence of some one particular delusion. Mind, vigorous : ideas, few, erroneous, fixed, not under control. Manner, in accordance with predominant idea. A false principle seized upon, which is pursued logically, and from which legitimate consequences are deduced. Thus, a monomaniac insists that his body is made of glass; and impressed with this idea he takes care to avoid rough
150 INSANITY.
handling-, lest he should be broken. Or, in belief that he is a divine instrument of vengeance, he may commit murder. Aside from his partial delirium, he will reason and act like other men ; so that the insanity is often difficult of detection.
There are particular forms of monomania: — Melancholia (Mt^aj, black; Xo'Kr^, bile), or lypemania (Airt*;, sadness; ^avia). is characterized by fear, moroseness, and great despondency ; an unwillingness to move, talk, or take food, etc. — In autoplionomairia (Aurotfoioj, a self-murderer) there is a desire for suicide ; to effect which, melancholies will take most extra- ordinary steps, — In androphonomania {'Avrjp, a man; ^ovivio, to kill) there is an uncontrollable tendency to murder. — Pyromania (nip, fire) is marked by a propensity to set buildings on fire. — An irresistible desire to steal is known as Meptomania [YJKiTtto. to steal).— In erotomania ("Epcoj, love) amatory delusions rule, just as religious delusions predominate in theomania (©soj, God), or religious melancholy. Erotomania may be an excessive degree of a chaste and honorable affection ; or it may be com- bined with nymphomania {Nvfx^r], the nympha) in women, or with saty- riasis {'2dtvf>oi, a satyr) in men. In ail forms of erotomania there is a great mental and bodily depression ; women suffer most frequently, espe- cially the single ; and the phenomena are often connected with some disease of sexual organs.
(3) Dementia [De, priv. ; mens, the mind), or incoherence : — That con- dition in which weakness of intellect, induced by accident or age, is the prominent feature. Mind, altogether feeble; ideas confused, vague, wan- dering ; memory much impaired. Patients ignorant of time, place, quantity, property, etc. : forget immediately what they have just seen or heard. Manners undecided, childish, and silly. The demented have neither affec- tions nor aversions, nor care for anything. Paroxysms of restlessness and excitement. Little or no control over bladder and rectum. In last stage, complete paralysis.
Acute dementia sometimes comes on suddenly in the young from shock or anxiety, etc. Patient lies in bed, takes no notice, refuses food, passes excretions under him. Mental faculties apparently in abeyance. Pupils large. May be cured by feeding and moral influence.
(4) Idiocy [Idiota, a simpleton): — Characterized by partial or complete absence of intellect, owing to congenital imperfection of brain. Mind, not developed: ideas simple or few. Manners foolish; transient gusts of pas- sion. Head small or misshapen. Countenance vacant. Articulation and gait often imperfect, and perhaps saliva dribbling. Occasionally, the idiot is a blind deaf-mute.
Treatment. Prophylactic : — Rest of mind, or change of occupation : proper amount of sleep. Attentions to functions of sexual system, skin, liver, kidneys, alimentary canal. Removal of any bodily disorder. — Hen- bane. Stramonium. Indian hemp. Digitalis. Morphia, or opium. Bromide of potassium. Chloroform. Quinine and steel. Syrup of phos- phate of iron. Phosphate of zinc. Bark. Cod-liver oil. Nourishing food : milk : stimulants with discretion. Change of air and scene.
Carcdive : — All antiphlogistic remedies badly borne. Removal of other disorders, — skin diseases, uterine disturbances, syphilitic taints, gastric and intestinal disturbances, etc. Then, in ordinary forms of insanity, a nutri- tious diet; warm clothing ; out-door occupations and amusements ; cheerful recreation. Sleep at night to be procured by sedatives. Healthy evacu- ations to be obtained from bowels by vegetable alteratives, and mild aperients. General strength to be improved by tonics. All bad habits, as onanism, to be prevented. Gentle and slow attempts to revive aff'ections, and strengthen bewildered intellect. Baths often useful, — douche, shower, warm, or Turkish. Where food is refused, any derangement of stomach or bowels to be removed, and healthy evacuations procured ; this failing,
INTERMITTENT FEVER OR AGUE. 151
forced alimentation, with stomach pump, will be required. All harshness and mechanical restraint to be avoided. Unfortunate patient's confidence to be obtained ; every promise that is made must be kept; as much indul- gence as possible to be allowed.
Restraint in a well-managed asylum, often necessary to enable treatment to be effectually carried out; imperatively called for, when patient has suicidal or homicidal tendencies.
INTERCOSTAL NEURALGIA.— Neuralgia {Niipov. a nerve: ai^yoj, pain) may affect the intercostal, as it does the other nerves of body. Chlo- rotic and hysterical women most liable to it. Sometimes occurs in Bright's disease, phthisis, after herpes zoster, etc. Must not be confounded with neuritis, or with pleurisy.
Symptoms. Pain of a dull and continued aching character, or sharp and paroxysmal. Sometimes lasts for weeks. Most frequently located in sixth, seventh, eighth, or ninth nerves of left side. Follows coui-se of nerves (ante- rior primary branches of dorsal), extending from anterior part of thoracic wall directly backwards to vertebra3. One or two painful spots sometimes detected on pressure. Occasionally, cutaneous hypertesthesia of whole mam- mary or infra-mammary region. Debility. No febrile symptoms. Iq women, cataraenia may be irregular : leucorrhoea.
Treatment. Quinine and aconite, 379. Quinine and steel, 380. Steel and arsenic, 399. Cod-liver oil. Belladonna and aconite liniment, 281. Strips of belladonna plaster completely round thorax. Flannel bandage. Subcutaceous injection of morphia or atropine, if there are one or more sen- sitive spots, 314. Nourishing food. Malt liquors or wine.
INTERMITTENT FEVER OR AGUE.— From Intermitto, to give over for a time. Synon. Periodic Fever. Sometimes termed Paludal fever, from Pa.lufi, a fen or marsh. Endemic. Chiefly due to marshy miasms, or emanations from soil, and not communicable from one individual to another. Characterized by febrile paroxysms, which are ushered in by rigors, and end in a critical sweat. During the remission there is good health; but at the end of a deflnite interval the phenomena are repeated, and this happens again and again until a cure is effected.
Three species of intermittent fever or ague, viz., Quotidian, Tertian, and Quartan. '^J'ertian most common in this country; quotidian in India. When the paroxysm occurs at same hour every day. it is called quotidian ague ; when every other day, tertian, though secundan would be more appro- priate ; and when absent for two whole days, and then recurrent, quartan, In first species the interval is twenty-four hours; in second, forty-eight; in third, seventy-two. The time between commencement of one paroxysm and beginning of next is termed the interval ; that between termination of one paroxysm and commencement of next, the intermission. In quotidians the paroxysm occurs, for most part, in morning; in tertian, at noon ; in quar- tans, in afternoon. The first is most common in spring ; the second, ia spring and autumn ; the third in autumn.
Symptoms. An ague fit is composed of three stages, — the cold; hot, and sweating. The first has a duration varying from 30 minutes to 3 or 4 hours : the second rarely lasts less than 3 or more than 12 hours : while the third continues a few hours, and ends in complete relief Patient comparatively well during interval. — Enlargement of spleen always present; in chronic ague becomes permanently hypertrophied — ague cake. Disturbance of liver and digestive organs. Chronic desquamative nephritis sometimes a consequence of repeated attacks.
Treatment. General rules : — Removal from malarious district. Nour- ishing diet with stimulants. Aperients, or emetics, if bowels or stomach be
152 INTESTINAL OBSTRUCTION.
loaded. Bicarbonate of soda or potash, with a few drops of tincture of bel- ladonna, if bladder be irritable.
In cold stage : — Warm diluent drinks, as weak tea, white wine whey, or Desrus. External warmth by blankets, hot bottles to feet, hot air baths.
In hot stage : — Cooling drinks. Sponging with tepid or cold water. Light coverings. In sweating stage : — Diluents freely. Repose.
Curative remedies: — Quinine; 2 or 3 grains to be given every six or eight hours during the intermission, in acid infusion of roses ; or a single large dose, 10 or 15 grains, just before rigor expected. In Indian iutermit- tents, 10 or 20 or 30 grains of quinine during sweating stage. Subcutaneous injection of quinine, 379. Arsenic, 52. Salicin. Sulphate of beberia.
To reduce the Spleen : — Quinine and iron. 380. Bromide of potassium, 42. Cod-liver oil. Friction with ointment of red iodide of mercury diluted with an equal quantity of lard. Iodide of potassium ointment. Compound ointment of iodine.
INTESTINAL CONCRETIONS.— Synon. Alvine Calculi; Intestinal Calculi.^CaXcuXon?, concretions very rare in human intestines, compared with their frequency in large ruminating animals. In man, they are more common in caecum and colon than in other portions of alimentary canal. Bezoars consist chiefly of imperfectly crystallized earthy salts and indiges- tible fibrous matters or husks of oats arranged in concentric layers round a nucleus — a gall-stone or anv foreign body. Other concretions may consist solely of hardened feces, with the phosphates of lime and magnesia; or of .chalk or carbonate of magnesia, where these substances have been largely taken ; or of hair, cotton, or paper when a depraved appetite has led to the consumption of either ; or of gall-stones with layers of inspissated mucus and fecal matter. Either kind may gradually increase in size, until there is complete obstruction of the gut. In fortunate cases, concretions have been expelled by vomiting or passed at stool. When situated in the rectum, they can be removed by the scoop. If one or more can be felt through the abdo- minal parietes, producing obstruction, an incision into intestine has been recommended, all other plans failing.
INTESTINAL OBSTRUCTION.— Synon. Ileus (from Ealw, to twist or contract): lleac Passion; Cohque de Misericorde ; Volvulus [Volvo, to turn or roll itself round aljout).
Causes. Excluding examples of inguinal and femoi'al and umbilical her- nia, the causes are : —
(1) Intermural, or those originating in and implicating mucous and mus-
cular coats of intestinal walls : —
a. Cancerous stricture, most common in sigmoid flexure of colon
and in rectum. h. Non-cancerous stricture, comprising —
1. Contractions of cicatrices following ulceration.
2. Contractions of walls of intestine from inflammation, non-
cancerous deposit, or injury.
c. Intussusception : ileum and caecum most commonly protruded
into colon.
d. Intussusception associated with polypi.
(2) Extramural, or those causes acting from without, or affecting the
serous covering : — .
a. Bands and adhesions from effusion of lymph. 6. Twists or displacements.
c. Diverticula.
d. External tumors or abscesses.
e. Mesocolic and mesenteric hernia.
/. Diaphragmatic and foramen of Winslow hernia.
INTESTINAL PERFOEATION— INTESTINAL WORMS. l^B
g. Omental hernia.
h. Obturator and ischiatic and perineal hernia.
(3) Intramural, or obstructions produced by lodgment of foreign sub- stances : — a. Foreign bodies, hardened feces, concretions having for nuclei gall-stones, etc.
Of these the most common and the most important is intussusception, which occurs most frequently in children, the symptoms being sudden oc- currence of abdominal pain, constipation, and vomiting, with passage of blood by the bowel, and collapse. tJsually a tumor can be felt at the seat of the invagination, and sometimes the invaginatod bowel can be felt in the rectum.
Symptoms of Intestinal Obstruction. Constant vomiting : at first of mucus and contents of stomach, but in a few days of fecal matter (stercora- ceous vomiting). Pain, often very severe. Tympanites, with violent bor- borygmi unless occlusion be high up. Hiccough, especially in strangula- tion of upper part of small intestines. Mental depression. Pathognomonic symptom — constipation. Palpation often detects increased fulness just above obstruction: more marked diminution of resonance at this point than elsewhere. Early prostration. Acute peritonitis commonly occurs in a few days. Gangrene most frequent in intussusception and obturator hernia. H'he lower the obstruction, the less urgent the vomiting, and the longer the time before it commences. The higher the obstruction, the greater the diminution in the quantity of urine.
Treatment. When diagnosis is doubtful : — Castor oil. 'Castor oil and turpentine enema, 190. Croton oil enema, 19L
Directly it is certain a mechanical obstruction exists : — Purgatives injurious. Extract of opium (gr. 1 every four, six, or eight hours). Opium and belladonna, 344. Subcutaneous injection of atropine, 314. — Fomenta- tions. Linseed poultices, with application of belladonna and opium. 297. — Food and fluids in very small quantity. Ice. Frozen milk. Lime-water and milk, 14. Tea and cream. Brandy and water. Essence of beef, 3. Eggs, cream, and extract of beef, 5. Brandy and ^gg mixture, 17.— Flot baths. Enemata of large quantities of fluid, with manipulation of intestines by pressure on them through abdominal walls. Inflation with air by means of bellows while under chloroform. Gastrotomy.
INTESTINAL PERFORATION.— The intestine may be perforated owing to: — (1) Disease in coats of bowel, — as in typhoid fever, inflamma- tion of caecum, dysentery, ulcer or cancer of stomach or intestines, etc. (2) From extension of ulceration in disease of adjacent organs, — as in hydatids and abscess of liver, calculi in gall-bladder, ovarian tumors, extra-uterine pregnancy, ovarian abscess, pelvic cellulitis, cancer of uterus or vagina, and suppuration in abdominal parietes.
INTESTINAL WORMS.— Seven principal entozoa ('Ev-r'oj, within; l^oi/, an animal) may be found inhabiting intestinal canal: — Tricocephalus dis- par, or long thread-worm; Ascaris lumbricoides, or large round-worm; Oxi/uris vermicidaris, or small thread-worm; Sclerostoma duodenrde, un- known in this country ; Taenia solium, or common tape-worm ; Taenia me- diocanellcda, or bookless tape-worm ; and Bothriocephcdus latus, or broad tape-worm, almost peculiar to inhabitants of Switzerland, Russia, and Poland.
Symptoms. Colicky pains and swelling of abdomen. Picking of nose. Itching of rectum and fundament. Foulness of breath. Irregularity of bowels. Grinding of teeth at night. Frequent feeling of malaise. Vora- cious or impaired appetite. Only conclusive sign, — passage of worms, or
154 INTRA-THORACIC TUMORS.
of joints of them, in stools. — From reflex irritation, epileptic attacks or chorea may occur.
Treatment. — For ta-pe-tunrms: — Liquid extract of fern root, 187. Kousso, 184. Kainela, 182. Decoction of pomeoranate root, 1.59.
for round-ioorms: — Santonin. For either kmd .-—Oil of turpentine, 183. Calomel with scammony or jalap, 159. Garlic (Allium sativum). Oil of rue. Assafoetida. Oxide of silver. Spigelia. Veratria. Chloride of tin. Sulphur. Gamboge. Croton oil. Covvhage (Mucuua pruriens). Com- mon salt.
For thread-ivorms : — Calomel with scammony or jalap for three succes- sive nights, to dislodge them from caecum. Then enemata of cold water; lime-water; infusion of quassia ; steel and quassia, 192; common salt, 188; spirit of ether (min. xv to each ounce of water); olive oil, 159. To kill or remove them from rectum : — Santonin, 185.
7'o prevent recurrence : — Avoidance of raw and underdone animal food, especially pork ; as well as of imperfectly washed raw vegetables. Steel and sulphate of soda, 180. Quinine, rhubarb, and hop, 370. Infusions of chamomile, chiretta, quassia, or rhubarb. Quinine and steel, 380. Steel, glycerine, and quassia, 392. Compound iron mixture and aloes, 393. Ex- tract of nux vomica, 175. Phosphate of iron, 405. Steel, hydrochloric acid and quassia, 397. Ammonia iron-alum. 116. Glycerine. Cod-liver oil. Extract of wormwood (Artemisia absinthium). Oil of stink wood (Cheno- podium anthelminticum. — See Entozua.
INTRA-THORACIC TUMORS.— May be aneurismal; or composed of cancer, enlarged glands, simple exudation matter, fibrous tissue, or of fatty or steatomatous matter. Discarding aneurisms, these tumors usually have their origin in the glandular structures, and are developed in the mediastina.
Symptoms. Chiefly due to pressure exerted on heart or lungs, or on the nerves and vessels. Hence, tumor often considerable before it interferes with circulation or respiration.
Genercd symptoms: — Will vary with situation, character, and rate of growth of tumor, and will be some of the following: — More or less pain; restlessness; cough; dyspnoea, or even orthopnoea ; frothy or viscid expec- toration; palpitation; hoarseness; frequently dysphagia; sometimes hffimo]itysis. Pleurisy with effusion, bronchitis, pneumonia, laryngitis, or tracheitis may arise from constant irritation. Pulmonary collapse may be caused by pressure. Bulging or even perforation of ribs and sternum. Dis- placement of heart. Impediment to circulation through aorta, or through superior or inferior vena cava. Spasm or paralysis of laryngeal muscles from pressure on recurrent laryngeal nerves. Dulness on percussion more marked as growth protrudes into anterior mediastinum. Auscultatory signs vary according to nature of secondary complications.
In primary cancer involving root of lung, inflammatory condensation of pulmonary tissue, with disorganization and abscess, may result early. These changes probably due to tumor involving and destroying all or a greater part of pulmonary nerves as they pass off" from root of lung.
Death takes place slowly in mediastinal tumor generally. The pain, want of sleep, loss of appetite, dyspnoea, etc., weaken patient. Anaemia, followed by anasarca, sets in. Sometimes sudden death from hemorrhage, thrombosis, or spasm of glottis. '
Treatment. All that can be done is to palliate symptoms. Temporary relief may be given by, — Diuretics and aperients Antispasmodics, — Ether, chloroform, belladonna, aconite, stramonium, opium, etc. Iodide of potassium, 31. Iodide of ammonium, 38. Chlorate of potash, 61. Dry cupping. Inunction with red iodide of mercury ointment, 302. Iodine and cod-liver oil ointment, 308. Iodide of cadmium ointment, 311. Venesec-
INTUSSUSCEFTION-IRITTS. 155
tion to six or eight ounces, if symptoms of pulmonary or cardiac congestion predominate.
INTUSSUSCEPTION.— From Intus, within : suscipio, to carry. Synon. Invagination [In, within; vagina, a sheai'h). — That condition in which one part of the bowel is drawn into another portion, just as the finger of a glove is pulled within itself. Owing to the congestion, effusion, and inflammation which result, the canal of the bowel gets more or less obstructed.
'I'he intussusception may be single or multiple : the traction is usually from above downwards : in about half the cases, ileum and caecum protruded into colon : most common in young children and aged persons.
Symptoms. The chief are sudden violent pain; sickness; obstinate con- ^ stipation; collapse; discharges of blood and mucus per anum. Spontane- ous reduction may take place. In less fortunate cases, inflammation of peritoneal coats of involved portion usually sets in between third and seventh days; opposed surfaces becoming adherent. Inflammatory action may end in gangrene ; several inches of included sphacelated bowel coming away by stool, and leaving canal of gut free. Usually fatal.
Treatment. See Intestinal Obstruction.
IRIS, Diseases of. — From 'ipt?. the rainbow, — any object supposed to resemble a rainbow. Suspended (like a curtain with a circular aperture in its centre) between the cornea and crystalline lens, and bathed on both sides by aqueous humor, the iris serves to regulate amount of light admitted to retina. By it. the cavity containing aqueous humor is divided into an an- terior and a posterior chamber.- — Iris composed of delicate bundles of fibrous tissue, of circular and radiating involuntary muscular fibres, and of pigment cells. Sometimes absent; or only present in a rudimentary form, a condi- tion known as Irideremia. — In Albinism the iris is of a rose color, while pupils present a deep red appearance owing to absence of opaque pigment (uvea). — In Coluboma the two halves of the iris have failed to unite, in consequence of arrest of development, so that pupil has an elongated form.
1. Acute Inflammation (Iritis). — Synon. Iriditis; Injlammatio Iri- dis. — The iris is seldom alone attacked : sclerotic and deep-seated textures of eye generally also involved. Hence, objections have been raised to use of term Iritis: its employment "has the effect of directing (he practititioner's attention to the iris, which bears a great deal of inflammation without de- struction to the organ, and withdrawing it from the retina, which bears very little without pertnaneut injury to vision." (Jacob.)
Symptoms. In first stage, iris presents a confused appearance, owing to its fibrous texture becoming indistinct : loses its contractile })ower, and un- dergoes a change in color. Sclerotic becomes extravascular. In next stage, fibrin effused on surface of iris, and in anterior chamber. If inflammation proceed, pupil may get closed, or its margin become adherent to capsule of lens ; or cornea may be rendered opaque ; or permanent opacity of lens or its capsule may result.
The important symptoms may be thus enumerated : — (1) Zonular sclero- titis; fine hair-like vessels, running in radii towards edge of cornea. (2) Discoloration of iris. If naturally blue, it becomes greenish ; if dark colored, reddish. This the result of increased vascularity, or of effusion of lymph into its substance, or on its posterior surface. ['?>) Contraction, irre- gularity, and immobility of pupil. (4) Effusion of coagulable lymph into pupil and posterior chamber, and occasionally into anterior chamber. (5) Adhesions of iris, and especially of pupillary edge, to capsule of lens ; in some rare cases, to cornea. (6) Tubercles, pustules, or small abscesses of iris. (7) Dimness of sight, and sometimes total blindness. (8) Pain in eye, and nocturnal circumorbital pain. (Mackenzie.)
156 IRITIS.
Not to be supposed that in every case all the foregoinnf symptoms will be met with : rather a certain number of them will be found, sufficient 1o render diagnosis certain. Constitutional disturbance well marked, thoug^h not generally severe.
If inflammation be not checked, it creeps on, involves choroid coat and retina, and. spoiling delicate texture of latter, completely destroys sight forever. — When one eye has been permanently injured, especially when any foreign body lodged in it, sympathetic subacute inflammation is not unfre- quently set up in the sound organ at the end of some months, or even in the course of a few days, which may go on to produce complete destruction. To prevent this it is often necessary to remove the eye which was first damaged.
The chief causes are : — Exposure to cold and wet. giving rise to rheumatic or idiopathic iritis ; syphilis, causing syphilitic iritis; injuries and wounds producing traumatic iritis ; and certain conditions of the constitution, espe- cially the scrofulous, rheumatic, and gouty.
Iritis arising as a secondary effect of syphilis is perhaps the most com- mon. May occur at all ages. Usually attended with other effects of consti- tutional syphilis — copper-colored eruptions, nodes, pains in bones especially severe at night, and ulceration of throat. At first, redness is less severe than in I'heumatic form ; there is seldom any haziness of cornea, as in rheumatic iritis ; iris often assumes a rusty color, especiallj^ near pupillary edge ; pupil is apt to be displaced, and to be drawn upwards towards the root of the nose.
The object must be to check flow of blood towards the part ; to arrest effusion of fibrin; and to procure absorption of that poured out. Patient to be kept quiet, preferably in darkened room, and with eye protected from light. — The pxii^il to he kept dilated (in order to prevent iris from forming adhesions with capsule of crystalline lens) by belladonna; or more conve- niently by solution of atropine, 288; or by atropine gelatine disks. Sedative fomentations, if the eye is morbidly sensitive; bowels to be kept regular by mercurial purgatives or enemata ; opium to be given to relieve pain; diet to be plain but nourishing, and free from stimulants. Iodide of potassium (31) often of great value, especially in rheumatic and strumous iritis; in that dependent upon syphilis, mercury (2.5, 34, 131) more useful, though not to salivation. — If there he depression, — Ammonia and bark, 371 ; quinine, 379 ; salicin and sarsaparilla, 388. — When circumorhital pain is 27?.^eH6e,^i'elief may be afforded by mixing three grains of powdered opium with ten of mercurial ointment, and well rubbing the compound into the temple. No astringeut or other collyria should be employed.
Other remedies recommended : — 'I'urpentine ; colchicum ; cod-liver oil ; santonin ; henbane. Stramonium (locally, as a substitute for belladonna).
2. Inflammation of Iris and Cornea. — It was erroneously believed until recently that a serous membrane or capsule covered the posterior sur- face of cornea, both surfaces of iris, and front of capsule of lens. Hence the present disease was supposed to consist of inflammation of this membrane, and was named " aquo-capsulitis."
Symptoms. They run a chronic course. There is chiefly — intolerance of light; vascularity of sclerotic; haziness of cornea; and slight change in color of iris. General health always bad. The disease very obstinate in delicate children. Probably always the result of inherited syphilis.
Treatment. Mild alteratives; tonics; good diet. Tincture of iodine carefully applied to skin of eyelids often relieves intolerance of light.
3. Mydriasis. — A dilated condition of pupil, causing imperfect vision. From MvSpiaotj. Formerly supposed to be due to redundancy of humors. — ■ From paralysis of third nerve or motor oculi, long continued use of bella- donna, and other causes, the iris sometimes loses its power, so that pupil
JAUNDICE— KELOID. 157
remains dilated. This condition must not be confounded with immobility of pnpil owing to disease of retina, from which it may be distinguished by a simple experiment. 'I'he patient is directed to supply the want of a contracted iris by looking through a large pinhole in a card held close to the eye. If case be one of mydriasis, he will see perfectly : whereas if retina be diseased, the aperture will be nearly or quite useless. — 'I'he remedies for mydriasis consist of tonics which act specially upon the nervous system, — Zinc, 414, 416; nux vomica, 387,409. Phosphate of iron. 405. Strychnia and steel, 408. Ergot of rye. A succession of blisters to the temple. Concave glasses often serviceable. The local employment of the Calabar bean might be useful where the disease has been caused by belladonna.
4. Myosis. — From MiJo, to contract. An unduly contracted state of the pupil. — There is obscurity of vision, especially in a weak light. The reme- dies are rest, with tonics to improve the general health. The use of bella- donna has been condemned.
JAUNDICE. — Probably from the French Jaunir, to become yellow. Synon. Icterus. — A prominent symptom of many varied morbid processes rather than a specific disease.
All forms can be included under one of two divisions: — (1) Those due to suppression of biliary functions, in which the coloring matter of bile and cholesterine accumulates in the blood. (2) Those arising from re-absorp- tion of bile properly formed, due either to derangement of the hepatic circulation or to obstruction to the flow of bile into the duodenum. After jaundice from obstruction has existed some time, suppression likewise occurs ; owing to backward pressure exerted on hepatic parenchyma by over-distended bile-tubes impeding capillary circulation through the gland.
Symptoms. Yellowness of conjunctivae and skin. Saffron hue, or brownish- black tinge of urine ; according to amount of bile-pigment present. White colour, or light clay appearance, of feces. Itching of skin. Perhaps, ex- haustion ; drowsiness, giddiness, and peevishness: bitter taste ; slow pulse; dyspepsia, especially for fatty food. Exceptionally, corneas, or aqueous and vitreous humors have become jaundiced, making all objects appear of yel- low hue.
If disorder be of long continuance, there may be marked stupor, delirium, and other indications of cerebral derangement. Weakness and emaciation from mal-nutritiou. 'J'endency to hemorrhage — bleeding from gums, pur- pura, etc.
For causes and treatment of jaundice see Hepatic Diseases and Gall- stones. The two most common causes are probably catarrh of duodenum and biliary passages and gall-stones. In the first, there are weight, uneasi- ness, and dull pain at epigastrium, nausea, flatulence, constipation, etc. Where there is obstruction from a gall-stone, most severe suffering results ; vomiting and hiccup, perhaps fatal exhaustion.
Test for bile in urine : — Add to small quantity of urine strong nitric acid, drop by drop. A play of colors, brown, green, blue, red, or sometimes only greenish tint shows presence of bile pigment. A purple color by strong sulphuric acid and sugar said to indicate biliary acids — this doubtful.
KELOID. — Perhaps from KrjXij, a tumor; fJSoj, like. Described by Ali- bert as Kelis, Cheloidea, or Cancroide ; owing to its presenting a flattish raised patch of integument, resemblig the shell of a tortoise (Xe^u?, a tor- toise ; terminal -ides). — Consists of flat, tender, cutaneous excrescences, one or more inches in diameter ; raised a few lines above level of skin ; having irregular forms, resembling a cicatrix left by a burn, and often arising in cicatrices. There may be only one tumor or several. Disease developed slowly ; rarely ends in ulceration ; sometimes disappears spon-
158 KNOCK-KNEES— LARYNGITIS.
taneonsly, merely leaving a cicatrix; is usually found on chest between the mammae; and is very uncommon.
'J'reatjient. Arsenic, .52. Donovan's triple solution, 51. Iodide of po- tassium. Cod-liver oil. Removal by knife or caustics, injurious. Pressure, useless.
KNOCK-KNEES, — Synon. Genua Volga. — A relaxation of internal lateral ligaments of knee-joints, allowing femur and tibia to become sepa- rated, so that an angular obliquity of the bones results. — May come on in delicate and strumous children when they begin to walk. Not uncommon in porters who carry heavy weights on the head. When treatment is called for may be remedied by an articulated apparatus extending from pelvis to heel. Improvement of general health.
LARYNGISMUS STRIDTTLITS.— From AapuyyJI^o, to vociferate with all his might ; Strideo, to make a hissing noise. Synon. Apnoea Infantum • Laryngospasmufi ; Infantile Laryngismus ; Thymic Asthma; Spurious or Cerebral CrnujD ; Child-crowing. — A spasmodic disease occurring in in- fants, chiefly during dentition. It consists of a temporary, partial, or com- plete closure of rima glottidis; by which entrance of air into lungs is im- peded or stopped.
Symptoms. Interruption of breathing. Rigidity of fingers and toes, — carpo-pedal spasm. Child suddenly seized with dyspnoea ; it struggles and kicks, is unable to inspire, and seems about to be suffocated. Presently, spasm ceases ; air drawn through chink of glottis with a shrill whistling or crowing sound. Paroxysms may return in a few hours or days ; induced by emotion, anger, fright, or come on when child wakes up or cries.
Treatment. During paroxysm : — Bot water to lower parts of body, with cold affusion to head and face. Slapping of chest and nates sharply. Exposure of face and chest to current of cold air. Gentle inhalation of chloroform. Vapor of ether or ammonia to nostrils. Artificial respiration, drawing tongue well forwards. As a last resource, tracheotomy. — During interval: — Mild purgatives. Cod-liver oil and steel wine. Anthelmintics, if necessary. Antispasmodic tonics : — Zinc and belladonna, 92. Assafcetida. Hydrocyanic acid. Valerianate of iron. Quinine. Out-door life. Espe- cially change of air. Cold sea-water sponge baths. Simple diet, with milk. Lancing of gums, if they be tender and swollen.
LARYNGITIS. — From Adpuyl, the windpipe; terminal -itis. — Acute inflammation of the larynx is a rare disease unless croup be included ; it is generally latal. OEdema of glottis may occur from other causes than acute inflammation. Larynx also liable to chronic inflammation, ulceration, polypi, etc.
1, Acute Laryngitis.— Synon. Infiammatio Laryngis ; Cynanche Laryngea ; Angina Laryngea. — Almost peculiar to adults. Generiilly arises from cold and wet in unhealthy constitutions. Occasionally caused by syphilis. Inflammation often of limited extent; the great danger due to its situation.
Symptoms. Come on insidiously. At end of some hours, — fever; red- ness of fauces; pain referred to pomum Adaini ; difficulty of breathing and swallowing ; considerable anxiety ; hoarseness or even complete loss of voice. Spasmodic exacerbations : paroxysms of threatened suffocation. Long in- spirations : peculiar wheezing sound, as if air were drawn through a narrow tube. Perhaps, harsh and brassy cough. Dysphagia : liquids swallowed with more difficulty than solids. Face gets flushed ; eyes protruded ; pulse hard ; great general distress. Larynx and trachea move rapidly upwards and downwards : all the muscles of respiration brought into strong action.
LEAD COLIC. 159
so that chest: heaves violently. Patient gasps for breath : tries perhaps to get to open window. He soon sinks into a drowsy and delirious state; and speedily dies suffocated, from obstruction of chink of rima glottidis.
'J'reatment. Rest and quiet: forbid talking. Air of room to be kept moist : temperature 70° F. 'i'urpentine, or hot water, stupes to neck. Ex- tract of belladonna to neck, with linseed poultices. Inhalation of steam of boiling Avater : or of vapor medicated with hydrocyanic acid, or a little chloroform, 261. Inhalation of spray medicated with stramonium, bella- donna, conium, or iodine, 262. A respirator to be worn during intervals between inhalations. Directly there are indications that the blood is not thoroughly oxygenated,- — tracheotomy. Milk or cream. Raw eggs. Beef- tea. Wine or brandy.
Bleeding, blistering, calomel, tartarated antimony, — positively injurious. If disease be due to constitutional syphilis, free mercurial inunction ; mer- curial vapor baths, 131.
2. (Edema of Glottis. — Synon. (Edematous Laryngitis ; Hydrops Glottidis ; Subviucous Laryngitis. — May be caused by laryngitis ; boiling water, or corrosive poisons taken accidentally into mouth ; pharyngeal ery- sipelas. Sometimes simulated by dyspnoea of general anasarca, renal dis- ease, etc. Hence a laryngoscopic examination should often be made to remove all doubt. To favor subsidence of tumefaction sponge epiglottis and cavity of larynx with solution of nitrate of silver (gr. 60 of crystals to one ounce of distilled water). Scarifications of oedematous swelling may be successfully made by aid of laryngoscope. These plans failing, — laryn- gotomy or tracheotomy.
3. Chronic Laryng'itis, etc. — Chronic inflammation and ulceration not uncommon in pulmonary consumption ; a species of tuberculosis known as 'phthisis laryngea. — Membrane lining laryngeal cartilages often becomes thickened and ulcerated in constitutional syphilis. — Polypi and warty tumors arise from different parts of larynx : cause great impediment to entrance and exit of air, and especially impairment or loss of voice. May be removed by aid of laryngoscope with a small wire ecraseur. — Epithelial cancer occasionally seated about vocal cords. — See Foreign Bodies in Air-passages.
LEAD COLIC. — Synon. Painter's Colic; Saturnine Colic; Morbus Metallicus ; Colica Rachialgia ; Dry Gripes ox Bellyache ; Cohca Pic- tonum, from its former frequency among the Pictones or inhabitants of Poictou. — Attacks of colic, vomiting, and constipation from the presence of lead in the system. Often followed by paralysis.
Symptoms. In addition to those of ordinary colic, and intense grinding or twisting sensation round navel ; retraction of abdominal integuments towards spine : pain in back. A blue or slate-gray line round edges of gums.
House painters suffer most frequently : often have many attacks before muscles of arms become affected with paralysis, causing drop-ivrist. Sleep- ing in a recently painted room, drinking fluids which have been kept in leaden vessels, effervescing drinks kept in bottles with syphon taps, taking snuff adulterated with lead, etc., are not uncommon causes.
'I'reatment. During attach: — Calomel and jalap, with sulphate of magnesia. 140. Sulphate of magnesia and sulphuric acid, 142. Sulphate of magnesia with tincture of opium and ether. Sulphate of soda and sul- phuric acid, 143. Castor oil, 164. Croton oil, 168. Enemata of warm water. Hot baths. Opium and chloroform, 316. Morphia and ether, 31.o. Morphia, chloroform, and Indian hemp, 317. Opium and belladonna, 344. Faradization : perhaps while patient is under influence of chloroform. Farinaceous food. — Subsequently, to eliminate pjoison : — Iodide of potas-
160 LEPRA— LEUCORRHOEA.
Kinm. 31. Sulphur baths, 125. Sulphate and carbonate of magnesia, 141. Colchicum, 46. — Prophylactic : — Sulphuric acid drink. Attention to functions of skin and bowels. Avoidance of abuse of alcoholic drinks. — See Col/'c ; Paralysis.
LEPRA. — From Asrtpa, a scaly state of the skin. Synon. Common Dry Tetter ; European Leprosy ; Alplios ; Psoriasis. — The most obstinate and troublesome of all curable cutaneous diseases. A non-contagious squamous eruption ; consisting of red and scaly circular patches, of various dimensions, scattered over different parts of body. Most frequently found in the neighborhood of the joints, especially near the knee and elbow. Common lepra affects mostly extensor aspect of limbs, olecranon and below patella ; syphilitic lepra often on flexor surface. By degrees, patches increase in size and number, and extend along extremities to trunk.
Varieties. When the patches are of moderate size, round and reddish, and covered with thin white scales, affection known as lepra vulgaris : when eruption is smaller and whiter than the foregoing, and of long stand- ing, disease termed Zej^j-a alphoides ; when it is copper-colored, result of syphilis, sypihilitic lepra.
Treatment. Locally : — Warm baths. Alkaline baths, 121. Tar oint- ment (unguentum picis liquida3, Phar. Lond. 1851).
Internally : — Aloes, gentian, and potash, 148. Pepsine and aloes, 155. Nitric acid, senna, and taraxacum, 147. Ammonia and rhubarb, 161. Arsenic, 52. Phosphorus. Donovan's triple solution, 51. Sarsaparilla and corrosive sublimate, 27. Infusion of dulcamara. Tar capsules, 36. Tincture of cantharides, 226. Copaiba. Carbolic acid. Cod-liver oil. Sulphur. Colchicum. Iodide of potassium, 31. Red iodide of mercury, 54. Red iodide of mercury and arsenic, 55. Harrogate waters. Purton spa. Barfeges. Simple nourishing food : avoidance of stimulants.
LETJCOCYTHEMIA.— From Aiwh^;, white ; xvi^os, a cell ; and al^a, blood. Synon. Leacocytosis ; Leuccemia ; White Cell Blood. — Two varieties, L. splenica and L. lymphatica, or Lymphaclenoma. A morbid state of the blood, in which the white corpuscles are greatly increased in number, while the red cells are much diminished. Connected with hyper- trophy of the spleen, or of the lymphatic glands.
Symptoms. Anaemic palloi'. Emaciation and debility. Abdominal swelling. Disordered respiration. Loss of appetite. Mental depression. Diarrhoea. Nausea. Hemorrhage from nose, lungs, or stomach. Jaun- dice. Anasarca. Ascites. Prostration, ending in death. Pathognomonic characteristics are presence of excess of white corpuscles in blood, and great enlargement of spleen or of lymphatic glands. Sometimes peculiar inflammation of retina.
Treatment. Phosphorus. Bark, 22, 376. Iron, 21, 392, 394, 405. Quinine, 379, 380. Carbcaiate of ammonia. Cod-liver oil, 389. Gallic acid, 103. Alkaline hypophosphites, 419. Iodide of potassium. Chloride of potassium. Nourishing food. Pepsine, 420. Stimulants. Sea air. Chaly- beate minei'al waters. — See also Adenoma.
LEUCODERMA. — From Aivxbg. white; Sipjxa, the skin. Synon. Leu- copcUhict ; Chloasma Album; Alphosis ; Achroma.—A rare condition; in which the skin is rendered white in various sized patches, from loss of cutaneous pigment. Occurs especially in negroes, — "the piebald negro." General health not affected.
LETJCORRHCEA. — From Afrxoj.white ; ,'ito, to flow. Synon. Menstrua Alba; Fluor Muliebr is ; Catarrhus Genitalium ; The Whites. — A mu- cous discharge from the lining membrane of the uterine cavity, or of the
LICHEN— LUMBAGO. 161
vaginal canal. Hence, there may be uterine or vaginal leucorrhoea. — See Endometritis ; Vaginitis.
LICHEN. — From Amx^v, moss. Synon. Papulce Siccce ; Licheniasis AduUorum ; Lichenous Rash. — An obstinate and annoying papular affec- tion of tlie skin. Recognized by the minute, hard, red elevations which it presents, and which are either distinct or arranged in clusters; by the tin- gling and irritation ; and by the slight desquamation which follows.
Varieties. (1) Lichen simplex: Eruption of red inflamed papulfe, on face or arms, extending to trunk and legs. Slight fever; itching or tin- gling; eruption fades in about a week, when desquamation takes place. Disease apt to return every spring or summer in irritable constitutions. Sometimes mistaken for measles or scarlet fever. — (2) Lichen pilaris, or hair lichen: a modification of preceding; papulaj appear only at roots of hairs. Often due to stomach derangement, especially that from abuse of alcoholic drinks. — (3) Lichen circumscripttis, or clustered lichen : patches of papulfe with well-defined margins and irregularly circular form — (4) Lichen agrius, or wild lichen : most severe form ; ushered in by fever. Papute much inflamed ; developed on an erythematous surface, which ap- ' pears hot and painfully distended. In a short time, inflammation diminishes : papulfe become covered with furfuraceous desquamation ; or their points are scratched ofif, surrounding skin becomes fissured into deep painful cracks, and sero-purulent fluid exudes, forming thin scaly crusts. Itching, tingling, and smarting intense ; fever, nausea, headache, rigors and other symptoms of constitutional disturbance. In mild cases, symptoms may subside and eruption die away in fourteen days : in severe varieties, disease frequently prolonged for months. — (5) Lichen liviclus : distinguished by livid hue of papulae, which chiefly form on Imibs, and are not accompanied by fever. — - (6j Lichen tropicus, or prickly heat : peculiar to tropical climates. Appears to be partly due to exposure during heat of day, before system bas become acclimatized. — (7) Lichen icrticcttus, or nettle lichen: peculiar, inasmuch as its commencement is marked by occurrence of wheals, like those produced by bites of bugs or gnats. AVheals subside and leave papulae, which are sometimes obstinate ; both wheals and papute accompanied with itching, pricking, and tingling.
Treatment. Fo7' all forms except Ath and 5th : — Only simple remedies required. Tepid baths : mild laxatives : acidulous drinks : an unstimulating diet. Irritation to be relieved by acetate of lead and hydrocyanic acid lotions, 263: or by equal parts of subacetate of lead and oxide of zinc oint- ments : or by glycerine and water, equal portions : or by corrosive sublimate lotion, 271 : or by collodium, 28.5.
Lichen Agrius: — Steel and aloes, 154. Steel and sulphate of magnesia, 166. Pepsine and aloes, 155. Nitric acid and bark, 376. Arsenic, 52. Corrosive sublimate, 27. Turkish bath, 130. Mercurial vapor bath, 131. Sulphur baths, 125. Cod-liver oil. Iodine. Iodide of potassium. Oolchi- cum. Pepsine.
Lichen Lividus: — Quinine and mineral acids, 379. Quinine and steel, 380. Phosphate of iron, 405. Tincture of perchloride of iron and glycerine, 392. Cod-liver oil. Generous diet : milk : malt liquors or wine.
LIP.XMIA. — From AJrta, fat ; alfxa, blood. Fatty blood. — See Picir- hcemta.
LOCK-JAW. — Synon. Trismus, from TpJfw, to gnash with the teeth. —
See Tetanus.
LUMBAGO. — From Lumhus, the loins. Synon. Rheumatismus Dor- salis ; Rachirrheuma. — See Musctdar Rheunnatism. 11
162 MALIGNANT VESICLE.
LUMBAR, PSOAS, AND ILIAC ABSCESS.-Chronic collections of pvis in these situations generally due to caries of bodies of dorsal vertebris. More seldom, are caused by general debility without spinal disease. Occur especially in strumous subjects.
Symptoms. Quantity of pus usually large. AVhen it points in the loins, generally on oue side of spine, it is known as lnynbar abscess. When in the groin, below Poupart's ligament, having travelled along the course of one or both psose muscles, it is called psoas abscess. When above Poupart's ligament, it is called iliac abscess. In exceptional cases, the abscess has burst into peritoneum, large intestines, or pleura. Very rarely the pus has been absorbed.
Treatment. When a permanent cure cannot be hoped for, it is unwise to interfere unless there be pain or much inconvenience. If diagnosis of spinal disease be uncertain, or if there be much pain or hectic fever, or if the abscess appear likely to burst, its contents may be let out by a valvular incision and the opening closed, or by free incision with employment of drainage tube. Antiseptic precautions highly necessary. Carbolic acid spray at operation, and dressings with carbolized gauze. Puncture with trocar and cannula sometimes advised, or aspirator employed. In all cases improvement of general health necessary. Bark. Ferruginous tonics. Good diet. Cod-liver oil. Sea air.
LUPUS. — From Lupus, a wolf,- — owing to its destructive character. Synon. Ulcus Tuberculnsum ■ Noli me Ikmgere. — A destructive skin dis- ease ; commencing in the form of one or more indolent, soft, dull red tuber- cles, which become covered with scabs, have a tendency to heal spontaneously, and always leave a scar. Most common on the face : occurs in the young or middle-aged : and is more often met with in women than men.
Varieties. Two forms. — Lupus non-exedens, and Lupus exedens. In ihe first, little or no ulceration, yet the tubercles leave deep cicatrized pits behind them; while when it spreads rapidly and superficially, the skin is left crossed by white scar-like ridges and bands. 'J'he second, very destruc- tive ; attacks the nose more frequently than any other region of body. Ex- tent of parts which it destroys varies; sometimes the whole nose being eaten away, sometimes only the point. — Both varieties may be present in same case : disease on alfe nasi consisting of lupus exedens, while that on face is of non-exedens form. Moreover, whether ulceration be present or not, the disease is essentially the same
Treatment. Infernally : — Quinine, 379. Quinine and steel, 380. Qui- nine, steel, and arsenic, 381. Arsenic, 52. Cod-liver oil, 389. Iodide of iron and cod-liver oil, 390. Phosphate of iron, 405. Opium. Free and continued purgation by calomel. Nourishing food. Exercise in pure air.
Locally : — Free destruction of entire tubercle or ulcer by actual or potential caustic ; repeating application until a healthy surface results. Chloride of zinc, rubbed in, or applied in paste, 197. Potassa fusa. Arse- nic and calomel powder, 203. Acid solution of nitrate of mercury. 195. Pure carbolic acid. Chromic acid, 196.
MALACOSTEON.— From MaJLaxoj, soft ; ocrrtoj;, a bone. Synon. 3Iolli- ties Ossium. — See Osteomalacia.
MALIGNANT VESICLE.— Synon. Charbon.—A furunculoid disease conveyed from cattle to man by inoculation. Bacteria said to be always present in blood.
Symptoms. A pimple or vesicle, which usually forms on a surface habitu- ally exposed. Swelling and discoloration. Severe carbuncular inflamma- tion : enormous swelling: brawny hardness: loss of vitality : blackness.
MAMMARY ABSCESS— MAMMARY TUMORS. 163
Foetid brealli. Embarrassed respiration. Great prostration. Death nith symptoms of general blood poisoning.
'I'heatmk.nt. Early incisions. Extirpation. Scariiications with appli- cation of caustics. Potassa fusa. Acid solution of nitrate of mercury. Actual cautery.
Sulphite of soda or magnesia, 48. Bark. Quinine. Opium. Tar cap- sules, 36. Essence of beef. Cream or milk. Raw eggs. Alcoholic stimu- lants. Current of pure air over bed.
MAMMARY ABSCESS.— Synon. 3Iadodynia Apostematosa ; Milh Abscess ; Abscess of the Breast. — May be acute or chronic; the former a result of active inflammation. Forms either in substance of gland, or be- tween gland and skin, or between gland and chest walls.
Symptoms. Acicte : — Occurrence of rigors during progress of inflamma- tion. Engorgement of breast. Deep seated or diffused burning pains : throbbing, and sense of heavy weight. Formation of a painful point. Fluctuation. Symptoms, general and local, most severe in intra-glandular abscess.
Chrom'e: — Most important because the lump or knot in breast is apt to be mistaken for a malignant tumor. Matter forms very slowly : may be result of scrofula or derangement of general health, without any inflamma- tory symptoms. Occurs in puerperal and in sterile women. First indica- tions are hardness of gland and soreness about nipple. An imperfectly cir- cumscribed and uneven tumor can be detected : fluctuation indistinct, often difficult to appreciate, owing to thickness of plastic effusion round the puru- lent collection. Nipple may be retracted. Adhesion occurs between tumor and skin.
Treatment. Tonics and stimulants. Nourishing food : malt liquors. Introduction of grooved needle, if diagnosis be doubtful. Free puncture at most depending point. Drainage tube. Poultices. Pressure wiih long- strips of strapping. Care necessary to prevent sinuses from burrowing. If they form, pressure or stimulating injections can be tried ; or setons should be passed through them. Attention to digestive and uterine organs.
MAMMARY HYPERTROPHY.— Enormous hypertrophy of one or both breasts may occur in single and married women. Usually one gland-first begins to enlarge, and slowly increases in size. At the end of a year or more, opposite mamma gets affected. No inflammatory symptoms, indura- tion, or pain. Enlargetiunit becomes burdensome and unsightly. Affected gland may project firmly from thorax ; or it may hang flabby and loose — Pendulous breast. In many cases, the uterine functions are imperfectly performed. General health usually impaired. Occasionally, perhaps, the result of masturbation. The worst case which the author has seen, was attributed to imperfect sexual intercourse : both breasts were affected, reach- ing to the umbilicus.
Treatment. Very unsatisfactory. Improvement of general health. Attention to uterine functions. Pressure with strips of ammoniac and mer- cury, or mercurial, or litharge, or belladonna plaster; or by spring pads, or Dr. Arnott's air cushion. Where patient is pregnant, a hope of cure may be entertained when lactation is set up. Various preparations of iodine have been largely tried : seldom with any benefit. The clitoris has lejn excised. In very severe cases, one or both breasts have been amputated.
MAMMARY TUMORS. — The female breast may be the seat of several varieties of tumor. Some are simple ; and, with one or two exceptions, are composed of elements more or less resembling those entering into the struc- ture of the normal gland. Others are malignant ; and are formed of ele- ments foreign to the heajthy organism.
164 MAMMARY TUMORS.
1. Lacteal Tumor. — From Lac, milk. Synon. Gcdadocele {rdxa, milk ; xYiX-zi, a tumor) ; Lactocele ; Milk Tumor. — A distension of one or more lacteal tubes, owing to occlusion of the orifices ; or a rupture of a milk duct, with escape of contents into surrounding connective tissue. Occurs during lactation.
Symptoms. A cystic growth, varying in size from that of a walnut to that of an orange, can be felt ; which when recent is elastic and fluctuating. As the serous portion of the milk gets absorbed, the tumor becomes firmer and feels almost solid. Absence of pain. General health unaS"ected. En- largement commonly discovered by accident: patient alarmed, fearing can- cer. Very rarely the earthy salts of the milk form a small concretion, — lacteal calculus.
Treatment. Free puncture, keeping the wound pervious until all discharge ceases. Sometimes a cure cannot be effected until gland tissue becomes inactive, — until infant is weaned. If slight inflammation and sup- puration follow the puncture, there will be no need for anxiety : a cure will occur as in abscess.
2. Fatty Tumor. — Masses of fat may be developed within the breast, or in front or behind it. They give rise to an appearance of mammary hyper- trophy. Such tumors grow slowly, sometimes attain a weight of several pounds, and are only inconvenient from their bulk.
3. Enchondromatous and Osteoid Growths. — Cartilaginous and bony tumors have been found in the breast on a very few occasions.
4. Fibro-Plastic Growths. — Synon. Recurrent Fibrous Tumor. — (Spindle-celled sarcoma?). Of very rare occurrence. The tumor may attain a large size : the integuments ulcerate, giving exit to a fungating mass which often bleeds readily. The lymphatics are not involved. General health good. After removal there is great probability of a recurrence of the disease, — perhaps on five or six or more occasions.
6. Hydatid Cysts.- — Cysts containing entozoa have been found in the breast. Echinococci to be detected on a minute examination of the fluid contents of the sacs. Sometimes curable by puncture of parent cyst and compression ; or by withdrawal of parent cyst through a free incision. Occasionally extirpation must be resorted to.
6. Chronic Mammary Tumor. — Synon. Adenoid Tumor; Adenocele ('AS}]!', a gland; pojx^j, a tumor); Partial Hypertrophy ; Mammary Glan- dular Tumor ; Hydatid Disease of Breast ; Serocystic Sarcoma. — A tumor of the breast, which generally commences in healthy women between the time of puberty and the thirtieth year : single, more liable than married women. Growth slow : an enormous size may ultimately be attained. Sometimes remains stationary for a long time, and then rapidly increases in bulk ; sometimes gradually diminishes, perhaps owing to absorption of fluid contents of cysts. Never disappears entirely. May be due to mechani- cal injury. One variety of mammary tumor is dense, compact, lobulated, and provided with a fibrous capsule: ducts and sinuses are developed through the new growth. In another form, there are cysts with growths attached to their walls, and floating in fluid. In a third group, dilated ducts get converted into cysts, with growths of gland tissue springing from their sides.
Symptoms. The tumor begins as a small, movable, nodulated growth : it appears isolated from gland tissue : is not painful : does not involve skin : no enlargement of axillary glands. As the foreign body grows, the true breast may atrophy. Rate of growth very variable. When large, the integuments may ulcerate : occasionally tumor protrudes through ulceration as a fungating mass.
'J'reatmext. Remedies to induce absorption only injure the general
MAM MILL ARY DLSEASES— MAMMITIS. 165
health. When the growth is increasing, excision should be resorted to. Recurrence is rare.
7. Mucous Cysts. — Consist of dilated and expanded gland ducts filled with mucus and epithelium. 'I'here may be one or several cysts, in one or both breasts. I'he growths seldom attain a greater size than that of a filbert. Most common after child-bearing period is over. A cure can often be effected by puncture and pressure. This failing, and irritation arising, the breast will have to be amputated.
8. Malignant Tumors. — Cancer of the breast may be of the nature of scirrhous, medullary, or colloid : the first by far the most common. Always primary. Only one mamma generally affected. Frequently developed between the ages of forty and fifty. The tendency of the disease is to increase, to ulcerate, to cause great pain, to affect the lymphatics and glands, to diminish health and flesh and strength, to set up the cancerous cachexia, to lead to secondary deposits in distant organs, and to destroy life in less than four years from commencement.
The male breast occasionally becomes the seat of malignant disease. — See Cancer.
MAMMILLARY DISEASES.-The nipple, or mammilla (dim. of Mavima, the breast), may be the seat of certain morbid processes.
The chief are : — Chronic eczema and pf^oriaais. There are excoriations covered with rather thick crusts. Aggravated by pressure against slays. May usually be cured by lime liniment, zinc ointment, or lotions of sulphate of zinc. In obstinate cases, arsenic, 52.
Inflammation of nipple very common at commencement of lactation. Exquisitely painful ulcers or abrasions form, — " fissures," " chaps," or " cracks." The acute suffering sometimes impairs general health ; there is constant dread, mental depression, loss of appetite, restless nights. The disease may often be prevented by bathing nipple night and morning, during last few weeks of pregnancy, with astringents, — Port wine, brandj', or sac- charaled lime-water. Numerous curative measures recommended; the most efficient being, Collodium, 285. Solid nitrate of silver, but it causes great pain on first application. Sulphurous acid. 'J'incture of catechu. Lead or zinc lotions, 264. Balsam of Peru and spermaceti ointments, 306. Glycerine, or almond oil. Lime liniment. Borax and glycerine lotion, 268. Dusting with powdered spermaceti, or oxide of zinc, tied up in a muslin bag. Nipple to be well-dried after nursing : child not to be allowed to lie w'ith it in the mouth, after a proper meal. Goldbeater's skin. Nipple-shields, of glass or boxwood or vulcanized India rubber, to afford protection during suckling. Mucous membrane of infant's mouth to be examined, so that any aphthous or other morbid state may be rectified. Other means failing, infant to be nursed only from sound breast.
Malignant disease may attack either the male or female nipple. Early extirpation is the only remedy.
MAMMITIS. — From 31amma, the breast; terminal -if is. Synon. Mazditis ; Mastitis ; Inflammatio Mammce. — Inflammation of the breast may be acute or chronic. Generally occurs during lactation : — from cold ; irritation of sore nipple ; external injury; too poor a diet ; inattention to suckling at proper intervals; general debility; or sympathy with gastric,, intestinal, hepatic, uterine, ovarian, or renal irritation.
Symptoms. When acute : — Considerable pain, swelling, induration. Shivering, fever, quick pulse, loaded tongue, delirium. Secretion of milk soon checked. Suppuration commonly results.
In chronic form : — Comes on insidiously. Enlargement of gland and induration : the hardness much less than in scirrhus. Often ends in sup-
166 MASTODYNIA— MEASLES.
puration. May follow acute inflammation ; or may arise in women of stru- mous constitution quite independently of childbearing.
Treatment. Acute: — Antiphlogistic remedies not advisible ; thoutrh rapid cures are said to have been effected by saline purgatives, anti- monials, and leeches. Mild aperients. Iodide of potassium, Bl. Aconite and opium, 332. Fomentations. Hemlock poultices. Linseed poultices, with application of extract of belladonna. "^Jliree or four leeches, where there is great congestion and the powers of life are not enfeebled. The breast to be supported. Arm to be kept quiet, by a sling or bandaging to the side. Lifant to be weaned at commencement. If milk accumulates and causes painful distension, it must be drawn off with breast-pump. In- cision as soon as there is fluctuation. Tonics, and good nourishing food. — See 3Iammary Abscess.
Chronic: — Ammonia and bark, 371. Quinine and mineral acids, 371. Cod-liver oil. Nourishing food. Support and pressure by strips of strap- ping, belladonna plaster, or bandage. Abscess to be opened at most de- pending point.
MASTODYNIA. — From Majroj, the breast; oSvvt^, pain. Synon. Mazodynia ; Mastcdgia ; Neurcdg/'a of Mamma: — The female breast is not unfrequently the seat of distressing pains, without any structural disease of the gland.
Symptoms. Occasionally there is slight heat and more or less swelling of affected breast. Sometimes the lobules feel rather firmer than is natural. More commonly, the gland is healthy to the touch. The pain may be of a wearying aching character: it may be very acute, liable to exacerbations, and perhaps periodic. — like neuralgia elsewhere. Very frequently due to some ovarian or uterine irritation. In many women the breasts are irri- table at the commencement of each menstrual period. General health seldom good. Nervous temperament. Loss of appetite, constipation, restless nights, anxiety.
Treatment. Cure of the disorder on which the pain depends. Removal of anv ovarian or uterine irritation. Attention to diet, exercise, clothina:.
Quinine, 379, 411. Ammonia and bark, 371, 372. Aconite, 330,374. Quinine and belladonna, 383. Cod-liver oil. Pepsine, 42(1. Castor oil. Iodide of lead and belladonna in vaginal pessaries, 423. Friction of breasts with belladonna liniments, 26.5, 281. Support by strapping or bandage, if breast is pendulous. Pressure by encircling the gland with strips of bella- donna plaster, or of ammoniacum with mercury (Emplastrum Ammoniaci cum Ilydrargyro, Brit. Phar.). The breast has been amputated ; the pain returning in cicatrix, or in opposite gland.
Young infants, and boys or girls about the time of puberty, are liable to enlargement and tenderness of breasts. Sometimes there is secretion of milk. The disorder subsides spontaneously, provided irritation is not kept up by application of iodine and similar drugs. The author has more, than once seen abscess in breast of infant, from the nurse usinsj friction with oil " to rub the milk away," or pinching the breast to " break the string of the nipple."
MEASLES. — From the Saxon Mesall. or Mysel, leprous : Meazel, a leper, or diseased person. Synon. 3Iorhilli ; Rubeola. — A continued infectious fever, preceded by catarrh, accompanied by a crimson rash, and often attended or followed by inflammation of the mucous membrane of the ■organs of respiration. Some authors divide measles into two grades, — the morhilli mitiores, and morhilli graviores ; but the latter only differs from the former in its greater severity, and in the fact that the eruption assumes a dark-purple color.
Symptoms. After a period of incubation, varying from 10 to 15 days,
MEDULLARY CANCER— MELANOID CANCER. 1G7
there are lassitude, shivering, pyrexia, and catarrh ; the conjunctiva3, Schneiderian membrane, and mucous membrane of the fauces, larynx, trachea, and bronchi being much affected. Swelling of eyelids, with eyes suffused and watery, and intolerant of light; sneezing; dry cough, hoarse- ness, and severe dyspnoea; drowsiness; great heat of skin; together with frequent and hard pulse. The eruption comes out on 4th day of fever, and fades on 7th : it consists of dots which coalesce into small blotches, raised above the skin, and often of a horseshoe or crescentic shape. Between the crescentie blotches the skin is of the usual color. Fever does not abate on appearance of eruption. Pulmonary complications are to be feared, espe- cially in winter and spring months. Occasionally, life endangered by the occurrence of laryngitis, cancrum oris, severe otitis, epistaxis, acute tuber- culosis, or acute desquamative nephritis.
Treatment. Confinement to hed in a moderately warm room. Pedilu- via, or warm bath, before the eruption appears. Milk diet; acid or mucila- ginous drinks. Castor oil. Rhubarb and magnesia. Cream of tartar. Solution of acetate of ammonia. Effervescing saline mixtures. Spirit of nitrous ether. Carbonate of ammonia. Alcoholic stimulants, if there be depression. Ipecacuanha and morphia, if cough be troublesome. Colchi- cum. Sponging with vinegar and water. Inunction with oil or lard. — Bark ; quinine ; steel ; cod-liver oil ; and nourishing food during conva- lescence.
MEDULLARY CANCER.— From Medulla, pith or marrow. Synon. Encephaloid Cancer, — 'Ey%sij)a^os, the brain. — These cancers are of two kinds — soft and firm ; the former most frequent. In either condition they are found as separable tumors, or as infiltrations. As separable tumors, when occurring in testicle, breast, eye, intermuscular and other spaces in limbs; as infiltrations, when occupying the substance of uterus, alimentary canal, serous membranes, and bones. In either form their course towards a fatal career is rapid ; average duration of life, from patient's first observa- tion of disease, little more than two years. — See Cancer.
MEL-ffiN"A. — From Mt-kai;, black. Synon. Dysenteria Splenica; Fluxns Spjlenicus ; Dejectiones Nigrce. — When the intestinal evacuations contain blood, whether this comes from vessels of stomach or only from those of intestines, there is said to be melccna. The evacuations are often black, and sometimes resemble tar ; but this dark appearance is by no means constant, and does not occur if the blood comes away too quickly to be acted npon by intestinal juices. Cirrhosis ofjjxer, or any disease which produces obstruction of portal sjstem, necessarily gives rise to congestion of gastric and intestinal vein^fV condition often terminating in extravasation of" large quantities of blood from the gastro-intestinal mucous membrane. Amongst other less common causes are enteritis, dysentery, intussusception, simple and carcinomatous ulcerations, aneurismal and other tumors, etc. Not to be confounded with bleeding from rectum, owing to the presence of a polypus or of hfemorrhoids.
'J'reatment. When there is gastric disease, see Hcematemesis. In other forms: — Calomel and jalap, 140. Sulphate of magnesia and aromatic sul- phuric acid. Podophyllin, 160. Turpentine, 102. Gallic acid, 103. Mineral acids and bitters, 378.
MELANOID CANCER.— From Mi-kavou. to grow black. Synon. Car- ciiioma Alelanoticum ; Fungus Melanodes ; Black Cancer. — Consists generally of medullary cancer, modified by the superaddition of a black pigment. Scirrhus sometimes becomes associated with melanosis, and more rarely epithelioma does so. — See Cancer.
168 MELANOSIS— MENORRHAGIA.
MELANOSIS. — From Maa$, black ; voio;, disesise. Synon. Nigritudo ; Black Tubercle. — A rare disorder, characterized by the deposition in various tissues of the body, of a black or dark-brown substance.
Melanotic formations may take place in various parts of body, may pre- sent much variety of form, and may owe their production to different ag'ents. They are divided into two great groups (Carswell) : — (1) True Melanosis, of which there is only one kind. (2) Spurious Melanosis, of which there are three kinds — a, that arising- from the introduction of car- bonaceous matter; h, from the action of chemical agents on the blood; and c, from the stagnation of the blood.
1. True Melanosis. — True melanosis is usually round or spindle-celled sarcoma, modified by the formation of black pigment in its elemental struc- tures. The primary growth usually arises in some pigmented tissue, as the choroid or a cutaneous mole ; the secondary deposits'"3isseihinated therer from occur inost commonly in connective and adipose tissues; but also, though rarely, in mucous and serous membranes, in tendons and cartilages, as well as in osseous system — particularly bones of cranium, ribs, and sternum. 'I'he organs it most commonly affects are liver, lungs, spleen, pancreas, lymphatic glands, brain, eye, kidneys, testes, uterus, ovaries, rectum, and mammsB. Melanosis is sometimes found associated with various forms of cancer ; and it has been met with in the false membranes formed on serous sutfaces (Andral).
Symptoms. In subcutaneous melanosis the tumors or nodules remove all difficulty as to diagnosis. — When internal organs are alone affected, the symptoms are obscure. Gradual sinking of the vital energies. A cachectic habit of body. Dusky or ash-colored countenance. Emaciation. Dropsy. Night-sweats. Gradual exhaustion.
Treatment. The symptoms to be combated as they arise. Cholagogue purgatives. Bark and mineral acids. Ferruginous tonics. Nourishing diet. Sea air.
2. Spurious Melanosis.— (1) From Iniroductioin of Carbonaceous Matter. — 'I'he lungs— it occurs only in these organs — present a black car- bonaceous color ; bronchial glands blackened; pulmonary tissue indurated and friable ; infiltrated with black serum, and often broken down into irre- gular cavities. The discoloration has its origin in inhalation of carbona- ceous products of ordinary combustion. Is chiefly found in lungs of those who have worked in coal mines.
(2) From Action of Chemical Agents on the Blood. — In digestion of coats of stomach by gastric juice after death, and in j^oisoning by acids, the blood contained in gastric capillaries, as well as that extravasated, will generally present a blackish tint. Sulphuretted hydrogen gas will also darken the blood in the intestinal capillaries.
(B) From Stagnation of Blood. — Retarded or impeded circulation may produce black discoloration of the blood. When blood ceases to circulate in capillaries of an organ it coagulates, the serum and salts become ab- sorbed, and a black substance remains. This probably consists of fibrin and hsematin. Occurs in the digestive and respiratory organs.
MELITTJRIA. — From Mm, honey; ovpoj', urine. Sweet urine. — See Diabetes Mellitus.
MENORRHAGIA. — From Mrivii, the menses ; lirjyvvnt, to burst out. Synon. Paramenirj, Profusa; Menstrua Saperflua ; Menorrhoea ; Pro- fuse Menstruation. — An abnormal increase of the catamenia.
Causes. May arise from diseases producing ansemia : — Tuberculosis ; Bright's disease ; affections of spleen ; undue lactation. Also from : — Ex:- citement at monthly period. Excessive sexual intercourse. Metritis and
METRITIS— MINERAL DEGENERATION. 169
ovaritis. Displacement of uterus. Relaxation of uterine tissue. Uterine and ovarian tumors, etc.
'J'reatme.xt. Bromide of potassium. Gallic acid; cinnamon; sulphuric acid; — either remedy alone or all in combination, 103, 104. Nitric acid. Solution of corrosive sublimate, 27. Erp'ot of rye. Ammonio-sulphate of iron, 116. Turpentine. Opium. Indian hemp. Ipecacuan. Savin. Rue. Nux vomica. Strychnia. Acetate of lead. Oxide of silver. Arsenic. Infusion of digitalis.
Local remedies: — Ice over pubes. Introduction of ice into vagina. Yaginal injections of tannic acid or of matico. Astringent vaginal pessa- ries, 423. Galvanism. Plugging os uteri with sponge, 426. Plugging vagina with cotton-wool. Styptic rod of tannin, 424. Cold water eneniata. — See Uterine Hemorrhage.
Remedies sometimes eviployed : — Yenesection. Leeches to labia uteri. Calomel. 'J'artarated antimony. Infusion of wood-soot (soot-tea).
METRITIS, — From Mr-rpa. the womb ; terminal -ttis. Synon. Fehris liter ina ; Hysteritis ; Ivjlamviatio Uteri. — Inflammation of the sub- stance of the unimpregnated uterus a rare disease. Muscular tissue of the body may be alone affected, or that of cervix, or that of whole organ will be involved.
Symptoms. Acute metritis may set in suddenly with rigors followed by fever. More commonly, comes on gradually. vSense of fulness, weight, and heat about pelvis. Throbbing, with tenderness, about pubes, and groins, and perineum. Irritability of bladder. Nausea and vomiting. Diarrhoea with tenesmus. After first day, acute paroxysms of uterine pain. A mucous, sometimes sanguineous, discharge. Suffering relieved by recum- bent posture.— Acute symptoms subside in about seven days. Resolution often occurs. But occasionally one or more abscesses form in uterine parenchyma : or subacute inflammation follows, pelvic areolar tissue get- ting involved : or fatal gangrene sets in : or it leaves hypertrophy of uterus, induration of labia, abrasions, and leucorrhoea.
"I'reatmext. Acute stage : — Complete repose. Simple diet : cooling drinks ; iced water. Hot hip baths. Leeches to labia uteri. Opium and belladonna pessaries, 423. Ice ; sinapisms to epigastrium ; a few drops of chloroform on sugar, — for relief of gastric irritability. Mucous diarrhoea to be checked by opiate enema or suppository, 339. 340.
Subacute stage : — Iodide of potassium and aconite, 31. Corrosive sub- limate, 27. Mercury, or iodide of lead pessaries, 423. Potassa fnsa to indurated labia. Nourishing food. Warm hip baths. Moderate exercise iu pure air.
METRORRHAGIA.— See Uterine Hemorrhage.
MILIARIA.' — From M ilium, miWei. Synon. 3Iih'ary Fever ; Miliaria Sudatoria; Exanthema Miliaria; Millet Seed Rash. — A vesicular eruption ; vesicles the size of millet seeds, containing a slightly opaque fluid, and surrounded by a narrow red margin. Occurs during progress of diseases attended with offensive sweating, — rheumatic fever, etc. Miliary eruptions have occasionally been epidemic (miliary fever) and attended with much danger. — See Sudamina.
MINERAL DEGENERATION.— Synon. Calcareous Degeneration.— Every texture of the body is probably liable to mineral or earthy degene- ration. Occurs most frequently in the coats of arteries and in cartilages. Tubercular and cancerous growths sometimes undergo this change, and so may fibroid tumors of uterus.
(1) It is important to distinguish between ossification and calcification.
170 MOLLITIES OSSIUM— MUSCULAR TUMOR.
Os.<iificatio7i does sometiines take place, with formation of dense or compact, and sponjry or cancellated tissne, and occasionally even of periosteum.
(2) In calcification or fetrif action there is a deposit of the salts of lime in the intercellular substance. The coats of large arteries are often found brittle from this cause. Sometimes plates of mineral matter are discovered embedded in the middle coat of the vessels, rendering them hard and rigid tubes. So the gall-bladder, pericardium, etc., have been found converted into calcareous shells. Or tuberculous deposit in the lungs, and tuberculous glands may undergo calcification.
MOLLITIES OSSIUM —From Mollis, soft : Os. a bone. A morbidly flexible condition of the bones, owing to an insufficiency of phosphate of lime.— See Osteomalacia.
MOLLTJSCUM. — From Ilolluscum, a fungus that grows on the maple tree. Synon. Ochthiasis ; Acne Mollusccride. — A rare cutaneous disease : of the order Tubercula, Consists of small tumors formed by an enlarged .sebaceous gland. Have usually a depressed spot on the summit. Varying in size from that of a pea to that of a pigeon's egg, occasionally of a brown color, sometimes growing from a broad base, and sometimes from a narrow peduncle. Two forms, one contagious, the other not. Contagious mollus- cum rare, severe, and chronic, most common in infants and children ; may be seen on the face of the child and breast of the mother. Non-coiitagious molluscum is less severe ; does not produce so much irritation as opposite kind ; tumors fil>roid, often numerous, after a time neither grow nor alter, but remain stationary for life. A cure can only be effected by snipping ofiT the tumors, or by incising them and applying nitrate of silver.
MORBILLI, — The dim. of Morhas, a disease : Mopoj ^iov, the fate of life, i.e., death. — See Measles.
MUSCjE VOLITANTES.— From Musca. a fly : Volito, to fly about. Synon. Flocci Volitantes. — Little specks, or floating black spots, which fly over the field of vision. Due to minute floating bodies, usually in the vitreous humor. Their presence generally gives rise to very unnecessary alarm. Quite compatible with lasting good sight.
MUSCULAE, TUMOR. — Synon. Phantom Tumor.— Vvom some pecu- liar action of diaphragm and other abdominal muscles, an appearance results exactly resembling that caused by a large foreign body. Sometimes simu- lates pregnancy. — Spurious pregiiancy : Grossesse simuUe par illusion pure of French authors. Has been mistaken for ovarian tumor. — An erroneous sensation of a small tumor often communicated to the hand by irregular contractions of recti muscles, in sensitive subjects.
Symptoms. Abdominal cavity appears to be entirely or partially filled by a foreign body, or by pregnant uterus. Swelling may be firm and un- yielding ; or it changes its position from day to day ; or appears movable and as if attached by a pedicle. Sometimes, tenderness on pressure. Bor- borygmi on auscultation. Resonance on percussion, unless there be much fat. Arching forwards of lower dorsal and upper lumbar vertebras. Swell- ing occasionally melts away under influence of prolonged manipulation : always dispersed on placing patient under full influence of chloroform.
General health usually bad. Anaemia. Hysteria. L-regularity of uterine functions. Dyspepsia. Ovarian irritation ; uterine disease.
Treatment. Improvement of general health. Cure of uterine or ovarian disease.— Bark and mineral acids, 376. Quinine, 379. Quinine and steel, 880. Quinine and nux vomica, 387. Steel and aloes, 393, 404. Strychnia and steel, 408. Ziuc and nux vomica, 409. Valerianate of zinc, 410.
MYALGIA— MYELITIS. 171
Hypnphospbite of soda. 419. Cotl-liver oil. Nourishing diet. — Galvanism. Sea bathing. Shampooing. Support by abdominal belt or bandage.
MYALGIA. — From Mi?, a muscle; d^ytw, to suffer pain. — Stiffness, cramp, soreness, or pain, in the v^olnntary muscles or their tendinous pro- longations. Arises from fatigue. — I'tTuscT^yorTrulik more commonly attacked than those of extremities ; of abdominal walls, than of thoracic ; and of legs than of arms. TeudLiiQiis„lxajJi.s more frequently the seat of pain than the fleshy ; the portions of tendons usually affected being the spot where they are inserted into bone, or where the tendinous joins the muscular fibre (InmanTT™' '
Myalgia common during progress of scurvy, tuberculosis, cancer, chlorosis, leucocythemia. chronic dysentery or diarrhoea, prolonged lactation, exhaust- ing uterine disease, etc. Also during convalescence from haemorrhage, severe inflammation, parturition, continued fevers, etc.
Symptoms. Pain : severe in proportion to the general debility : aggra- vated by any movement which calls affected muscle into play: seldom com- plained of in the morning after a good night's rest, but soon following upon a few hours' exertion, and gradually increasing towards night. General health more or less depressed. Skin cool. Pulse natural, or feeble and somewhat quickened. Appetite good. Tongue clean. — In exceptional cases,— fever ; night sweats; loss of appetite; impaired digestion; consti- pation ; a disinclination for work of any kind ; severe mental depression.
Treatment. Quinine, .379. Quinine and steel. 380. Cod-liver oil, 389. Steel and cocoa-nut oil, 39L Steel and glycerine, 392. Steel and pepsine, 394. Phosphate of iron, 40.5. Chloride of ammonium. 60. Hypophosphite of soda and bark, 419. Morphia, chloroform, and Indian hemp, 317. Sub- cutaneous injection of morphia or chloroform, 314. Ether spray. Linseed poultices, with belladonna and opium. 297. Friction with' belladonna lini- ment. 281. Partial rest of affected muscle to be ensured by bandag'e; strips of belladonna or opium plaster. Galvanism Shampooing. — Animal food: milk or cream : raw eggs : wine, or malt liquors, or whiskey, brandy, etc.
MYCETOMA.— From Mvxrji. rito^, the mushroom. Synon. Fungus Foot of India.^A. destructive parasitic disease. The mucedinous fungus {Chionyphe Carteri) eats its way into the metatarsal and tarsaTTiones,~and ultimately into lower extremities of til2i,ii-and fibula. Numerous fistulous channels result, becoming filled with rouyjled black masses of fungus. Ob.'^erved only in natives of India, who go about with naked feet. Sporules of the fungus get introduced beneath the cuticle, through some scratch or abrasion. Amputation seems to be the only resource.
MYELITIS. — From Muf^oj, marrow ; terminal -itis. Synon. Spino- dorsi'tis ; Rachialgitis ; Ivjlammatio Medulhe Spinalis. — Inflammation of the substance of the spinal cord is__a^ rare disease. Sometimes coexists with pneumonia . "ga sTf fy'c i 1 1 e r i 1 i s . and continued fever. May be excited by cold, damp, wounds, contusions, etc. Often ends in softening, or suppuration.
Symptoms. Not very uniform. If cranial portion of cord be affected : — Deep-seated headache; convulsive movements of head and face ; inarticulate speech; trismus; difficult deglutition; impeded spasmodic breathing; ir- regular action of heart ; paralysis. If about to prove fatal in acute stage, great prostration; increased dyspnoea; involuntary escape of excretions. When whole thickness of cord above origin of phrenic nejves is attacked, '■ death occurs rapidly from ce.=?satioh "of respi"rcCtOTy~m6vements. — Inflamma- . tion of cervical portion : — Difficult deglutition ; impossibility of raising or,' supporting head ; pain in back of neck; urgent dyspncea ; sense of pricking and formication in arms and hands ; paralysis of upper extremities. — Of dorsal region : -Pain over affected part; numbness or pricking sensations
172 MYOCARDITIS— MYOSTITIS.
in fingers and toes ; paralysis of arms and lower extremities ; dyspnoea ; great palpitation. — OF lumbar portion : — Marked paralysis of lower extremi- ties at early period ; abdominal pain, with sensation, as of a cord tied tightly round body; convulsions; retention, fol 1 o wedTjyi-nieetri-iffe-itee o-f -nTTireTmvi n g to paralysis of bladder; involuntary stools, from paralysis of sphincter ani.
Pain in affected part of cord less severe than in meningitis; increased by application of heat (as of hot sponge), and by pressure. Bedsores very apt to form.
Treatment. Calomel and jalap, 140, 159. Jalap and senna, 1.51. Castor oil and turpentine enema, 190. Corrosive sublimate and sarsaparilla, 27. Iodide of potassium, 31. Great care necessary to keep patient dry and clean. Bladiler to be emptied by catheter, unless urine be passed freely. Bedsores to be prevented by amadou plaster, water-bed, etc.
MYOCAEDITIS. — From M1S5, a muscle ; xap^Ja, the heart ; terminal --itis. Synon. Carditis. — Inflammation of muscular substance of heart.
Seldom occurs as a distinct affection: generally combined with pericar- ditis, or endocarditis, or both. Walls of left ventricle suffer more frequently than other parts. Action of heart feeblelinfliTCTfwetft j oppression ; dyspnoea ; anxiety ; sometimes death from failure of heart action. — Results, — induration of muscular structure from deposit of lymph ; formation of abscesses ; aneu- rismal dilatation of walls of heart; softening of heart, and possibly rupture.
MYOPIA.— From Mvco, to contract; Ci-^, the eye. Synon. Hypome- tropia ; Short-sightedness ; Near-sightedness. — When the distance at which ordinary type can be easily read is less than twelve inches, the vision is said to be myopic. Near objects are seen distinctly. Myopia most fre- quently arises from two great a convexity of the cornea, or of the crystalline lens, or both. May be owing to a lengthening of the eyeball : to an undue density of any or of all the refractive media. The rays of light from objects at the usual distance are brought to a focus before they reach the retina, instead of being concentrated upon it. Sometimes associated with strabis- mus. Myopia rarely decreases as age advances, though popularly believed to do so. It is often hereditary.
In many cases of short-sightedness the iris is either preternaturally con- tracted, or it possesses unusually irritability. 'I'his occurs especially in individuals of a very nervous temperament. Exposure to bright light aggravates this condition. Snow-blindness chiefly due to it; consisting in a great measure of excessive contraction of pupil.
Treatment. Avoidance of over-work, examination of minute objects, etc., especially by gas-light. — Well adjusted double coniyive glasses or spectacles : single eyeglasses ai"e bad. The greater the aegr^g^'of short- sightedness, the greater must be the concavity of the glasses. The glasses had better be worn only when required. Heat and congestion about the eyes to be relieved by the eye douche. Where the iris is unusually irritable belladonna gives i-elief. Where there is disease of choroid, a prolonged course of corrosive sublimate in small doses.
MYOSITIS, — From Miij, a muscle; terminal -itis. Synon. Myitis; Sarcitis ; Ivfiavimatio Muscidorum. — Inflammation of n[iu.s6ular,fibre is a rare affection. May occur from injury, over-exertion, disease of adjoining textures, etc.
Symptoms. Pain : greatly aggravated, by any movement of affected muscle. Heat and swelling ; the latter often distinct, simulating a tumor. Symptomatic fever. May terminate in induration ; or softening ; or suppu- ration ; or even gangrene.
Treatment. Hot fomentations. Rest. Opium. Nourishing food, in proportion to the failure of general strength.
NiEVUS. 173
NJEVTJS. — As if Gnccvus, from ysveui, whence yt'yi/co, to be born ; because the lik'inish is congenital. Synon. Ncevus Maternus ; Mother's Mark; Erectile or Vascular Tumor ; Aneurism by Anastomosis. — A growth formed by enlarged and dilated arteries, veins, or capillary vessels.
Arterial na3vi more commonly begin in youth than infancy. The diseased vessels become enlarged and elongated and tortuous ; forming a tumor of irregular shape, which is spongy and compressible and pulsating. A loud superficial bruit is audible. — Venous nievi give rise to irregular tumors of a purple color; which feel doughy, and ai'e diminished in size by pressure. 'J'hey may be as small as a nut, or as large as an orange. — Capillary ntevi most common. Usually congenital. Commence as vivid red or purplish spots, which gradually spread. May affect the skin and subcutaneous areolar tissue of any part : more commonly met with on scalp or face or neck, than on back or buttocks or organs of generation. — Na3vi of a mixed character not rare.
Treatment. When small, producing no disfigurement, and not increasing in size, they are best left alone. Occasionally, spontaneous cure occurs. Interference being necessary, attempts must be made. — To excite adhesive inflammation so as to coagulate the blood and obliterate the vessels ; or to destroy the growth by caustics ; or to effect removal by knife or ligature.
(1) To excite adhesive inflammation : — Vaccination, making several punctures at circumference of spot and one or two on surface, so as to pro- duce a confluent vesicle. Compression ; by a piece of sheet-lead and band- age, or by the finger applied for some hours ; or painting with collodium. Frictions with compound iodine, or croton oil, or red iodide of mercury, or tartarated antimony ointments. Equal parts of tartarated antimony and resin plaster mixed and melted together, and spread on thin leather : the nsevus is to be accurately covered with this plaster, which shoujd be kept on until pustulation and sloughing are set up. Congelation : either by application of ice, or ice and salt in a piece of bladder; or by ether spray, two or three times a week until a cure is effected. Dotting the surface with a small and pointed actual cautery. Setons; passing several threads with a common sewing-needle in all directions, across the tumor, and leaving them until suppuration is excited. Breaking up substance of growth, subcutane- ously, by a common dissecting-needle. Injection of a few drops of tincture of pei'chloride of iron, or of tincture of iodine, with a sharp-pointed syringe. — Passing a needle under the growth, when small, and twisting a thread around it so as to cause considerable pressure, and allowing it to remain for forty-eight hours (Fergusson). — Introduction of two needles, at right angles to each other, under the mass, and winding of a ligature round the whole. Immediate withdrawal of needles ; ligature to be untied in four hours. A scab forms, which drops off in ten or fourteen days; no suppuration nor open sore. Without destroying the ntevus, sufficient obstruction is caused to allow the blood in the tissue to get consolidated (Cooper Forster).
(2) Destruction by caustics: — Nitric acid, or acid solution of nitrate of mercury, repealed once or oftener. Potassa fusa. Super-sulphate of zinc, 198. Electrolysis and coagulation of blood by galvanism, needles being passed into the growth connected with the poles of a battery. Actual cautery ; free application, so as to ensure complete destruction.
(3) Removed by knife or ligature : — Use of knife rarely advisable ; if employed, the incisions must be made wide of the disease, or hemorrhage will be great. Where the nrevus has a distinct capsule, the tumor may be enucleated ; using the knife cautiously, but keeping it close to the invest- ing capsule. — Ligature, safe and convenient: may be used in many ways. Amongst other plans, the ligatures may be passed subcutaneously around the nasvus, and tightened so as to strangulate it, without involving the skin. Or a needle carrying a double thread can be passed through the centre of the base of the growth, and the ligatures tied round each hemi-
174 NASAL LIPOMA— NEPHRITIS.
spherical division, first making an incision or groove through the skin in which the ligatures may lie. In either case, the ligatures may have to be tightened in four or five days, or an e astic ligature may be employed. As granulations form, any tendency to nseviis growth must be checked by application of nitric acid. — In n?evi within the orbit, or in other inaccessible parts, it has been found necessary to tie the nutrient vessel : ligature of the common carotid has been resorted to under such circumstances.
NASAL LIPOMA, — From At'rtof. fat, — Hypertrophy of skin and sub- cutaneous tissue of apex and ate of nose. Most common in men who are advanced in years and have lived very freely. When the growth is con- siderable, a cure can only be effected by paring off the redundant tissue. In other cases, increase in size may be prevented by careful diet ; avoid- ance of intoxicating drinks ; frequent use of astringent washes.
NASAL POLYPTJS.— From Yloxh^, many ; rtov?, a foot. Nasal polypi are of three kinds : — Mucous, or gelatinous ; fibrous ; and medullary.
Symptoms. A sense of stuffiness in one or both nostrils. Frequent desire to blow the nose, with no relief on doing so. Increased mucous discharge. Attacks of bleeding — epistaxis. Impairment of smell and taste. When uninterfered with, displacement of septum of nose ; deafness from pressure on Eustachian tube ; indistinctness of articulation ; deformity of cheek, from expansion of bones ; obstruction to tears ; and even fatal cerebral pressure. 'J'hese tumors very apt to return again and again, after removal.
Treatment. Removal by strong, toothed, slightly curved forceps, applied to neck of growth, so as to twist it off. Reuioval by the " noose," — encircling the peduncle with a wire, and tearing away the tumor with it. Employment of tannic acid as a snuff. Astringent injections.
NECRjXMIA. — From Nfxpo?, dead ; ut/xa, blood. Death of the blood, as perhaps occurs in cases of blood poisoning — .typhus, smallpox, etc.
NECROSIS. — From Nfxpdw. to produce mortification or decay. The death of a portion of tissue. Usually applied to mortification, etc. Mor- tification or death of a bone, or portion of a bone. Osteonecrosis ; Osfeo- gangrcena. — The term usually restricted to one form ; in which part of the shaft of a cylindrical bone dies, and is enclosed in a case of new bone. ■Exfoliation signifies uecrosis of a thin superficial layer, which is not en- cased in any shell of new bone (Druitt).
Frequently attacks the tibia in children : the phalanges, from whitlow : the skull and clavicle, from syphilis. May arise, from mechanical injury, or from inflammation however set up. A peculiar form of necrosis of the lower jaw occurs amongst the makers of Inciter matches, being produced by the fumes of phosphorus.
Symptoms. Indications of acute osteitis. Suppuration, with formation of sinuses, or cloacae ; through which, on passing a probe, the bare dead bone (the seqitestrinn) can be touched. Abundant fetid discharge. Inflammatory fever. Separation of sequestrum from the living bone after a variable in- terval. Disease very chronic.
Treatment. Incision and removal of sequestrum as soon as it is detached, and when it can only act as an irritating foreign body.
NEPHRALGIA. — Synon. Fecial Colic. — Severe pain in region of kidney and along ureter; usually due to passage of a calculus.
NEPHRITIS. — From Nf^po^, the kidney ; terminal -itis. — Under this head may be arranged for convenience: — Inflammation of the substance of the kidney ; acute desquamative nephritis ; chronic desquamative nephritis.
NEPHRITIS. 175
1. Nephritis. — Synon. Nephrophlegmone ; Ivflammatio Renum ; In- flammaliou af Suhslance of Kidney. — Comparatively a rare disease. May arise without appreciable exciting cause, especially in strumous subjects ; from exposure to cold and damp; gravel and calculi; mechanical injuries; poor living combined with intemperance; abuse of diuretics; use of caa- tharides, oil of turpentine, etc. May end in resolution ; or go on to suppu- ration, variable sized abscesses resulting, which sometimes destroy entire gland. Intlanimation of raucous lining of pelvis and infundibula is known as pyelitis.
Symptoms. Severe pains in loins, increased by pressure or exercise: pain often extending along ureter to neck of bladder, groin, scrotum, or testicle. Numbness of thighs : retraction of testicle. Much constitutional disturb- ance: shivering, fever, nausea, and vomiting, hard and frequent and full pulse, constipation, tympanites. Frequent and urgent desire to empty bladder: urine high colored, often contains renal casts with blood^ind pus corpuscles. Sometimes, suppression of urine; with uriemia, convulsions, and coma. AVheu recovery follows, foundation for future renal diseases often laid.
When one or more abscesses form, they perhaps lead to ulceration, per- foration of capsule, renal fistulae, and establishment of a purulent discharge. Sometimes, fatal hectic fever. In more favorable cases, pus passes away by natural passages and is found in the urine. — Renal abscess may also be a secondary affection : due to irritation of a calculus, obstructive diseases of urinary passages, etc.
Treatment. Hot hip baths. Yapor, or hot air batlis. Fomentations. Poultices. Mild aperients. Diaphoretics, especially such as contain opium if there be ura^mic symptoms. Rest in bed, preferably between blankets. Low diet; with tea, milk, ice, and simple diluents. Sinapisms to epigas- trium if there be sickness. — Stimulants, tonics, and support as soon as pros- tration sets in, or there are indications of suppuration. — See Urcemia.
2. Acute Desquamative Nephritis.— Synon. Tubular Nephritis; Nepliria ; Acute Diffuse Nephn'tis ; Acute Albuminous Nephritis ; Acute Bright's Disease ; Acute Inflammatory Dropsy. — Has its origin in many causes, — intemperance, starvation, exposure to wet and cold, but especially scarlet fever. Characterized by excessive proliferation of epi- thelium of convoluted tubes of kidneys, with congestion of Malpighian tults. There is effusion of serum and tibrin from the congested Malpighian vessels into the tubes ; the serum mingles with urine, and renders it albuminous ; the fibrin coagulates in the tubes and forms casts, which may be detected in urine, usually entangling epithelium. Walls of vessels also usually give way, and blood corpuscles therefore found entangled in the casts; then urine will present a dark-colored sediment. The undue proliferation of the epithelium of the tubes chokes them, and obstructs secretion. Cortex of kidneys pale from amount of epithelium in the tubes ; Malpighian bodies form bright red points; pyramids dark and congested; kidneys much enlarged.
Occasionally there is general dropsy and albuminuria without desquama- tion of renal epithelium — non-desquamative disease of kidney. Often attended with prominent symptoms of blood-poisoning ; owing to some failure and imperfection in effort to eliminate morbid material from .system (George Johnson).
Symptoms. Chilliness, rigors : soon followed by feverish reaction, head- ache, thirst, restlessness, pain and tenderness about loins, vomiting. Dropsy : face puffy, general oedema and effusion of serum into one or more of serous cavities. Frequent micturition : urine scanty, of a dark smoky color, highly albuminous, abundance of fibrinous and epithelial casts, renal epithelium, blood casts, and free blood corpuscles. — Earliest signs of amendment, —
176 NEURALGIi^.
disappearance or lessening of dropsy ; increase in quantity of urine ; steady diminution of albumen. In unfavorable cases, — suppression of urine ; ui'ajmia, or effusion into serous cavities, peritoneum, pleura, pericardium.
Treatment. At onset : — Confinement to bed ; preferably between blankets. Low diet: free allowance of milk, tea, cold water, barley-water, lemonade, ice. Hot water baths. Blanket-batlis, 136. Hot air, or vapor baths. Dry cupping to loins. Linseed poultices to loins. Compound jalap powder. Sulphate and carbonate of magnesia, 14L Sulphate of magnesia and antimonial wine, 1.52. Sulphate of magnesia, and sulphate of iron. Resin of podophyllum, 160. Elaterium, 1.57. Solution of acetate of am- monia. Citrate of potash. Nitrate of potash and nitrous ether, 212. At end of a few days : — Tincture of perchloride of iron, 392, 397. Phosphate of iron, 405. Iron-alum, 116. Quinine. Animal food ; milk ; raw eggs. Bordeaux or Hungarian wines. Warm clothing : flannel next the skin. Avoidaj>ce of spirits and beer : of exposure to cold and damp. — For urasmic poisoning, see Uroeinia.
Remedies occasionally employed: — Blood-letting. Cupping. Leeches. Blisters. Tartarated antimony. Colchicum. Digitalis and broom. Digi- talis and acid tartrate of potash. Chloroform.
3. Chronic Desquamative Nephritis. Synon. Chronic Diffuse Ne- phritis ; Chronic Brighfs Disease ; Contracted Granular Kidney ; Gouty Kidney ; Cirrhosis of Kidney. — May result from acute desquama- tive nephritis : more frequently due to chronic gout, or some allied disorder. Pathology differently represented. According to Dr. Geo. Johnson char- acterized by long-continued shedding of renal epithelium, which appears in urine in a more or less disintegrated state. The tubes lose their epithelial lining and become atrophied or filled with new material ; or sometimes get dilated into cysts. According to Virchow, Dickinson, and others, the morbid process is inter-tubular, consisting in proliferation and fibrillation, or cirrhosis of matrix in which vessels and tubes embedded, commencing at surface, extending inwards, strangling vessels and tubes. Kidney becomes granular and contracted. L^rine pale, slightly albuminous : of a low density ; contains granular epithelial casts.
Symptoms. Come on insidiously. Run their course slowly. Health gradually fails. Debility and loss of flesh. Urine copious, pale, of low density, contains albumen often only in small amount ; deposits whitish sediment, in which granular epithelial casts and epithelium. (Edema usually only slight ; sometimes anasarca or dropsy of one or more serous cavities. Inflammation of serous membranes. Resistance to circulatien of blood, which is impure and deteriorated, whence high tension in arteries, hypertrophy of muscular coat of arterioles, and hypertrophy of heart, which almost always present ; sometimes valvular disease induced. Structural changes in, or great functional disturbances of, nervous centres. Retinitis and retinal degeneration. Death may result from urasmia, or from inflam- mation of lungs, pericardium, etc., or from cerebral hemorrhage.
Treatment. — Removal of prominent symptoms. Simple nourishing food. Attention to functions of skin. Cure of any gouty condition. Improve- ment of blood by ferruginous tonics. Sea air.
NEURALGIA. — From NEipoi/, a nerve ; aXyo^, suffering. Synon. Neu- rodynia ; Nervous Pang. — Violent pain in the trunk or branch of a nerve, occurring in paroxysms, perhaps at nearly equidistant intervals. May attack nerves of head, trunk or extremities : subcutaneous nerves of these regions suffer most frequently. Where branches of affected nerves pass through a foramen or pierce fascia to become superficial, tender points developed.
Varieties-. When the pain affects branches of fifth pair of nerves, —
NEURALGIA. 177
nenralgia faciei, or tic douloureux: certain nerves about head. — hemi- cra.rria : sciatic nerve, sciatica. — Some authorities regard anpina pectoris as neuralfjia of cardiac nerves : gastrodynia, as a similar disease of nerves of stomach.
(1) Tic Douloureux :— May affect either of three chief branches of fifth pair of nerves. Where pain depends upon morbid condition of first or ophthalmic, branch, the frontal ramification of it — supra-orbital nerve — is most frequently attacked : suffering' referred chiefly to forehead. Tender points over supra-orbital foramen and supratrochlear notch. Supposing second or superior maxillary branch is seat of complaint, infra-orbital nerve most commonly affected : symptoms consist of excruciating pain shooting over cheek, lower ej'elid, alas of nose, and upper lip. Tender point over infra-orbital foramen and sometimes over malar bone. Tic douloureux of third or inferior maxillary branch is generally confined to inferior dental nerve, especially to portion which emerges from mental foramen and extends to lower lip : pain referred to lower lip. alveolar process, teeth, chin, and side of tongue. Tender yjoint over mental foramen.
Whichever nerve suffers, the torture is usually confined to one-half of face. Attack comes on suddenly, patient at once putting up his hand to press the seat of suffering : it greatly increases in severity, gets lancinating and burning ; often ceases suddenly. Attack perhaps preceded by derange- ment of digestive organs; by dyspnoea; by slight rigors followed by heat. Sometimes absent for weeks, and then almost constant paroxysms for many days. In some cases there is muscular spasm in the painful part, true " tic;" sometimes flushing or lachrymation. A distressing and obstinate variety is when the act of eating or a touch in the area of the inferior division of the fifth nerve brings on a dart of exquisite pain in the teeth, cheek, and tongue. — May be due to dyspepsia ; anaemia ; renal disease ; disease of facial bones; organic disease of brain ; disease of teeth or gums; poison of malaria, etc. •
(2) Hemicrania : — Headache affecting one side of brow and forehead. Often accompanied with sickness. Sometimes periodical. Has been called Stm-pain, as at times it only continues so long as sun is above horizon.
(3) Sciatica: — Acute pain following course of great sciatic nerve. Ex- tends from sciatic notch down posterior surface of thigh to popliteal space, and often along nerves of leg to foot. May be due to pressure of intestinal accumulations, of simple or malignant uterine tumors. Other causes, — in- flammation, rheumatism, gouty or syphilitic taint, malaria, over-fatigue, exposure to cold and wet.
(4) Other variet/es : — Brachialgia. Pain in branches of brachial plexus. Neuralgia of cervical plexus ; great occipital nerve, etc. Intercodal neu- ralgia. Neuralgia of abdominal viscera. Hepatalgia. Enteralgia. etc.
TreatmexXT. Removal of cause. (Neuralgia the ci-y of an impoverished nerve for better blood.) Improvement of health. Purgatives, only if actually required. General Remedies : — Nourishing diet : regulated amount of bitter ale, stout, or other alcoholic stimulants : raw eggs : milk, in place of tea and coffee. Warm clothing: flannel next the skin, or chamois leather jackets and drawers. Warm, tepid, or cold salt water baths. Turkish bath. Fric- tion of skin.
Drugs: — Aloes, gentian, and liquor potassfe, 148. Sulphate, or phos- phate, of soda, 148, 149. Pepsine and aloes, 155. Croton oil (in sciatica from faecal accumulation), 168, 191. Quinine, 379. Quinine, steel, and arsenic, 381. Phosphorus. Cod-liver oil, 389. Iodide of iron and cod-liver oil, 390. Steel and pepsine, 394. Steel and arsenic, 399. Phosphate of iron, 405. Strychnia and steel, 408. Valerianate of zinc, quinine, steel, or ammonia, 410. Sulphate of zinc, 413. Hypophosphite of soda, or lime, 419. Iodide of potassium, 31. Guaiacum and aconite, 43, 330. Colchicum, 12
178 NEURITIS-NOSTALGIA.
46. Turpentine, 50. Chloride of aminoniura, 60. Opium, 340, 345. Mor- phia, etc., 317. Hypodermic injections of morphia, or atropine, or aconi- tine, 314. Chloroform inhalation, 313. Stramonium, 323. Belladonna, or atropia, 326. Digitalis, 334. Coiiium. Galbanum. Glonoin. Oxygen inhalation. Salicin. Sabadilla. Sulphate of beberia. Arnica. Musk.
Topical Expedients : — Division of affected nerve. Removal of tumors and foreign bodies. Extraction- of decayed teeth. Application of iodine. Blisters, dusting raw surface with morphia. Blisters, dusting raw surface with from 10 to 15 minims of tincture of aconite : the effect of the applica- tion to be watched. Spray of pure ether. Aconitine, 296. Veratria, 304. Belladonna, with opium or mercury, 297, 298. Chloroform, belladonna, and aconite, 281, 282. Belladonna and glycerine, 265. Hypodermic injections of morphia, etc., 314. Cyanide of pota.ssium. Hot douches of medicated "water. Continuous galvanic current. Acupuncture. Dry cupping.
NEURITIS. — FromNfvpov, a nerve; terminal -itis. Synon. Neurophlo- gofiis ; Neurophlegmone. — Inflammation of a nerve is a rare disease. Usually due to a bruise or wound, or to inclusion of some nervous branch in a liga- ture when taking up an artery. May perhaps arise spontaneously in gouty or rheumatic subjects.
Symptoms. Severe and continuous pain along trunk of nerve and its ramifications. Fever. Restlessness, especially at night. Wasting of mus- cles. In chronic form, symptoms of neuralgia.
Treatment. Iodide of potassium. Aconite. Colchicum. Local use of belladonna. Hypodermic injection, in neighborhood of pain, of morphia or aconite, 314. Fomentations. Water dressing. Rest of affected part.
NEUKOMA. — From NsiJpoi', a nerve. — A solid or cystic tumor connected with a nerve. Solid growths are of a fibrous nature, consisting of dense plastic matter, implicating neurilemma and nerv,e-fibres. Occasionally, nerve-fibres merely spread over tumor, without being involved in its tex- ture.
Neuromatous tumors may form spontaneously. Single, more painful than multiple, growths. May result from a wound or other injury : occasionally produced on ends of nerve after amputation.
Symptoms. Neuromatous growths vary in size from a barleycorn to a melon. Occur most frequently on spinal nerves : branches of ganglionic system very rarely affected. Growth steady but slow. Of an oval or oblong form ; long axis corresponding with direction of nerve to which there is attachment. Darting pains ; much increased by moving tumor in direction of nerve. Occasionally convulsions induced by pressure or motion of growth. — In traumatic neuroma, growth single : source of paroxysmal pains, like shocks of galvanism.
Treatment. Excision offers the only hope of cure. Tumor to be care- fully dissected out, if possible. When complete excision is adopted, the ends of divided nerve to be brought into apposition by sutures : by main- taining continuity there is no loss of power in parts supplied by the nerve.
NOSTALGIA. — From Noartco, to return ; aXyoj, suffering. Synon. Nos- tomania ; Homesickness. — The ungratified desire to return home may give rise to symptoms of melancholia. Great bodily and mental depression. Loss of appetite. Inability to procure sound sleep. In some cases there has been a gradual wasting, delirium, and fatal prostration. When other diseases supervene on nostalgia, the danger of the former is greatly in- creased. Kind treatment, amusement, out-door exercise, nourishing food, remedies to induce sleep, and attention to the secretions may afford relief for a time. A temporary return home often suffices to effect a cure.
NYCTALOPIA-OESOPHAGEAL CANCER. 179
UTCTALOPIA. — From Nij|, evening ; oritofxai, to see. — That condition in which vision is most powerful during twilight. The opposite state to hemeralopia. — See Amaurosis.
OBESITY. — From Ohesiiis, fat or gross. Synon. Polysarcia ; Polysar- cosifi. — The over-accumulation of fat under the integuments and around some of the viscera constitutes obesity. Not to be confounded with fatty degene- ration of tissues. The term corpulency to be retained for those cases where the amount of fat does not constitute a disease.
Symptoms. Impeded play of various important organs. Diminution of bodily and mental activity. Disturban(;es of organs of respiration, circula- tion, and digestion. Panting on slight exertion. Blood comparatively deficient in quantity or quality. Weakness of muscles. Countenance bloated and sallow. Liability to gouty and neuralgic affections. Obesity not conducive to longevity. Sudden death not uncommon.
Partial obesity, — e. g. fatty tumors, fatty accumulation around heart, fatty-omentum or " pot-belly."
Causes. Hereditary tendency. Over-feeding. Consumption of large quantities of fluid. Indolence, and too much sleep. Excessive use of fatty, farinaceous, vegetable, and saccharine foods. Fat is formed in the body from food containing it; also from chemical transformation of starch and sugar.
Treatment. Rational treatment : — Diet of meat, white fish, green vegetables, biscuit or dry toast, tea, claret, sherry. Avoidance, more or less complete, of bread, butter, milk, sugar, beer, potatoes, beans, and sonp. Bromide of ammonium, 37. Carbonate of ammonia. Magnesia. Colchi- cum. Exercise. Seven hours for sleep.
Diminution of weight not to exceed one pound a week. General health, state of appetite, and condition of bowels to be watched.
Bemedies formerly employed : — Bleeding from the arm, or jugular vein. Dry cupping. Prolonged blistering. Vegetable diet with vinegar. Acids, except the nitric and phosphoric. Turkish baths. Hot baths. Salt water- baths. Baths of Aix, Spa, Forges, Rouen, and Acqui. Occasional starva- tion. Guaiacum and sassafras. Scarifications. Grief and anxiety to be induced. Purgatives. Diuretics. Preparations of iodine and bromine. Liquor potassae. Fucus vesiculosus. Emetics. Digitalis. Tobacco. Soap. Salt. Mercury. Inhalation of oxygen gas.
(EDEMA. — From OtSsco, to swell. Synon. Hydrooedema ; Hydroncus. — Dropsy of the subcutaneous areolar tissue of any one region.
Treatment. Elaterium, 157. Acid tartrate of potash, 228. Compound jalap powder. Compound scammony powder. Acetate of potash. Digi- talis and squills, 219. Gin. Acupuncture. — '^qq Anasarca ; Dropsy.
(ESOPHAGEAL CANCER.— From Olso^dyoi, the swallow. Synon. Cancer of the Gullet. — May occur through whole length and circumference of tube, or be very limited. Of scirrhous, medullary, or epithelial variety: latter most common. Generally fatal within a year from commencement.
Symptoms. Soreness of throat. Difficulty in swallowing. Occasionally cutting pain in ears. Frequent, sometimes constant, sickness. Decided obstruction : after a time, not a particle of food reaches stomach. Forma- tion of a pouch above constriction, in which food lodges. Burning pain in canal, back, or between shoulders. Cough, or hiccough. Hemorrhage. Wasting. Debility. Cancerous cachexia.
Treatment. Opium, or morphia, 31.5, 317. Opium by rectum, 339, 340. Subcutaneous injection of morphia, 314. Nutrient enemata, 21, 22, 23. Sometimes, a large gum elastic catheter (No. 14) may be passed through
]80 (ESOPHAGEAL STRICTURE— (ESOPHAGTSM.
contracted oesophagus and left in: so that cream, solution of raw beef, wine and opium may be injected through it every four or six hours. Ice, to relieve thirst. Iced milk.
(ESOPHAGEAL STRICTURE, - From Oimfdyo?, the swallow.— Stric- ture of the gullet may be organic or functional (spasmodic): —
1. Organic Stricture. — Genei-ally the result of an attempt to swallow some corrosive poison.
Symptoms. At first, vomiting. Pain about oesophagus, perhaps darting through to between shoulders. An apparent cure, after rest and simple diet and demulcent drinks. — At end of some nine or twelve months, dys- phagia which increases gradually ; emaciation from inability, which has been gradually increasing for several weeks, to take solid food. - A gum elastic catheter can generally be introduced ; through which solution of raw beef, cream, and port wine can be injected into stomach. By gradual use of larger and larger tube, stricture appears to be cured. Patient is perhaps removed from observation. But in a few months, all the symptoms return : the wasting and anaemia become extreme : no instrument can be passed down oesophagus: and death occurs from starvation in spite of nutrient enemata.
Treatmekt. The only remedy of any avail, consists of dilatation by frequent use of bougies for ni.mj months. At first, a gum elastic catheter can be constantly worn. Sub.oquently, a bougie ought to be introduced at least twice a week. — In hopeless cases, it may be justifiable to make an incision through abdominal parietes into stomach; forming an opening sufficiently large to allow of daily introduction of food. Gastrotomy can be performed with knife : or, perhaps better, by exciting inflammation, adhesion, and ulceration with potassa fusa.
2. Spasmodic Stricture.— Synon. (Esophagospasmus ; Tenesvrus Gii- Ice ; Dysphagia Spasviodica. — Like the urethra and bronchial tubes, the oesophagus may be affected with spasmodic contraction. Young hysterical women subject to it.
Symptoms. Difficulty in swallowing. Sense of fulness and choking under influence of any excitement. Languor. Anaemia, etc. Spasmodic cannot be confounded with permanent stricture, because dysphagia is only tempo- rary : a bougie passes with little or no difficulty : symptoms aggravated when patient's attention is directed to them.
Treatment. Ammonia and assafoetida, 86. Ether and chloroform, 85. Assafoetida and chiretta, 89. Valerianate of quinine, 414. Valerianate of zinc, 410. Phosphate of zinc, 414. Strychnia and steel, 408. Compound iron mixture and aloes, 393. Cod-liver oil. Galvanism. Cold shower bath. Nourishing food. Cure of any general or uterine disorder which may be present.
(ESOPHAGISM. — From Olaoq>dyoi, the swallow. — A nervous disorder, in which the symptoms are allied to those produced by spasmodic stricture.
Symptoms. An individual fancies he has swallowed a pin, or fish bone, or other hard substance, and that it can be felt sticking in the gullet. Irri- tation increases as the delusion is nourished. There is difficulty in swallow- ing owing to spasmodic or irregular action of the superior, middle, or inferior constrictor muscle. Even the medical man may be misled by trusting to patient's symptoms ; or by feeling, with finger in throat, upper edge of cornn of os hyoides, and mistaken it for a foreign body.
Treatment. A careful examination with finger, bougie, or laryngoscopic mirror fails to detect any substance. Galvanism. Quinine, 379. Valeria- nate of zinc, 410.
(ESOPHAGITIS— OPHTHALMIA TARSI. 181
CESOPHAGITIS. — From Olm^dyo^. the swallow (ol'co, to carry : fdyui, to eat); terminal -it is. Synoii. Angina (Esophag(ea ; Dysphagia Inflam- matoria; Injiammatio Gidce. — Inflammation of the oesophagus very rarely a primary disease. Generally a result of strumous diathesis; of one of eruptive fevers; of abuse of alcoholic drinks, or irritating drugs; of use of acrid poisons, etc. — Characterized by dysphagia; symptomatic fever; burn- ing pains shooting from throat to between shoulders ; fits of coughing, hic- cough ; constipation, etc. Suppuration, ulceration, or gangrene may result. — Remedies consist of mucilaginous drinks ; milk or cream ; aperient enemata; hot fomentations to throat; and perfect quiet, even talking being forbidden.
Simple ulceration of oesophagus is attended with difficulty in swallowing ; sometimes so great that deglutition is impossible. Pain at epigastrium, or top of sternum, or between shoulders. Nausea; anxiety; emaciation and debility. Ulceration may extend into trachea, pleura, bronchial tube, peri- cardium, or aorta. — Chief remedies: — sponging with solution of nitrate of silver (gr. 20 to fl. oz. j). Atomized astringent fluids, 262. Bark. Steel. Quinine. Cod-liver oil. Iodide of ammonium. Iodide of potassium. Nourishing food. Sea air. Where death is approaching from starvation, the formation of a gastric fistula should be attempted.
OLIG.ffiMIA. — From 'OXt'yo?, little ; al,ua, blood. Synon. Oliogohcemta ; Hypcemia ; Ht/pohcemia. — Deficiency of blood. — See Anaimia.
ONYCHIA.. — From "OtoI, a nail. Synon. Paronychia; Onychitis; Onychia Maligna. — An inflammation of the matrix of the nail. May arise from mechanical injury ; or from depraved state of constitution.
Symptoms. Pain and swelling at root of nail, and about surrounding textures. Exudation of sanious discharge on pressure of nail. Nail gets raised, and finally detached, exposing a foul ulcer. Ulcer becomes glazed and irritable : perhaps extends in all directions. Occasionally, necrosis of distal phalanx.
Treatment. Removal of nail. Ulcer to be dressed with zinc lotion, 264. Nitrate of silver. Nitrate of lead ointment. Local fumigation with calomel. Arsenic, chlorate of potash, and bark, 402. Quinine and steel, 380. Cod-liver oil. Nourishing food. — In syphilitic onychia, — Red iodide of mercury, 54. Mercurial vapor bath, 131. Solution of corrosive subli- mate, 27. Iodide of potassium, 31.
ONYXIS. — From "Oi'dI, a nail or hoof. Synon. Aduncatio Unguium ; In-growing of the Nail. — Inflammation and ulceration of side of toe, owing to margin of nail being pressed into the flesh. Ulcer gets covered with flabby and sensitive granulation. Causes great suffering, especially during walking.
Treatment. Removal of pressure of boot. Nails to be ordinarily cut off square, instead of down inner and outer sides. Scraping side of nail very thin, soaking in hot water, and introduction of pellet of cotton-wool so as to separate nail from ulcer. Removal of offending half of nail: anes- thesia or ether spray. Subsequent dressing with zinc lotion, 264. Excision of bulbiform enlargement close to edge of nail, leaving a sloping surface ' with the nail overhanging raw surface.
OPHTHALMIA.— From 'O^e^Xfihi. the eye. — A general term for inflam- mation of the eye. — See Conjunctivitis ; Sclerotitis, etc.
^ OPHTHALMIA TARSI.— From 'O^-eaMo?, the eye : Tapcroj, a hurdle. Synon. Blepharophthalmia ; Blepharotitis ; Adennphthalmia. — Inflam- mation of the palpebral conjunctiva and edge of eyelids ; with formation of minute pustules at roots of eyelashes, the discharge from which produces
182 OECHITIS— OSTEOMALACIA.
small crusts matting the hairs together. When attended with much irrita- tion it is sometimes termed Tinea ciliaris, or tinea palpebrarum, or psor- ophthalmza.
Symptoms. When acute, considerable pain and soreness. Usually chronic :— Itching ; destruction of tissues M'hicli secrete the hairs; a blend- ing of the skin and conjunctiva into a red shining cicatrix. Obliteration of puncta, causing stillicidium lachrymarum. — See Epiphora.
Treatment. Internally : — Improvement of general health. Tonics. Alteratives. Arsenic and steel. Cod-liver oil. Animal food : milk. Change of air. — Locally: — Great cleanliness to prevent accumulation of crusts. Eyelashes to be cut off close. Ointments, properly diluted, of nitrate of mercury, red oxide of mercury, or of oxide of zinc. Diluted solution of subacetate of lead. In obliteration of the lower punctum, the whole course of the canaliculus to be slit up to the caruncle, so as to lay open the canal and extend its orifice backwards to the point where the teai-s accumulate (Bowman).
ORCHITIS. — From ''Op;^'^?- a testicle ; terminal -itis. Synon. Hernia ^w?«orrt//s.— Inflammation of the testicle. — See Tentitis.
ORTHOPNCEA.— From 'Op9o5, erect; rtww, to breathe.— Excessive diffi- culty of breathing, so that the sufferer has to maintain erect position. Often present in asthma, bronchitis, pneumonia, dropsy, valvular affections of the heart, paralytic diseases, etc.
OSTEITIS. — From 'Orrrtov, a bone; terminal -itis. Synon. Ostitis. — Inflammation of bone arises from same causes as periostitis. Where the latter is of long duration, the former arises.
Symptoms. Great tenderness. Deep seated pain, aggravated at night ; influenced also by weather. Enlargement of aflected bone.
Treatment. See Periostitis. — Where suppuration occurs, and the me- dullary canal and cancellous structure get filled with pus, tonics and free supply of nourishment required. Amputation sometimes necessary. See Osteomyelitis. — In circumscribed abscesses of cancellated structure of either ■extremity of tibia, trephining the bone must be resorted to, so as to let out the pus.
OSTEOID CANCER.— From 'OstBov, a bone.— These cancers usually grow from some bone, and especially from the lower part of femur. Their general history correspends to that of the scirrhous and medullary varieties. They are as malignant and as quickly fatal as the medullary ; and they give rise to secondary deposits in areolar tissue, lymphatics, lungs, etc. — See Cancer.
OSTEOMALACIA. —From 'Oatiov, a bone; fiaXaxb^, soft. Synon. Mol- lities Os!<ium ; Malar.osteon ; Rachitis Adultorum ; Softening of the Bones. — The characteristic feature of this disease, as of rickets, is a defi- ciency of phosphate of lime; so that the bones become soft and unnaturally flexible. The morbid action induces fatty degeneration of the osseous tissue. The aSection is constitutional ; the whole skeleton is usually affected, pro- ducing distressing and remarkable deformity. Women beyond the age of forty are most obnoxious to it : the pelvis often first attacked in childbear- ing women. Large quantities of earthy salts are passed in the urine. The general health becomes hopelessly impaired : gradual loss of flesh and strength. Severe and intractable pains of a rheumatic character: sponta- neous fractures. Sooner or later, in spite of tonics and opiates and nour- ishing food, death.
OSTEOMYELITIS— OTITIS. 183
OSTEOMYELITIS. — From 'Ocjtsov, a bone; jxviXo;. marrow; terminal 't'tis. Synon. Medullitis ; Endosfeitis. — Inflammation of the medullary membrane lining- the central canals of long bones, as well as the cells of the flat and irregular bones; which delicate vascular membrane secretes the medulla, and is continued into the cells of the cancelli and the Haversian canals.
Generally the result of injury: a frequent cause of death after amputa- tion and other operations on bone. The symptoms are usually obscure, being masked by accompanying inflammation and suppuration of soft parts. It causes the periosteum to recede or separate from surface of the bone. Liable to give rise to pyiemia. But little modified by medicines. Removal of entire shaft of bone, leaving the periosteum. Amputation of limb, or of remainder of limb, often necessary. — See Osteitis.
OTALGIA. — From OJ?, the ear; aXyo^, pain. Synon. Otodyne ; Earache. — May be sympto^nattc of inflammation of ear, or of presence of foreign bodies in external meatus, or of tonsillitis, or of disorder of primje vise, or of rheumatism of the head. etc. ; or it may be idiopathic, — true neuralgia of auditory nerves. In latter case, suffering most severe on in- vasion ; unlike the pain in otitis, it does not increase in severity, is unattended by fever, and often disappears suddenly. Nervous otalgia may be con- nected with imperfect performance of functions of stomach or liver; or may arise from uterine derangement; or may occur in early stage of utero-gesta- tion ; or may be due to a carious tooth; the branches of the fifth pair of nerves supplying both the tooth and the ear; or it perhaps alternates with sciatica, tic douloureux, etc. Sometimes pain very severe; it frequently shoots through nervous filaments distributed over same side of face and head, causing much suffering and restlessness.
Treatmknt. When symptomatic, attention to be directed to primary disease. — When idiopathic, — mild purgatives; quinine; opium; Indian hemp. Application of a small blister behind affected ear ; local use of chloroform vapor, aconite liniment, cotton-wool saturated with laudanum, steam of decoction of poppy heads, linseed poultices, the boiled bulb of common onion or of garlic. Carious teeth to be extracted or stopped.
Noises in the ears (tinnitus aurium), deafness, confusion in the head, etc., may arise from accwnulation of cerumen in external meatus. 'J'he wax to be removed by thoroughly syringing with warm water ; or with solution of carbonate of potash (gr. 10 to fl. oz. j). Avoid mistaking deafness and singing in the ears, owing to the pressure of a mass of hard wax on the membrane of the tympanum, for symptoms of incipient cerebral disease.
OTITIS. — From Ouj, the ear; terminal -itis. Synon. Tnflavimatio Auris ; Inflammation of the Ear. — Various parts of the organ of hearing may be attacked : —
1. Inflammation of External Meatus. — Synon. External Otitis ; Otitis Catarrhalis. — The sensitive dermis of the canal may become inflamed from introduction of irritating matters, an accumulation of hard wax, blows on side of head, cold, syphilis, gouty state of system, impoverished blood, etc.
Symptoms. Dull aching pain, increased on moving jaw. Vascularity and tumefaction, the latter sometimes closing canal and causing temporary deaf- ness. Swelling of cervical glands on affected side. In a day or two, a copious secretion of mucus, — often very thin and abundant. In chronic cases, persistent otorrhcea : the dermis remains more or less tumid ; epi- thelium thrown off in scales which accumulate and obstruct canal: dimin- ished power of heai'ing ; great itching; and general depression.
A small circumscribed abscess in the meatus will cause acute throbbing
184 OTITIS.
pain ; narrowing of aperture of canal ; dulness of hearing. Often occurs ■when there is a tendency to boils or styes.
Treatment. The general health to be improved. Nourishing food, with plenty of milk, when digestion is good. Quinine. Iron. Chlorate of potash. Colchicum? Cod-liver oil. Sea air. — Locally: — Fomentations and poultices; frequent bathing to remove the irritating discharge. If much pain and swelling, a couple of leeches to margin of meatus will relieve congestion. When inflammatory symptoms terminate in chronic irritation, the collection of epidermis must be removed by syringing with warm water; mild astringent injections generally useful ; glycerine or olive oil. Some- times the cure is hastened by application of small blisters over mastoid process.
2. Inflammation of Membrana Tympani. — Synon. Myringitis. — May be acute or chronic. The consequence of cold ; of irritating matters; of gouty, tubercular, or syphilitic taints ; of the extension of disease from walls of meatus.
Symptoms. Pain, itching, slight deafness. A sense of discomfort on af- fected side of head. On examination with speculum, the membrana seen to be opaque, and traversed by distended vessels. Ulceration may take place, and even lead to perforation. Another result to be feared is permanent relaxation of the membrane; which loses its natural degree of resiliency, becomes flaccid, and falls in towards the promontory. A third consequence is thickening and hypertrophy of the fibrous lamin<e.
Treatment. AVhen due to gouty, strumous, or syphilitic taints, the ap- propriate remedies for these conditions are needed. In other respects, the treatment is the same as for inflammation of external n)eatus. AVhere there is perforation, the artificial membrana tympani. — a thin circular plate of gutta percha with a silver wire handle; or a layer of moistened cotton-wool with a thread attached to it.
3. Inflammation of Tympanic Cavity. — Synon. Internal Otitis.— A. severe disease. Rendered more serious by usually being combined with inflammation of the internal coat of the membrana tympani.
May arise from cold, rheumatism, or gout, scarlet fever, and the strumous constitution. Not uncommon in youth : many cases of children's earache, causing miserable nights, really due to it.
Symptoms. Uneasiness in ear on blowing nose or on swallowing : in a short time the discomfort becomes continuous. There may be violent head- ache ; followed by intense and sharp and gradually increasing pain in ear, with loud or beating noises. Then, a sense of bursting or distension in ear ; more or less deafness. Eyes become injected; countenance anxious; skin hot; pulse frequent; functions of kidneys and bowels disordered. Delirium often present; or. in children, convulsions. Always great depression ; fore- boding of some heavy calamity. Facial paralysis (caused by inflammation extending to bony canal in which portio dura passes round tympanum) may occur : power regained as morbid action subsides. 'I'ermination in one of three ways : either by resolution ; by suppuration, the pent-up pus bursting through membrana tympani, and so discharging itself; or by inflammatory process spreading through mastoid cells internally, or by bony meatus to periosteum covering mastoid process externally.
In external otitis, perforation of membrana tympani may take place owning to extension of ulceration from without inwards. In present case, the reverse happens; morbid action progresses from within outwards. This latter the most frequent cause of formation of an orifice ; fortunately the opening generally closes spontaneously in the course of a week or two.
Treatment. 'I'o be conducted with caution. Bowels should be mode- rately acted upon ; action of skin promoted: patient kept in bed in a quiet room.
OTORRHCEA— OTORRHAGIA. 185
Ralines, 348. Refrio-erating' drinks, 355, 356. Chlorate of potash, 360. Wliere there are manifestations of rheumatism or jront, iodide of potassium and colchicum, 31. Opium or morphia. 315, 317. Aconite, 330, 331. — Ijocally : — Vapor of boiling' water. Fomentations with poppy heads, chamomile flowers. Linseed, onion, or garlic poultices. Small blisters to mastoid process. When abnormal aperture in membrana tympani fails to close, attempts to be made to induce cicatrization by occasional use of nitrate of silver. This failing, and opening being of such a size as to cause deafness, application of artificial membrane, after producing healthy state of lining tissues of tympanum by mild astringent lotions and gentle syringing.
OTORRHCEA.— From Ol^, liro?, the ear ; h«'w, to flow. Synon. Otir- rJia'CC ; Bleuolorrlicea ; Catarrh of the Ear. — A purulent or muco-purulent discharge from the ear. A symptom of certain diseases of the ear ; as of catarrhal inflammation, polypus, sebaceous tumor in meatus, granulations on the surface of the membrana tympani, etc. Occurs very frequently, without any appreciable cause, in young children about the time of denti- tion ; or on the subsidence of any of the exanthemata, especially in strumous subjects. In adults it occasionally seems to be due to a depressed condition of system. 'Ilie secretion is generally offensive and irritating; when it has existed for any length of time, it is often tinged with blood.
Symptoms. Commonly the discharge ceases in a short period. Occasion- ally it becomes chronic, and when this happens it may continue for years. In purulent catarrh there may be in the course of time destruction of the membrana tympani, the ossicula auditCis, and caries of the bony walls of the meatus and tympanum. The disease may even extend to the cells of the mastoid process of the temporal bone ; or in the opposite direction to the surface of the petrous portion of the same bone, until the brain and its membranes become involved in the unhealthy action. This event indicated by rigors, fever, and marked cerebral symptoms : ultimately convulsions, coma, and death. Inflammation and abscess of the brain may be induced by extension of disease to the cerebral sinuses and veins as well as to the dura mater. Cases of phlebitis, with pleurisy and pneumonia, have also resulted from caries of the mastoid cells.
Treatment. Syringing gently with warm soap and water ; then careful examination of meatus auditorius externus with ear speculum. If no cause (as polypus, etc ) be found, attention to general health. Nourishing diet, — animal food, milk, etc. Quinine and steel, 380. Steel and pepsine, 394. Phosphate of iron, 405. Mineral acids and bark, 376. Iodide of iron, 32, 382. Iodide of potassium and guaiacum or sarsaparilla, 31. Cod-liver oil. — Locally: — Frequent syringing with warm water. Injections of alum, zinc, sulphate of cadmium, or tannin, of same strength as collyria, 291. Glycerine. Olive oil. Painting walls of canal with solution of nitrate of silver — gr. 6 to fl. oz. j. Equal parts of balsam of Peru and ox gall daily dropped into ear. Ointment of carbolic acid — gr. 10 to lard oz. 1. Solu- tion of chlorinated soda — min. xxx to fl. oz. j.
OTORRHAGIA. — From 03?, i3r6j, the ear ; [jriyvvfii,, to burst out. Hem- orrhage from the ears arises from different causes : — (1) Fracture of base of skull, by which a communication is established between sinuses of dura mater and middle ear. The membrana tympani being ruptured, blood escapes externally. If both petrous bones be injured, hemorrhage from both ears. Occurrence of bleeding, on one or both sides, generally regarded as of unfavorable import. — (2) Wounds and idcerations of auditory canal ; whether produced by earpicks or other instruments, insects, foreign bodies voluntarily introduced, or old hardened .ceruminous concretions. To be stopped by extraction of foreign body. — (3) Granulations, polypi, and abscesses of auditory canal. To be cured by removal of polypus, use of
186 OVARIAN DISPLACEMENTS— OVARIAN TUMOR.
nitrate of silver to granulations, or incision into abscess. — (4) Caries and necrosis of petrous portion of temporal hone, ivifh destruction of mem- hrana tympani. If" walls of carotid canal be involved, a spiculum of bone will possibly wound internal carotid artery, and cause fatal loss of blood. Ligature of common carotid may have to be resorted to. — (5) Rupture of membrana tympani ; which may occur during ascent of high mountains, or in descent of low valleys, or in going to any great depth in a diving-bell, etc. ; during violent sneezing or vomiting ;'or during paroxysms of hooping- cough or asthma. The air is violently forced through Eustachian tube into tympanum, the delicate membrane of which gives way where it is least capable of offering resistance — near insertion of handle of malleus. The bleeding to be checked by swabbing meatus with styptics. Subsequently, an artificial tympanum may be needed to relieve deafness. — And (6) It may he a vicarious hemorrhage, — i. e.. it may perhaps replace menstruation, or long-continued bleeding from piles or old ulcers.
OVARIAN DISPLACEMENTS.— One or both ovaries are occasionally forced out of position by some uterine or other tumor; or an ovary may descend into the retro-uterine pouch of peritoneum or escape from pelvis, forming a true hernia of this gland. Displacements of first class, usually aggravate the symptoms of the disease causing them : suffering often ceases, if tumor increase in size and pass upwards out of pelvic cavity. Those of second class may be congenital, or may happen accidentally after puberty. Occasionally, the ovary forms the contents of an inguinal, crural, or umbilical hernia.
OVARIAN TUMOR. — From Ovarium ('fiaptoj/, a small egg, dimin. of uiof), the ovary : Tumor ( Tumeo, to be swollen), a tumor. Synon. Ovarian Dropsy ; Cystic Disease of Ovary. — Consists of a conversion of the ovary, or of parts of it, into cysts. Three varieties of cysts : — Simple or unilocular ; compound, multilocular, or proliferous; and dermoid cysts, the lining mem- brane of which has the power of producing hair, teeth, sebaceous matter, etc.
Symptoms Very slight in early stage : disease generally escapes detec- tion until abdomen begins to be enlarged. In exceptional cases, tumor while in pelvic cavity causes irritation of rectum and bladder : sense of weight and oppression : pain and numbness down thigh of affected side. Backache. Menstruation usually regular, perhaps abundant.
In more advanced stage, great pain and tenderness : distension of abdo- men. Disordered menstruation, perhaps suppression. Loss of flesh. Con- stipation. Indigestion. Frequent micturition : urine often scanty. Loss of appetite. Restless nights. Dyspnoea. Diminution of strength. Abdo- men found enlarged : fluctuation, varying in distinctness according to number of cysts, their distension, and capacity. Dulness on percussion, not varying greatly with position of patient. Tumor may cause ascites. (Edema of thighs and legs. — At length, suffering rapidly augmented. Patient's move- ments impeded from bulk of tumor. Miserable nights : attacks of dyspnoea necessitate sitting up in chair. Considerable oedema. Sometimes, suppres- sion of urine and uriEmic poisoning. Fatal prostration.
Treatment. Abdominal tapping, followed by well-adapted pressure, and administration of iodide of potassium. 3L Tapping, with introduction of drainage tube, so as continually to withdraw fluid as it is re-secreted. 'J'ap- ping, followed by prolonged administration of chlorate of potash in full doses. Tapping, with injection of iodine. Tapping, with application of ligature around pedicle. Tapping through vagina. Abdominal section, — ovariotomy.
Drugs to produce absorption of multilocular tumors, worse than useless. Application of blisters, leeches, iodine ointment, mercurial ointment, stimu- lating liniments, electricity, etc. to be avoided.
OVARITIS— OZvENA. 187
OVARITIS. — From Ovarium ('Qa'ptoi/, a small ego', flimin. of u>6v), the ovary; terminal -jV^s. Syiion. Oophoritis; Odritis ; Inflammatio Ovarii. — Inflammation of the ovary occurs under two forms, — the acute, and sub- acute or chronic : —
1. Acute Ovaritis.— May arise from violence, use of strong caustics to labia uteri, dilatation of os with sponge-tents, sudden suppression of menses from shock, cold, gonorrhoea, etc. Left ovary more frequently attacked than right : double ovaritis rare.
Symptoms. Pain of variable amount : sometimes most intense, causing paroxysms like labor-pains ; more frequently of a dull aching character, with occasional sharp lancinating attacks. Tenderness about lower part of abdomen : of groin and inner part of thigh corresponding to affected gland. If morbid action continue, peritoneum gets involved. Bladder becomes irritable : urine scanty, high-colored, and scalding. Tenesmus. Passage of hardened feces causes much suffering by pressure on ovary. Fever; rapid pulse; nausea; restlessness; disgust for food. On examina- tion, the swollen and exquisitely sensitive ovary easily detected. — If suppu- ration occur, there will be rigors ; quick and feeble pulse ; glazed red tongue; excessive sickness; sense of weight and throbbing about pelvis. Abscess may burst into peritoneum, setting up severe peritonitis : more favorably, into rectum or vagina. Such cases sometimes very tedious: opening closes, but pus accumulates again and again.
Treatment. Hot hip baths, night and morning. Pessaries of conia, opium, and belladonna, 423. Fomentations : hemlock poultices : linseed poultices, — to vulva, hypogastric, and inguinal regions. Saline aperients in early stage. Iodide of potassium, 31. Guaiacum and aconite, 43. Opium and belladonna, 344. Rectum to be emptied by enemata of olive oil, ]88. Leeches to labia uteri, if attack be due to sudden suppression of menses. If an abscess point in vagina, it may be cautiously opened with a trocar or bistoury.
2. Chronic Ovaritis. — A common disease during period of sexual vigor. Runs a tedious course. May be set up by excessive sexual intercourse; un- skilful use of uterine sound, or caustics ; rheumatic and syphilitic taints, etc.
Symptoms. Dull and continuous aching in ovarian and sacral regions.. Tenderness in inguinal region or of upper part of one or both thighs. Scanty and difficult menstruation. Pain on sexual intercourse. Irritability of stomach ; nausea, indigestion, constipation, flatulence. Fits of hysteria. Irritability of bladder. Tumefaction and tenderness of one or both breasts. — Attacks of nymphomania, or even some forms of chronic insanity, may arise from subacute ovaritis. Infiamed gland found swollen and sensitive, on making a vaginal examination.
Treatment. Iodide of potassium, 31. Bromide of ammonium, 37. Guaiacum and aconite, 43. Hydrochlorate of ammonia, 60. Cod-liver oil, 389. Pepsine, 420. Ammonia and bark, 371. Quinine and belladonna, 383. Iodide of iron and cod-liver oil, 390. Conia or iodide of lead and belladonna pessaries, 423. Belladonna plaster to sacrum. Warm hip baths. Warm clothing : flannel drawers. Animal food : milk, raw eggs. Gentle walking exercise.
Avoidance of : — -Blisters. Leeches. Calomel. Antimony. Strong pur- gatives. Sexual intercourse.
OZ^NA. — From "of};, a stench. Synon. Coryza Virulenta ; Pyorrhoea Nasaiis ; Rhinitis Ulcerosa. — Chronic inflammation of the nostrils. Due to long-continued attacks of catarrh, especially in gouty or strumous subjects ; syphilitic taint ; abscess of septum ; chronic ulceration ; polypi ; necrosed bone : or foreign bodies in nasal cavities.
Symptoms. Appearance, perhaps, of common cold. Uneasiness and
188 PANCREATIC DISEASE— PARALYSIS.
" stuffiness" of nose. Swelling of pituitary membrane. Headache. Pro- fuse, fetid, muco-purulent discharge; sometimes tinged with blood. Forma- tion of flakes of fibrin or hardened mucus ; which, if allowed to remain in nose, decompose and give out a most disgusting odor. Septum of nose often eaten through, leaving a small round hole. Caries or necrosis of spongy bones, especially in syphilitic cases.
Treatment. General remedies: — Quinine and iron, 380. Nitro-hydro- chloric acid, 378. Arsenic and bark, etc., 52. Steel with arsenic, 381, 399. Cod-liver oil. Chlorate of potash and steel, 402. Iodide of iron and cod- liver oil, 390. Iodide of potassium, 31. Corrosive sublimate, 27. Red iodide of mercury, .54, 55. Green iodide of mercury, 53. Mercurial vapor baths, 131. Sea air. Nourishing food. Warm clothing.
Z/Oca//_y .'—Nasal douche with weak solution of permanganate of potash, or carbolic acid, or tannic acid, or frequent and thorough syringing with warm water. Injections of alum- or zinc; or permanganate of potash, 78. Inhalation of steam, or application of spray medicated with iodine, 259 ; or creasote, 260: or turpentine. 260. Iodine vapor, 259. Nitrate of mercury ointment, 305. Iodide of lead ointment, 293. Pulverized medicated fluids, 262. Snuffs of chlorate of potash and sugar (gr. 30 and oz. ^) ; or of red oxide of mercury and sugar (gr. 5 and oz. ^); or of white bismuth.
PANCREATIC DISEASE.— Disease of pancreas (from Haj, all ; xp^'aj, flesh) of comparatively rare occurrence. When aff"ected, it is mostly im- possible to diagnose exact nature of morbid state.
Diseases which may occur are : — Congestion, hypertrophy, inflammation, suppuration, induration, serous softening. Atrophy ; fatty degeneration. Simple cystic tumors; hydatid tumors. Scirrhous or medullary cancer. Calculous concretions, composed of carbonate and phosphate of lime cemented by animal matter, are not uncommonly found in pancreatic duct or its branches : of a white color, varying from size of a pea to that of a walnut, and existing singly or to the number of fifteen or twenty.
Symptoms. Most pancreatic disorders attended by enlargement and tenderness of gland. Epigastric tenderness ; fulness or hardness ; sense of heat and constriction. Nausea and vomiting; salivation; loss of appetite; inodorous eructations. Fatty stools. Mental depression. Debility, with emaciation, If common choledic duct be pressed upon by pancreatic tumor, or if it be involved in structural disease of gland, there will be per- sistent jaundice.
Treatment. Alleviation of prominent symptoms. Pancreatine. Pan- creatic emulsion. In obstinate sickness. — nutrient enemata. Ice. Setoa in abdominal wall over seat of gland. Repeated small blisters.
PARALYSIS. — From HapaXvui, to relax — to affect with paralysis. Synon. Paresis; Palsy. — A total or partial loss of sensibility or motion, or of both, in one or more parts of body. Sometimes said to be:— (1) Perfect when both motion and sensibility are affected. (2) Imperfect, when only one or the other is lost or diminished. Divided into acmesm ('A, priv. ; xivrjnK;, motion), paralysis of motion; and ancesthesia ('A, priv. ; ainBdvo^ai, to ieel), paralysis of sensibility. Term local palsy used, when only a small portion of body is affected ; as face, a limb, one foot. In reflex paralysis (Reflecto. to turn back) the irritation extends from periphery to centre, and thence reflected to affected muscles : diseases of urinary organs, uterus, and intestines most common causes of this form. A peculiar disease known as ivastmg palsy, prominent symptom of which is a degeneration and wasting of the muscles.
Palsy may be due to disease of brain arising from apoplexy, embolism, or thrombosis, abscess, softening, induration, tubercular, cancerous or syphi- litic tumors, renal disease, epilepsy, chorea ; to disease of spinal cord, as
PARALYSIS. 189
inflammation, atrophy, solution of continuity, etc.; to diseases of investing parts of brain or corf], acting by pressure; to lesion or compression of a nerve, by which its conducting power is impaired ; to some atfection of the muscle itself; to hysteria, or to rheumatism; and to influence of such poisons as lead, mercury, etc.
1. General Paralysis. — Complete loss of sensation and motion of whole system cannot take place without immediate death. Term " general par- alysis" usually applied to a peculiar form of insanity : see Insanity. Some- times to palsy affecting the four extremities.
A case has been related in which power of motion in every part of body was lost, save in muscular apparatus of tongue, and of organs of degluti- tion and respiration. Sensibility also wholly destroyed except in a small patch on right cheek, by tracing letters on which the patient could be com- municated with (Defermon).
2. Hemiplegia. — From "H^trnj?, half; rtX>;wcd, to strike. Synon. Semi- p/e(ym.— Paralysis of one side, involving upper and lower extremity, and same side of face and tongue. Most common form of palsy. Usually spoken of as '• a paralytic stroke." Left more frequently affected than right side, ^^ft o^piipi-^Uy mm-P completely paralyzed than leg. Occa- sionally limbs of one side and opposite third nerve or opposite side of face, or of tongue affected ; forms of transverse or crossed palsy.
Symptoms. Face only partially paralyzed. Muscles of eyelid and of brow very little affected ; palsied cheek drops loosely, while mouth is drawn towards sound side by non-counteraction of paralyzed muscles (but much less than in facial paralysis of Bell, due to lesion of portio-dura, in which also the eye is staring open). Tongue implicated ; when protruded, point turned to paralyzed side, owing to vigorous action of healthy muscles pushing sound half further out than the other. Articulation imperfect. _Third nerve not involved in the common form of hemiplegia, but temporary^ "lateral deviation of both eyes, and persistent turning of head towards the sound side frequent in severe cases. Arm more completely paralyzed than leg, as a rule, and recovers more slowly. Paralyzed limbs usually flaccid at first, sometimes rigid. Thoracic and abdominal muscles not obviously affected. Sensation may be perfect or impaired, or almost lost. Mental faculties frequently damaged. Tendency to shed tears. Forgetfulnessand misplacement of words. In red softening of brain, muscles of one of affected limbs often rigid and contracted. — In hopeless cases, limbs waste: muscles atrophy, owing to descending sclerosis in cord and diminution of nutrition. In favorable instances, symptoms of amendment first observed in leg. Where the arm regains power before the leg, prognosis unfavorable.
Treatment. Indiscriminate depletion injurious. Cathartics sometimes u.seful at first: — Scammony and jalap ; calomel; croton oil; stimulating purgative enemata. Efficacy doubtful of blisters to scalp or nucha, or of setons.
When collateral symptoms point to embolism, or thrombosis, or softening from defective nutrition, vvine and nourishment to be given ; cod-liver oil ; ammonia and bark ; ammonio-citrate of iron ; hypophosphite of soda or lime.- — When the hemiplegia ^-QTi^pflVijr cPi-phr^l h,TRipn;iicIi!iop there may be symptoms of inflammation round the clot. In such, riiild purgatives ; blisters ; sulphur baths ; when the cause is syphilis, iodide of potassium. — In reflex hemiplegia, removal of the cause.
In chronic forms : — Small doses of strychnia, where there is no active dis- ease of brain. Mild ferruginous tonics : phosphate of iron ; ammonio-citrate of iron. Cod-liver oil. Animal food : milk. Frictions of limbs and spine with flesh-brush; liniments of turpentine, cantharides, ammonia, etc. Elec- tricity and galvanism, when paralysis remains without muscular rigidity.
190 PARALYSIS.
3. Paraplegia. — From llaparCKrj^ia, partial paralysis, — TtapaTfKrjnuu, to strike badly. Synon. Rnchioplegia; Myeloparalysis ; Paralysis Spinalis. — Palsy of the lower half of body. Two varieties : (1) That due to disease of spinal cord or membranes. Spinal meningitis, myelitis, congestion, softening, hasmorrhage, tumor, syphilitic disease, etc. (2) Reflex paraplegia, that caused by excitation which has reached the cord from a sensitive nerve. There is probably an insufficient amount of blood in cord.
Symptoms. Usually begin slowly and insidiously. AVeakness and numb- ness and tingling of feet and legs. Weakness increases, until there is com- plete loss of sensibility and motion in lower extremities. Paralysis of bladder and sphincter ani. Decomposition of urine in bladder. Involuntary move- ments and spasms of legs often very distressing. Reflex movements excited more easily in paraplegia than hemiplegia. Marked deterioration of general health.
Special Symptoms. — In spinal meningitis, severe pains in limbs and back, especially on movement, sometimes simulating rheumatism; reflex move- ments sometimes exaggerated, paralysis of sphincters late.
In myelitis, dull pain. Sensation of cord round body ; paraplegia more pronounced ; reflex action in parts below segment attacked, often exag- gerated ; sphincters early affected.
In congestion symptoms less definite ; often worse after night's rest from increase of congestion by recumbent posture. A rapidly fatal congestion sometimes seen, characterized by paralysis, advancing from below upwards till respiratory muscles involved.
Syphilitic disease of cord a common cause of paraplegia, to be recognized chiefly by concomitant symptoms and history.
Treatment. An important distinction to be drawn between cases where there is congestion or inflammation of spinal cord or membranes, and the opposite condition.
(1) Where amount of blood is increased, as in chronic local myelitis, there are symptoms of irritation ot mTJTOf^ierve-nuclei, — as convulsijina^ramps, twitchings, priapism ; with indications of irritation of sensTTTveiierve-nuclei, — as^tcfrrng, pricking pains, abnormal sensations of cold or heat, etc., and also symptoms of irritation of vaso-motor or nutritive nerve-fibres, — as wast- ing of muscles, bed-sores, alkaline urine, etc. Pain corresponding to upper limit of inflammation. Tenderness on pressure. Application ofaJjjiLsiiiMige causes sense of heat in all parts above inflammation, witlTburHtng sensation at upper limit. Application of a piece of ice over vertebras gives rise to sense of cold everywhere except at level of inflammation, where feeling of heat is experienced. In treating these cases, quantity of blood sent to cord is to be diminished. Ei-£o| -f:^ rye^i five or six grain doses, twice daily. Belladonna. Belladonna^lasT^TTr^r spine. Iodide of potassium, in con- junction with belladonna. Cod-liver oil. Henbane, conium, or Indian hemp to relieve restlessness. Avoidance of opium, as it causes congestion of cord. Nutritious diet: wine or beer, milk. Nutrition of limbs to be maintained by shampooing, stimulating liniments : at a subsequent period by very gentle galvanic current. (Brown-S6quard.) To which list may be added mercury.
(2) In paraplegia due to diminished nutrition of cord, as that caused by white softening and reflex palsy, food and remedies needed to improve quality of blood, and cause an increased quantity to be sent to cord. Strychnia, gr. /jj daily. Opium. Quinine and iron. Nitrate of silver and hypophos- phite of soda, 419, deserving of trial. Cod-liver oil. Sulphur baths. Very nourishing food. Patient to lie on his back, with head and shoulders and lower extremities raised, so that blood may gravitate to cord. (Brown- Sequai'd.)
In syphilitic paraplegia, iodide of potassium in large doses, and in some cases mercury.
A controlling power can be exercised by means of heat and cold applied
PARALYSIS. 191
to flifTeront parts of back, over the circulation in brain and spinal cord and , ganglia of sympathetic, and through agency of these nervous centres in every other organ. In this way, reflex excitability, or excito-motor power of cord, and contractile force of arteries in all parts of body can be modified. To lessen the excito-motor power, ice is applied in an India rubber bag about two inches wide, over that part of spine on which it is wished to act. On same principle, vitality of cord increased by using hot water and ice alter- nately, each in an India rubber bag if energetic action be required : where less vigorous eff'orts are called for, ice or iced water only employed, resorting to application several times a day, for a short time on each occasion, with long intervals between (John (,'hapman).
In reflex paralysis, while relieving loss of power on preceding principles, the external cause must be removed. Thus, the practitioner should expel intestinal worms ; lance gums ; relieve irritability of urinary and sexual systems ; cure skin diseases, etc.
4. Local Paralysis. — Many varieties of local palsy. Only necessary to mention one, — Facial paralysis of Dell. Results from pressure on, or lesion of portio dura of seventh nerve, which may be at the nucleus or root of the nerve, or in its intra-cranial or petrosal portion, or after its exit from the stylo-mastoid foramen, or at the peripheral extremity. Exposure to cold, and debility, most frequent causes of facial palsy. May also be due to irritation of decayed teeth. Otitis leading to caries of petrous por- tion of temporal bone may produce it, especially in children, or it may be caused by tumor or other disease in or near the pons. It will last from a few days to several weeks. Usually free from danger.
Symptoms. Appearance remarkable, as only one-half of face is usually palsied. Features on aff"ected side blank, unmeaning, void of all expression. Orbicularis palpebrarum muscle powerless, so that eye staring open and not closed, either by effort or in reflex winking. Inability to frown or blow ; nostril does not dilate ; cheek hangs loose ; angle of mouth droops. Fifth pair of nerves unaffected ; so that muscles of mastication act pro- perly. No loss of sensibility. — In paralysis of the face due to cerebral hemorrhage the symptoms are less marked, though of same character as foregoing.
Paralysis of portio dura on both sides, a rare affection. When it occurs there is no distortion of features owing to symmetrical nature of disease. On close examination, however, nostrils are found motionless ; cheeks flat and relaxed ; inability to close eyes completely ; defective articulation with regard to sounds formed by lips, but unimpaired lingual articulation.
Other Common Local Paralyses. — Paralysis of ocular muscles. Of muscles supplied by 3d nerve. — Ptosis ; immobility of eyeball, outward squint, dilatation of pupil, double vision. Of external rectus supplied by 6th nerve — inward squint. Of superior oblique supplied by 4th nerve — double vision and giddiness without obvious squint, the two images ob- liquely placed and receding as patient looks down.
These common in syphilitic disease at base of brain. Paralysis of supi- nators and extensors of forearm and hand, sometimes caused by pressure on musculo-spiral nerve.
Trkatment. Remove cause if it can be ascertained. Mild antacid aperients. Iodide of potassium. Bromide of potassium. Nourishing- food. Warm bathing. Friction with shampooing. Galvanism.
6. Locomotor Ataxy. — From 'A, neg. ; ■tdaau, to order. Synon. Pro- gressive Locomotor Ataxy ^ Tabes Dorsalis ; Sclerosis of posterior columns of Spinal Corel. — A peculiar form of imperfect paraplegia some- times attributed to sexual excesses, exposure to cold and damp, rheuma- tism, gout, etc. Most common in males about middle period of life. In well-marked cases it has been shown that atrophy and disintegration of
192 PARALYSIS.
nerve-fibres of posterior columns of spinal cord have taken place, with formation of amyloid corpuscles and hypertrophy of connective tissue. These changes included under term sclerosis. Lesion not always confined to posterior columns of cord. Often also a certain gray degeneration of cerebral nerves, of spinal nerves, and various lesions of gray substance and cord (Lockhart Clarke),
Symptoms. 'J'he pathognomonic symptom is a diminution or total absence of power of co-ordinating movements; so that patient has difficulty in walking, loses his balance, and has a peculiar gait. Can move limbs and has considerable power in them when lying down. Distinct from ordinary paraplegia, in which there is impairment or loss of voluntary motion.
Early Symptoms.-^Seweve stabbing or darting pains in legs. Squint- ing ; double vision, impairment of sight. Occasionally partial paralysis of other cranial nerves besides ocular. Mode of walking peculiar, feet lifted up and thrown out in an irregular and extravagant manner, and brought down violently ; turning round is difficult. Patient has to watch his legs in order to guide their motions ; cannot stand when eyes shut, or in the dark, still less walk.
Intellect and memory unaffected. Rarely deafness. A sensation as of strings tied round abdomen now and then complained of. No tenderness on examination of spine. " Pins and needles," with numbness in lower extremities; sometimes violent cramps or neuralgic pains. Ultimately loss of sensation in lower limbs ; complete amaurosis from atrophy of optic nerve; increasing weakness, so that patient cannot leave his bed. Progress of disease slow : recovery very rare. Occasionally death occurs from inter- current affections, as bronchitis, pneumonia, erysipelas, etc.
Treatment. A nourishing diet : animal food; raw eggs ; rum and m.ilk ; milk cocoa in place of tea and coffee. Nitrate of silver, .59. Phosphate of iron, 405. Iodide of iron, 32, 390. Quinine and iron, 380. Bark and phosphoric acid, 376. Aloes and pepsine, 155. Aloes and reduced iron, 404. Phosphorus. Hypophosphite of soda or lime, 419. Belladonna. Calabar bean. Indian hemp. Cod-liver oil. Sulphur baths, 125. Con- tinuous galvanic current to lower part of spine. Mineral waters, in earl}' stage, of Bareges, 470 ; of Marienbad, 497 ; of Wiesbaden, 489.
Remedies often recommended:- — Iodide of potassium. Ergot of rye. Arsenic. Bromide of potassium. Nux vomica and strychnia. Opium. Turpentine. Galvanism. Faradization. Actual cautery, moxa, blisters, and leeches to spine.
Sclerosis of Lateral Columns of Cord. — Excessive formation of con- nective tissue with wasting and disintegration of nerve fibres of lateral columns, invading also anterior cornua of gray matter.
Symptoms. Gradual paralysis with rigidity of muscles and contraction of limbs. No loss of sensation. Sphincters not affected till late.
'^I'keatment. As of locomotor ataxy.
Disseminated Sclerosis. — Patches of sclerosis in different parts of brain and cord.
Symptoms. Gradual loss of power with tremor and agitation of muscles whenever they are called into action. Lips and tongue tremulous on speak- ing. Chin kept on breast to avoid effort of supporting head, which brings on tremor. Limbs quiet till moved ; then agitated.
6. Infantile Paralysis. — Occurs at or before the second teething, fre- quently in strong and healthy children. Access rapid ; usually ushered in by pyrexia, and during, or after this, the paralysis observed. One or both lower extremities or the arm and leg may be affected. The affected parts are powerless and flaccid ; there may be hypersesthesia at first, afterwards sensation not impaired. The paralyzed muscles rapidly lose their sensibility
PARALYSIS. 193
to Faradic electricity, but retain sensibility to galvanism much longer. Frequently some muscles recover while others do not, and thus deformity produced.
Treatment. At time of attack incise gums if necessary. Warm bath. Stimulating liniment to spine. Friction of limbs. Mild aperients. Later the paralyzed parts to be kept warm and to be rubbed daily. Galvanism to be employed early, and when susceptibility to Faradic electricity restored, the induced currents. The general health to be maintained.
7. Hysterical and Rheumatic Paralysis.— In hysterical palsy there is neither disease of nervous centres nor of motor nerves. Occurs in hysterical women : produced by fright, over-excitement, ovarian irritation, etc. Muscles of lower extremities may be affected (hysterical paraplegia) ; or muscles of arm and leg on same side (hysterical hemiplegia) ; or only one or two particular muscles. Generally, other symptoms of hysteria present. May be cured by remedies which improve general health. Ferruginous tonics. Antispasmodics. Galvanism.
In rheumatic palsy muscles of lower extremities often attacked : or ex- tensor muscles of forearm, or deltoid and trapezius, rendering it difficult to rise arm. May come on suddenly or gradually. To be cured by galvanism, shampooing, iodide of potassium, cod-liver oil.
8. Progressive Muscular Atrophy.— From 'A, priv. ; * pt^w, to nourish. Synon. Wasting Palsy ; Creeping Palsy ; Idiopathic Degeyieration of Voluntary Muscles ; Atrophic Musculaire avec Transformation Grais- seuse. — Paralysis with granular and fatty degeneration and extreme wasting of muscular fibre, owing to some error of nutrition. Patches of granular degeneration found in those parts of gray substance of spinal cord whence nerves pass off to affected muscles. Also, amyloid corpuscles round central canal of cord. Nerve-cells shrunken and atrophied. It has been questioned whether spinal cord lesion is primary or secondary. The former is rendered more probable than was formerly believed, by researches of Lockhart Clarke.
Symptoms. The pathognomonic feature is a degeneration, and consequent loss of volume and power, of voluntary muscles ; without diminution of intelligence or sensibility. May affect upper or lower limbs, or voluntary muscles of whole body; usually symmetrical.
Scapular muscles, deltoid, muscles of thenar eminence often affected early. The muscles attacked waste way, and almost entirely disappear, leaving bony prominences bare. With the wasting comes weakness.
Fibrillary tremors or convulsive quiverings of some of the fasciculi which form the muscle produced by irritation of skin ; patient unconscious of their occurrence. Occasionally, neuralgic or rheumatic pains. Great sensitive- ness to cold. Intellectual powers undisturbed. General health moderately good. — As disease progresses, total deprivation of motion in affected limbs, of which only skin and bone left. Patient often has to be fed and carried about like a child. Power of deglutition and articulation may be lost. Fatal asphyxia a common termination, — for, as a consequence of catarrh, bronchitis, etc., mucus accumulates in air-tubes : owing to diaphragm and intercostal muscles being involved, no efforts at expectoration can be made. Occasionally, apncea from paralysis of respiratory muscles.
Duration of disease varies from a few months to some years. Complete recovery rare : progress of disease sometimes suspended, esf)ecially when muscles of trunk are not involved. General muscular atrophy spares neither children, adults, nor aged people : partial form most common between thirtieth and fiftieth year. Males suffer more than females. Exposure to wet and cold, or hard work, often assigned as causes. May follow fever, sunstroke, falls and blows, etc. It is hereditary.
Treatment. Attention to digestive organs. Hypophosphite of soda or lime, 419. Nitrate of silver, 59. Frictions of affected muscles. Sulphur 13
194 PARALYSIS.
batlis, 125. Galvanism to wasting muscles. Localized Faradization ; not giving more than one or two minutes to each muscle, lest it get fatigued, and not prolonging each sitting for more than ten or fifteen minutes.
Remedies which have generally failed :— Strychnia and nux vomica. Mercury. Iodide of potassium. Tonics. Cod-liver oil. Setons, issues, or blisters over vertebral column. Cold baths during active stage.
9. Pseud-hypertrophic Paralysis.— A disease of early childhood mostly affecting males. The child weak on his legs, constantly falling, and getting up with difficulty; walk slow, clumsy, and waddling. Great aching of loins. Characteristic feature is great size of calves of legs, and of buttocks, but when muscles examined under microscope the increase of bulk found to be due to connective tissue, the muscular fibres being wasted. No treat- ment effectual.. Death usually occurs before the age of eighteen from pul- monary afl'ection.
10. Mercurial Palsy. — Synon. Mercurial Tremor. — A convulsive agi- tation of voluntary muscles, increased when volition is brought to bear upon them. In advanced stages, articulation and mastication and locomotion performed with difficulty. Sometimes delirium or even acute mania. Use of hands almost entirely lost. Epilepsy. Great weakness. Restlessness at night. Skin acquires a dirty-brown hue. Soreness of gums. 'J'eeth turn black, decay. — The sufferers are workmen exposed to fumes of mer- cury,— gilders of buttons, glass-platers, barometer makers, etc. Chemists working with mercuric methide ought to take special precautions to avoid the deadly influence of this very poisonous compound.
Treatment. Withdrawal entirely from injurious atmosphere. Iodide of potassium, 31. Nourishing food. Cod-livor oil. Warm baths. Sulphur baths, 125. Galvanism. Sea air.
11. Lead P&,lsy. — Synon. Paralysis Satumina ; Metallic Palsy; Painter's Palsy. — Often follows or accompanies lead colic, though it may exist independently. Operatives in lead-works and mines suffer much from saturnine emanations. Work-rooms where manufacture of white lead is completed have their atmosphere loaded with minute particles of lead compounds ; so that workers in them get " leaded," become victims of paralysis, colic, gout, sleeplessness, neuralgia, spasms of respiratory mus- cles, debility and pallor and emaciation, etc. Plumbers, painters, color- grinders, type founders, etc., also suffer much.
Symptoms. Poison of lead exerts a peculiar noxious influence over nerves of fore-arm and hand ; in consequence of which, extensor muscles of hands and fingers get paralyzed, and hands hang down by their own weight when arms are stretched out, — the ^vrists drop. Inferior extremi- ties rarely affected. Frequent attacks of lead colic. Saturnine taste and odor in breath. Fortnation of a blue or purplish line round edges of gums, just where they join the teeth, a characteristic feature. — Death may occur when system has long been exposed to influence of lead; especially if health be also injured by intemperance, or by frequent attacks of gout.
Treatment. Curative: — Iodide of potassium, 31. Galvanism. Sulphur baths, 125. Support of hand by splint. — Prophylactic : — All workers in lead should drink sulphuric acid lemonade daily. To avoid intoxicating drinks. Functions of skin to be promoted by cleanliness.
12. Paralysis Agitans. — Synon. Parcdysis Tremida ; Tremor; Shakiiig Palsy. — Characterized by an involuntary tremulous agitation of muscles which is independent of exertion, and goes on during repose of muscles, commencing in hands and arms, or in head, and gradually extending over whole body. Finger and thumb generally in contact as if taking pinch of snuff. Associated with great restlessness and sense of heat. Diminished muscular power. Senses and intellect injured. Disease
PAEAPHIMOSIS— PELLAGRA. 195
progresses slowly. When far advanced, agitation may be so violent as to prevent sleep. Deglutition and mastication perlbrnied with difficulty. A propensity to bend the trunk forwards, and to pass from a walking to a gentle ruiniing pace. Inclination of body forwards, with bending of chin on sternum. Livoluntary escape of feces and urine. Slight delirium and fatal coma.
Treatment. Few remedies of much use. The effects may be tried of pure air, nourishing food, baths, ferruginous tonics, cod-liver oil, and occa- sional opiates. Benefit may perhaps he obtained from employment of con- tinuous galvanic current, such as can be derived from a Pulvermacher's chain-battery of 120 links.
PARAPHIMOSIS.— From ITapa, beyond ; fifioio, to bind tight. Synon. Phimosis Cii-cumligata. — That condition in which a tight prepuce having been drawn back over the glans penis, the latter becomes constricted and swollen, so that the prepuce cannot be replaced.
Symptoms. Great swelling of areolar tissue behind constriction. Mu- cous membrane of withdrawn prepuce forms a thick and brawny girdle. Congestion of glans penis. Pain, inflammation, if neglected, ulceration, anxiety, etc.
Treatment. Reduction : — Parts to be well oiled : glans to be com- pressed and gently pushed backwards with right hand, while the prepuce is drawn steadily forwards with the left. Compression of glans sometimes effected by encircling it with a narrow strip of adhesive plaster; or by a loop of tape ; or by spoon-bladed forceps. Application of ice, or stream of cold water, before trying reduction, sometimes useful. All failing, a notch or free division of tight preputial collar with probe-pointed bistoury.
Permanent Care : — To prevent a recurrence, circumcision may be advan- tageously practised. — See Phimosis.
PARAPLEGIA,— From llapa.7fKr^la,, partial paralysis; rtapart^crcfw, to strike badly. Synon. Kackioparcdysis ; Myeloparalysis ; Paralysis Spinalis. — Paralysis confined to inferior half of body. — See Paralysis.
PARASITIC ANIMALS AND PLANTS.— From napaotrtco, to flatter another and live at his expense. — See Entozoa ; Epizoa ; Epiphytes.
PAROTITIS. — From Ilaptt, near; oi-j, the ear; terminal -itis. Synon. Cynanche Parotidea ; Mumps. — A specific and contagious inflammation of salivary glands, and of parotid gland especially.
Symptoms. Chilliness. Slight fever. Pains in limbs. Tumefaction and soreness in one or both parotid regions. Disease reaches its height in four days ; then declines. Very rarely runs on to suppuration. Occa- sionally, during or after decline, testicles or mammae become painful and swollen.
Treatment. Mild diet. Cold acidulated drinks. Ice. Gentle laxatives. Solution of acetate of ammonia, 349. Carbonate of ammonia, 361. Hot fomentations. Linseed poultices.
PELLAGRA. — From Pellis. skin ; cegreo, to be sick,— unhealthy skin. Synon. Mania Pellagria ; Mai de Sole ; Elephantiasis Italica ; Scurvy of the Alps. — Common in Lonibardo-Venetian country. A severe con- stitutional or blood disease attended with an altered state of skin. The eruption merely symptomatic of the vitiated state of system. — Cause not clearly made out. Mostly ascribed to peasants living chiefly on maize, — nine-tenths of their food consisting of this substance made into polenta with coarse bread, etc., but may occur when this grain is not eaten. Probably
196 PELVIC CELLULITIS— PELVIC HEMATOCELE.
disease due to insufficient nourishment, and the use of dry farinaceous food without sufficient fatty matter.
Usually ends in mania, imbecility, and slow death. Softening of peri- phery of brain has been often met with in autopsies : softening of part of spinal cord almost always.
Symptoms. Disease begins insidiously at commencement of warm spring •weather, with a shining red spot suddenly arising on back of hand or some part of body. This spot elevates skin, and produces numerous small tuber- cles. Epidermis dries and cracks, falls off; but shining redness underneath continues. At end of summer, eruption generally disappears ; suspended till following spring, when it reappears. This first stage may go on thus for seven or eight years. — The second stage is characterized by the disease setting in with greater constitutional disturbance, general debility, disturb- ance of nervous system (despondency, cramp, spasm). Convulsions severe : when paroxysm ends, patient becomes a pray to melancholy of a religious character with suicidal tendency. At end of autumn there is a remission, but less marked than before. Then next year, symptoms greatly aggravated. Skin all over body, gets dry, rough, and shrivelled : great debility : diarrhoea : breath and sweat most offensive : great flow of saliva. Pain in the head, vertigo, delirium ; dyspnoea ; cramps ; bilious vomiting ; low fever ; dropsy ; epilepsy; and surviving these, mania or fatuity. Disease may not prove fatal for 5, 10, or even 15 years. Its popular name — malattia di miseria — sufficiently justified.
'1'reatment. In early stage : — Removal to healthy locality. Good nour- ishing food, with milk, fatty matters, etc. — When fairly established : — All treatment useless, beyond attempts at relieving the most prominent symptoms.
PELVIC CELLULITIS.— From Pelvis {UsXTii^, or UirKa), a bowl : Cel- hila (dimin. of cella), a little cell; terminal -/^is.— Inflammation of the cellular or areolar tissue of pelvis. — Occurs mostly in connection with abortion, or lingering labor at full term. Also as a consequence of external violence, uterine disease, or some strumous state of constitution.
Symptoms. May come on insidiously. More commonly, — Constitutional disturbance. Fever, headache, restlessness. Local pain and throbbing and tenderness. Aching pains in limbs. Difficult micturition. Tenesmus. Nausea and vomiting. Painful swelling, sometimes appreciable at lower part of abdomen : always detected by vaginal examination.
If morbid action go on to suppuration. — Increased severity of general symptoms. Rigors. Severe throbbing and tenderness. Neuralgic pains down thighs. Fluctuation. Pus may be discharged into upper part of vagina, or bladder, or colon, or rectum : rarely, into peritoneum, causing severe peritonitis : or it will burrow and make its escape externally. I'rou- blesome sinuses sometimes produced. Pus formed again and again for months.
Treatment. Castor oil, 164. Rhubarb and magnesia, 165. Citrate of ammonia or potash, 362. Morphia, chloroform, and Indian hemp, 317. Opiate enemata, 339. Opium and belladonna suppositories, 340. Mercurial and belladonna pessaries, 423. Ammonia and bark, 371. Quinine and mineral acids. 379. Hot hip baths. Fomentations. Linseed poultices. Hot water vaginal injections. Milk, raw eggs, beef-tea, arrowroot, tea : animal food as soon as it can be digested. Wenham lake ice. Sinapisms to epigastrium, if thei'e be sicknesss. Abscess may sometimes be opened with advantage.
PELVIC HEMATOCELE.— From Pelvis, a basin ; Al/^a, blood; xvp.'^, a swelling. Synon. Sanguineous Pelvic Tumor; Ovarian Apoplexy ; Retro-uterine Hoematocele ; Peri-uterine Hcematocele. — An effusion of blood into peritoneal pouch between uterus and rectum, or into subperito- neal tissue behind and around the uterus.
PERFORATION OF STOMACH. 197
Symptoms. Yary accordins" to amount of loss. If excessive, — Nervous shock. Exhaustion from internal liemorrhape. Acute pain in lower part of abdomen. Chilliness or shivering : coldness of extremities. Vomiting. Increasing feebleness of circulation. Ghastly expression of countenance. Death may occur in a few hours.
Where loss is great but not excessive, — Violent abdominal pain. Sickness. Chilliness followed by fever. Anxiety of countenance : pinching and pallor of face. Difficult micturition, with frequent desire to empty bladder. Irri- tability of rectum. Perhaps, sudden cessation of catamenia if flow be on at the time. Pelvic tumor : appreciable through abdominal and vaginal walls.
In a third class of cases, symptoms of same character but less acute than foregoing. Pelvic tumor : only appreciable by vaginal examination. Fear of peritonitis : of hemorrhage returning after an interval. Absorption may be hoped for.
In all cases uterus fixed by coagulation of blood around it. Usually dis- placed forwards, and tumor felt bulging posterior wall of vagina.
Treatment. In acute cases : — Brandy. Wine. Opium, in large doses. Sinapisms to extremities. Bladders of ice to lower part of abdomen and vulva.
Where loss is moderate : — Perfect repose in recumbent posture. Opium, in sufficient doses to relieve pain and prevent faintness. Gallic and aromatic sulphuric acids. 103. Alum and sulphuric acid. 115. Ice. Sinapisms to epigastrium. Cold applications to vulva. Catheterism. Puncture of pro- minent part of tumor by rectum with trocar ? Rest and care at two or three succeeding catemeuial periods.
PEMPHIGUS.— From nE>tii a bubble or blister. Synon. Fehris Bullosa; Bladdery Fever; Waterblebs. — A non-contagious skin disease. Characterized by large round or oval vesicles, or bullse [Bulla, a bubble of water), two or three inches in diameter, which appear on one or more regions. Each bleb filled with alkaline serum ; which soon loses its transparency, becoming acid and puriform. Slight fever, etc. Very liable to relapse.
Pompholyx (no,aij)6j. a blister) is merely a variety of pemphigus.
Treatment. Arsenic usually most effectual. Phosphorus. Ammonia, and bark, 371. Nitro-hydrochloric acid, 378. Quinine and steel, 380. Cod- liver oil. Eff'ervescing citrate of magnesia, 169. Arsenic, quinine, and steel, 381. Chlorate of potash. Iodide of potassium. Vesicle to be punc- tured : cuticle not to be removed.
PENIS CANCER. — Malignant disease of the male organ is generally of the epithelial kind. Commences as a warty or cauliflower-looking growth on inner surface of prepuce : followed by unhealthy and very destructive ulceration. Lymphatics on doi'sum of penis, and the glands in the groin, gradually get involved. Sanious discharges. , Retention of urine. Cancer- ous cachexia. Painful death. — Most common cause, irritation by soot in chimney sweeps, but the disease may result from irritation of retained secre- tions of corona glandis in phimosis, where there is predisposition to cancer. — Early and complete amputation offers the only hope of cui'e.
PERFORATION OF STOMACH.— In cancerous as well as in simple ulceration of stomach perforation may occur, with escape of contents into peritoneum. Where this viscus has contracted adhesions, a communication may fortunately only form between stomach and outside of abdomen ; or between stomach and colon or duoden^im ; or even between stomach and pleural cavities, lungs, or pericardium. Must not be confounded with post^ viortem, perforation due to digestion of stomach by gastric juice. — See Gas-^ trie Ulcer ; Gastric Cancer ; Gastro-Cutaneous Fistula ; G astro- CJiolic . Fistula.
198 PERICARDITIS-PERIOSTITIS.
PERICARDITIS. — From Uppi. about; xapSi'a, the heart; terminal -ttt's. Synon. Exocarditis ; Ivflammation of the Pericardium. — Inflammation of the external fibro-serous covering of heart. May be regarded as a local manifestation of constitutional disease. Occurs most frequently in connec- tion with acute rheumatism, Bright's disease, ichorhaemia, and scurvy.
Symptoms. Sometimes so slight that disease is not suspected. When there is only a slight exudation of fibrin, or when effused serum has been rapidly absorbed and adhesions early effected, there may be only a feeling of fever and oppression. If effusion be copious (hydro-pericardium) so as to press on heart and embarrass its movements, or when there is coexistent myocarditis, symptoms much more decided. High fever, as ascertained by thermometer; pain in cardiac region, darting through to left scapula, upwards to left clavicle and shoulder, and down arm ; tumultuous action of heart ; irreg^ilarity of pulse ; dyspncea ; inability to lie on left side ; anxiety of countenance ; noises in ears, giddiness, epistaxis, etc. As disease advances, — Extreme debility, cough, suffocative paroxysms, tendency to syncope, oedema of face and extremities. Great restlessness, delirium, dis- tortion of features, tetanic spasms.
Physical signs : — (1) Sensations of friction communicated to hand. (2) Friction-sounds ; an alternate rubbing, or to-and-fro sound. (3) Friction- sounds attended with, or preceded by, valvular murmurs. (4) Extension of dulness over heart, and muffling of heart sounds, owing to serous effusion. (5) Signs of eccentric pressure analogous to those of empyema. (6) Signs of excitement of heart. (7) Signs of weakness or paralysis of heart.
Treatment. Perfect quiet in bed. Temperature of room 6.5° to 70^ F. Neutral salts, if there be constipation, 141, 144, 150, 152. Opium, in full doses. Opium and belladonna, 344. Bicarbonate of potash (gr. 30 every two or three hours). Bicarbonate of potash drink, 355. Cream of tartar drink, 356. Chlorate of potash drink, 360. Poppy-head fomentations. Large linseed poultices. Belladonna and opium, over cardiac region, 297. Vapor baths. — Light diet, — Gruel, arrowroot, milk, mutton broth. As soon as strength fails, — Soup, essence of beef, raw eggs, wine.
When effusion is abundant : — Iodide of potassium, 31. Red iodide of mercury, 54. A succession of blisters. As a forlorn hope, tapping of peri- cardium.
Remedies sometimes used : — Mercury. Tartarated antimony. Digitalis. Drastic purgatives. Bleeding. Leeches. Blisters. Leeches useful in early stage.
PERINEPHRITIC ABSCESS.— From nfp.;, around; w^po?. the kidney. — Abscess of the areolar tissue surrounding the kidney. — See Abscess of Abdominal Walls.
PERIOSTITIS. — From Periosteum (llfpt, round about; ontihv, a bone) ; terminal -zY/i'. Synon. Ivflammatio Periostei. — Inflammation of the perios- teum may result from injury, syphilitic taint, rheumatism, abuse of mercury, and from atmospheric exposure acting upon broken down constitutions.
Symptoms. Pain, generally aggravated at night ; very acute if subjacent bone be involved. 'J'enderness. Thickening of inflamed part from deposit of plastic matter, forming a tense elongated swelling. — a node. Constitu- tional disturbance; varying from slight impairment of health, to acute inflammatory fever. Restless nights. Mental depression. Rigors indicate suppuration.
'1'reatment. Calomel and opium. Corrosive sublimate. Red iodide of mercury. Iodide of potassium, 31. Syrup of iodide of iron. Morphia and Indian hemp, 317. Cod-liver oil. — Locally : — Leeches, rest, and hot fomen- tations (in acute cases). Iodine liniment. Blisters. Friction with equal parts of belladonna and mercury liniments. Subcutaneous incisions through
PERITONITIS— PERITYPHLITIS. 199
the membrane flown to tlie bone, to relieve periosteal tension when excessive, or to prevent suppuration when imminent. Early incision, through skin and periosteum, when there is pus beneath the membrane.
PERITONITIS.— From Uspttsivu. to stretch all over; terminal -itis. Synoii. Liflamatio Per?.Vo??e?'.— Inflammation of the serous membrane lining abdominal and pelvic cavities, and investing the viscera. May be jicute or chronic. Rarely idiopathic; may be due to injury, perforation of stomach or intestines, disease of abdominal viscera, etc. : —
1. Acute Peritonitis. — Acute inflammation of peritoneum a serious dis- ease. Accompanied with pain and swelling of abdomen, and severe symp- tomatic fever.
Symptoms. Pain, gradually extending over whole abdomen. Sometimes chilliness and rigors. Fever, with small, hard, long pulse. Exquisite ten- derness of abdomen ; increased by slightest pressure, and by any movement calling abdominal muscles into action. Patient lies on the back, with knees bent and legs drawn up. Abdomen tense, hot, and often tympanitic ; motionless in respiration. Constipation; nausea and vomiting; dry burn- ing skin; rapid feeble pulse; hurried respirations; often hiccough; and tongue thickly furred. Countenance expressive of anxiety and suSering. After a time, belly ceases to be tympanitic but remains enlarged from eff"u- sion of serum. When diseiise is about to end fatally, abdomen usually gets much distended ; pulse thready and very quick ; face assumes a ghastly ex- pression ; cold clammy sweats ; and death takes place from exhaustion within eight or ten days of onset.
Treatment. Opium. 344. Opiate suppositories, 340. Opium and aconite, 332. Opium and belladonna, 344. Poppy bead fomentations. Belladonna and opium, with fomentation flannels, flemlock poultice. Linseed poul- tice. Turpentine stupes. Leeches. Enemata of warm soapy water, if there be faecal accumulation in colon or rectum.
Diet: — At first to be restricted to milk and water, tea. arrowroot, beef- tea, ice, iced water, barley water. Lime-water and milk, 14. When ex- haustion sets in, brandy; aromatic spirits of ammonia; spirit of ether; brandy and e^g mixture, 17. Essence of beef, 3. — Most perfect quiet. Air of sick room to be warm but pure. A cradle over abdomen to support bed- clothes. Good nursing.
Remedies sometimes emp/o^/ed;— Bloodletting. Blisters. Calomel and opium. Tartarated antimony. Tobacco enemata. American hellebore. Antiphlogistic regimen.
2. Chronic Peritonitis. — Sometimes the sequel of an acute attack : more frequently an independent affection. May be due to presence of tubercles on peritoneum, — Tubercular peritonitis.
Symptoms. Somewhat obscure. Abdominal pain slight. Attacks of colic : perhaps fever with obstinate diarrhoea. Tenderness and swelling of abdomen. Peculiar rigidity of abdominal walls. Nausea. Anaemia and wasting. Abdominal enlargement from efl'usion. When with tuber- cular peritonitis there is disease of mesenteric glands, phthisis, etc., the case rapidly runs on to fatal termination.
Treatment. Attention to bowels. Mild but nutritious diet : milk or cream; cocoa; raw eggs ; solution of raw meat, 2. Cod-liver oil. Iodide of iron. Quinine or bark. Chemical food, 40.t. Hypophosphite of lime, or soda, and sumbul, 419. Pepsine, 420. Diluted iodine liniment to ab- dominal wall. Iodine and cod-liver oil ointment, 308. Iodide of cadmium ointment, 312. Blisters. Sea air.
PERITYPHLITIS.— From ITfpi;, around ; rv^Xoi, blind ; terminal -itis. Obstinate inflammation of the areolar tissue connecting the cascum with the psoas and iliac muscles.
200 PERTUSSIS— PHLEBITIS.
Symptoms. Severe pains shooting from right iliac region. Constipation or diarrhoea and tenesmus. Nausea. Mental depression. Fever. Pain and tenderness over cajcum, with tumefaction and increased resistance on pressure. Frequently suppuration. When abscess opens into cavity of caecum, recovery often follows.
Treatment. See Gcecitis.
PERTUSSIS. — From Pe7', very ; tussi's, a cough. Synon. Tussis Con- vulsiva ; Whooping-cough ; Chincough, etc. — See Hooping-cough.
PHARYNGITIS.— From ^a'pvyl, the gullet; terminal -Ms. Synon. Cynanche Fliari/vgea. — Inflammation of the pharynx not as common a disease as might be expected.
Occasionally, especially in hospitals and workhouses, walls of pharynx are affected with diffused erysipelatous ivjiavimation. Attended with low fever, difficulty in swallowing, rapidly increasing prostration. Morbid action may run on to sloughing. Death from exhaustion not uncommon. The remedies are, — Ammonia and bark, 371. Chlorate of potash and steel, 402. Quinine, 379. Ether and brandy, 367. Wine or brandy. Raw eggs. Restorative soup, 2. Thorough ventilation of sick room.
Syphilitic idceration of velum and fauces may, after healing, produce narrowing and contraction of upper part of throat so as to impede degluti- tion and obstruct respiration. Incising edges of contracted opening some- times useful. In severe cases, tracheotomy. 'I'he tracheal tube has been worn with comfort for years.
Elongation of uvula may result from chronic inflammation, or from a generally relaxed state of fauces. By irritating- pharynx and epiglottis the hypertrophied uvula produces a troublesome tickling cough, worse on lying down at night, with occasional inclination to vomit. Astringent gargles, application of nitrate of silver, nourishing food, and ferruginous tonics failing to cure, two-thirds of the organ had better be snipped off. — See Retro- Pharyngecd Abscess.
PHIMOSIS. — From *ta6w, to bind tight. Synon. Ligatura Glandis ; Strictura Prcepntii. — A preternatural constriction of the foreskin, preventing its being drawn back over the glans penis. May be congenital or acquired.
Symptoms. In children, a long and contracted foreskin often gives rise to symptoms resembling those of stricture, or of stone in the bladder. Irri- tation, from inability to wash away secretions of corona glandis. In adults it may result from the inflammation of a gonorrhoea, or of a chancre. Swelling, from inflammation of areolar tissue. Irritation, from accumula- tion of discharg-es ; which may produce balanitis, and in after life epithelial cancer,— if there be any predisposition.
Treatment. Palliative: — Warm bathing. Fomentations and poul- tices. Tobacco or belladonna lotions Injection of astringent lotions under prepuce. Stretching with bougies : with blades of dressing forceps. — Radical cure: — Circum(-ision. Slitting up of prepuce on dorsal aspect as far as the corona ; and stitching of edges of mucous lining to skin. Water dressing after either operation. — See Parapjhimosis.
PHLEBITIS. — From ^Xs-:^, ^KiSoi, a vein ; terminal -itis. Synon. Inflam- matio Venarum. — Inflammation of the veins depends upon, or is accom- panied by, a morbid state of the blood. The history of phlebitis is that of the coagula (thrombi) formed within the aff'ected veins, and of the metamor- phoses through which these coagula pass (Yirchow).
Symptoms. Pain, increased on pressure ; swelling, stiffness, and redness in course of vessel, generally spreading upwards towards heart. When suppuration results, rigors and flying pains in various parts of body. Con-
PHLEBOLITES— PHOTOPHOBIA. 201
stitntional disturbance always great. The result of admixture of pus or other morbid fluids with blood is to cause the latter to coagulate: in this way a vein sometimes becomes filled with a coagulum; .sometimes the areolar tissue around inflames, suppuration and abscess follow, coats of vein ulcerate, and contained clot is discharged by means of the abscess. On the contrary, if poison does not produce coagulation, it mixes with the blood, affects entire system, and gives rise to secondary abscesses in distant parts — lungs, liver, spleen, eye, joints, areolar tissue, etc. Occasionally a clot is carried from a large vein to the heart, and causes sudden death.
Treatment. Ammonia and bark, 371. Chlorate of potash, 61. Sulphite of soda or magnesia, 48. Quinine, 379. Brandy and egg mixture with opium. 318. Opium, or opium and belladonna, 344. Morphia, chloroform, and Indian hemp. 317. Essence of beef, 2. Eggs, cream, and extract of beef. 5. Lime-water and milk, 14. Port wine or brandy. — Perfect repose. Fomentations. Linseed poultices. Hemlock poultices.
PHLEBOLITES. — From ^%f-\,. a vein ; uOo;, a stone. Synon. Vein Stones. — Small calculi, from size of millet seeds to that of peas, occasionally found in the veins. Frequently, produce no obstruction ; they lie in dilata- tions. Chiefly composed of phosphate of lime, carbonate of lime, and animal matter. Probably formed by calcareous deposits from the blood, having a small clot as a nucleus.
PHLEGMASIA DOLENS.— From ^Tisyw, to burn ; doleo, to be in pain,
Synon. Phlefimasia Alba Dolens ; (Edema Lacteum ; Crural Phlebitis; Obstmctrve Phlebitis ; White Leg; Milk Leg ; White Swelling of Ijymg- in Women. — A brawny, non-oedematous, painful swelling of one or both lower extremities, attended with prostration. Probably depends on spon- taneous coagulation of blood within internal or external iliac and femoral veins ; coagulation due to some poisonous or acrimonious fluid entering the veins, or merely to cachectic state of system. Most probably, lymphatics also involved ; they become obstructed. — Not uncommon after parturition, especially in women weakened by flooding, etc. Frequently occurs towards termination of uterine cancer. A similar condition may be induced in upper extremity by cancer of the axillary glands. — Left leg more often attacked than right.
Symptoms. Commence in from one to five weeks after labor. Fever : headache; thirst; nausea; pain. Sometimes, chills or rigors. Swelling and loss of motor power in affected extremity. Limb unnaturally hot ; tender; non-oedematous, but swollen perhaps to twice its naturally size, of pale white color, tense and elastic ; having a glazed or shining appearance. — After subsidence of acute symptoms, limb often remains enlarged for many weeks.
Treatment. Acute stage : — Ammonia in effervescence, 362. Carbonate of ammonia, 361. Chlorate of potash, 61. Sulphite of soda or magnesia, 48. Hydrochloric acid. Opium. Aconite. Iodide of potassium. Quinine. Simple diet. Diluents. — Perfect rest. Fomentations. — Chronic stage : — Iodide of iron. 32. Iodide of potassium and bark. 31. Ammonia and bark, 371. Phosphate of iron, 405. Nourishing food : milk, wine, and malt liquors. — Bandaging. Friction with stimulating liniments. Cold water douche. Flying blisters.
Remedies sometimes employed: — Venesection. Leeches. Blisters. Evaporating lotions. Mercurial ointment. Calomel. Blue pill. Digitalis. Creasote. Antiphlogistic regimen.
PHOTOPHOBIA.— From "f-cLj, light; ^oj3bu, to dread. Synon. Pheno- phobia ; Aversion to Light. — Intolerance of light is a painl^ul symptom in many diseases of the eye, — e. g., strumous ophthalmia, sclerotitis, etc. It
202 PHRENITIS— PHTHISIS.
may often be relieved by protecting the ej'e with a large green shade or veil, or by spectacles with glasses of a neutral tint. By darkening the room, with careful avoidance of subsequent sudden admission of light. Hot fomentations ; or the steam of hot water, medicated with extract of bella- donna or extract of poppies. Hen)lock poultices over eye. Exposure of the eye to the vapor of twenty or thirty drops of chloroform placed in the warm hand. Small blisters behind the ear, or on temple. Painting skin of upper eyelid with tincture of iodine.
The constitutional remedies will be those required by the disease of which the photophobia is only one of the results.
PHRENITIS. — From *p;7i', the mind ; terminal -itis. Synon. Cepha- litis; Cere.hritis ; Brain Fever. — See Cerebral Infiammation.
PHTHIEIASIS.— From a>e«?p, a louse. Synon. Morbus Pedicularis ; Phtheiriaus ; Pediculatio ; Lousiness. — Human body may be infested with three kinds of lice : — Pediculus corporis vel vestimentorum ; Pedi- culvs capitis or head louse ; and Pediculus pubis or crab louse. Prurigo senilis very frequently due to the pediculus vestimentorum. All are ovi- parous, the eggs being known as nits: sexes distinct: young are hatched in five or six days, and in eighteen days are capable of reproduction.
Treatment. Free washing with yellow or soft soap and hot water. Sulphur bath, 125. Mercurial vapor bath, 131. Mercurial ointment. Dusting with calomel. Corrosive sublimate lotion (gr. 2 to fl. oz. j). Sulphur, Stavesacre or Cocculus ointment. Infusion of tobacco. Nits to be combed away, after washing the hairs with vinegar or spirits of wine. Underclothing to be boiled, not simply washed; other clothes to be ironed with hot flat-iron.
PHTHISIS. — From <S>9i,'co, to waste away. — Synon. Tabes Pulmonum, ; Tubercular Phthisis ; Pulmonary Consuv\ption ; Decline. — Phthisis may be inherited or acquired. Left lung suffers most frequently. Apices and posterior parts of upper lobes most frequent seats of deposit at first. No period of life exempt from this scourge. — See Tuherculosis.
Phthisis has long been understood to imply tubercular disease, but though this is tlie most frequent and important cause of the destructive changes in the lungs constituting pulmonary phthisis, they may be induced otherwise. The following are.recognized varieties : — ■
Pneumonic phthisis, starting in pneumonia, the pneumonic products not being absorbed, but undergoing caseous degeneration, which is followed by destructive processes. Caseous pneumonia is, however, said to be depen- dent on antecedent tubercle.
Phthisis ab Hasmoptoe, beginning in an attack of haemoptysis; the blood, congealing in the air-cells, setting up destructive inflammation independently of tubercle. It is very rarely that this sequence can be established.
Fibroid Phthisis, in which the lungs are invaded by fibroid tissue. This may extend inwards from pleuritic exudation, or be due to a chronic pneu- monic process, or to fibroid changes in tubercle. Said to be often associated with fibroid changes in other organs, and to be the result of a special con- stitutional tendency.
Fork and File Grinders' Phthisis, Miners' Phthisis, caused by irritation of solid particles, which set up a slow, destructive inflammation of the lungs.
Syphilitic Phthisis, due to syphilitic deposit.
Of 'J'ubercular Phthisis there are two chief forms —
1. Acute Phthisis. — This form very rare. Commences suddenly with shivering, fever, rapid pulse, pain, cough, dyspnoea. Shortly afterwards,
PHTHISIS. 203
hectic fever, profuse sweatint'', diarrhoea. Increasing emaciation. Death from .exhaustion, often before the tubercles have softened, and without formation of cavities, perhaps in from three to twelve weeks of commence- ment of disease. — Tubercle generally spread all through lungs in miliary form, deposit often begins in middle and lower lobes.
2. Chronic Phthisis. — The variety ordinarily met with. The tubercle may be confined to one or both lungs. There is first formation of tubercles, which interferes with passage of air to and from the air-cells ; then inflam- mation round the tubercle and consolidation of the lung substance; finally, breaking down of structure, and formation of cavities. Tubercle may be deposited also in mesenteric glands, tissues of intestinal walls, kidneys, liver, nervous centres, etc.
Symptoms. Gradually increasing cough, sometimes haemoptysis, debility, e.xpectoration; loss of appetite, and dislike to fatty food, dj'spepsia. accele- rated pulse, pyrexia, slight dyspnoea, loss of flesh, sweating, diarrhoea. Weakness of voice or hoarseness. A festooned appearance at reflected edge of gums. Dull aching pain under clavicles or scapulae. Sometimes, fistula in ano one of earliest symptoms. So long as tubercle is being de- posited, the temperature of the body is usually' raised.
Haemoptysis most frequent in early stage : it is very rarely fatal. Mucous membranes of bronchi, larynx, and pharynx apt to get affected with low form of inflammation : tubercle sometimes deposited in submucous tissue of these organs. Disturbance of uterine functions in women : cessa- tion of catamenia. Congestion and tenderness of liver. Incurvation of finger-nails: clubbed appearance of ends of fingers. The debility and emaciation become more and more marked. Profuse night sweats. Diar- rhoea : either due to disordered secretions, or to ulcerations about ileum and colon. . Aphthae about mouth and fauces. Urine sometimes contains albumen, or sugar. Tenderness and oedema of extremities. Mental faculties usually remain clear until death.
Physiccd signs : — At first there may be no perceptible dulness on per- cussion. Respiratory sounds at affected apex feeble or harsh, and expira- tory murmur audible and prolonged, with perhaps faint ci'epitus, or dry crackling. If tubercular deposit considerable, flattening of infra- and supra-clavicular regions. Defective expansion of upper and front part of aff"ected side. Dulness on percussion, or percussion note of higher pitch. Harsh or tubular inspiration. Expiratory murmur prolonged. Bronchial respiration and bronchophony.— In second stage, more marked depression of infra- and supra-clavicular regions. Deficiency of chest movement. De- cided dulness on percussion, unless amount of tubercle be small and sur- rounded by emphysematous lung. Large crepitation. Puerile breathing in sound lung. — In third stage, great depression below clavicle. Flatten- ing of whole of affected side. Retraction of intercostal spaces. Heart's impulse seen and felt at higher point than normally. Dulness on percussion, or " cracked-pot" sound, owing to solidity of layer of lung forming wall of cavity. Gurgling. Cavernous respiration, if cavity be empty or nearly so ; amphoric resonance and pectoriloquy, if it be also large.
For diminution of Vital cii\)acity, see Spiro7netry. — For extent of Loss of weight, see Weight of Body.
Treatment. General rules : — Improvement of general nutrition. Attention to quantity and quality of food. Residence in a healthy climate : not necessarily a warm one. Exercise in open air, preferably without fatigue, — by driving, sailing, etc. Ensuring purity of air in apartments occupied. Warm clothing : flannel or chamois leather next the skin. Daily tepid sponging, preferably with salt water : friction with coarse towels, flesh-brush. Strength on no account to be lowered : exacer- bations of fever to be treated by simple salines, omitting tonics for a couple
204 PHTHISIS.
of days or so. In early stage, any complication (such as fistula in ano) may be cured by operation.
Diet: — Most nutritious. Animal food, so long as it can be disrested. Pepsine, 420. Milk ; cream ; raw eggs. Iceland moss and quinine jelly, 13. Milk, flour, and steel, 16. Asses' milk. Saccharated solution of lime with milk, where there is acidity of stomach. Koumiss. Rum and milk. Brandy. Port wine or sherry. Burgundy. Champagne. Hungarian wines (Ofner Auslese. Szamarodnya Muscat, Carlowitz, etc.). Stout; bitter ale ; Scotch ale ; Guinness' stout. Too long an interval not to elapse between meals.
Change of air and scene : — Very valuable in early stages. Patients requiring a relaxing or sedative atmosphere in this country may be sent to Torquay, Undercliff of Isle of Wight, Sandgate, Hastings, Penzance. Where a more bracing air is suitable, Brighton, Southport, Queenstown, Western coast of Scotland. If a more complete change than this country affords be wished for, Mentone, Cannes, Ajaccio, Malta, Malaga, Algiers, Madeira, Colony of Natal, Canada ; when a sea voyage is indicated, Australia or New Zealand.
Mountain climates sometimes of great service ; numerous elevated situa- tions in Switzerland and Tyrol suitable for summer residence; at St. Moritz in Engadine arrangements made for winter.
Drugs: — Cod-liver oil, 389. Ozonized cod-liver oil. Cod-liver oil and bark enemata, 22. Inunction with oil, 283. Steel and cocoanut oil, 391. Steel and glycerine, 392. Hypophosphite of soda or lime, 419. Arsenic. Bark in full doses. Various preparations of iron, 380, 394, 397, 401, 403, 40.5, etc. Iodide of iron. Quinine. Liquor potassse. Carbonate of anmio- nia. — If there he hcemoptysis : — Iron alum, 116. Gallic acid, 103. Tannin and nitric acid, 99. Oil of turpentine, 102. Lead and acetic acid, 117. — To relieve cough : — Opium or morphia, 31.5, 316, 317, 346, 347, etc. Decoc- tion of Iceland moss. Demulcent drinks, 19. — If heart's action he irritable : ■ — Hydrocyanic acid. Digitalis. — To check night siveats : — Oxide of zinc, 111. Belladonna. Gallic acid. Mineral acid with bark. Quinine. Spong- ing body with very hot water. — To check diarrhoea : — Rhatany, 96. Cate- chu, 97. Vegetable charcoal, 98. Matico and rhatany, 105. Sulphate of, copper and opium, 106. Nitrate of silver and opium, 107. Kino and log- wood, 108. White bismuth, 112. Astringent enemata, 113. — To check expectoration, and lessen laryngeal irritation: — Turpentine inhalations, 260. Hydrocyanic acid inhalations, 261. Inhalation of spray medicated with tannic acid, turpentine, steel, etc., 262. Sponging epiglottis, pharynx, and even interior of larynx with solution of nitrate of silver.
Local applications to chest ivalls : — Strapping of affected side to pre- vent movements of chest and give the diseased organ rest. Iodine liniment. Dry cupping. Croton oil liniment, 303. Succession of small blisters. Blisters, kept open by savine ointment or by A-lbespeyre's plaster, 208. Issues, or setons, below clavicle. Frequent sinapisms. Turpentine stupes. Friction with salt water; cod-liver oil, 283; salad oil ; belladonna and aco- nite liniment, 281.
Remedies which have been recommended : — Pancreatine and pancreatic emulsion. Naphtha. Malt (Byne). Bromide of iron. Peroxide of hydro- gen. Acetic acid. Actea racemosa. Hydrosulphuret of ammonia. Iodide of ammonium. Glycerine. Common salt. Sulphur. Codeia. Digitaline. Phosphorus. Carbonate of lead. Sanguinaria Canadensis. Arsenic. Oxalic acid. Phosphate of lime. Tartarated antimony. Mercury and chalk and other mercurials. Colchicum. 'J'ar. Excreta of reptiles. Daily emetics. Frequent small bleedings. Inhalations of naphtha; chlorine; carbonic acid ; oxygen gas ; iodine ; tar vapor. Arsenical cigars. Stramonium cigars. Turkish baths. Horse exercise. Laying open cavity by incision through intercostal space, and treating it as a chronic abscess.
PIARHJ3MIA— PLAGUE. 205
PIAKH^MIA. — From Tltap, fat; alua, blood. Syiion. Lt'pcemia ; Pioxitinia. — Milkiiiess of the serum or fatty blood is met with under certain circumstances in disease. Its physical causes are two — viz., free fat, and molecular albumen.
(1) Piarhffimia a physiological result of digestion, pregnancy, lactation, and hybernation. During digestion, lactescence of serum begins aboat two hours after ingestion of aliment, and continues for two or three hours. The serum is turbid, opalescent, and semi-opaque ; a condition only transitory, and due to absorption of fattjr matters of food, formed into an emulsion by pancreatic juice, and absorbed as such in duodenum. Examined micro- scopically, the serum is found to contain a large number of fat globules and of molecular grannies of albumen. The passage of chyle into the blood renders the serum turbid ; this turbidity lasting until fatty matters enter into combination with free soda of blood.
(2) Lactescent serum a pathological result of disease. The cases in which its occurrence has been noted are diabetes, chronic alcoholism, dropsy, jaundice, nephritis, hepatitis, pneumonia, and especially Bright's disease.
PICA. — From Pica, a magpie, probably because this bird was supposed to live on earth or clay. Synon. Malacia ; Heterorexia ; Limosis Pica ; Cittosis ; Allotriophagia or Endemic Pica; Depraved Appetite. — A depraved form of appetite, in which there is a longing for remarkable sub- stances, such as sand, cinders, slate pencil, chalk, clay, coal, sponge, etc., most common in pregnant women, chlorotic girls, and children.
Symptoms. Distaste for usual food. An almost uncontrollable desire for improper substances. Emaciation, anemia, mental depression, colicky pains : sometimes diarrhoea from irritation of the intestinal mucous meralarane, excess of acidity in gastric secretions.
Treatment. Vegetable tonics. Antacids. Mild aperients. Ammonia and steel. Opium. Bismuth. Quinine. Lime-water and milk. Sucking ice. Regulation of diet.
PITYRIASIS. — From liitvpov, bran. Synon. Herpes Furfuraceus ; Branny Tetter; Dandriff ; Dandruff. — A chronic, non-contagious, squa- mous inflammation of the skin; attended with slight redness and much irritation. Characterized by production of minute white scales, or scurf, in great quantity. May attack any region: scalp and parts covered with hair most common seats of it — pityriasis capitis. Desquamation takes place copiously and incessantly, often for months. When occurring in red and rough patches, it is known as pityriasis rubra. Forming brown patches on chest, etc., pityriasis versicolor due to fungus. See Tinea versicolor.
Treatment. Locally: — Warm baths. Conium and starch baths, 122. Borax baths, 129. Gelatine baths, 122. liOtion of glycerine and water, equal parts. Glycerine and lime-water, 286. Lime liniment. Borax and glycerine, 268. Morphia and solution of potash, 266. Nitrate of mercury ointment, 305. Calomel ointment.
Internally. — Arsenic, 52. Cod-liver oil. Corrosive sublimate. Col- chicum.
PLAGUE. — From Plaga (rc^rjyyj), a blow or wound. Synon. The Black Death; Pestilential Fever ; Levant Plague; Septic or Glandular Pes- tilence.-— A continued contagious fever, attended with petechias and suppu- rative inflammation of lymphatic glands ; has a certain resemblance to typhus.
Symptoms. A period of incubation, varying from a few hours to three weeks. Petechias. Buboes, from effect of poison on the cervical, axillary, inguinal, and mesenteric glands. Carbuncles. Fever. Diarrhoea. Vomit-
206 PLEURISY.
ing. Great congestion and softening of heart, liver, and spleen. Intense prostration. Suppression of urine. Attacks of hemorrhage. Convulsions, coma, or fatal exhaustion.
Treatment. Emetics. Mild aperients. Diaphoretics. Salines. Mineral acids. Disinfectants. Cold affusion. Friction of body with oil, as a pre- ventive measure. Avoidance of contact.
PLETHORA OF FULNESS OF BLOOD.— Synon. Polycemia ; Hce- matoplethora ; Hypercemia. — Partial plethora, or a local congestion or determination of blood, is the superabundance of this fluid in one or more particular organs or tissues. — See Hypercemia.
PLEURISY, — From n?ifvpa, the side ; the pleurae being the serous mem- branes which invest the lungs and inner surface of thoracic walls. Synon. Pleuritis ; Ivjiammatio Pleurae; Morbus Lateralis. — Inflammation of the pleura runs an acute or chronic course ; may be attended or not with eflusioa of fluid into pleural cavity. One side only may be effected, or both — bilateral pleurisy.
Symptoms. Chilliness, or slight rigors. Fever. An acute lancinating pain in the side, called "a stitch;" situated commonly below nipple, over anterolateral attachment of diaphragm. Pain aggravated by expansion of lung in inspiration, coughing, lying on affected side, and by pressure. A short harsh cough. Hot and dry skin : temperature not very high I01°- 103°, unless pneumonia also present or pleurisy, the result of blood poison- ing, or assuming the form of acute empyema. Flushed cheeks. Hard and quick pulse. Slightly increased frequency of respirations. Anxiety and restlessness. Scanty and high-colored urine. — Physical signs: — At first a friction sound ; caused by the dry and inflamed pulmonary andcostal sur- faces of the pleura rubbing against each other. This rubbing may some- times be felt by hand. It soon ceases : as the inflammation is resolved, and the two surfaces become moist and smooth ; or the surfaces get adherent, the exuded lymph forming a pseudoareolar tissue; or the surfaces become separated by effusion of serum, constituting hydrothorax. Quantity of effusion varies from a few ounces to several pints: when excessive it com- presses yielding lung, suspends its functions, displaces heart, mediastinum, and diaphragm, and somewhat distends thoracic parietes.
When pleurisy ends in suppuration, and pus accumulates in cavity of chest, the condition is known as empyema. When this occurs, constitu- tional symptoms more serious, and temperature high : fever often of hectic character. The pus sometimes forms a bulging tumor in an intercostal space, with appreciable fluctuation. Occasionally, ulceration of costal pleura follows, extends through muscles and forms an external aperture (a partial fistula) through which pus is discharged. Or, pulmonary pleura may be perforated, an opening form into air-tubes (a bronchial fistula), and pus be expectorated.
Whether matter effused be serum, or serum mixed with blood, or pus, there will be dulness on percussion over lower part of chest. On ausculta- tion respiratory murmur diminished. When lung compressed, so that air only enters bronchial tubes, no vesicular murmur at all will be heard ; but instead bronchial respiration, and bronchial voice or bronchophony. Per- haps also, cegophony. When amount of effusion considerable, no sound may be audible in lower part of lungs. The fluid prevents the transmission of vibrations from the lung to the chest walls, whence absence of vocal vibra- tion or fremitus, which distinguishes the dulness due to consolidation. Heart may be greatly displaced ; when fluid in left pleural cavity, impulse may be felt far to right of sternum. Affected side, enlarged : intercostal muscles, inactive : spaces, obliterated or even bulging ; fulness of infra- clavicular region ; shoulder depressed. Pleuritic effusion occurs most fre-
PLEURODYNIA— PLEUROPNEUMONIA. 207
qnently on left side. On healthy side, respiration puerile. Sometimes patient cannot lie on sound side, because movements of healthy lung become impeded by superimposed weight of dropsical pleura. — When absorption of effusion occurs, and owing to adhesions the lung cannot expand, there will be a shrinking inwards of aff'ected side.
In latent pleurisy, there may be neither pain, cough, nor dyspnoea. Yet effusion may occur until one-half of chest is found fuil of fluid.
'J'reatment. In acute stage : — Perfect rest in bed. Avoidance of talking or of full inspirations, so as to prevent undue friction between inflamed surfaces. A fine flannel bandage round chest lessens the movements of ribs. Large hot and moist linseed poultices, covered with extract of poppies. Poppy-head fomentations. Sinapisms. 'I'urpentine stupes. Leeches. Cupping to three or four ounces, often relieves severe pain more quickly than other measures. Aperients, if there be constipation. Subcutaneous injection of morphia, 314. Opium. Aconite. Citrate of potash and am- monia, 211. Ether and ammonia, 212. Diet of gruel, milk, arrowroot, tea, and broths. Soda water. Lemonade. Cream of tartar drink, 356. Indian sarsapariila and barley water, 20.— Tonics and good food, during conva- lescence.— Quinine, nourishing soups, and wine if patient be aged, or when symptoms assume a typhoid character.
To promote absorption of effused fluids : — Moderate diet, free from stimulants. Sinapisms to diseased side. Flying blisters frequently repeated. Friction with ointment of red iodide of mercury. Iodide of potassium, 31. Squills, digitalis, and blue pill, 28. Iodide of iron. Cod-liver oil. 'I'he thorax to be tapped, and fluid withdrawn by aspirator whenever suffocation is threatened by amount of effusion, or from paroxysms of dyspnoea, or when remedies fail to produce absorption. In empyema, tapping with use of drainage tube.
Remedies sometimes emptloyed : — Calomel, or blue pill. Tartarated anti- mony. Colchicuni. Hydrochlorate of ammonia. Hydrocyanic acid. Ame- rican hellebore (Veratrura viride). Digitalis. General bleeding. Leeches. Blisters.
PLEURODYNIA. — From n?i?t'pa, the side; o^vvrj, pain. Synon. Pleu- ralgia ; Pleurodyne ; Rheumatism of Walls of Chest; False Pleurisy ; Stitch in the Side. — Chiefly of importance because the pain, which is often severe, may be wrongly attributed to pleurisy or pericarditis, or even to peritonitis.
Symptoms. General health impaired. Loss of appetite. Low spirits. Urine loaded with urates or phosphates. In exceptional cases, rheumatism of joints. Acute pain, often coming on suddenly, frequently referred to infra-mammary region : increased by a deep inspiration, or by any movement which stretches the muscles. In nineteen cases out of twenty, muscular and fibrous textures of left side of chest alone affected.
Treatment. Ammonia, aconite, and bark, 371. Iodide of potassium, 31. Chloride of ammonium, 60. Subcutaneous injection of morphia or chloroform, 314. Cod-liver oil. Warm baths. Turkish baths, 130. Sul- phur baths, 12.5. Belladonna and opium liniment, 281. Veratria ointment, 304. Hot linseed poultices. Sinapisms. Animal food : milk. Steel, milk, and flour, 16. Light wines. Brandy and soda water.
Cupping, leeching, blistering, and purging will only render the disorder more intractable.
PLETJRO-PNETJMONIA. — Synon. Pleuro-peripneuvionia. — Inflam- mation, attacking simultaneously the pleura and lung. — Pneumonia may happen without pleurisy. But when the pleura is involved in the inflam- mation, the pneumonia forming the chief affection, the double disease is
208 PLICA POLONIC A— PNEUMONIA,
known as 'pleuro-pneumonia. If the pleurisy predominate, it is sometimes called pneumo-])leurit{s. — See Pneumoma.
PLICA POLONICA.— From Pb'eo, to twine together. Synon. Tn- chosis Plica; Trichoma; Polish Ringworm. — A disease of the hair, probably allied to common ringworm of this country. Endemic in Poland, and some parts of Russia and Tartary. Characterized by tenderness and inflammation of scalp ; hairs become swollen and imperfectly formed ; hair follicles secrete a large quantity of viscid reddish-colored fluid, which glues the hairs together, and unites them into tufts or felt-like masses. Two cryp- togamic plants — the Tricophyton tonsurans and Tricophyton sporuloides — have been detected by a minute examination. Sometimes, matted hairs loaded with pediculi. Disease not confined to the scalp, but may involve hairs on any part of integument. Odor from affected parts said to be most disgusting.
'1'reatment. See Tinea.
PNEUMONIA. — From IIwD^ow'a, a disease of the lungs. Synou. Pul- monitis ; Infiammatio Palmonum ; Peripneumony. — Acute inflamma- tion of the substance of the lungs. Right lung suffers twice as often as left. Lower lobes more frequently attacked than upper.
Symptoms. Disease ushered in with restlessness and general febrile dis- turbance. Sudden and severe rigors ; followed by nausea, cough, expecto- ration of viscid and rust-colored sputa, pain in side, frequent distressed breathing, a pulse reaching to 140 or even 160 beats in minute ; dry pungent heat of skin, calor mordax; temperature of body rising quickly, perhaps to 105° F. ; thirst, loss of appetite, prostration, headache, and perhaps transient delirium ; Herpes labialis common.
Each case may be said to consist of three stages: — (1) That of engorge- ment or splenization, in which substance of affected part gets loaded with blood or bloody serum, and there is exudation into air-cells, with prolifera- tion of lining epithelium. On auscultation, minute crepitation is heard ; at first, mingled with vesicular murmur. Percussion, at commencement, aff'oi-ds riatural resonance, which gradually becomes obscured. — (2) If the inflammation proceed, it passes into stage of red hepatization, in which the air-cells are choked by coagulated exudation, and the spongy character of lung is quite lost, and it becomes solid, though more lacerable than natural. Neither minute crepitation nor vesicular murmur can now be heard. Dul- ness on percussion, bronchial or tubular breathing, and bronchophony present, together with increased vocal vibration, communicated to the walls of the chest by the solidified lung, and felt by the hand, unless there is also eff'usion into the pleural cavity. (3) When disease still advances, there is reached the stage of gray hepatization, or purident infiltration ; consist- ing of diff'used suppuration of pulmonary tissue, parts of lung remaining dense and impermeable. Often, no true suppuration : appearance of such simulated by liquefied exudation matter in air-cells preparatory to its re- moval. In latter case, air begins to re-enter affected part of lung; as evi- denced by return of crepitation, less fine than at fii'st, and heard at end of inspiration, mingled with and then superseded by healthy vesicular mur- mur. Temperature falls, and general symptoms ameliorated before the physical signs begin to disappear. Commencement of defervescence gene- rally between the 5th and 7th day, may occur sooner or later; convales- cence and clearing of lung occupies variable time. When portion of lung breaks down and pus is expectorated, large gurgling crepitation will be heard.
For first day or two of pneumonia a normal amount of chlorides will be found in the urine ; the quantity diminishing as inflammation advances, until they have disappeared by time hepatization is complete. As latter
PNEUMOTHORAX— POISONS. 209
recedes, the chlorides reappear. A deficiency of chloride of sodium in urine not peculiar to pneumonia. — Occasionally, in depressed constitutions, pneumonia ends in diffused, or in circumscribed, gangrene.
Chronic pneumonia may occur as sequel of acute disease ; giving rise to persistent consolidation of a portion of pulmonary tissue. May be mistaken for solidification due to tubercle. It causes weakness, emaciation, cough, attacks of feverishness, loss of appetite, and sense of oppression about chest.
Treatment. Acute form : — Perfect rest in bed. Temperature of sick room not to fall below 6.5° F. Air to be kept moist by steam. A dose of castor oil, if there be constipation. Solution of acetate of ammonia, 211. Small doses of opium, if there be pain or restlessness. Vapor of chloro- form, to relieve cough and dyspnoea. Carbonate of ammonia, if there be much debility, 212. Large linseed poultices, or poppy-head fomentations, to affected side of chest. Turpentine stupes. Light diet, with plenty of cold water. Strong beef-tea, wine or brandy, milk or cream, as soon as there are indications of exhaustion. During convalescence :—'K\\k, raw eggs, wine, animal food. Ammonia and bark, 371. Quinine and steel, 380. Ood-liver oil.
Chronic pneumonia : — Iodide of potassium and bark, 31. Iodide of iron, 32. Hydrochlorate of ammonia. Cod-liver oil. Nourishing food. Turpentine stupes. Iodine liniment
Remedies sotnetimes employed : — -Tartarated antimony. Calomel. Vera- trum viride. Digitalis. Iodide of potassium. Bicarbonate of potash, grs. 3 to 30 every 3 or 4 or 6 hours, according to age. freely diluted with some mucilaginous drink. Application of ice to walls of chest. Bloodletting. Leeches. Blisters. Antiphlogistic regimen.
PNEUMOTHORAX.— From ni/fi^a, air; 9wpa|, the chest. Synon. Pneumatothorax ; Emphysema Pectoris; Aerothorax. — A collection of air in the pleura. When, as generally happens, there is liquid with the air, the disease is called Pneumothorax with Effusion or hydro-ptneumothorax. — May arise from injury to the lung by jagged ends of a broken rib: from an external penetrating wound : from ulceration and perforation of the pleural surface by extension of a tubercular cavity. — Physical signs : — Great resonance on percussion ; with indistinctness of respiratory murmur on auscultation. Amphoric resonance and echo ; elicited by placing Stetho- scope at one point and tapping chest with finger at another. Metallic tinkling, on practising succussion, in pneumothorax with effusion.
Treatment. Quiet, strapping of affected side, or bandage round chest. In some rare instances, the dyspnoea has been so urgent that the air, or air and fluid, have had to be evacuated by puncturing pleural cavity with a grooved needle.
POISONS. — Consist of any matters which, when absorbed into the blood, are capable of destroying life. " Deadly poisons" are such substances as rapidly prove fatal in small doses. The term " destructive thing" is applied to any mechanical irritant, — such as pins, needles, particles of iron or glass, sponge, etc.
Poisons are arranged according to their action into three classes, — Iri'i- tants, Narcotics, and Narcotico-Irritants. Another division is into Irri- tants and Neurotics; the latter consisting of Narcotics or Cerebral poisons, and Narcotico-Irritants or Spinal and Cerebro-spinal poisons (Taylor) . — See Poisons, in Tabular Synopsis.
Symptoms. Irritants: — Give rise to pain in stomach and bowels, sick- ness, purging with tenesmus. Evacuations often tinged with blood : pulse feeble and irregular: skin cold. Many irritants corrode the tissues with which they come in contact; hence they produce severe burning sensations 14
210 POISONS.
in mouth, oesophagus, and stomach. The degree of chemical action pro- duced will vary in proportion to amount of water with which noxious agent has been jiiluted. 'I'hey cause death by inducing collapse, or convulsions; or by exciting severe inflammation ; or, after a variable interval, by leading to stricture of oesophagus. Diseases which most resemble action of irritants are, — Malignant cholera, severe diarrhoea, colic, gastritis, enteritis, rupture of stomach or intestines, trichiniasis, and obstruction of bowels.
Narcotics : — Act on brain and spinal cord, inducing headache, drowsi- ness, giddiness, stupor, and insensibility. Frequently there are convulsions ; sometimes paralysis. Very seldom vomiting or diarrhoea. The symptoms of apoplexy, epilepsy, and uragmia, bear a resemblance to those caused by poisons of this class. With regard to one intensely powerful agent (nitro- benzole) the sj'mptoms may not come on for a few hours, unless several drops have been taken. In the latter case, there is rapid coma and death.
Narcotico-Irritants : — Produce gi'eat thirst, pain in throat and stomach, vomiting and purging, delirium with spectral illusions, and rarely convul- sions. Sometimes tetanus, sometimes coma or syncope. Diseases of brain and spinal cord often very insidious in their progress: hence they give rise to symptoms which may be improperly attributed to poisoning. The history, mode of attack, etc., should serve to prevent error.
Treatmext. The object of practitioner may be comprised under three heads: — (1) To -promote discharge of foison from system. When the poison has been introduced into stomach, recourse to be had to stomach- pump or to emetics. The stomach-pump is the best instrument for empty- ing the stomach, washing it out, and administering the antidote. Its em- ployment not advisable in poisoning by corrosives, as it might cause lacera- tion of tissues, or even perforation of oesophagus or stomach. When used, less fluid should be withdrawn than is pumped into stomach. If stomach- pump cannot be employed, emetics must be trusted to, unless the poison has itself produced suflicient vomiting. Sulphate of zinc, rapid in action and but slightly depressing in its effects, 232. Mustard useful, 232. In poisoning by opium and other narcotics, when other emetics fail, sulphate of copper often acts well, 232. Ipecacuanha useful, especially for children, 231. A warm and stimulating emetic can be made with ipecacuanha and ammonia, 233. Vomiting may also be excited by tickling the fauces: by free administration of hot water, or of hot greasy water.
AVhen poison has been administered by rectum, or when it is thought to have passed from stomach into bowels, enemata are necessary. Salt and water, oil and barley water, soap and water, 188. Castor oil and turpen- tine, 190. Croton oil, 191.
When poison has been applied through wound in skin, absorption to be prevented. Ligature between trunk and wounded part, as near latter as possible. Removal of deleterious substance by suction ; use of cupping glasses. Stream of cold water, long continued.
(2) To counteract operation of poison by antidotes. No universal antidote known : hence treatment varies with nature of substance taken. An antidote should possess these properties :^It ought to allow of being g.ven in large doses without danger ; it should act upon the poison, whether ii quid or solid, at a temperature equal to or below that of body ; its action should be quick ; it should be capable of combining with the poison, though shielded by gastric juice, mucus, bile, or other substances contained in stomach ; and it should deprive the poison of its deleterious properties (Orfila). Antidotes operate by forming harmless chemical combinations, or by producing insoluble compounds : they thus destroy the poison, or prevent its absorption. Purified animal charcoal has been recommended. It seems to have the power of combining in the stomach with poisonous principles of animal and vegetable substances, so as to produce innoxious substances: when given in large quantities it will absorb some mineral
POISONS. 211
substances (especially arsenic) and renJer them inert : about half an ounce of charcoal is required to each grain of morphia, strychnia, or any other alkaloid ; but much less for the drugs from which they are obtained, a scruple of nux vomica, for example, not requiring more than half an ounce of charcoal ; and, lastly, this antidote has no injurious action on the body (Garrod).
In poisoning by Mineral Acids, the remedies are : — Carbonate of soda, calcined magnesia, or carbonate of magnesia, freely in mil It or any muci- laginous fluid. In absence of these, whiting, soap and water, plaster of the walll. Olive oil, linseed tea, gruel, milk, barley water. If breathing be impeded, bj' injury to larynx, tracheotomy. Subsequently, remedies against gastritis. External parts when injured to be bathed with soap and water, olive oil, lime liniment. *
Vegetable Acids: — Stomach-pump or emetics. Draughts containing magnesia, chalk, or whiting : mucilaginous or demulcent drinks. Alkalies (soda, potash, or their carbonates) form salts with oxalic acid, which are as injurious as the acid itself.
Pkosjphorus : — Vomiting to be encouraged by large draughts of muci- laginous or albuminous drinks. Full doses of magnesia. Oil to be avoided, as it is a solvent of this substance.
Iodine : — Vomiting to be encouraged. Free administration of amy- laceous fluids, as gruel, arrowroot, starch. Latter to be continued as long as blue iodide of starch is vomited.
Ammonia, Potash, Soda, and their Carbonates :—YmegRV and water to neutralize poison. Acidulated barley water, orange juice. The use of oil has been recommended, with object of converting the alkali into a soap.
Nitrate, Sidphate, and Acid Tartrate of Potash : — No antidotes known. Vomiting to be produced. Demulcent drinks.
Baryta and its Salts : — Sulphate of soda, or sulphate of magnesia, or some earthy sulphate, so as to convert the poison into an inert and insoluble sulphate of baryta. Emetics or stomach-pump.
Arsenic: — Stomach-pump. Emetics. Vomiting to be kept up by albuminous or mucilaginous diluents. Raw eggs in milk. Eggs, milk, and lime-water. Equal parts of oil and lime-water. Castor oil (fi. oz. ij) to carry oif any portion which has passed into intestines. Animal charcoal. Calcined magnesia. Hydrated sesquioxide of iron has been undeservedly praised : if given, large doses necessary (a tablespoonful, frequently re- peated). Subsequent depression of nervous power to be combated by stimulants and opium. For any inflammatory action, opium or couium or henbane.
Corrosive sublimate : — Vomiting to be encouraged. Best antidotes, albumen and gluten of wheat : — White and yolk of several raw eggs ; flour, made into a paste with milk or water. Subsequently, demulcent drinks and milk and Wenham Lake ice. Gargles of alum and myrrh, 252 ; tannin, 2.51; borax, 250; chlorinated soda, 2.54. Opiates. Chlorate of potash, 61. Iodide of potassium, 31.
Salts of Lead .-—Soluble alkaline or earthy sulphates, as the sulphates of soda or magnesia. Milk, or milk and raw eggs. Emetics, or stomach- pump. Croton-oil enema, 191. In chronic lead poisoning : — Croton oil, 168. Castor oil and opium, 164. Sulphate of magnesia with sulphuric acid, 142. Enemata of hot water. Hot sulphur baths, 125. Opium, 316, 317, 339, etc. Iodide of potassium, 31.
Scdts of Copper : — Vomiting to be encouraged by warm water. Albumen, the only effectual antidote. Hence several raw eggs are \o be given, followed by milk or mucilaginous drinks.
Tartarated Antimony (Tartar Emetic) : — Vomiting to be encouraged by milk ; warm greasy water. As taunale of antimony is inert, tea to be
212 POISONS.
given ; decoctions of oak bark ; gallic or tannic acid. Tincture of galls. Cinchona bark in tincture or powder.
Chloride of Antimony (Butter of Antimony) : — Magnesia in milk. Tea ; decoction of oak bark ; gallic acid.
Sulphate of Zinc: — Vomiting to be encouraged by milk or albuminous fluids. Remedies containing tannin, as for antimony.
Chloride of Zine : — Emetics and albuminous drinks, followed by pre- parations of tannin.
Nitrate of Silver : — Common salt. Emetics, if vomiting be absent.
Bismuth : — No antidote known. Vomiting to be promoted. Emollient drinks.
Chrome : — Emetics. Magnesia or chalk.
Sulphate of Iron (Green Vitriol): — Magnesia and diluents.
Vegetable and Animal Irritants : — Vomiting to be excited or encouraged. Purgatives. Linseed tea, gum water, gruel. Warm baths. Opiates. Emollient enemata. In poisoning by cantharides, oil to be avoided ; as it is a solvent of the active principle (cantharidine).
Irritant Gases : — Eemoval of patient to pure air. Artificial respiration (see Suspended Animation). Cautious inhalation of ammonia, ether, or steam.
Opium : — Stomach-pump. Emetics of sulphate of zinc, 232 : sulphate of copper, 232: of a tabiespoonful of mustard and water. Where there is inability of swallowing, emetics to be administered as enemata. Patient to be prevented from sleeping by dashing cold water over head and chest ; walking him up and down in open air between attendants ; electro-magnetic shocks to spine ; flagellation to legs with a wet towel ; administration of strong coffee. Alcoholic stimulants. Artificial respiration. Belladonna, in from thirty to sixty minim doses of the tincture every hour, as an antidote.
Hydrocyanic Acid (Prussic Acid) : — No antidote to be relied on. Chlorine and mixed oxides of iron been recommended : if they were at hand their efficacy would be doubtful. Animation to be restored by cold afiFusion ; stimulating frictions to chest and abdomen ; ammonia to nostrils. Artificial respiration. After recovery from immediate effects, vomiting to be pro- duced. Strong coffee. Brandy.
Nitro-Benzole (Essence of Mirbane, Artificial Oil of Bitter Almonds) : — Strong cofTee. Brandy. Ammonia. Turpentine enemata. Cold affusion. Galvanism. Artificial respiration. — The same treatment is necessary in poisoning by Aniline. No antidotes are known ; but it might be advisable to try the effects of animal charcoal, if the case were seen early.
Chloroform and Ether : — Stomach-pump if these poisons have been swallowed. Where symptoms follow inhalation, — Exposure of patient to current of pui'e air. Cold affusion. Galvanism. Artificial respiration, 313.
Alcohol: — Stomach-pump. Cold affusion. Solution of acetate of am- monia properly diluted. Warmth to be promoted. Sinapisms to extremities and cardiac region.
Henbane, Lettuce-Opium, and Nightshade: — Emetics. Full doses of castor oil.
Narcotic Gases : — See Suspended Animation.
Nux Vomica, Strychnia, and Brucia : — Emetics. Stomach-pump. Purgative ememata. Olive oil. Animal charcoal. Warmth and sweating to be induced. Perfect quiet. Chloral in large doses. Chloroform to diminish tetanic spasms.
Belladonna : — Emetics. Morphia. Castor oil. Animal charcoal
Aconite : — Emetics. Castor oil. Animal charcoal. Strong coffee. Ammonia or bi'andy. Limbs to be rubbed with hot towels. Artificial respiration.
Digitalis • — Emetics. Castor oil. Infusions containing tannin, as tea,
P0LYJ3MIA— PRIAPISM. 213
decoction of oak bark, tincture of galls. Tannic acid in water. Strong coffee or brandy.
(3) To remedy effects 'produced and obviate tendency to death. Fre- quently too long an interval lias elapsed between exhibition of poison, and the time when emetics or antidotes can be of use. If absorption have taken place, the symptoms must be palliated. In poisoning by depressing agents and narcotics, or such as destroy nervous force, lowering agents to be avoided; whilst stimulants and cold affusion and galvanism are resorted to. When breathing and circulation seem about to cease, artificial respiration may preserve life till the poison is is eliminated. To promote elimination, the excreting functions are to be excited. Thus, in poisoning by arsenic, the employment of diuretics has been proposed, because it has been found that this poison is eventually carried off in large quantities by the urine.
POLY.ffiMIA. — From lioXvi, much ; al.aa, blood. — Abundance of blood. — See Hypercemia.
POLYDIPSIA.— From UoXvi. much; 5l^. thirst. Synon. Sitis Mor- hosa ; Excessive Thirst. — A symptom in many diseases, — fever, inflamma- tion, cholera, diabetes mellitus, diuresis, etc.
POLYPUS. — From VLoXvi, many; rtovj. a foot. — A tumor so named be- cause it was supposed to have numerous attachments or feet. — See Nasal Polypus; Otorrhagia (for polypus of ear); Uterine Tumors; Rectal Polypus.
POLYSARCIA. — From rioxi)?, much ; oapl, flesh. Synon. Carnositis ; Corpulentia ; Steatites. Excessive corpulency. — See Obesity.
POLYUmA. — From HoXvi, much ; ttrea. Synon. Azoturia. — A con- dition in which a larger quantity of urine than natural is seci-eted, contain- ing an absolute and relative increase of urea. — See Diuresis.
PRESBYOPIA. — From Ilpss3vi, an old man ; cd>}/, the eye. Synon. Pres- bytia; Visus Senilis; Long-sight. — An alteration in the refractive powers of the eyes, producing presbyopia, or long-sightedness, is one of the earliest indications of the commeucement of old age. Seldom begins before the forty-fifth year.
Symptoms. The range of accommodation is diminished ; vision is imper- fect for near objects ; distant ones are seen clearly. Often accompanied by weakness of sight (amblyopia). Rapid increase of presbyopia is a precursor of glaucoma.
Treatment. Convex glasses directly vision fails for ordinary work : to be so worn that they can be seen over at pleasure for distant objects. If there be anajmia, quinine and ferruginous tonics. Cold water douche to eyes.
PRIAPISM, — Priapismus, from nptartoj, the virile member; terminal -la^bi. Synon. Tentigo Penis; Horn Colic. — Constant and distressing erection of penis. May arise from : — (1) Injury or disease of spine, as frac- ture of lower dorsal or upper lumbar vertebrae. Disease of brain. (2) The rupture of some vessel, with extravasation of blood into corpora cavernosa.
(3) Subacute inflammation, with effusion of lymph into corpora cavernosa.
(4) Vascular nervous excitement, owing to excessive venery.
Priapism may sometimes be relieved by:— Bromide of potassium, 42. Iodide of potassium, 31. Henbane, camphor, and hop, 32.5. Camphor and belladonna, 326. Belladonna suppositories, with opium if there be pain, 340. Iodoform suppositories. 338. Aconite or belladonna lotions, 265. Cold lotions, 273. Arnica lotions, 275.
214 PEOCTALGIA-PEUKIGO.
PROCTALGIA,— From npwxroj, the rump or anus; aXyoj, pain. Synon. Prodagra ; Proctodynia ; Dolor Am. Pain about the auus : due to neuralgia, or to organic disease. — See Rectal Neuralgia.
PROCTITIS. — From npcoxfoj, the rump or anus ; terminal -itis. Inflam- mation of the rectum and anus. — See Rectitis.
PROPTOSIS OCTJLI.— From nfjorttWco, to fall forward : Oculus, the eye. A protrusion of the eyeball, so that the lids cannot cover it. Met with in peculiar forms of anaemia. — See Graves' Disease.
PROSTATIC ENLARGEMENT.— Hypertrophy may result from chronic prostatitis, or in advanced life independent of any inflammatory action. Produces displacement or compression of urethra, so that mictui'i- tion is rendered slow and difficult. The whole gland may enlarge equally, or only the central portion. In hypertophy due to inflammation a cure may sometimes be effected by a course of mercury. In senile form, only pallia- tives are useful : — Acids, buchu, steel, opiates, aperients, careful diet, avoid- ance of cold, etc. Care must be taken that the bladder is completely emptied, or chronic cystitis will be set up. Partial or complete retention of urine requires the employment of a long catheter with a large curve.
Very rarely the prostate becomes the seat of cancer, — especially the medullary form.
PROSTATITIS.- From Prostata, the prostate gVcXwA—Prosto, to stand in front, this gland being anterior to the bladder; terminal -z'^/s. Synon. Inflanimatio Prostatce. — Inflammation of the prostate may occur in course of gonorrhoea, from violence, use of strong injections to urethra, exposure to wet in unhealthy constitutions, excessive venery, diseases of rectum, and irritation of cantharides.
Symptoms. Pain and tenderness about perineum, with sense of heat. Frequent painful micturition. Pain during defecation. Feeling of weight about perineum and rectum. Great suff"ering if a catheter be passed. Ag- gravation of suffering, rigors, fever, difficulty of micturition, etc., when the morbid action progresses to abscess.
Treatment. Perfect rest in bed. Hot hip baths. Fomentations. Poultices. Free use of belladonna to perineum. Opiate suppositories or enemata, 339, 340. Simple nourishment, M'ithout stimulants. Oolchicum, 46. Iodide of potassium, 31. Bromide of potassium, 42. Hydrochlorate of ammonia, 60. Opium, 324, 339, 340, 34.5. Aconite, 330, 331. Bella- donna, 326, 344.
In abscess: — Incision through perineum directly there is fluctuation. Ammonia and bark. Nourishing food ; raw eggs, cream, essence of beef, etc. Wine, if there be much depression.
PRURIGO. — From Prurio, to itch ; terminal -igo. — A chronic non-con- tagious cutaneous disease, characterized by an eruption of small papulte or pimples. Causes intense discomfort. The term Prurigo should not be used as the synonym of Pi-aritus or Itching.
Varieties. Prurigo mitis, the mildest form. — Prurigo formicans, the itching being combined with a sensation like the creeping of ants or sting- ing of insects. — Prurigo senilis, which occurs in old age, and may last for the remainder of patient's life. — Irritation from prurigo not to be con- founded with that caused by lice. These insects often present in old age, where there is a want of cleanliness.
Treatmknt. Internally : — Aloes, gentian, and potash, 140. Sulphate of soda and sulphur, 148. Sulphur and magnesia. 153. Rhubarb and magnesia, 165. Pepsine and aloes. 155. Sarsaparilla and iodide of iron, 32. Tar capsules, 36. Arsenic, 52. Steel and arsenic, 399. Bark and
PRURITUS ANI— PUERPERAL FEVER. 215
mineral acids, 376. Nitro-hj'drocliloric acid, .378. Quinine, 379. Nourish- ing food, avoidiiiii' stimulants. Acidulous drinks.
Locally : — Alkaline baths, 121. Sulphur baths, 125. Conium baths, 122. Creasole baths, 123. Applications of vinegar, lime-water, tobacco-water, solution of corrosive sublimate, solution of creasote, solution of hydrochlorate of ammonia, lotions with prussic acid and glycerine. Ointments of aconitine, tar, nitrate of mercury, stavesacre, sulphur, etc. Sponging with apple vine- gar, and then smearing with diluted nitrate of mercury ointment.
PRURITUS ANI. — From Prurio, to itch ; Anus,- the fundament. — A very troublesome itching of anus not uncommon in cases of haemorrhoids, dyspepsia, intestinal worms. Old people often complain of it ; as do women towards the end of pregnancy, and such as have uterine disease, or such as have recently got over the change of life.
Symptoms. Severe itching of fundament; increased by heat, rich living, etc. Often prevents sleep. The friction resorted to causes the surrounding tissues to become thickened and furrowed. Care necessary lest irritation be due to pediculi.
Treatment. Lit email y : — Electuary of senna and taraxacum, 194. Confection of pepper or sulphur. Rhubarb and blue pill, 171. Simple enemata, 188. Arsenic with bitter infusions, 52. Iodide of iron and sarsa- parilla, 132. Tar pills or capsules, 36.
Locally: — Tobacco water, 265. Corrosive sublimate and prussic acid lotion, 263. Borax, morphia, and glycerine, 268. Lint dipped in tincture of opium. Lemon juice. Vinegar. Olive oil. Calomel and belladonna ointment, 299. Diluted citrine ointment, 305. Fuller's earth (chiefly a com- pound of silica, alumina, oxide of iron and magnesia]. Glycerine. Nitrate of silver. Leeches.
General Remedies: — Cold bathing or sponging. Daily exercise in open air. A diet free from alcohol, coffee, and seasoned dishes. Cool bed-room : to sleep on hard mattress, without too heavy clothing.
PRURITUS VULV^.— See Vulval Pruritus.
PSORIASIS. — From •'P'tjpa, tetter. Synon. Psora Leprosa ; Diffused Dry Tetter; Lepra Diffusa.— A variety of lepra, the eruption being diffused over the whole body. — See Lepra.
PTOSIS.— From ITt'oco, to fall. Synon. Ptosis Palpebral; Blepha- roptosis ; Prolapsus Palpebrce. — An inability to lift the upper eyelid from palsy of the third nerve. May be due to cerebral disease, to congestion of brain, to simple debility. When there is organic disease it may be accom- panied by amaurosis.
PUERPERAL FEVER.— From Paerpera, a woman in childbed.— Fever in a woman recently delivered. From the condition of the blood after childbirth, a woman is at this time peculiarly susceptible to the influence of septic, or other blood poisons, which give rise to a severe and often fatal form of fever.
The poison may be from scarlatina or other fever, from erysipelas, post- mortem, or dissecting-room taint, but especially from a previous case of puerperal fever. It may be introduced through the atmosphere, or through a breach of surface of the vulva, or in the vagina. Or septic matter from decomposing blood or offensive lochia may enter blood by the raw surface left by detachment of placenta.
Symptoms. Rigor, or repeated slight shivering, usually within three days of delivery, sometimes later ; followed by high fever. Temperature 103°- 105°. Pulse very rapid. Anxious expression. Prostration of strength.
216 PULMONARY CONDENSATION.
Tenderness on pressure at hypogastriuni. Abdomen distended. Lochia and milk suspended. Course of disease varied : sometimes rapid death from blood-poisoning, or peritonitis with extreme tympanites, or diarrhoea, or phle- bitis and phlegmasia dolens, or pelvic cellulitis and abscess.
Treatment. Calomel and James's powder, followed by salines at onset (Rigby). Quinine. Quinine and nitric acid. Turpentine. Opium. Morphia injections. Fluid food. Stimulants early.
Locally:- — Wash out vagina and uterus with weak solution of iodine, permanganate of potash, or carbolic acid. Fomentations. Poultices.
PUERPERAL MANIA. — From Puerpera [Puer and parto), a woman in childbed : MatVo/^ai, to rage. — A peculiar form of insanity occurring to women soon after delivery.
Symptom.s. Commence with restlessness, insomnia, severe pain in head, diminution of secretion of milk. Sometimes, skin hot and dry: pulse full and quick: tongue thickly furred. Often, great debility: perhaps prostra- tion from flooding', lingering lal)or, or some morbid poison in system. De- lirium frequently violent. Great general irritability. Tendency to suicide, or child-murder.
Treatment. Indications are, first to rouse and support powers of patient : second, to allay ii'ritability of brain and nervous system. (1) Brandy and egg mixture, 17. Ammonia and bark, 371. Quinine and phosphoric acid, 379. Cod-liver oil, 389. Pounded beef in broth. Wine. Beer. Milk. (2) Extract of stramonium, 323. Extract of opium, 343. Morphia and Indian hemp, 317. Subcutaneous injections of morphia, 314. Chloroform inhalation, 313. — Patient to be controlled by a trained nurse. Separation from family and friends, unless symptoms quickly yield to remedies.
PULMONARY APOPLEXY.— From Pulmo, the lungs.— The effusion of blood into the air-cells of the lungs, and its coagulation there. It may be circumscribed, the effusion varying in size from a pea to an orange ; or it may be diffused through the broken-down pulmonai*y tissues. Arises from disease of heart, lung tissue, bloodvessels, or anaemia.
PULMONARY CANCER. — Most comrfonly of encephaloid or sai'coma- tous character. May occur as a primary or secondary infiltration, or as a primary or secondary nodular deposit. Generally associated with medi- astinal cancer. — See Intra-Thoracic Tumors.
Symptoms. When occurring primardy : — Flattening of affected side, impairment of respiratory movements, dulness on percussion. Pain, ema- ciation, night sweats, dyspnoea, failure of powers of life, purulent expecto- ration, etc. Right lung most frequently affected. Often, effusion into pleural cavity or chronic bronchitis as a complication.
In secondary cancer, symptoms very obscure. Frequently, dyspnoea the chief indication of pulmonary mischief. Both lungs usually affected.
Primary cancer of pleura very rare. Usually the disease is associated with cancer of lung, pericardium, mediastinum, etc. Deposit found as small spots, or hard layers, or in form of tumors which sometimes become pedicu- lated. May be attended with effusion of serum, or pus, or blood. Symp- toms sometimes simulate those of phthisis.
Treatment. Attempts must be made to relieve symptoms as they arise. Strength to be supported by nourishing food ; cod-liver oil ; stimulants. If there be much suffering, morphia with chloroform and Indian hemp, 317. Opiate enemata, 339. Opiate suppositories, 340. Subcutaneous injections of morphia, 314.
PULMONARY CONDENSATION.— Consolidation of the vesicular tissue of the lung may arise from several causes. Thus, it may result from
PULMONARY GANGRENE. 217
pneumonia, phthisis, cancerous deposit. From pressure exerted on lung, by tluid poured out in pleurisy; by extravasated blood, as in pulmonary apoplexy ; by enlarpfed bronchial lymphatic glands, which are arranged along sides of air-tubes ; by aneurismal or other intra-thoracic tumors. A small tube, or even a main bronchus, may thus become so obstructed that air cannot pass; and as a consequence there results collapse of that portion of lung to which the compressed bronchus leads.
In cirrhosis of the lung (fibroid infiltration), the vesicular structure of affected part contains no air ; it is dense and hard ; and is infiltrated by a tough, fibrous, and grayish material ; or intersected by bands (if white fibrous tissue in all directions. Perhaps there may be numerous small cavities filled with yellowish viscid mucus ; the cavities consisting of dilated bronchial tubes. If entire lung be affected there will be dulness on percus- sion ; expansion movement scarcely perceptible ; no vesicular murmur; but perhaps loud gurgling rhonchi on forced inspiration. Usually the result of pleurisy, with exudation of layer of lymph, which becomes organized and invades lung substance. Of great rarity as an idiopathic affection : often connected with tubercle.
Another important form of pulmonary condensation is due to collapse of the air-cells from the plugging up of a bronchial tube. This condition sometimes described as disseminated lobular fneumonia, marginal pyieu- motiia, carnification , or 'pulmonary collapse. It may be acquired or con- genital : —
In acquired pulmonary collapse, the margin of lung, or an irregular portion of one lobe, or an entire lobe, or the whole of the organ may be involved. Obstruction owing to increase in secretion of mucous lining of tubes, with inability to cough it up. Hence, not uncommon during course of bronchitis or hooping-cough in feeble subjects. Or, secretion natural in quantity, but unduly viscid; while from debility or old age it is expelled so imperfectly that an accumulation takes place in central or some other part of lung, and acts like a plug. Physical signs,^ — dulness on percussion, with an absence of respiratory murmur over affected parts : unless morbid con- dition has been of some duration, when these signs may be masked by occur- rence of a kind of compensating emphysematous distension of those portions of lung anterior to obstruction. — Stimulants, tonics, and restorative food are the only remedies of any value.
Congenital non-expansion of air-cells met with in weakly infants. Known as Atelectasis, from 'A^eI^.j;?, imperfect ; IxtaoLi, expansion. — An infant so affected looks as if about to die. Often jaundiced : cry consists of a weak whimper : inability to suck : drowsiness and exhaustion : surface cold and slightly livid: chest but partially dilated by imperfect respiratory movements. The solidity will perhaps lessen as strength is gained, and good health be ultimately attained : or death may occur from exhaustion, with convulsions. To obviate latter, child to be wrapped in cotton-wool, and kept in warm room ; hot bath once or twice in twenty-four hours ; friction of chest with cod-liver oil and soap liniment; administration of milk, port wine, a few drops of tincture of bark, and solution of raw beef every two hours.
PULMONARY GANGRENE.— Gangrene of the lung is an occasional termination of pneumonia in enfeebled constitutions, with a depraved state of blood. Yery rarely occurs independently of pneumonia, from some impediment to pulmonary circulation. May be met with in children as an accompaniment of cancrum oris. The gangrene may be diffused or circum- scribed.
Symptoms. Great and increasing debility. Loss of flesh. Hectic fever. Night sweats. Weakness and rapidity of pulse. Anxiety of countenance. Cough. Expectoration of frothy greenish-tinted sputa, which have a most
218 PURPURA— PYROSIS.
offensive odor. Offensive putrid breath. In diffused gangrene, patient soon sinl\S from exhaustion. In the circumscribed form the symptoms come on more gradually, beginning with indications of pulmonary congestion. After a time there maybe a little improvement; which slowly increases, and patient recovers. — In both forms, the physical signs are those of pul- monary condensation ; with, subsequently, those caused by destruction of tissue and formation of a cavity.
Treatment. Ammonia and bark, 371. Bark and nitro-hydrochloric acid. Tincture of perchloride of iron. Quinine with a mineral acid, 379. Solution of chlorinated soda, 76. Opium. Compound tincture of benzoin. Sulphite of magnesia, 48. Chlorate of potash. Inhalation of turpentine vapor. 260. Inhalation of atomized solutions of turpentine, steel, iodine, or sulphate of zinc, 262. Inhalation of diluted oxygen gas. Cod-liver oil. Animal food. Good soups. Milk, cream, and raw eggs. Stout, or ale. Port wine or brandy.
PURPURA. — From nop'})upa, a purple dye. Synon. Hcemorrhoea Pete- chicdis. — A morbid condition of the blood and capillary vessels; leading to extravasations of blood into the skin, and upon mucous surfaces.
Symptoms. Languor and debility. Sallow or dusky complexion. Epis- taxis. Pains about epigastrium. Craving for food. Palpitation. Giddi- ness. Constipation. Sanguineous effusions into different tissues. Small hemorrhagic spots or petechiie. Large patches, — vibices or ecchymoses. Enlargement and softening of the spleen.
Treatment. Animal food. Fresh fruit or vegetables. Milk. Wine or beer. Aloes. Senna. Castor oil. Bark and mineral acids, 376. Nitro- hydrochloric acid, 378. Quinine, 379. Arsenic, 381. Iron, 397, 399. Vinegar. Nitrate of potash ? Oil of turpentine, 50. Gallic acid, 103. Citric acid. Lemon juice.
PYEMIA OR PYOH^MIA.— From riiW, pus ; al,ua, blood.— Blood-poi- soning, owing to absorption of ichorous or putrid matters. — See Ichorhcemia.
PYELITIS. — From ITue^loj. a trough; terminal -itis. — Inflammation of mucous membrane lining pelvis and infundibula of kidney. — See Nephritis.
PYREXIA. — From ITup, a fire ; tp^co, to hold. — The febrile state, or an attack of fever. — See Fevers.
PYROSIS. — From nupou, to set on fire. Synon. Ardor Stomachi ; Water-brash. — A form of indigestion in which there is frequent eructation of a thin, watery, and acid or tasteless fluid. More common in women than men. Not infrequent in advanced life. Often exists in connection with some derangement of nervous or uterine system ; or with organic disease of stomach, pancreas, or liver.
Symptoms. Pain at pit of stomach, followed by eructation of watery and insipid or acid fluid. Sometimes nausea and vomiting ; heartburn. Often associated with other symptoms of indigestion.
Treatment. White bismuth. Solution of ammonio-citrate of bismuth (Schacht's). Bismuth lozenges (officinal). Bismuth, with magnesia or soda, 65, 112. Saccharated solution of lime and milk, 14. Solution of potash and lime-water, 73. Ammonia in effervescence, with hydrocyanic acid, 362. Carbonate of magnesia. Opium. Henbane. Hop. Kino. Powder of kino and opium. Compound powder of rhubarb. Aromatic sulphuric acid. Nux vomica. Alum. Nitrate of silver. Oxide of silver. Oxalate of cerium. Compound tincture of benzoin. Gallic acid. Tannin lozenges (officinal). Iron-alum.
For diet, etc., see Dyspepsia.
rYTIfOGENIC FEVER-RECTAL PROLAPSUS. 219
PYTHOGENIC FEVER.— Look in.? to the origin of the typhoid poison, the appelhition of Piillidfjenic fever has been suo^p^estecl, — TtvBoyfvr^i;. from 7iv9u>v (rtv9o/j.ai. to putrefy), and yrwdu), to engender. Literally, "born of putridity" (Murchison). Synou. Enteric or Typhoid Fever. — See Tt/phoid Fever.
RABIES. — From Bahio, to rave. Synon. Morbus Hydroplwhus ; Rabies Canina ; Water-Fright. Canine madness. — See Hydrophobia.
RACHITIS. — From 'Pa;5^i?, the spine; terminal -itis ; so named because of the o])inion that the spina! cord is in fault. Synon. Rhachitis ; Osteo- malacia Infantum ; Innutritio Ossium. — See Richets.
RECTAL CANCER. — May be of scirrhous, medullary, or colloid form. Epithelial cancer sometimes attacks anus, and may extend some distance up the rectum.
Symptoms. Not well marked at first: but little suffering until difficulty in defecation arises. A¥hen practitioner is consulted, coats of bowel gene- rally found extensively infiltrated with cancer, producing considerable con- traction. Severe lancinating pains. Frequent attacks of hemorrhage. Offensive muco-purulent discharges. Debility, ending in complete prostra- tion. Loss of flesh. Cancerous cachexia, etc. Ulceration into bladder or urethra in men : frequently, into vagina in women. Death from exhaustion.
Treatment. Opium, 343. Opium and belladonna, 344. Opiate sup- positories, 340. Subcutaneous injections of morphia or atropine, 314. Morphia, chloroform, and Lidian hemp, 317. Iodoform pills or supposi- tories, 338. Nourishing food : milk, cream, raw eggs. Brandy : wine. Formation of artificial anus in left loin; so as to prolong life for a few months, and render it more endurable. In epithelial cancer, — excision, cutting wide of affected tissue, and immediately afterwards touching all parts of raw surface with chloride of zinc.-^-See Cancer.
RECTAL NEURALG-IA.— Synon. Proctalgia. — May persist for many weeks, without altogether subsiding for a day. Pain aggravated by pas- sage of stools. Tenesmus. Pain may be confined to a single spot. — To be cured by nourishing food. Pepsine. 420. Simple eneniata, 188. Sup- positories of opium and belladonna, 340. Quinine. Zinc. Steel. Cod- liver oil. — See Neuralgia.
An irritable sphincter muscle causes pain in defecation. On introducing finger, the muscle grips it very tightly. Mild laxatives. Bougies. Bella- donna ointment. Improvement of general health.
RECTAL POLYPUS. — From noAu?, numerous ; rtoi)?, the foot, — because these tumors were supposed to be attached by many roots.— More connnon in children than adults. The pedunculated growth arises from the mucous membrane ; and it may be soft or follicular, or firm and fibrous. A villous tnmor, resembling that sometimes found in urinar}' bladder, occasionally grows with a broad base from mucous membrane of rectum.
Symptoms. Uneasiness about fundament. Frequent desire to go to stool. Mucous discharge tinged with blood. In villous growths, perhaps abundant hemorrhage. A polypoid tumor usually descends whenever the bowels act.
Treatment. Application of a ligature, and immediate removal of tumor below it with scissors. If there be no fear of bleeding, excision only. .
RECTAL PROLAPSUS— From Prolnbor, to glide forward. Synon.
Prolapsus Ani ; Proctocele ; Ectopia Ani ; Falling of the Fundament. — There may be protrusion only of mucous lining of rectum, or all the coats
220 EECTAL STRICTURE— RECTAL ULCERS.
of the bowel will be found prolapsed. Caused by want of tone in sphincter ani, constipation, straining at stool, prolonged diarrhoea, irritation of worms, disease of urinary organs, stone in bladder, etc.
Symptoms. At first, protrusion only occurs when bowels act. After a time, descent follows any exertion, as standing, coughing, etc. Only a fold of mucous membrane comes down, or inverted bowel is forced out to extent of five or six inches. When prolapsus is almost constant, intestinal mucous membrane becomes indurated, perhaps ulcerated : sphincter ani found much relaxed. Discharge of mucus tinged with blood. A general sense of weight and distress about the body, with severe pain on going to stool.
Treatment. Replacement usually effected without difficulty. Some- times, especially in children, bowel descends immediately after reduction : to be prevented by applying a pad of lint, and drawing buttocks firmly together with a broad strip of adhesive plaster. Advantageous to make children pass their motions in a recumbent posture, so as to prevent violent straining. General health to be improved: bark, quinine, glycerine, steel, cod-liver oil. Constipation to be prevented: taraxacum, carbonate of mag- nesia, cream of tartar, or mercury and chalk. After each evacuation, bowel to be replaced : anus to be sponged with cold water. Astringent enemata of alum and decoction of oak-bark ; or of tincture of perchloride of iron and water ; or of infusions of matico or rhatany. Suppositories of tannic acid and cocoa butter.
Medical treatment failing : — Rectal supporters worn for some time. Production of superficial sloughs by application to mucous membrane of nitrate of silver, nitric acid, solution of perchloride of iron, potassa fusa, or actual cautery. Acid solution of nitrate of mercury objectionable : it may cause salivation. Excision of two or three folds of mucous membrane and skin at margin of anus. Several small folds of mucous membrane, at different parts of prolapsed bowel, to be taken up with forceps and then tightly ligatured : ligatures to be cut off short, intestine returned, a dose of opium administered, and patient to be kept in bed until ligatures come away.
RECTAL STRICTURE. — Synon. Redostenosis ; Proctostenosis; Strictura ^Hz.^Stricture of i-ectum may be limited to a ring of condensed tissue, — the annular form ; or it may be confined to one side of bowel, as when it follows cicatrization of ulcers ; or almost the whole gut may be narrowed and indurated. Tft be distinguished from constriction due to cancer, or to pressure of tumors ; as well as from simple spasmodic contrac- tion produced by irritable ulcer, etc.
Symptoms. Constipation ; small stools ; great difficulty in voiding solid motions. Straining and bearing down efforts. Flatulence. Pain in loins and sacrum. Mucous discharges, sometimes stained with blood. Depres- sion of general health ; low spirits. If ulceration follow, burning pains ; tenderness about sacrum' and fundament ; discharges of blood and pus ; considerable constitutional disturbance.
Treatment. Dilatation by bougies : an instrument to be passed occa- sionally for some months after apparent cure. Sponge tents, 426. Slight notching of annular stricture with probe-pointed bistoury, and plugging with oiled lint; subsequently, use of bougies. Suppositories of opium and belladonna, .340. Aperient electuaries, 194. Simple enemata, especially of olive oil, 188. Nourishing food. Glycerine. Cod-liver oil.
RECTAL ULCERS. — (1) Irritable ulcer of rectum, or fissure of anus. An apparently slight affection, but one which causes great suffering. Ulcer generally superficial ; about one eighth of an inch broad and third of an inch long; seated immediately withiu anus, and generally towards the coccyx.
RELAPSING OR FAMINE FEVER. 221
Most common in women ; sometimes produces ovarian pain, irritability of bladder, and great pain during sexual intercourse. Passage of stools irri- tates the sore ; producing spasm of sphincter ani, and acute burning pain which lasts some hours. — To make a thorough examination, chloroform sometimes needed. — To heal the ulcer, constipation to be prevented by mild aperients. Castor oil. Electuary of senna and taraxacum, 194. Dinner pill of pepsine and watery extract of aloes, 1.5.5. Belladonna. Cod-liver oil. Copaiba. Nourishing food, free from stimulants. Locally, — Mercurial ointment and belladonna, made into a solid stick with cocoa butter, 424. Ointment of nitrate of mercury, 305. Calomel and belladonna ointment, 299. Nitrate of silver to be avoided. A longitudinal incision through centre of ulcer and superficial fibres of sphincter ani : one or two grains of opium immediately afterwards, so as to confine the bowels for two or three days. Forcible dilatation of anus so as to rupture fibres of sphincter. If an external pile be present near fissure, it should be snipped off.
(2) Chronic ulceration ivith thickening of coats of rectum. May arise as one of secondary effects of syphilis. May also be due to deposit of tubercle ; to cancer ; or only to a depressed state of general health. Cause to be removed. Opiate and belladonna suppositories, 340. Subsequent contraction to be prevented by bougies.
(3) Rodent ulcer. This intractable disease is met with at margin of anus, the sore gradually creeping up rectum. Requires, — Complete excision. Destruction with potential caustics, — chloride of zinc, 197. Steel with arsenic, 381,399. Cod-liver oil. Sulphate of zinc ointment, 294. Subcutaneous in- jections of atropine, or morphia, 314.
RECTITIS. — From Rectus, straight ; terminal -itis, — because this por- tion of the gut was supposed to be straight. Synon. Proctitis ; Architis. Inflammation of the rectum and anus. A rare disease, now that drastic purgatives and alcoholic drinks are less abused than formerly. May be produced by external violence, or introduction of some foreign body into gut.
Symptoms. Sense of intense heat ai'ound anus. Severe pain shooting up sacrum and back. Spasmodic contractions and excessive sensitiveness of sphincter ani. Tenesmus, with passage of dark-colored gelatinous mucus. Irritability of bladder. Constitutional disturbance.
Treatment. Rest in bed. Milk and farinaceous diet. Sedative enemata, 339. Opiate suppositories, 340. Ipecacuanha. Saline draughts, 348. Hot hip baths. Linseed poultices.
REFLEX PARALYSIS.— From Reflecto, to turn back. That form of palsy in which the irritation is reflected from periphery to centre. Diseases of uterus, urinary organs, and intestines common causes of this form. To be remedied by cure of cause, provided irritation has not existed long enough to induce organic disease in spinal cord. — See Paralysis.
RELAPSING OR FAMINE FEVER.— The name of relapsing or re- current fever has been bestowed upon this infectious disease, because at a certain period of the convalescence there is a relapse of all symptoms. Epidemics of it have been recognized, during seasons of famine and desti- tution, since 1739; and have been described under various names, — M'ye- day fever, Seven-day fever. Bilious remittent fever, Mild yelloiv fever, Synocha, and Irish famine fever .
Symptoms. There may be a latent period of 3 or 4 days, or not.- — Sudden accession of rigors, frontal headache, muscular pains; followed by fever, rapid pulse, thirst, pain at epigastrium, and vomiting. Jaundice occasionally present. Temperature often very high, sometimes 107°. Sometimes great desire for food. True petechise and purpuric spots perhaps appear, but no
222 REMITTENT FEVER— EENAL CANCER.
characteristic eruption. Prostration. On .5th or 7th day profuse perspi- ration and complete subsidence of fever. Patient apparently quite well but weak, or suffering from rheumatoid pains, when about 14th day from commencement of symptoms, there is a relapse. On 3d or 4th day after- wards, there is again improvement, and gradual restoration. — Seldom fatal : mortality about 1 in 40.
Treatment. Gentle aperients. Refrigerating drinks. Farinaceous diet. Perfect repose. Quinine. Opium. Wine. Tea and coffee. Wet pack. Sponging body with tepid water, or vinegar and water, 138. If there be jaundice, nitro-hydrochloric acid, 378. Nitrate of potash. Dry cupping to nape of neck. No remedy prevents the relapse.
REMITTENT FEVER.— From Remitto, to abate. Synon. Fehris Rcmittens. — The cause of this disease being the same as that of ague, it might be described as miasmatic or paludal remittent fever.
Remittent fever varies much in severity according to nature of climate in which the poison is generated. Autumnal remittents of England and France, comparatively mild : endemic remittents of tropical climates often very severe and fatal. The locality where the fever prevails seems often to impress some peculiarity upon it, especially as regards the nature of the complications which arise : hence remittent fever has been described under the names of Walclieren fever, Roman fever, Mediterranean fever, Jungle or Hill fever of East Indies, Bengal fever, Bilious remittent of West Indies, Sierra Leone fever, African fever, etc.
Symptoms. The symptoms bear a resemblance to those of intermittent fever, except that there is no cessation of the fever, but simply an abate- ment or diminution. Shivering, followed by high fever, vomiting, sometimes jaundice. Length of remission varies from 6 to 12 hours; at the end of which time the feverish excitement increases, the exacerbation being often preceded by chilliness and rigors.
Remissions usually occur in the morning: the principal exacerbation is generally towards the evening. The disease may run on for some 14 or 15 days, and end in an attack of sweating ; or it may merge into low fever. Infantile remittent fever, so-called, is a form of typhoid fever.
Treatment. Principles to be followed, the same as in ague. Attempts to be made to shorten the exacerbation, and to lengthen the remission. — Saline and effervescing draught, 348, 349, 354. Cold drinks, — water; lemonade ; ice ; cold tea ; cream of tartar, 356, 360. Aperients, 139, 140, 144. Emetics of ipecacuan, if there be nausea without vomiting, 231. Sinapisms to epigastrium, if there be troublesome vomiting. 'J'epid spong- ing, 138. Cold affusion, 134. Wet sheet packing, 136. Simple diet. Avoidance of stimulants.
Directly remission takes place, from 1 to 6 grains of quinine to be given every six hours : omitting it as the hot stage sets in. At next remission, to be commenced again.
Salicin. Sulphate of beberia. Warburg's tincture. Cold affusion ; blisters to nape of neck, if stupor sets in. If there be jaundice, turpentine stupes or sinapisms to epigastrium. Nourishing broths ; raw eggs ; and stimulants when depression follows. Avoidance of mercury and bloodletting at any stage.
RENAL CANCER.- — The rarest form of kidney disease : most common during first years of childhood and in old age. Encephaloid cancer much more frequent than scirrhus. When the disease is primary only one gland is usually attacked : if secondary, the reverse. Cancerous degeneration usually commences in cortical substance, and thence extends to medullary cones as well as to pelvis and ureters.
In primary cancer, the renal tumor frequently attains an enormous size :
RENAL DEGENERATIONS. 223
I
fills abdominal cavity, so that it has been mistakei'i for ovarian tumor. In secondary form, kidneys enlarge to smaller extent : often feel nodulated on surface.
Chief symptoms, — Enlargement of affected gland. Hsematnria; more blood escaping than in cases of calculus. Pain in loins. Sickness. Ema- ciation. Anasarca: perhaps ascites. Fatal exhaustion.
Medical skill can only relieve the prominent symptoms. If passage of urine be obstructed by blood clots, catheter must be used.
RENAL DEGENERATIONS.— From Ren. a kidney : Degenero, to de- generate.— Three different varieties of kidney disease included under this head : — Fatty, amyloid, and Cystic Degeneration.
1. Fatty Degeneration. — Synon., Gramd'ar Degeneration of kidney ; Bright's Di.sease. — May be the I'esult of acute desquamative nephritis; of strumous diathesis ; bad living, intemperance, constant exposure to wet and cold, etc. Kidney large, pale, soft, evidently fatty on section.
Symptoms. Gradually increasing debility ; frequent and irritable pulse ; striking pallor — perhaps combined with puffiness — of face and skin generally ; frequent micturition, patient having to rise once or oftener in night to pass water ; dyspepsia, with attacks of obstinate vomiting. A tendency to grave inflammations of serous membranes — pericarditis, peritonitis, meningitis, pleurisy; also to amaurosis, usually attacking both eyes, and due to albu-- minuric retinitis and degeneration. Anasarca of limbs, with dropsy of dif- ferent cavities; in rare cases (unless there be co-existent heart disease) oedema of lungs, setting in suddenly, and rapidly producing serious dyspnoea. Ultimately some form of urgemic poisoning, such as convulsions, due to effects of retained urea upon nervous system ; coma, soon ending in death.
Characteristic appearances of urine: — Scanty secretion, highly albumi- nous, of low specific gravity. In early stages, generally free from sediment; examined by microscope, neither renal epithelium, nor casts of tubes found. After a variable interval, while general characters of urine remain unaltered, there appears a light cloudy sediment ; containing small waxy casts, in which are entangled one or more globular or oval cells enclosing numbers of oil-globules. Several cells completely filled with oil, presenting appear- ance of dark opaque masses. Usually, the casts have adhering to their surface many small oil-globules, which have escaped from ruptured cells; while numerous cells containing oil, together with detached oil-globules, are scattered over field of microscope.
When the urine is of natural color, highly albuminous, and presents a large number of oily casts and cells, prognosis most unfavorable. These appearances indicate as serious and intractable a malady as tubercular dis- ease of lung (George Johnson).
Treatment. Palliation of symptoms. Regulation of diet : abstinence from intoxicating drinks, starch, sugar. Sea air. Occasional purgatives, — Compound jalap powder ; elaterium, etc. Bark, or quinine. Mineral acids. Ferruginous tonics. Opium may be needed if there be great irritability and restlessness : it must be prescribed with great caution. Hot water or vapor baths. Puncture of anasarcous extremities. — See Nephritis ; Urae- mia; Fatty Degeneration.
2. Amyloid Degeneration, — Synon. Waxy Amyloid for r)i of Bright's Disease. — Waxy, lardaceous, or amyloid degeneration of kidney probably never exists alone. It renders kidney inefficient as an excreting organ, and ultimately useless. Has often some connection with scrofula, syphilis, or disease of bones. Kidney large, firm, heavy, has glistening section; turns blue or almost black color, with iodine and sulphuric acid.
Symptoms. Loss of sti-ength, coming on gradually. Lassitude. Thirst. Excessive secretion of urine: patient has to rise two or three times during
224
EENAL TUBERCLE.
night to micturate. OEdetna of feet and ankles. Enlargement of liver and spleen. Urine albuminous, of low specific gravity, pale in color, of acid reaction : under quarter of an inch object-glass delicate and transparent and waxy or hyaline tube-casts are seen, which are formed by the coagula- tion of an exudation from bloodvessels into tubules denuded of epithelium. Progress of case slow. Sooner or later, ansemia ; diminution in quantity of urine, with increase of albumen. Diarrhoea, if intestinal mucous membrane become affected with waxy degeneration. Ascites, or general dropsy. Death from effusion into pleurae or pericardium ; from bronchitis, or phthisis ; from exhaustion ; or from convulsions and coma due to ursemic toxtemia.
l^REATMENT. Good may be effected in early stage by sea air: nourishing food : ferruginous tonics. If there be any syphilitic taint, — Iodide of potas- sium, 81. Iodide of iron, 32,»390. Subsequently relief of prominent symp- toms.— See Urcemia.
3. Cystic Degeneration. — Four forms of cystic disease may affect the kidiiey : — (1) Small scattered cysts, few in number, are often present on surface of kidneys, or in cortical substance, without interfering with func- tions of these glands. Very rarely such a cyst attains a great size, .contains some pints of fluid, and forms an appreciable abdominal tumor. — (2) Cysts, varying in size from a pin's point to a hazel-nut, ai-e not uncommonly developed in kidneys affected with chronic desquamative neplmtis. Result of obstruction of uriniferous tubes by exudation. — (3) Congenital cystic degeneration, may be complete or incomplete. Infants sometimes born with large irregular-shaped kidneys made up entii'ely of cysts, without any trace of secreting tissue. Usually combined with other malformations. — (4) General cystic degeneration may occur gradually in adults, owing to expansion of portions of uriniferous tubes, with obstruction and atrophy of intervening sections. Symptoms come on very gradually, not very marked: perhaps, frequent attacks of haeraaturia, albuminuria, pains about loins. Occasionally, enlargement of kidneys, so as to produce distinct tumors. Death from some complication, or ultimately from uraemia.
RENAL INFLAMMATION.-See Nephritis.
RENAL PARASITES.— Four varieties of Entozoa may infest the kidneys: — (I) Hydatids, containing echinococci. Very much more rare than in the liver. Sometimes, renal hydatid cysts discharged with urine : perhaps with symptoms like those pi'oduced by passage of a' calculus. Recovery may follow : or cysts may be discharged at intervals for years : or death occurs fi'om rupture of parent cyst into parts around kidney, or from its exciting inflammation and suppuration. Opium, iodide of potas- sium, and warm baths are remedies to be tried. If cyst attain a large size, puncture with a fine trocar may be justifiable. — (2) Distoma haematobium : cause of endemic hsematuria of Egypt, etc. See Ilcematozoa. — (3) Tetras- toma renale : said to infest uriniferous tubes, but no instance of its occur- rence known in this country. — (4) Strongylus gigas : very rare. One specimen in Museum of Royal College of Surgeons. — See Entozoa.
RENAL TUBERCLE.— Synon. Tuberculous Pyelitis.— lAwch more commonly a secondary than a primary affection. In former case, seldom detected till after death : both glands involved. In latter, disease extends from kidney to ureter and bladder. Large tubercular cavities produced, with destruction of renal tissue. Hgematuria an early symptom ; sometimes repeated later. Urine contains pus, often in large amount, blood, and tubercular debris if ureter be unobstructed. One or both kidneys may be affected. Symptoms, those of tuberculosis; with burning pains in loins, purulent and bloody urine, and rapid emaciation. Perhaps, renal tumor ;
RETINITIS— RHEUMATISM. 225
owing to confluence of tubercular deposits, or to grarlual distension of pelvis by retained urine and pus. Death occurs from exhaustion, in course of eighteen months; from progress of similar disease in other organs; or from urLcmia, or ichorha3mia.
RETINITIS. — From Bete, a net or web ; terminal -itis. Synon. Tn- flammatio Relince. — Inflammation of the delicate nervous membrane called the retina occurs as a sympathetic affection in the course of other oph- thalmiaj. As a simple idiopathic inflammation it is exceedingly rare.
Symptoms. Acute deep-seated pain in the eyeball, extending to temples and forehead ; great intolerance of light : diminution or loss of power of vision ; frequent sensations of flashes of light. Pu^jJJtyind coutrac^ted ; iris loses its brilliancy and becomes motionless; vascularity oTth"?"^(3ferotic. Constitutional disturbance severe. II igh fever and delirium often present. — When acute symptoms have subsided, the ophthalmoscope shows vessels of retina congested and varicose ; transparency of retina impaired ; while extravasations of blood may often be seen, owing to rupture of one or more vessels. In unfavorable cases, masses of black pigment are visible on choroid and retina : these tissues gradually get atrophied : total blindness results.
Generally caused by exposure to vivid light — large fires, furnaces, etc. Light reflected from ground very injurious to retina, because the eyes can- not be protected from it, hence pernicious effects of glare from snow, or from burning sands of tropical climates.
Treatment. Perfect rest in' a darkened room. Application of cold lotions or of hot fomentations, according to tlie patient's feelings. Mild purgatives. Sedatives to relieve pain. Simple diet.
RETEO-PHARYNGEAL ABSCESS. - From Retro, backwards: ^apuyl, the pharynx: Ahncedo, to form an abscess. — Result of acute or chronic inflammation of loose areolar tissue between posterior wall of pharynx and muscles on anterior part of spine. Often connected with strumous diathesis. Perhaps may occur in association with syphilitic taint. More common in children than adults.
Symptoms. Derangement of cerebral, respiratory, and circulatory sys- tems. Fever, nausea, restlessness, soreness of throat. Difficulty in swal- lowing and breathing. A fixed and j:g,toaet£d....stot.e~.-^.^head,: rigidity of ™US£les^,tJiack^4f neck. — More or less locked state of jaws : painful and difficult and drawling articulation. ATpainfurdeglutition increases, solids are refused ; liquids regurgitate through nose. Spasmodic efforts at swal- lowing, as if there were food in gullet. — On examining fauces, a firm and projecting tumor is felt just beyond b^^se of topo-ue. — Death has occurred from convulsions ; from coma ; from tumor pressing pharynx forwards on epiglottis and rima glottidis, causing suffocation; fi'om abscess suddenly bursting, with inspiration of pus into trachea.
Treatment. Puncture with a bistoury: head to_ be_pre£sed forward.s directly opening is made so as to facilitate escape 6T pus by nioutli. Am- monia and bark, 871. Syrup of phosphate of iron, 405. Quinine, 379. Cod-liver oil. Nourishing food. Malt liquors : wine.
RHEUMATISM, — 'PEu.uarKT^oj, a flux or looseness ; Ijfvfxati^o^ai, to be affected with looseness, — from ^jevaa, a humor floating in the body causing disease. There are two forms of rheumatism, the acute and chronic : —
1. Acute Rheumatism. — Synon. Rheumatic Fever; Synocha Rheum a- tica ; Hcemoarthritia. — A formidable disease owing to the suffering it causes, the intensity of the fever, and the damage it so frequently inflicts 15
226 ETTEUMATISM.
upon the heart. — A superabundance of lactic (?) acid in the system is the supposed cause.
Symptoms. Restlessness and fever, stiffness and aching pain in limbs, following exposure to cold and damp. Pain quickly increases ; swelling and tenderness of one or more large joints : high fever and constitutional disturbance. Temperature rises to 102°, in bad cases to 104° or 10.5°: in fatal eases has reached 110° and 111° a few hours before death. Patient soon rendered a pitiable spectacle of helpless suffering. He dare not move ; is unable to sleep; pain in joints so agonizing, that weight of bed-clothes cannot be borne ; skin bathed in sweat, of a disagreeable acid or sour odor ; pulse full, bounding, and quick ; usually constipation, sometimes diarrhoea ; tongue moist, but thickly furred ; and urine high colored, acid, scanty, loaded with urates. Relapses very common.
Complications. — A tendency to metastasis, the inflammation suddenly leaving one part and reappearing in another. Most serious change, when the pericardium or endocardium becomes affected. Sometimes complicated ■with bronchitis, pleurisy, pneumonia, or inflammation of brain and its mem- branes. Disorganization of one or more of the affected joints rarely occurs.
When uncomplicated, average duration from twelve or sixteen to thirty days. If fatal, this result usually due to the cardiac affection, or to hyper- pyrexia.
Treatment. Venesection been recommended, but loss of blood is badly borne. Saline purgatives, 140, 141, 152, 155, 165, 169. Calomel and jalap. Opiates, in doses sufficient to relieve the pain. Powder of ipeca- cuan and opium, 213. Quinine. Quinine and iodide of potassium. Ameri- can hellebore. Guaiacum. Liquor potass*. Sulphur. Citrate of potash, sometimes to extent of 480 grains in 24 hours. Lemon juice. Free blister- ing, excluding all drugs and other applications : a band of blistering fluid, about two inches deep, painted above and below affected joint; to be fol- lowed in a few hours by linseed poultice (Dr. Herbert Davies).
Most reliable remedies :—0])mm. Large doses of the alkalies and their salts, as from 20 to 6J)_grains of bicarbonate of potash or soda, in an effer- vescing drauglTt7"every three (ir Inur hours. Coichicum, if urine continue loaded with lithates. Iodide of juitassium, if disease remain stationary in one or two joints. Hot air or vapor baths, if perspiration be scanty. Tincture of perchloride of iron (^ss every six hours). Daring conva- lescence :—Ammoma, and bark, o71. Quinine and iodide of iron, 382. Mild preparations of steel, 390, 391, 394. 401, 403, 404. Cod-liver oil, 389.
Diet :— At first low: slops and arrowroot. Beef-tea; milk and lime- water, 14; eggs, cream, and beef extract, 5 ; sherry and soda-water. Light puddings; vegetables; white fish. Mutton, poultry, and beef not to be allowed too soon. Malt liquors, port wine, and sugar to be avoided.
Local remedies: — To lie between blankets in preference to sheets. Most complete rest in bed to be enjoined : patient not even to sit upright in bed, or to leave it for any purpose. Wrapping affected joints in cotton-wool and oiled silk. Hot alkaline fomentations. Hemlock poultices. Small blisters at a late stage Iodine paint, 205. If the heart be irritable, large hot linseed-meal poultices. If there be effusion into pericardium, large blisters over cardiac region. Turpentine stupes.
2. Chronic Rheumatism. — Synon. Rheumatismus Non-fehrilis ; Elieumaialgia ; Arthrodynia. — Sometimes a sequel of rheumatic fever, but generally a separate constitutional affection. Very common in old age. The fibrous textures around the joints, or the fii)rous envelopes of the nerves, or the aponeurotic sheaths of the muscles, or the fascia and tendons, or the periosteum are the parts which suffer.
Varieties : — Gonorrhceal rheumatism. Lumbago. Sciatica. Stiff or wry neck. Pleurodynia.
RHEUMATOID ARTHRITIS. 227
Treatment. Attention to the general health, and to the organs of diges- tion. Sedatives to procure sleep. — Iodide of potassium, with tincture of serpentarj- or bark, 31. Liquor potassas. Ammoniated tincture of guaiac, 43. Cod-liver oil, 389. Quinine, with or without belladonna, 45, 386. Iodide of iron, 32. An)nionia and bark, 68, 371. Oil of turpentine, 50. Colchicum, 46. Sarsaparilla, 26. Corrosive sublimate, 27. Red iodide of mercury, 54. Arsenic, 52. Aconite, 330. 331. Sulphur, 43, 148. Hydro- chlorate of ammonia, 60. Tincture of actea racemosa, 320. Arnica. Morphia, chloroform, and Indian hemp, 317. Opium and ipecacuanha, 324. Subcutaneous injection of morphia, 314.
Sulphurous waters of Harrogate; Ruxton. Sea air, and warm salt water baths. Alkaline waters of Yichy. Antacid springs of Carlsbad. Hot air or vapor baths. Alkaline baths. Sulphur baths. — Ventnor ; Hastings; Rome ; and Nice, are good winter residences for habitual sufferers.
Locally: — Blisters, 208. Iodine paint, 205. Belladonna and aconite liniment, 281. Chloroform and opium liniment, 282. Veratria ointment, 304. Powdered sulphur. Plasters of belladonna or opium. Acupuncture. Ironing the part, a piece of brown paper being placed between the skin and hot iron. Moxas. Application of a bladder of ice for a few minutes. Flannel next the skin. Faradization. Continuous galvanic current.
RHEUMATOID ARTHRITIS.— From 'Pfr^m, a humor floating in the body causing disease ; rlhoi, appearance : ap9poi', a joint, terminal -itis. Synon. Rheumatic Gout; Chronic Rheumatic Arthritis ; Noclocity of the Joints. — A chronic inflammator}' affection of the joints, not unlike gout in a few of its characters, somewhat resembling rheumatism in other points, but differing essentially from both.
Symptoms. Pain, swelling and stiffness of affected joints. In acute cases, disease comes on abruptly with fever and general disturbance ; but usually the affection is chronic, commencing with languor, restlessness, loss of appe- tite, and vitiated secretions. The joints become stiff and painful ; effusion into thp synovial membranes causes them to appear swollen and distended, while limbs generally waste ; and if hip, knee, or ankle be the parts affected, there is lameness. Fluctuation can sometimes be detected ; or, a distinct kind of crepitus may be felt. A peculiar crackling of the joints on move- ment is appreciable to the patient. If the disease be of long continuance, a degree of rigidity may occur from thickening of the articular textures, equal to that produced by bony anchylosis; or the joint may become quite disorganized from a gradual wasting of the cartilages. In addition, the articulations become deformed ; there are painful spasms iixth£_niuscles of the limbs, mental dejorejsi p n , gsiier aPTrcKSttud e, dy speps l^a with acidity of stomach, rest a/TTiTght disturbed, every change in the weather felt, while owing to the languid circulation the patient suffers much from cold. The complaint always lasts for several months, — sometimes for years.
Treatment. General health to be improved. Uterine functions to be regulated. Generous diet, with animal food. Claret, sherry, brandy, whisky, bitter ale. Warm clothing. Carriage exercise. Sugar, pastry, pickles, and cheese to be forbidden.
Sulphate and carbonate of magnesia, 141. Confection of sulphur. Sul- phate of soda, 148, 153. (Jod-liver oil. Arsenic with quinine, iodide of potassium, steel, taraxacum, and colchicum, 31; 32, 46, 52, 381. Either of foregoing drugs separately, especially arsenic or phosphorus. Lemon juice. Mineral acids, 376, 378. Guaiacum,43. Bark and serpentary, 375. Opium. Indian hemp. Aconite. Chloroform. Tincture of arnica. Leeches. Blis- ters. Mercurial or iodine plasters. Sulphur and flannel bandages. Aconite lotions. Friction, or shampooing.
Sulphur or alkaline baths, 121, 125. Arsenical baths, 128. Yapor or
228 EHINOLITHES— EOSEOLA.
liot-air baths. Harrogate waters; Buxton ; Bath; Spa; Schwalbach ; Aix- la-Chapelle ; Wiesbaden ; Wildbad, or Baden-Baden ; (jarlsbad ; Vichy.
EHINOLITHES. — From 'Piv, the nose ; XiOo^. a stone. — Concretions of phosphate and carbonate of lime, magnesia, and mucus, which occasionally form in one of the nasal cavities. Nucleus may consist of a shell, piece of pencil, bean, or any foreign body. Easily detected by sounding with a probe. Removal with forceps. — See Ozcena.
KHINOIIEHCEA.— From 'Flv, the nose; lAu>, to flow. Synon. Rhino- Nennorrhcea ; Nasal Gleet. — Chronic inflammation of the nostrils, pro- ducing a constant discharge of mucus. — See Ozcena.
RICKETS. — Synon. Rachitis; Osteomalacia Infantum. — A disease peculiar to childhood, as osteomalacia is to adults. Usually appears to commence about the fifteenth or eighteenth month after birth, when the child begins to walk. The bones as they grow remain soft and flexible : they bend under weight of body. The osseous tissue looks natural in structure, but is insufficiently impregnated with earthy salts. Strumous children of the poor mostly suffer.
Symptoms. Pallor; imperfect digestion; profuse perspiration during sleep, especially about head and face. Ends of long bones enlarged. Phy- siognomy peculiar. Growth stunted. Head usually large ; forehead promi- nent; fontanelles close slowly. Tonsils often enlarged. Chest narrow, with prominent sternum — pigeon-breasted. Spinal curvature. Pelvic deformity, so that in after life parturition would be attended with great difficulty. Curvature of the limbs, especially of lower extremities (bandy legs). The deformed bones become firm after puberty.
'J'REATMEiXT. Attention to general habits, exercise, and clothing. Animal food : milk : raw eggs. Phosphate of lime. Phosphate of iron. Chemical food, 40.T. Cod-liver oil. Tannic acid. Carrageen, or Irish moss. Light supports for spine, or lower limbs. Bathing with salt water. Fiiction. Sea air.
RINGWOUM.— See Tinea Tonsurans.
RODENT ULCER.— From Rodo, to gnaw. Synon. Lupoid Ulcer; Cancroid; Peculiar Ulcer ^f Eyelids. — Commences as a hard, irritable, and painful tubercle. Ulceration ; the ulcer having hard margins, a dry glossy surface, and tubercles in or adjoining it. Tendency to spread slowly in every direction, completely destroying all adjacent textures — as muscle, bone, eye, etc. Most frequently situated on eyelids ; next on nose or cheeks ; sometimes seen on scalp or vulva. Lymphatic glands not affected. General health often remarkably good, even when the ulceration has produced fright- ful disfigurement. Occurs equally in both sexes, after middle period of life. No affinity between rodent ulcer and lupus : former, more allied to cancer.
Treatment. A cure can be effected by thorough extirpation with knife or caustics, — chloride of zinc, potassa fusa, nitric acid : in either operation, ani3esthesia should generally be employed. Opium. Cod-liver oil. Nourish- ing food.
ROSEOLA. — Dimin. of Rosa, a rose. Synon. Rose Rash ; False Measles; Epidemic Roseola. — A non-contagious inflammatorj^ affection of the skin. One of the Exanthem'cTtU. ' Characterized either by transient patches of redness, of small size and irregular form, distributed over more or less surface of body ; or by formation of numerous, s-mall, separate, rose-
RUBEOLA NOTHA— SCABIES. 229
colored spots. Accompanied by slight fever. Occasionally prevails as an epidemic. Duration from one to seven days.
Roseola sometimes simulates measles, sometimes scarlatina. No coryza. Soreness and redness of fauces, with g-astric disturbance, often presenT. — Roseola restiva affects adults, especiall}' women, in the summer. May arise in children from dentition. Eruption often preceded by chills and smart fever.
Treatment. Citrate of magnesia. Sulphate of magnesia with acid infu- sion of roses, 142. Compound rhubarb powder. Solution of acetate of ammonia with spirit of nitrous ether, 348. Aromatic sulphuric acid and compound tincture of gentian. Nitric acid. Quinine. Plain diet. Lemon- ade. Warm baths. Sponging with vinegar and water. During teething, lancing of gums may be required.
RUBEOLA NOTHA.— From 7?»fteo, to blush. Synon. Eotlielv; Scar- latina MorhilUiHa. — flas been supposed to be a compound of measles and scarlet fever, but really a distinct disease.
Symptoms. Fever, which often runs very high. Tongue furred; slight sore throat; little or no coryza. Eruption resembling measles.
Treatment. Rest in bed. Diluent drinks. Warmth. Colchicum has been recommended.
RXJPIA. — From 'Prrfoj. filth ; owing to the foulness of the affected parts. Synon. Ulcus Atonicum ; Ecphlysis Ehypza. — A non-contagious skin disease. May be regarded as a modification of pemphigus occurring in debilitated constitutions, and especially in systems contaminated with poison of syphilis. Characterized by eruption of flattened vesicles or bullae; con- taining at first serous fluid, which soon becomes purulent or sanguinolent, and then concretes or dries into dark and black and rough scabs. Margins of surrounding skin inflame ; serum continues to be poured out ; incrustation increases in circumference and thickness until it somewhat resembles the shell of a limpet. As crusts fall off they leave circular ulcers, which often only cicatrize after lapse of many weeks. Loins and lower extremities most frequently' affected. Duration varies from two or three weeks to several months. Seldom any danger, unless a great deficiency of vital power be present.
Varieties. Three forms usually described. When crusts are thin, and ulcers beneath them superficial,— 7-i/p/a simplex. If crust be large, consti- tuting marked featui'e of case, — ritpia promniens. Where ulceration is extensive and deep and spreading, — rupia escharotica.
'I'reatmext. Nitric acid and bark. 376. Quinine and mineral acids. 379. Quinine and steel, 380. Cod-liver oil. Phosphate of iron, 405. Bullae to be punctured. Generous diet : milk ; wine or malt liquors. Warm baths. Change of air.— 772 syphilitic form : — Iodide of potassium and bark, 31. Iodide of iron, 32. Corrosive sublimate, 27. Red iodide of mercury, .54. Mercurial vapor baths, 131.
SAINT ANTHONY'S FIRE.— The popular name for Erysipelas. St. Anthony of Padua was supposed to work miraculous cures of this disease. — See Erysipelas.
SCABIES. — From Scabo, to scratch. Synon. Psora; Itch; Scotch Fahile. — A contagious troublesome skin disease, attended with great itch- ing ; irritation increased by warmth. Commences as a papular, vesicular, or pustular eruption ; vesicles or pustules ruptured by scratching, causing excoriations. Most common about flexures of joints, especially on hands, between fingers, and on abdomen.
Due to an animal parasite, the Acarus Scahiei, or Sar copies Hominis.
230 SCARLET FEVER.
Female larger than male : after impregnation she burrows beneath epider- mis, forming furrows or cuniculi. in wliich her eggs are usually deposited. Males wander over surface of epidermis.
Treatment. Thorough washing with warm water and soft soap. Sul- phur ointment. Sulphur baths. 125. Sulphur soap. Lotions containing creasote, carbolic acid, corrosive sublimate, or tobacco. — (!ontaminated clothes to be fumigated with sulphurous acid gas ; or boiled, ironed with very hot iron, or exposed to a temperature of over 212° F. ; or sprinkled with powdered sulphur.
SCAKLET FEVEE,. — This disease, known also as Scarlatina,— horn. the Italian Scarlatti), scarlet — is an infectious fever, characterized by scar- let efflorescence of skin, and mucous membrane of fauces and tonsils ; the efflorescence commencing about second day of fever, and declining about fifth. Often accompanied by inflammation of throat, and sometimes of sub- maxillary glands. Like measles, essentially a disease of childhood ; but more to be dreaded. As a rule, scarlet fever occurs only once ; in the event of a second attack there is often no rash, little or no throat affection, and the disorder runs a favorable course.
'I'hree forms : — Scarlatina simplex, in which skin is most affected ; scar- latina anginosa, in which both skin and throat are severely implicated ; and scarlatina maligna, in which there may be death within one or two days with cerebral symptoms, or the fever may have an adynamic type : rash dusky, tongue dry, throat little swollen, but tending to slough.
Symptoms. In scarlatina simplex, after a latent period of from 4 to 6 days, there is fever, lassitude, and headache. On 2d day, eruption appears in form of numberless minute dots of a bright scarlet hue. This terminates by desquamation of the cuticle : which begins about the end of 5th day. While the rash has been appearing, the mucous membrane of mouth, fauces, and tonsils has also been affected. Tongue covered with a thick white fur, through which red elongated papillae project : as the fur clears off, the organ presents a strawberry appearance.
In scarlatina anginosa, more violent symptoms. Greater fever, vomit- ing, delirium, prostration. The fauces, palate, uvula, and tonsils get swollen, and covered with an exudation of coagulable lymph. Nasal mucous mem- brane frequently affected, swollen and red, and there is purulent discharge from nose. Sometimes there is diffuse inflammation of cellular tissue of neck, which is swollen and of brawny hardness. 'I'he eruption may be delayed to 3d or 4th day, and may come out in. scattered patches. With its fading on 5th or 6th day, the fever and inflammation of throat begin to abate. Severe inflammation of the serous and mucous membranes to be feared.
In scarlatina maligna, the fever assumes a malignant or typhoid character. Great cerebral disturbance. Convulsions. Urgent prostration. Low mut- tering delirium. Tongue dry. Throat of dusky red, sometimes sloughing. The rash comes out late, disappears in a few hours, and is renewed several times. Often a fatal termination on 3d or 4th day.
In all forms the urine to be examined daily ; as to quantity, reaction, and freedom from albumen. Two great sources of danger : — suppression of urine with uraemia, and formation of fibrinous clots in right cavities of heart.
Sequelce.: — Ulceration and enlargement of tonsils. Strumous ulcers. Ophthalmia. Scrofulous enlargements of cervical glands. Otitis and abscesses in the ears. Diseases of the scalp. Acute rheumatism. Cardiac inflammation. Scarlatinal vaginitis. Anasarca, dropsy of the serous cavi- ties, and acute desquamative nephritis with albuminuria: to be feared as much in mild, as in severe cases Uraemia.
'J'reatment. '^o prophylactic YQmQi\y known. Acetic acid, belladonna, and inunction with oil or lard useless. — The simple form only requires con- finement to the bedroom ; a warm bath or two ; proper clothing ; spare
SCIATICA— SCLEEOTITIS. 231
diet; anrl attention to the bowels. Cure to be taken lest the escape of the poison by the skin be checked, and thrown back upon the kidneys. Car- bonate of ammonia, 3GL Acetic acid; or a drink of vinegar and water. Sponfjin'r of akin with vinegar and water, 138. Daily inunction of entire surface with hot lard.
Scarlatina Angmo-ta : — Emetics of ipecacuanha at onset. Saline effer- vescing drau.srhts. Carbonate of ammonia, 361, 364, 371. Cold or tepid sponging with vinegar and water. Wet sheet packing. 136. Cold affusion, 134. Inunction with lard. Scalp to be shaved, and cold lotions applied, if there be much delirium. Good beef-tea. Nourishing soups. Milk : cream. Eaw eggs. Port wine.
Malignant Scarlet Fever: — Demands stimulants from commencement. Carbonate of ammonia. Bark. Port wine. Brandy. Quinine. Chlorine, 77. Hydrochloric acid and ether, 365. Ice. Acid drinks; or chlorate of potash drink, 560. Cold affusion, 134. Astringent gargles, 249, 252, 254. Nitrate of silver to throat. Essence of beef, 2. Restorative soup, 3. Cream. Raw eggs. Brandy and egg mixture, 17.
ir/ien Drofsy supervenes: — Compound jalap powder. Elateriura. Tincture of perchloride of iron. Ammonio-citrate of iron. Quinine. Mineral acids. Warm baths. Hot air or vapor baths. Nourishing food.
SCIATICA. — From 'l(5x^ov. the hip. Synon. Neuralgia Ischiaclica ; It^chiaigia ; Coxalgia. — Acute paiu in sciatic nerve. — See Neuralgia; Rlieumatiam.
SCIRRHITS OR. HARD CANCER.— From Sxt/V^o?, indurated. Synon. Scirrhoma ; Carcinoma Fibrosum ; Fibrous Cancer. — The most frequent variety of cancer. Seen occasionally in stomach, upper part of rectum, and elsewhere; but most frequently by far in the female breast. Average dura- tion of life, after patient's first observation of the disease, 48 months.- See Cancer.
SCLEREMA, — From ^x^rj^oi;. hard or stiff. Synon. Algicle (Edema (from Algeo, to be cold; and oibiut, to swell). — -A peculiar disease of new- born infants, not uncommon in France, but rarely met with in this country. Consists of partial or universal induration of subcutaneous areolar tissue, with serous eifusion.
Symptoms. Somewhat resemble those of ordinary anasarca. Usually occurs within ten days of birth ; mostly in feeble or premature children. The skin assumes a dry. stiff, waxy, yellowish appearance: it gradually gets distended and unyielding, so that the infant is said to be skin-bound. Temperature of body gets reduced. Infant appears prostrated, unhealthy, perhaps jaundiced, and as if dying from exhaustion. Indications of distress, restlessness, whining cries, refusal of food, feeble pulse, laborious respiration. Gastric and intestinal disturbance apt to set in. Death often occurs from asphyxia, within a week from commencement of attack.
Treatment. Warm bath. Friction with warm flannels. Body to be enveloped in cotton-wool. Port wine with a few drops of tincture of bark. Ether. Acupuncture. Solution of raw beef in distilled water, 2. If child cannot suck, mother's milk to be drawn off in a spoon and given frequently. Goat's milk. Cream.
SCLEROTITIS. — From Sclerotica, the firm fibrous tissue of the eyeball; terminal -itis. — Inflammation of the sclerotic coat of the eye. Two varieties : —
1. Rheumatic Ophthalmia. — Synon. Ophthalmia Arthritica. — Acute
inflammation of the sclerotic excited by cold, or by the poison of rheumatism.
Symptoms. Pale pink redness of the eye ; the turgid vessels being
232 SOROFULA-SCEOTAL ELEPHANTIASIS.
arranged in a radiated or zonular form, and being evidently beneath the conjunctiva. Severe aching pain round the orbit, in the eyebrow, and over the temple, always most severe at night. Occasionally, intolerance of light. Dimness of vision, from haziness of the cornea and contraction of pupil. Fever and constitutional disturbance.
Treatment. Attention to diet; avoiding port wine, beer, and sugar. Bark and iodide of potassium, 31. Iodide of iron and cod-liver oil, 380. Colchicum, 46. Turpentine. Morphia. Henbane. Calomel and opium. Alkaline purgatives, 141, 148. Warm baths. Blisters behind the ears or to nape of neck. Friction of forehead with belladonna liniment, or with chloroform liniment. Application of muslin bags filled with chamomile flowers, and dipped in a hot and strong decoction of poppy heads. Eye- shades. Spectacles with glasses of a neutral tint. CoUyria of little use.
2. Catarrho-Rheumatic Ophthalmia. — Not an uncommon affection : characterized by a combination of the symptoms of conjunctivitis and scle- rotitis.
Symptoms. A feeling as of sand between the ball and lids. Oircum- orbital pain. Scarlet redness of eye, chemosis, intolerance of light, epi- phora, etc. If unchecked may lead to ulceration of cornea, ony.x, suppura- tion in anterior chamber, effusion of lymph into pupil. General health usually bad.
Treatment. Iodide of potassium and bark, 31. Opium. Turpentine. Nourishing diet : milk. Cod-liver oil. Warm fomentations. Sedative collyria. Chamomile bags dipped in decoction of poppy heads.
SCROFULA, — From Scrofa, a sow ; because swine were supposed to sufierfrom this disease. Synon. Scrophula; Tabes Gland uralis ; Struma; King's Evil. — See Tuherculosis.
1. Scrofulous or Strumous Abscesses. — Often commence insidiously in areolar tissue. Sometimes become indolent. Suppurate imperfectly. In other cases they burrow deeply, and in all directions. Long sinuses, from which exudes a thin sanious pus. Occasional extension to the bone, — necrosis resulting. General health much depi'cssed. Only to be cured by a very nourishing diet ; bark ; iron ; cod-liver oil ; and sea air. Iodine and its compounds ri^garded as anti-strumous remedies. " Chemical Food," i. e., the phosphates of lime, iron, soda, and potassa, in syrup, 405.
2. Scrofulous Ulcers. — An indication of the weak cachectic condition of the strumous system. Most commonly situated about neck, shoulders, arms, or hips. Extensive tracts of skin destroyed by their gradual extension. Efforts at repair slow and imperfect. Granulations absent, or exuberant and flabby: subjacent tissue boggy, and readily broken down by finger or probe. General health bad from the beginning, with daily deterioration. Cicatrization sometimes procured after destruction of the unhealthy tissue with strong caustics: nitric acid, or potassa fusa. Ordinary astringent lotions useless. Constitutional treatment most essential. Occasionally, strumous ulcerations and lupus coexist.
3. Inflammation and Suppuration of Lymphatic Glands,— One of the most frequent results of the strumous habit. Glands of neck most liable. Extensive tracts of skin and areolar tissue sometimes destroyed. W^hen pus has formed, early evacuation by knife or potassa fusa required. The resulting cicatrix becomes a great disfigurement. Constitutional remedies. — See Adenitis.
SCROTAL ELEPHANTIASIS.— Enormous hypertrophy of the scro- tum, lo many cases the tumor has reached below the knees. Very rare in temperate climates. There is no cure but by removal. — See Barbadoes Leg.
SCROTAL (EDEMA— SLEEPLESSNESS. 233
SCROTAL CEDEMA. — Simple oedema of scrotum is usually an accom- paniiiuMit of general anasarca, especially in kidney disease. If it cause distress, relief may be <;iven by acupuncture, but slonghiuff is apt to fdilow. The areolar tissue of scrotum may rapidly become infiltrated with serum as a result of erysipelas. Great constitutional disturbance: fatal sinkino- sometimes occurs early. Sloughing- apt to take place. Tonics and stimulants must be freely employed. Scrotum to be well supported by small pillows. Fomentations. Care must be taken not to mistake oedema from extravasation of urine for erysipelatous inflammation. — See Erysijielas.
SCURVY. — ^yy^on. ScorhutuR ; Land Scurvy; Sea Scurvy. — A com- plex morbid state, caused by long-continued privation of fresh succulent vegetables or fruits, or their preserved juices.
Syjiptojis. Sallow dusky hue of countenance, and of skin generally. Swollen, spongy, pallid or livid gums. Fetid breath. Debility. Heme- ralopia. Deafness. Dyspnoea. Sloughing of gums. Loosening of the teeth. Hemorrhage from gums, nose, mouth, stomach, intestines. Exten- sive ecchymosis. Brawny swelling in hams, and stiffnCvSs of legs. Want of energy : despondency. Diarrhoea. Dysentery. Dropsy. Exhaustion. Thrombosis.
'J'reatiMent. Lemon or lime juice. Oranges. Salads. Watercresses. Potatoes. Pickles. Broccoli. Cabbage. Vinegar. Horseradish. AVood sorrel. Common sorrel. Milk. Wine or beer. Spruce beer, 7. Fresh meat and fish. Raw meat. Fresh blood. Citric acid. Iron. Catechu. Gallic acid. Tannic acid lozenges. Salts of potash with vegetable acids, but not with mineral acids. Opium. Pure air. The recumbent posture.
SEPTICEMIA. — From 2>7rtco, to putrefy; alua. blood. Synon. Septcemia ; Putrid Ivfectton. — Contamination of the blood with putre- fying matters.— See Jchorhcenna.
SIMPLE CONTINUED FEVER. — Synon. Febricula; Eplxemera (when only lasting a day). — A mild disease, having a variable duration of from one to ten days.
Symptoms. Patient suddenly seized with lassitude, nausea, anorexia, chilliness, and pains in back and limbs. After a few hours,— heat of skin, rapid pulse, headache, thirst, constipation, and scanty urine. Perhaps slight delirium. Symptoms aggravated at night. About fourth day. or later, a remission ; critical sweating, or diarrhoea. Convalescence often somewhat slow.
Treatment. The indications are : — (1) To moderate, when necessary, the violence of febrile excitement by saline laxatives, rest in bed. and low diet. (2) To support the powers of the system, as soon as they begin to flag. (3) 'i'o obviate local inflammations and congestions. And (4) to relieve any urgent symptoms if they arise.
SINGULTUS.— From Singultus, a sobbing. Synon. Spasmolygmus ; Hiccup. — See Hiccough.
SLEEPLESSNESS. — Synon. Insomnia (from In, priv. ; somnus, sleep) ; Pervigilium (from Pervigilo, to watch, or be awake all night).
Often a premonitory symptom of insanity. Commonly present in mania, aggravating the symptoms. Desire for sleep often banished in the insane : sometimes they are afraid to sleep because of frightful dreams and visions. Sleep prevented by exciting passions; mental anxiety; many acute dis- eases; dyspepsia; imperfect action of liver; constipation; diseases of heart and large vessels ; pregnancy ; jaundice, though sometimes where
234 SMALLPOX.
blood is much poisoned there is a tendency to excessive drowsiness. Medicinal doses of strychnia, or nux vomica, will often cause bad nights.
Treatment. Daily exercise in o]')en air. A dioestible diet, such as will not favor production of acidity or flatulence. Avoidance of tea and coffee in after-part of day. Pinner at one or two o'clock in afternoon, with light supper at night. Bedroom to be quiet, well ventilated, warm. Bed to consist of mattress, without too many heavy blankets. Some nervous subjects can only sleep with head quite low, and lying on face with arms folded underneatli.
When there is debility, a tumblerful of port-wine negus, or mulled claret, or white-wine whey the last thing at night. A pipe of mild tobacco often unobjectionable.- — Where skin gets hot and dry, a tumblerful of cold water or soda-water on going to bed. Eapid sponging of body with tepid water. Wet-sheet packing, 136. Warm foot bath. A hot-water bottle in bed draws the blood from brain to extremities. Wet compress over the eyes.
Removal of any physical cause for wakefulness. Aperients if there be constipation. Alteratives and laxatives if stools be unhealthy. Bismuth, or soda, if there be heartburn or acidity. A rag dipped in cold water, or a tight band round forehead, if there be headache. In some acute diseases, a bladder containing ice to head.
Chloral, henbane, .S2.t, 387. Stramonium and henbane, 323. Hop, etc., 325. Indian hemp and henbane, 337. Morphia, chloroform, and Indian hemp, 317. Opiate enemata or suppositories. 339, 340. Hypodermic in- jection of morphia. 314. Codeia. ISlusk, with or without assafoetida, in hypochondriasis. When insomnia is due to nervous irritability, bromide of potassium, 42. Mesmerism. Hypnotism.
SMALLPOX.— Synon. Far/o/a.— A continued infectious fever, attended with an eruption. Due to absorption of a speciGc poison. The disease would i)rnbably become extinct, were vaccination universally and efficiently performed.
SyiMptoms. 'J'his disease goes through four stages, — that of incubation, primary fever, eruption, and secondary fever.
'J'he period of latency or incubation lasts twelve days. Then there is lassitude, headache, fever, vomiting, and well-marked muscular patn-i tn back and loins. These symptoms succeeded at end of 48 hours by erup- tion of small red pimples, which in course of a week become vesicular, inflame and suppurate. In many instances accompanied by a similar affection of mucous membrane of nose and mouth; generally by soreness of throat ; in some, by swelling and inflammation of subjacent areolar tissue; occasionally by marked irritation of nervous system. When vomit- ing and pain of back are violent, they are generally precursors of a severe attack.
Peculiar eru])tion of pimples or papulis begins to show itself on com- mencement of third da}^ of fever, appearing in following order: — First on face, neck, and wrists ; secondly on trunk ; and lastly on lower extremities. The papulai have at first a hard shotty feel, then present vesicles on the summit which gradually expand laterally to about diameter of split-pea, are flat and depressed in the centre or umbilicated. On eighth day of disease an inflammatory areola forms round vesicles, and contents become cloudy and then purulent. Vesicles thus gradually ripen into pustules, suppuration being con)plete by ninth day of eruption ; at which time pustules break, and crusts or scabs form. In four or five days more these scal)S are falling off.
The severity of the disease usually bears a direct relation to quantity of eruption. When pustules are few, they remain disthict, and separate from each other; when very numerous, they run together, coalesce, and lose their regularly circumscribed circular form. Hence, a division of smallpox into ■ — variola diacreta, and variola confluens. Former seldom attended with
SPANiEMIA. 235
danger; latter never free from it. Eruption on face may be oonfliient, while it is scanty elsewberc ; still the rlisease is of confluent kind. Sometimes, pustules so numerous that they touch each other, l)ut do not coalesce; dis- ease then said to be of cohering or semicovjiue'id form. Sometimes the pustules grouped in clusters and the name corymhose applied. If, in con- fluent cases, symptoms of malignancy and putrescency are added, the disease becomes malignant smallpox. — a most formidable affection. Occasionally after initial symptoms, pain in back, vomiting, and fever, a rubeoloid erup- tion and later minute petechige which increase in number and size; hemor- rhage takes place into conjunctivas, and from bladder, bowel, etc., and death occurs on 4th or 6th day ; no characteristic eruption or only a few scattered papules or vesicles having appeared. This hemorrhagic smallpox is almost invariably fatal.
The greatest difference betvveen distinct and confluent forms is in the sec- ondary fever ; slightly marked in first, intense and perilous in second. Sets ill usually about eleventh day of the disease, or eightli of eruption, and occa- sionally at once proves fatal ; the system being overwhelmed by virulence of the yioison. During its course, troublesome complications may arise, — as erysipelas, swelling of glands in groin and axilla, phlebitis, ichorhasmia, glossitis, pleurisy, pneumonia, ulceration through cornea, suppuration of ear. conjunctivitis, etc.
No contagion so powerful or certain as that of smallpox : infection lasts from end of latent period until every crust has fallen off and skin ci(;atrized. One attack exhausts susceptibility of system to future influence of the poison, as a rule. Variola occui^ring in persons unprotected by inoculation or vaccination is fatal on average to one in every three. AVhen variolous matter is introduced into skin — inoculated smallpox — disease is in all respects of a mild nature. Practice of inoculation, now illegal.
Treatment. In simple cases the less drugs are used the better. Fatient to be kept quiet in bed ; in a weli-ventilated room, free from carpets, cur- tains, etc. Some disinfectant to be employed, — iodine very good, 81. Diet, — arrowroot, gruel, weak beef-tea, tea with milk, ripe fruits. Lemonade; barley water; plain water; raspberry vinegar and water soda water; ice. Tepid sponging. Wet-sheet packing where there is high temperature, irri- tabilitv and sleeplessness, 136. Change of linen once a day. Mild saline laxatives, 139, 141, 1.5.5, 169. Opium or henbane, 315, 318, 325, 340: pro- vided there be no fear of mucus accumulating in the bronchi and threatening suffocation. Sarracenia purpurea, useless. Good broths, wine, ether, bark, etc.. when maturation of pustules proceeds tardily. Complications to be palliated : anti]ililogistic remedies injurious.
In secondary fever : — Mild laxatives if necessary: — Effervescent citrate of magnesia ; compound rhubard powder. Astringents, if there be diar- rhoea. Sedatives, once or twice daily, if there be restlessness. Nourishing food : pounded meat in beef-tea, good soup, milk or cream, raw eggs. Alco- holic stimulants, in proportion to the depression. "When patient appears to be poisoned by absorption of septic material, from pustules, continuous immersion in bath kept at temperature of 98° to 100° may save life. — If any boils or abscesses Ibrm, early incision.
For sloughing or gangreyinus sores: — Quinine. 379. Bark and nitric acid, 376. Ale, wine, or brandy. Milk : pounded beef. Water bed.
To prevent ptif ting : — Internal administration of arsenic (?), external application of olive oil. Glycerine and rose-water (equal parts). Lime liniment. Nitrate of silver. Puncturing the pustules. Collodion. Gutta percha and collodion. Mercurial ointment. Tincture of iodine. Sulphur. Linseed or yeast poultices. Water dressing. Oxide of zinc ointment.
SPAN^MIA, — From STttti-of. thin or poor; alua, blood. Thin or poor blood : a diminution in the quantity of red corpuscles. — See Anoemia.
236 SPEEMATOEKH(EA— SPINA BIFIDA.
SPERM ATOERHCE A. —From Srffp^a, seed ; [Jio, to flow. Synon. Sper- morrhcea ; Gonorrhuea Vera; Prnfliujuim Seminis ; Pollution. — A de- rang-ed state of mental and bodily health, due to the too frequent escape of seminal fluid. Masturbation the most common cause.
Symptoms. There may be only a repeated escape of seminal fluid ; or this may be associated with morbid chantjes in vesiculpe seminales. ejacula- tory ducts, bulbous portion of urethra, and prostate gland. Urine some- times rendered slightly albuminous by seminal fluid.
General weakness : nervous irritability, with a dreamy absent kind of manner. Flatulence and constipation. Dulness of sight and perhaps of hearing. Weakness of memory. Attacks of palpitation, giddiness, head- ache, neuralgia. In extreme cases, final result may be epilepsy, phthisis, impotence, insanity.
Treatment. General rulefi : ■ — Moderate mental and bodily work. Cheerful society. Not more than eight hours for sleep, on a mattress, with- out too much clothing. Obscene works of quack doctors and sham museums, to be shunned like virulent poisons. Avoidance of heavy meals, alcoholic drinks, and tobacco: substitution of milk for tea and coffee. If emissions take place when patient lies on his back, a cotton-reel to be tied over middle of spine at night. Salt-water sponge baths, tepid or cold, with friction of skin. Careful ablution of glans penis to remove irritating secretions of sebaceous follicles. Support of testicles by suspensory bandage.
Drugs : — Phosphoric acid, nux vomica, and bark, 376. Sulphate of zinc and nux vomica, 409. Phosphate of zinc. Quinine and iron, 380. I^arge doses (.^j) of tincture of perchloride of iron. Cod-liver oil. Bromide of potassium. Camphor, conium, and belladonna, 326. Digitalis. Ergot of rye. Cubebs. — Removal, Avhen present, of oxyurides from rectum ; or of excessive acidity of urine.
Local treatment : — Only required in exceptional cases. Introduction of metallic sound into bladder, once or twice a week. Nitrate of silver to prostatic portion of urethra, — Lalleraand's porte caustique. Circumcision. Galvanism.
SPINA BIFIBA. — Synon. Hydroracliitis, from "TScop, water, and |'a;i;t5, the spine; Hijdroracliis Congenita-; Cleft Spine. — A congenital defi- ciency of the posterior laminas and spinous process of one or more vertebrae ; owing to which there is undue distension of membranes of cord with cerebro- spinal fluid. May exist in cervical, dorsal, lumbar, or sacral region : most common in lumbar.
Symptoms. A tumor is formed, varying in size from a walnut to a child's head. There is fluctuation : swelling most tense when child is held upright: swelling semi-transparent, or skin may be unaffected, or congested and blue. Prognosis unfavorable, if complicated with hydrocephalus; if there be paralysis of bladder or rectum and lower extremities : if the tumor threaten to burst by increasing in size. When only two or three upper lumbar ver- tebriB are affected, the spinal cord seldom deviates from its course and only the posterior spinal nerves have any connection with the sac. If tumor occupy part of lumbar and part of sacral region, the cord itself and its nerves will almost always be found in close contact with the sac. The disease is not necessarily fatal.
Treatment. If general health be good, and tumor small, interference will be unnecessary, beyond protectine the growth by a piece of leather or gutta percha moulded to the part. Where there is slow enlargement pres- sure may be tried by an air pad, or by painting with collodium. Where growth is rapid, and there is a fear of skin giving way, tapping with a small trocar may defer a fatal result: after emptying the sac, pressure to be ap- plied. Iodine injections have succeeded twice at least : their employment fraught with danger. In another case, a cure was effected by application
SPINAL CONGESTION— SPINAL CURYA'l'URE. 237
of a clamp to the broad base, the instrument being gradually tightened until the tumor sloughed off.
SPINAL CONGESTION. — Usually chronic, and occurring in feeble constitutions after middle life. Attended with aching of back and limbs, and gradual loss of power in lower extremities. Symptoms most marlved in morning, the congestion being favored by the recumbent posture.
Tkeatmknt. Promote general health. Friction to spine. Cod-liver oil. Iron and nux vomica. Arsenic. Phosphorus.
An acute form of congestion sometimes seen in young persons. Para- plegia gradually advancing upwards till respiratory centre involved, and death occurs from suffocation.
Treatment. Alternate application of ice and hot water to spine. Quinine in large doses. Nux vomica. Mercury. Iodide of potassium.
SPINAL CTJRVATUEE.— The causes of spinal curvature are :— Pecu- liar avocations, causing the muscles on one side to become unduly developed and powerful: e.g. habitual use of right arm in blacksmiths. Constant assumption of an unnatural attitude : e. g. nurses carrying children always on one arm ; repeatedly standing on right leg with left knee somewhat bent. General weakness, producing a relaxed and flabby state of all the tissues ; or a deficiency of earthy matters in the osseous system, so that there results a loss of equilibrium between the resistance of spinal column and weight of upper part of body : e. g. curvature from rickets, and destruction of the bodies of the vertebrae by caries. — There are three principal varieties : — Lateral curvature, the convexity being to either side, but usually to the right. Posterior curvature, or excurvation. And anterior curvature, or incurvation.
1. Lateral Curvature. — The most common form. Appears chiefly in young women between the ages of ten and eighteen ; who are said to outgroio their strength, i. e. the wants of the system are insufficiently supplied owing to imperfect assimilation of food, too little outdoor exercise, and inattention to position while standing or walking. Its recurrence favored by myopia, leading to constrained position in writing.
Symptoms. One shoulder observed to be higher than the other: together with a growing out of one scapula. While one shoulder is high, the other is unduly depressed. So one hip projects, while the opposite curves inwards. On examination the vertebral column is found to be curved : in double lateral curvature it is twisted like the italic /. As the thoracic and ab- dominal cavities are more or less deforn)ed, the play and free movements of the viscera get impeded. If there be difficulty in taking full inspirations, dyspnoea will be present. The action of the muscles of trunk is impaired. General health suffers. Pain in side, from pressure exerted on the nerves. In curvature from rickets there is also distortion of the limbs : patient's aspect rickety.
Treatment. Maintenance of general health at highest point of efficiency. Animal food : milk ; raw eggs. Cod-liver oil. Sea air, and baths. Quinine and iron, 380, 382. Phosphate of iron ; chemical food, 405. Strengthening of muscles and ligaments which act on vertebra;, by frictions, palpation, shampooing. Carefully devised gymnastic exercises. Removal from spinal colunm, by proper apparatus, of such weights or forces as tend to keep the various segments of spine in an unnatural relation to one another.
2. Posterior Curvature. — Chiefly affects the cervical and dorsal regions. May be caused in infancy by the frequent practice of raising the child by placing the hands under the arm-pits, and so compressing the ribs and forc- ing back the sternum and spine. The muscles and ligaments which keep the column erect, become relaxed. In rare cases, there is disease of bodies of vertebrae.
238 SPINAL HE^rORRHAGE-SPINAL IRRITATION.
3. Anterior Curvature. — Synon. Angular Curvature ; Fott's Curva- ture.— Tbe most niicoiumon variety. Generally associated with some con- stitutional affection (scrofula), producing caries or ulcerative destruction of bodies of vertebr*, or interstitial softening and absorption of calcareous elements of osseous texture. As bodies destroyed spines project backwards forming a prominent angle. As many as five or six vertebrte, with the intervertebral substances, may be affected. More frequent about mid-dorsal regions than elsewhere.
Symptoms. General indications of scrofula. Weakness, coldness, and numbness of legs, with twitchings and spasms. Subsequently paraplegia Avith paralysis of bladder and rectum. Tenderness or dull aching pains, in back. 'JMghtness of chest with more or less dyspnoea. Occasionally, for- mation of strumous abscesses. Exhaustion and hectic. Under favorable circumstances, disease gets arrested; bones collapse, anchylosis occurs, and pus becomes absorbed ; patient recovering, but with incurable deformity. Sometimes sudden death ; owing to diseased bodies of vertebra3 giving way and crushing spinal cord, or from occurrence of dislocation of odon- toid process of axis in consequence of ulceration and destruction of its liga- ment.
Trkatment. Perfect rest in horizontal position is indispensable. Use of a reclining couch, so shaped as to keep the trunk perfectly quiet. A stiff bandage, or pair of stays, extending from occiput to hips, to insure rest. Any active attempts to reform deformity will altogether prevent a cure of the disease. Pain to be relieved by belladonna or opium plasters : issues, setons, blisters, or leeches worse than unnecessary. Abscesses to be opened when they point. Improvement of general health, by good diet, cod-liver oil, phosphate of lime, bark, or steel. During convalescence, mechanical support to the trunk judiciously applied.
SPINAL HEMOKRH AGE.— Synon. Myelorrhagia ; Mt/elapojilexm ; Apoplexia Myelitica ; Apoplexy of the Cord; Paralysis from Effusion of Blood into Spinal Canal or into Substance of Cord. — More rare than cerebral hemorrhage. Arises from injury ; acute inflammation of cord or membranes ; fatty degeneration of coats of vessels ; caries and other dis- ease of vertebra. — Blood poured out external to dura mater; or between membranes ; or into gray portion of cord. Death may happen at once ; or after a variable interval from chronic softening of nervous substance.
Symptoms. Vary according to seat of ruptured vessels. Blood effused between the membranes, gravitates to lowest part of spinal canal : hence, paralysis which gradually extends upwards. Acute and sudden pain in back, sometimes in head. Often, severe convulsions Difficult breathing when there is pressure on upper part of cord. Heart's action depressed. Surface pale and cold. Consciousness unimpaired. — Effusion into substance of cord produces sudden paralysis in all parts supplied with nerves coming off below its seat: where hemorrhage is very slight, loss of power occurs slowly after lapse of some hours.
Treatment. Further effusion to be checked by perfect repose : applica- tion of ice along spinal column.
SPINAL IRRITATON.— Synon. Rhachialgia; Neuralgia Spinalis ; Notalgia..- — Probably no disease exists deserving this name. The symptoms mostly observed in women : pains about mammae, thorax, abdomen, or uterus. Tenderness on pressure over spinous processes of certain vertebrae. 'I'he suffering due to a combination of myalgia and hysteria, with constitutional weakness. This opinion confirmed by curative influence of belladonna plas- ters ; nourishing food ; cod-liver oil ; bark or steel ; sea air ; and moderate exercise.
i
SPINAL MENINGITIS— SPINAL TUMORS. 239
SPINAL MENINGITIS.— From Spina, the backbone : Mi^viyl, a mem- brane ; leriiiiiKvl -/Y/.s. -Synon. Perimyelitis; Myelomeningitis ; Acute Paralysis from Inflammation of Memhraiies of Spinal Cord. — Acute inflammatioi) of membranes of cord not a common disease. It terminates in resolution, effusion of serum, softening of cord, or suppuration. When acute, may be associated with disease of cerebellum or of cerebral mem- branes ; when chronic, mostly connected with caries of vertebras. Mechani- cal injuries, and exposure to wet and cold in rheumatic subjects, the most irequent causes.
Symptoms. High fever and sleeplessness. Acute burning pains along spine, extending into limbs; greatly aggravated by motion of limbs but especially of spinal column and by pressure ; often simulating rheumatism. Rigidity, or tetanic contraction of muscles of neck and buck. When upper part of cord affected and membranes of base of brain, the head generally thrown back. Feebleness of limbs, perhaps to extent of paralysis of lower extremities : loss of power extends upwards as effused serum inci'eases in quantity. Suffocating sensations: feeling of constriction in neck, back, and abdomen. Retention of urine. Priapism. Obstinate constipation, some- times succeeded by diarrhoea. Great prostration, if morbid action proceed ; sometimes, feverish delirium and coma.
Cerebrospinal meinngitis occasionally occurs as an epidemic : inmates of workhouses, soldiers in over-crowded barracks liable to it.
Treatment. Iodide of potassium and aconite, 31. Corrosive sublimate and sarsaparilla, 27. Red iodide of mercury, 54. Aconite and guaiacum, 330. Stramonium. Henbane. Belladonna. Castor oil. Calomel and jalap. — Locally.- — Lint, saturated with belladonna or aconite liniment, and oiled silk. Linseed poultices. Fomentations with poppy heads and chamo- mile flowers. Ice. Blisters. Tartarated antimony ointment. Painting of spine with diluted iodine liniment. Leeches.
'I'o prevent the spread of epidemic cerebro-spinal meningitis, removal from unhealthy locality is necessary.
SPINAL MYELITIS.— From MvsT.Sv, marrow ; terminal -itis. Inflam- mation of the substance of the cord; usually only a segment involved, and not entire length, may be due to injury or to disease of vertebra. Syphilis a common cause.
Symptoms. Slight fever. Pain in back, of dull aching character, gradual loss of power in lower limbs and body below seat of disease, and later also of sensation. Early loss of control over bladder and rectum. Sensation as of cord round body. Tenderness on percussion of spine, and pain on appli- cation of hot sponge over affected segment. Reflex action often exagger- ated in lower extremities, and involuntary starting of limbs ; tendency to formation of bedsores.
Treatment. Remove any known cause if possible, such as injury or dis- ease of vertebrae. Iodide of potassium, mercury — these especially if disease of syphilitic origin. Belladonna. Henbane. Locally, blisters, cautery? Iodine; ice; fomentations. Great attention to be given to bladder to pre- vent accumulation and decomposition of urine and inflammation of bladder. Bowels to be relieved by aperients and enemata. Water bed or cushions to prevent formation of bedsores by pressure.
SPINAL TUMOHS, — Paralysis may arise from long-continued pressure of tumors on the cord, producing partial atrophy. Morbid growths consist of tubercle, syphilitic deposit, cancer, bone, or hydatid cysts. Exostosis of odontoid process of second cervical vertebra, an occasional cause. Some- times, tumor has its origin in syphilitic disease of vertebrae.
Symptoms. Come on slowly. Paralysis often not manifested until great pressure is exerted. Paralysis of motion almost always precedes that of
240 SPIEOMETRY— SPLENIC DISEASE.
sensation. Pain over seat of growth. Cramps, and convulsive movements of extremities. Nature of tumor to be inferred from history and associated symptoms.
TreaTxMent. Iodide of potassium. Iodide of ammonium. Eed iodide of mercury. Corrosive sublimate. Syrup of iodide of iron. Cod-liver oil. Nourishing food : milk. Counter-irritants to painful parts of spine, occa- sionally useful.
SPIEOMETRY.— From Spiro, to breathe; ^f^plco, to measure. The mode of measuring the quantity of air which the lungs can contain.
Spirometers, or Spiroscopes. or Pneumometers, are instruments for measur- ing the volume of air expired from the lungs. This volume is diminished in each stage of phthisis. Quantity of air expired after most complete inspi- ration is the vital volume or vital capacity. The vital capacity always increases with stature; also slightly affected by weight, but not sufficiently to interfere with correctness of following table, which shows the capacity in health and in the three stages of phthisis : —
|
Ft. 5 |
Height. in. Ft. 0 to 5 |
in. 1 . |
Capacity in Health. Cut), in. . . . 174. . |
Capacity in Phthisis Pidmnnalix. 1st Stage. 2d Staue. 3d Stage Cub. in. Cub. in. Cub. in. .117 99 82 |
|
|
5 |
1 |
' 5 |
2 . |
. . . 182 . . |
.122 102 86 |
|
5 |
2 |
' 5 |
3 . |
... 190 . . |
.127 108 89 |
|
5 |
3 |
' 5 |
4. |
... 198 . . |
. . 133 113 93 |
|
.5 |
4 |
' 5 |
5. |
... 206 . . |
.138 117 97 |
|
.5 |
5 |
' 5 |
6 . |
. . .214 . . |
. . 143 122 100 |
|
5 |
6 |
' 5 |
7 . |
... 222 . . |
.149 127 104 |
|
5 |
7 |
' 5 |
8 . |
... 230 . . |
. . 154 131 108 |
|
.5 |
8 |
' 5 |
9 . |
... 238 . . |
.159 136 112 |
|
5 |
9 |
' 5 |
10 . |
... 246 . . |
. . 165 140 116 |
|
.5 |
10 |
' 5 |
11 . |
. . . 2.54 . . |
. . 170 145 119 |
|
5 |
11 |
' 6 |
0 . |
.. .262 . . |
.176 149 123 |
This table reads : — A man whose height is between 5 ft. 7 in. and 5 ft. 8 in. should breathe in health 230 cubic inches ; in first stage of consumption this is reduced to 154; in second, to 131 ; in third to 108 cubic inches.
To test the vital capacity the patient loosens his vest, stands perfectly erect, takes as deep an inspiration as possible, and places mouth-piece of spirometer between his lips. The observer having opened the tap, patient empties his lungs, steadily making the deepest possible expiration; at termi- nation of which the operator turns off the tap, thus confining the air in receiver. 'J'he receiver is then to be lightly depressed until the surfaces of spirit in bent tube on outside of instrument are on a level with each other, when the vital capacity may be read off from scale.
SPLENIC DISEASE.— The spleen, like other glands, is liable to,— con- gestion, intlammation, softening, abscess, gangrene ; tubercular, amyloid, and malignant disease ; fibrinous deposits — remains probably of extrava- sated blood; serous and hydatid cysts; and simple enlargement, enlarge- ment of spleen associated with leucocythemia. — More common among resi- dents of tropical and mai'shy than of temperate climates.
Enlargement of Spleen ("■ Ague-cake") generally results from repeated attacks of intermittent fever. Sufferers from it have a peculiar sallow and unhealthy aspect ; ansemic appearance of gums and buccal mucous mem- brane; tendency to hemorrhage; dyspepsia; debility and loss of flesh. When result of ague, — aperients: bark or quinine; arsenic. In other forms, — steel ; phosphorus ; bromide of potassium ; sulphate of zinc. Friction with diluted ointment of red iodide of mercury. Good nourishing food.
STOMATITIS— STOMATORRHAGIA. 241
Residence in a dry and bracinj^ locality. Avoidance of mercury and deple- tion. Iodine, iodide of lead, nitric acid, ertjot of rye, have been employed. Rusot (an extract prepared by natives of India from the Berberis Lycinm and Berberis Aristata) has been stron,n:ly recommended. Extirpation of the spleen (Splenectomy) has been resorted to.
STOMATITIS. — From Sro^a, a mouth ; termital -itis. Inflammation of the mouth. A conrmon disease of young children. It may occur in tliree forms, — i. e., according as chief seat of morbid action is in mucous follicles of mouth, substance of gum, or in tissues of cheek.
1. Follicular Stomatitis. — Inflammation of mucous follicles of mouth may be idiopathic, or a sequela of one of the eruptive fevers.
Symptoms. Difficulty of sucking. Abundant flow of saliva. Submaxil- lary glands tumid and tender. Restlessness, with fever. Loss of appetite. Diarrhoea with offensive motions. Small vesicles on inside of mouth, on tongue and fauces : vesicles burst and form ulcers, which are covered with dirty-white or yellowish sloughs.
Treatment. Application, with a camel's hair pencil, of borax and glyce- rine, 250. Mild tonics. Carbonate of magnesia. Chlorate of potash. Attention to the milk supplied to child. Beef-tea.
2. Ulcerative Stomatitis, — Synon. Noma, from NfV'^, to corrode. — Ulceration of the gums, sometimes destroying these parts and denuding the teeth. Occurs mostly in badly nourished children. May be erroneously attributed to use of mercury.
SvMPTOMs. Heat of mouth. Salivation. Offensive breath. Swelling of upper lip: enlargement and tenderness of submaxillary glands. Gums get swollen, red or violet colored, and covered with a laj-er of pulpy grayish matter. If disease proceed, gums become destroyed by the ulceration : teeth are exposed and loosened. Inside of cheeks may be involved : irregular sloughing ulcerations.
Treatment. Chlorate of potash : gr. .5 may be given every four hours in sweet tea to an infant one year old. Subsequently, bark in wine. Cod- liver oil. Pure milk ; that of the ass, goat, or cow. Solution of raw meat, 2. Beef-tea, 6.
3. Gangrenous Stomatitis. — Synon. Cancrum Oris ; Sloughing Pha- gedcena of Mouth. — A formidable disease. Occurs in weakly children, between second and fifth year.
Symptoms. Debility. A hard indolent swelling on one cheek. On ex- amining mouth, a whitish or ash-colored eschar is seen in centre of cheek : sloughing increases until it spreads over whole of inside of cheek, lips, and gums. Saliva copious : breath horribly fetid. Great constitutional dis- turbance. Pulmonary complications apt to occur. Frequently death. — Often attributed to use of mercury : may occur where none has been given.
Treatment. Application of nitrate of silver, sometimes of strong nitric acid, to slough. Frequent syringing of mouth with warm water : with solu- tion of permanganate of potash, 78 : with chlorinated soda gargle, 2.54. Chlorate of potash in bark. Wine, or brandy. Raw meat, 2. Milk: cream.
STOMATORRHAGIA. — From Sx'o^a, a mouth; ,!,5jyi/i;,at, to break out. Synon. Stomatorrhoia ; Hcemorrhagia Oris; Buccal Hcemorrhage. — Discharges of blood from mouth and throat seldom give trouble, except when they occur during last stages of scurvy or purpura, or after exces- sive use of mercury. In some instances, small veins about mouth and pharynx become varicose ; should their walls rupture, severe or fatal bleed- ing may result. Ulcers about tongue seldom bleed much. Gangrenous glossitis has ended fatally with haemorrhage.
Treatment. Ice. Cold astringent washes. — See Hcemorrhage. 16
242 STROPHULUS— SUSPENDED ANIMATION.
STROPHULTTS. — Synon. LicJieniasia Strophulus ; Tooth-rash; Red Gttin Bash. — A papular skin disease, peculiar to infants and young child- ren. Characterized by an eruption of minute, hard, sometimes slightly red, and clustered and scattered, pimples. May appear upon a part, or extend over whole surface of body. Irritation slight.
Varieties. Several described, according as papulae are large or small, scattei-ed or grouped. But whether papules are scattered, with red dots interspersed among them, as in strophulus intertinctus ; or white and large, often resembling flea-bites, as in strophidus candidus ; or forming circular patches, which come out successively in different parts of body, as in strophulus volaticus, — is of little moment. Practically, all forms due to stomach or intestinal derangement ; the consequence of improper feeding, or of irritation about gums from dentition.
Teeatjient. Careful diet. Avoidance of acid milk. Mild antacid ape- rients. Syrup of iodide of iron. Syrup of phosphate of iron. Quinine. Weak glycerine lotions. Lancing gums, in strophulus connected with diffi- cult dentition.
STYES. — A stye or hordeolum (from Hnrdeum, barley) is due to inflam- mation and suppuration of a Meibomian follicle, forming small boils, of the size and firmness of a barleycorn, situated at the edge of the eyelid.
STJDAMINA. — From Sudo, to sweat. Synon. Hydroata ; Papidce Sudorales ; Sweat Vesicles. — Consist of crops of small transparent vesicles, which come out in many diseases attended with sweating. The skin looks as if dotted with small colorless glass beads. Most common in front of neck and chest. No treatment required. — See Miliaria,.
SUPRA-RENAL CAPSULAR DISEASE. — Synon. Morbus Addi- sonii ; Supra-renal Melasma. — An excessive degree of anaemia, with bronz- ing of the skin, supposed to be due to scrofulous disease of the supra-renal capsules, which found in caseous condition.
Symptoms. Commence very gradually : failing health and debility. Languor ; loss of appetite ; feeble pulse ; irritability of stomach ; progressive emaciation. Paroxysms of vomiting and gastric irritation ; with faintness; indications of disturbed cerebral circulation. A gradual discoloration of skin ; most marked about face, neck, arms, circumference of navel : gradu- ally becoming of a dingy, bronzed or smoky hue. This discoloration now said (contrary to Addison's original views) not to be a necessary element; appears only when case has been of long duration, and perhaps not then. Dark patches often present, also on mucous membrane of mouth. — After an average duration of eighteen months, death from extreme anaemia and exhaustion.
Treatment. Relief of prominent symptoms. Phosphorus. Ferruginous tonics, with good nourishing food, are useful for a time. Alcohol. Wine.
Remedies sometimes employed : — Bark. Iodide of potassium. Bromide of potassium. Strychnia. Blisters. Electricity. Actual cautery over region of capsules.
SUSPENDED ANIMATION.— Synon. Asphyxia; Apnoea ; Apnoe- asphyxia. — May result from syncope ; strangulation, and obstruction of larynx by foreign bodies ; inhalation of chloroform, carbonic acid, or other poisonous gases ; narcotic poison ; a stroke of lightning ; and drowning. In all forms, treatment resolves itself into allowing free ingress of pui-e air to lungs ; and then inducing warmth and circulation.
Aippearances luhich indicate death: — Complete cessation of breathing -and heart's action; eyelids half closed, and pupils dilated; jaws clenched; tongue appearing between teeth, with frothy mucus about the mouth and nos- trils ; fingers semi-contracted ; with increasing coldness and pallor of surface.
, SUSPENDED ANIMATION. , 243
1. Drowning", or Suffocation,— The following rules for treatment are esseiilially tliose druwii up by Dr. H. R. Silvester, and circuhited by the Royal Humane Society : —
Rule 1. — To maintain a Free Entrance of Air into the Windpipe. —
Cleanse the mouth and nostrils : open the mouth : draw forward patient's tongue, and keep it forward ; an elastic band over the tongue and under the chin will answer this purpose. Remove all tight clothing from about neck and chest. Make sure that no foreign body is lodged in pharynx, larynx, or oesophagus.
Rule 2. — To adjust the Patient's Posif.io7i. — Place the patient on his back on a flat surlace, inclined a little from the feet upwards ; raise and support the head and shoulders on a small firm cushion or folded article of dress placed under the shoulder-blades. Supposing i\\^.t natural respiration has ceased, proceed -
Rule 3. — To imitate the Movevients of Breathing. — Grasp palient's arms just above the elbows, and draw the arms gently and steadily upwards, until the.y meet above the head (this is for the purpose of elevating the ribs and thus expanding the chest and drawing air into the lungs) ; and keep the arms in that position for two seconds. Then turn down patient's arms, and press them gently and firmly for two seconds against sides of chest (this is with the object of pressing air out of the lungs. Pressure on the breast-bone will aid this). Repeat these measures alternately, deliberately, and perseveringly. fifteen times in a minute for two or three hours, or until a spontaneous effort to respire is perceived ; immediately upon which cease to imitate the movements of breathing, and proceed to induce circulation and ivarmth.
Should a warm bath be procurable, the body may be placed in it np to the neck, continuing to imitate movements of breathing. Raise the body in twenty seconds in a sitting position, and dash cold water against chest and face, and pass ammonia under nose. Patient should not be kept in warm bath longer than five or six minutes.
Rule 4. — To excite hispjiration. — During employment of above method excite nostrils with snuff or smelling-salts, or tickle throat with a feather. Rub chest and face briskly ; dash cold and hot water alternately on them.
Rule .5. — To induce Circulation and Warmth. — Wrap patient in dry blankets and commence rubbing limbs upwards, firmly and energetically. Friction must be continued under blankets or over dry clothing.
Promote warmth of body by application of hot flannels, bottles or bladders of hot water, heated bricks, etc., to pit of stomach, armpits, between thighs, and to soles of feet. Warm clothing may generally be obtained from by- standers.
On restoration of life, when power of swallowing has returned, a tea- spoonful of warm water, small quantities of wine, warm brandy and water, or coffee, should be given. Patient should be kept in bed ; disposition to sleep encouraged. During reaction, large mustard plasters to chest and below shoulders will greatly relieve distressed breathing.
2. Intense Cold. — Acts chiefly on nervous system. There is giddiness; inability to see ; weakness and rigidity of limbs ; almost imperceptible res- piration and pulse; tendency to profound sleep; and coma. — Attempt restoration of circulation and sensibility by rubbing body with snow or ice or cold water. Then friction with flannel long-continued. Very gradual application of warmth. A stimulating enema, unless warm milk, or coffee, or beef-tea, or wine can be swallowed.
3. Syncope. — From 'Evyxorttio, to be affected with sudden prostration. Synon. Swooning; Fainting.— 'RemeAie?, for fainting are: — Recumbent position with head low. Cold air. Cold water dashed over head and chest. Smart blows on chest with corner of a wet towel. Friction or sinapisms
244 SYPHILIPHOBIA— SYPHILIS.
over heart's region. Small quantities of ammonia or brandy. Galvanism to rouse heart's action.— In apparently hopeless cases of syncope from hem- orrhage, a full dose of opium in braudy. Transfusion.
4. Intoxication, or Narcotic Poisons. — Treatment of r-i^Patient to be placed on his side, with head slightly raised. Cold affusion. Heat to ex- tremities. Stimulating embrocations to chest. Use of stomach-pump, a,s emetics and tickling of fauces seldom act where insensibility is great. Arti- ficial respiration. Galvanism. Strong tea or coffee. Solution of acetate of ammonia.
SYPHILIPHOBIA.— From Sypliilis ; and ^n(iiu>, to dread. Synon. Sypliiloynayiia ; Noddle Pox. — A morbid or hypochondriacal fear of syphilis, producing imaginary symptoms of the disease.
Symptoms. Allied to those presented in fictitious cases of spermatorrhcEa or impotence. Great mental suffering. Impairment of general health. Urgent desire for anti-syphilitic drugs.
Treatment. Some preparation of zinc with strychnia or nux vomica, 407, 411. Iron, 380, 387, 408. Mineral acids, 376. Hypopliosphite of soda and bark, 419. Cod-liver oil. Good diet. Cold or tepid baths. Sea air.
SYPHILIS. — Several derivations have been given of this word ; but according to Ur. Mayne none seem better than that of Blancardus, — Siic, together; ^iXiLo, io Ioyq. Synon. ij'6te.s Venerea; Venereal Disease ; Pox.
1. Primary Syphilis. — Occurs as a specific ulcer or chancre, the ulcer appearing on the part to which the virus has been directly applied. There are four distinct varieties of sores: — ■
(1) Indurated, Hunterian, Infecting, or True Chancre. — It is ac- companied by the adhesive inflammation, and gives rise to a specific chronic enlargement of the inguinal glands. It is followed by constitutional symp- toms. A period of incubation, varying from ten days to six or seven weeks, elapses from the time of inoculation to the appearance of the induration. The sores are characterized by their margins and hasps being indurated from the effusion of lymph ; while the secretion from them is scanty, and formed of serum, lymph globules, and epithelial debris. 'J'his secretion is not iuoculable upon the infected party. A mercurial course, similar to that required in constitutional syphilis, is necessary. — See Syphilization.
(2) SiMPi-E, Soft, NoN indurated Chancre. — Accompanied by suppu- rative inflammation. It is a local disease, not followed by secondary symp- toms. There are one or more sores, with well-defined edges, lookin,i»- as if portions of healthy tissue had been punched out. The secretion abundant and purulent; auto-inoculable. If seen within five days from inoculation, effective cauterization will destroy the sore and virus. Best caustics, — nitric acid, acid solution of nitrate of mercury, potassa fusa. In other cases astringent lotions. Ferruginous tonics. Nourishing food. Suppurating bubo common.
(3) Phagedenic Chancre. — Accompanied by ulcerative inflammation. The ulcer is small, irritable, ragged, secreting unhealthy pus. The sore has a tendency to spread irregularly. A suppurating bubo forms, which yields inoculable pus. It is not followed by constitutional syphilis, and does not usually require specific remedies. Fomentations and poultices, or soothing lotions. Lotion of tartrate of iron. Bark and nitric acid. Ferruginous tonics. Iodide of potassium and sarsaparilla. Nourishing diet, free from stimulants.
(4) Sloughing Chancre, or Gangrenous PnAGEOiENA. — Accompanied by mortification. It does not affect the inguinal glands, is not usually fol- lowed by constitutional infection, and requires only local treatment. A
SYPHILIS. 245
true syphilitic chancre may, however, take on a sloughing character. Some- times the disease so severe, that the prepuce and a portion of the glans may be destroyed. Tn enfeebled prostitutes the whole of the labia and nymphaj nuiy slough away. Fomentations and poultices. Patient made to sit in hip-bath of water kept at temperature of body for twenty-four or forty- eight hours or longer. Opium. Nourishing food. Stimulants. Confine- ment to bed.
2. Constitutional Syphilis. — Result of indurated or infecting chancre. Many cases of chronic ill-health are due to it ; while it is often the cause of obscure diseases of the vital organs, affections of the bones, rebellious ulcers of the cutaneous or mucous suifiices, troublesome skin diseases, im- potence or sterility, abortion, and the death of the foetus in utero.
Symptoms. Divided into two classes, Hecondary and tertiary, which differ in character. In the beginning there is general disturbance of the system. Fever, mental depression, lassitude, pains in the limbs, and a sal- low hue of skin. Shortly, unmistakable evidence afforded by early seconda- ries, a fugitive roseolar eruption on chest and abdomen not attended with itching, which leaves a yellow discoloration when the redness is removed by pressure ; with this will usually be erythematous sore throat, enlargement of glands of back of neck and perhaps loss of hair. The later secondary cutaneous eruptions may be papular or scaly, of coppery tint, sometimes pustular; and the sore throat is ulcerative. Mucous tubercules or patches on fauces, at commissures of lips, about vulva, scrotum, anus, etc., common at this period; also alopecia, loss of eyebrows and eyelashes; iritis; deaf- ness ; discoloration and crumbling nails, or inflammation and ulceration about their roots; superficial ulcerations on the tongue and lips. The tertiary affections of the skin are rupia. ulcerations and gummy deposits; other tertiary symptoms are perforating ulcers of soft palate, destructive ulcera- tion of pharynx, gummatous tumor and ulceration of tongue; ulceration of thelaryn.x; diseases of the periosteum and bones, as nodes; pain about middle of sternum ; and in a tew instances diseases of the brain, spinal cord, lungs, heart, liver, kidneys, etc.
'1'keatment. Diet light and nutritious; fish, meat, milk, cream, raw eggs; claret or sherry and water. Warm clothing, flannel, and avoidance of cold and damp. Warm water or vapor baths. Blue pill. Calomel. Compound calomel pill. Mercury and chalk. Inunction with mercurial ointment; sixty or more grains every night. Mercurial vapor baths, 131. Solution of corrosive sublimate, given for many weeks, 27. Green iodide of mercury, .53. Red iodide of mercury, ,54. Oonovan's solution. .51. In tertiary stage : Iodide of potassium, 31. Iodide of sodium, 39. Iodide of iron, 32. Opium. Cod-liver oil. — "' Derivative" treatment as practised hy Dr. Hjort: — Application to different parts of body, beginning between the scapula}, of stibitite plasters (made with one part of powdered tartarated antimony and three of adhesive plaster, melted together) the size of a visiting card. As soon as good pustules are produced, poultices. At same time, caustics to mucous tubercles, ulcers on fauces, etc. — The " Zittmann" eliminative plan consists of rest in bed in a warm room : a vei-y moderate diet without stimulants: a mercurial purgative every second day: and the production of sweating by copious draughts of compound decoction of sar- saparilla. Subsequently, a course of tonics or of alkaline waters.
3. Infantile Syphilis — May be hereditary, or acquired. Infant usually born healthy-looking: but sometimes with its skin of a dull color, and its features contracted — like a little old man.
Symptoms. Generally within the month, symptoms of coryza set in ; cough, difficulty in sucking, dryness of the lips and mouth, the " snuffles." Yoice shrill and hoarse. Superficial ulcerations about mouth and throat. Parts around the mouth, nostrils, buttocks, arms, and flexures of joints be-
246 SYPHILIZATION— TABES MESENTERICA.
come copper-colored, fissured, and excoriated. Child wastes and gets very weak. Amyloid disease of liver. Indurated nodules in lungs. Syphilitic iritis. Chronic interstitial keratitis. Deafness. — In children loith inherited syphilis : — A peculiar physiognomy. Tendency to chronic intestinal kera- titis. Notching of central upper incisors of pm-manent teeth (Hutchinson). Treatment. Mercurial inunction. Mercury and chalk. Iodide of po- tassium. Chlorate of potash. A healthy wet-nurse ? Feeding by hand, — goats', asses', or cows' milk.
SYPHILIZATION — A term applied by Auzias Turenne to the con- dition produced by successive inoculations with syphilitic poison ; in which each succeeding chancre becomes less and less, until a time arrives when no nicer can be produced by insertion of venereal virus. Hence the inference has been drawn that, by repeated inoculation, a constitutional state is in- duced in which the system is no longer capable of being affected by syphilis.
Sperino inoculates with matter from a soft chancre for from 6 to 10 chan- cres at each sitting; and allows three or four days to elapse between each operation. By continued inoculation from the chancres thus produced the ulcers become less and less until no effect is produced ; but the individual is still susceptible, though in a less degree, to matter taken from another source, again to a third, and so on until at last no effect is produced by any syphilitic poison. The general health, instead of suffering, improves during process of inoculation. Time required to produce immunity varies : in one case it was obtained after 71 chancres ; in most instances upwards of 300 were produced, treatment lasting for nine or twelve or twenty months and more. It may be practised at any age. To obtain a complete cure when patient has previously been mercurialized, the use of iodine has often to be combined with syphilization. Dr. Boeck asserted in 1858, that inno disease has the practitioner a more certain method of cure, but independent in- vestigation does not bear out this statement. Disadvantages of the method, — its offensive nature, and the length of time necessary for effectually carrying it out : on the other hand, the immunity produced is thought to last for life.
TABES DORSALIS.— From Tabeo, to waste away; dorsum, the back. Synon. Phthisis Dorscdis ; Myelophthisis. — A state of atrophy of pos- terior columns of spinal cord producing palsy. — See Locomotor Ataxy, under head of Parcdysis.
TABES MESENTERICA.— From Taheo, to melt away ; Misavttpiov, the membrane wdiich connects the intestines together, — fiiaoi, htcpov. Synon. Phthisis 31esaraica ; Scrofida Mesentericct ; Mesenteric -Disease ; Ab- dominal Phthisis. — A tubercular degeneration of the mesenteric glands. Tubercle effused into the glands, destroying their structure, and obstructing the passage of chyle through the convoluted lacteals traversing them. Par- ticularly affects infants and young children. Often combined with tuber- cular peritonitis and tubercular disease of intestinal mucous membrane.
Symptoms. More or less constant pain in the bowels: sometimes severe, causing legs to be drawn up towards belly. Deep red color of lips ; angles of mouth covered with smull ulcers, or lips fissured. Irregular action of bowels : motions generally frequent, watery, unhealthy, and fetid. Abdo- men swollen and tense ; wasting of other parts of body until extreme ema- ciation ensues. Great pallor : general debility, weakness rapidly increasing. Recovery occasionally takes place, if disease be checked before functions of glands are much impeded. Symptoms of pulmonary consumption, or of tuberculization of bronchial glands, or of tubercular meningitis may super- vene.
Treatment. Phosphate of iron (" Chemical Food"), 405. Hypophos-
TESTICULAR NEURALGIA. 247
phite of soda or lime, 419. Ammonia and bark. Cod-liver oil, 389. Steel wine. Tincture of perchloride of iron. Ainmonio-citrate of iron. Iodide of iron. Quinine. Iodide of ammonium. Iodide of potassium. Solution of chlorinated soda. Peroxide of hydrogen in weak solution. Glycerine. Taraxacum, bicarbonate of potash, and sarsaparilla. Mercury and chalk, with soda and magnesia, 34. Mercury and chalk with powder of ipecacuan and opium. Trichloride of mercury in small doses. Aromatic powder of chalk and opium. Bismuth. Logwood. Catechu and chalk mixture. — Mild nourishing food. As,sea' or goats' milk. Milk and soda-water. Milk and lime-water. Cream. Raw eggs. Carrageen or Irish moss. Raw minced beef, 2. — Friction of abdomen with soap or opiate liniments. Lin- seed poultices. Wet compress. Warm, or tepid, salt-water baths. Iron, or oak bark, baths, 126. Warm clothing. Fannel bandage round abdo- men, night and day. Well ventilated sleeping room. Sea air.— Margate, Bi'oadstairs, Folkestone, Scarborough, Brighton, Hastings, Yentnor.
TEMPERATURE OF BODY.— The normal temperature at unexposed parts of surface is 98.4° Fahr. A persistent rise above 99..5°, and a con- tinued depression below 97.3°, are indicative of disease. The increase above 99° is the best index of amount of fever present.
Observations should be taken at least every morning and evening, always at the same hour, throughout the whole illness. Pulse and respiration to be noted at the same time. The bulb of thermometer to be placed under the tongue or applied to armpit, groin, or belly : to be kept in close contact with skin ; to remain in situ at least three minutes. Were it not for obvious objections, the rectum would be the best situation.
There is a continuous elevation of temperature in most cases of progres- sive i(H&e7vu/o.s-e'.s from the beginning; the temperature becoming normal when the disease becomes arrested. — A continued elevation occurs in all acute inflaininatory diseases. In rheumatism : empyema: suppuration: continued and eruptive fevers, etc. During paroxysms of ague, from com- mencement of the rigor to the termination of the sweating stage. — A per- sistent temperature of 10.5° is indicative of danger, or of a tendency to some important complication, in -pneumonia, typhoid fever, typhus, small- pox, measles, scarlet fever, erysipelas, acute rheumatism, and ichorhoemia. In any case, a rise above 106° very unfavorable ; above 110°, disease in all probability will be fatal. In typhoid fever, a sudden fall below normal heat has indicated the occurrence of hemorrhage from ulcerated Peyer's patches, many hours before blood has appeared in the stools. — During con- vcdescence from acute disease, a sudden rise in temperature may be the first indication of a relapse : an abnormal fall (as to 95°) shows a tendency to col- lapse, and indicates the need of hot applications, stimulants, warm soups, etc.
TESTICULAR K'EURALGIA.- There may be merely increased sensi- bility of the testicle, — irritable testis. Or the pain will be most distressing, assuming the character of true neuralgia. No swelling or increase of heat : but only intolerance of least pressure, and retraction of gland close to the groin during the paroxysms. Either irritable testicle or neuralgia may arise from onanism, or excessive intercourse ; disease at prostatic part of urethra ; as a sequel of testitis ; from gout ; dyspepsia, with very acid urine ; a calculus in kidney or ureter ; varicocele, etc. The remedies are : — Belladonna, aconite, and opium locally applied: cold lotions or even ice bag: subcutaneous injections of morphia into scrotum. Quinine; iron; arsenic ; valerianate of ammonia or zinc. When pain has been very acute, patients have demanded castration: compliance with such a wish perfectly unjustifiable, save in very exceptional instances. Where castration resorted to, the pain would return in the cord, unless due to actual disease of the gland.
248 TESTICULAR TUMORS— TESTITIS.
TESTICULAR TUMOES.— The testicle may be the seat of a fibr,ous transformation. Of fibro-plastic or myeloid growths ; or of enchondromatous (cartilaginous) tumors. Non-malignant cysts of different kinds may form, by dilatation of the seminiferous tubules [hydatid disease of Sir Astley Cooper; cystic sarcoma of recent writers). Very rarely, malignant cystic disease has occurred. Scirrhous is less frequent than medullary cancer. Young children are occasionally affected with scirrhus, more often with encephaloid. Extirpation is the only remedy in all cases, where treatment is really necessary. In cystic sarcoma, a perfect cure may be hoped for by removal : in cases of carcinoma a recurrence is very much to be feared.
TESTITIS. — From Testis, a witness. — because the testicle is a proof of virility ; terminal -itis. — Inflammation of the testicle may be acute or chronic ; or it may be specific, — syphilitic, or tubercular.
1. Acute Testitis.— Synon. Hernia Humorah's ; Orihitis ; Orcliio- cele ; Sioelled Testicle. — Generally due to extension of gonorrhoeal inflam- mation from urethra ; such inflammation having been often aggravated by strong injections, use of alcoholic drinks, active exercise, neglecting to wear a suspensory bandage, etc. The central portion or body of the gland may be affected ; usually the epididymis and tunica vaginalis are attacked [epi- didymitis) ; or all these parts may suffer.
Symptoms. Pain and feeling of weight in cord and testicle. Uneasiness about the loin, groin, and upper part of thigh. Frequent micturition. Di- minution of urethral discharge. Swelling of epididymis, which embraces and hides the testicle; scrotum firm and tense: swelling of cord. Great tenderness; pressure aggravates the pain. Febrile disturbance: nausea and vomiting: constipation. Abscess rarely forms. Very seldom the in- flammation has ended in gangrene.
Treatment. Prior to setting in of swelling the disease may perhaps be checked by antimonial emetics, 281. Alkaline aperients, — Sulphate of soda and taraxacum, 144. Sulphate and carbonate of magnesia with colchicum, 141. Iodide of potassium, 31. Aconite, 330, 331. Opium, in doses suffi- cient to relieve pain. Rest in bed : scrotum to be supported by small pil- lows. Hot fomentations with application of extracts of belladonna and poppies, 297. Pressure by means of strapping, or of strips of mercurial plaster, methodically applied : seldom to be used till towards the end of acute stage.
Puncture with a thin sharp knife into body of testis, so that by division of tunica albuginea the pressure on lobules and convoluted tubes may be removed : the incision allows a quantity of serum and a few drachms of blood to escape: there is immediate relief, the process seldom requiring re- petition (Henry Smith). Puncture of the testicle, followed as soon as bleeding has ceased by tight compression with strapping : administration of one grain of opium (Spencer Watson).
2. Chronic Testitis. — Synon. Sarcocele, from 2ap|. flesh ; x-^'Kt], a swell- ing.— Is either the sequel of an acute attack ; or the inflammation may be subacute or chronic from commencen)ent. May be due to stricture of ure- thra ; to gleet ; very frequently to tertiary syphilis.
Symptoms. Morbid action usually begins in epididymis, and extends to body of testicle. There is swelling, hardness, and tenderness on pressure : a sense of weight. Sometimes, effusion of serum into tunica vaginalis — hydro-sarcocele. When due to constitutional syphilis (syphilitic sarcocele) there are often other manifestations of this state : pustular or scaly skin eruptions, rheumatic pains with nocturnal exacerbations, ulcers about tongue or throat, derangement of general health, and sometimes iritis.
Treatment. Removal of cause : examination of uretlira for stricture, etc, Avoidance of active exercise. Use of suspensory bandage. Pressure,
TETANUS. 249
firmly and evenly applied, by encircling the gland with strips of strapping or of mercurial plaster. Iodine liniment diluted. Red iodide of mercury ointment diluted, 302. Iodide of potassium, 31. Mercurial vapor baths, 131. Eed iodide of mercury, 54. Corrosive sublimate with sarsaparilla, 27.
3. Abscess and Fungus of Testicle,— May result from acute or chronic inthvnimation ; usually due to scrofulous disease. When fluctuation can be detected, and the skin is adherent, a puncture should be made ; pressure being applied after evacuation of the pus.
Sometimes, when matter forms, the tunica albuginea gets perforated ; the integument thins and gives way : and through the opening a protrusion of fibro-plastic matter with some of the tubular structure takes place. There is but little pain. The fungus slowly increases ; unless it has buen returned and kept in place by strapping, after separating by dissection the thickened integument adherent to the margins of the wound, and then carefully bring- ing the edges together. "Where the protruded part has become disorgan- ized, it must be sliced off, — a proceeding equivalent to partial castration.
4. Scrofulous Testicle. — Slow and subacute inflammation, with deposit of tubercular matter between the tubuli seminiferi, or into the epididymis.
Symptoms. Formation gradually of a nodular swelling, withont pain. Tumor seldom attains much size. Softening and suppuration ; the swell- ing bursts, pus and tubercular matter coming away; sinuses form, and communicate with similar enlargements. The sores may put on a healthy character, or there may be a protrusion of tubular structure, — fungus of testicle. Tubercular disease of lungs often also present.
Treatment. Nourishing food : stimulants, milk, cream, raw eg'gs, beef solution, 2. Sea air. Cod-liver oil. Ammonia and bark. Hypophos- phites of soda or lime, and bark, 419. After evacuation of pus, pressure by strapping. Lotions of sulphate of zinc. 264; or iodine, 269. Where constitutional disturbance is great, removal of source of irritation by cas- tration may be required.
TETANUS. — From Tf(,'^'to, to bend or strain. Synon. Rigor Nervorum ; Spasm with Rigidity. — A disease, the chief feature of which is long-con- tinued contraction or spasm of certain muscles. Rigidity of muscles con- tinuous, and hence spoken of as tonic spasm or spastic contraction ; in contradistinction to clonic spasms of convulsions, where there are alter- nate contractions and relaxations. Cause : usually a wound, but especially exposure to cold after a wound. — Cases of idiopathic, more hopeful than oi traumatic, t^Xmwx?,. Symptoms very similar to those produced by poi- sonous dose of strychnia.
Symptoms. Usually set in suddenly : muscles of jaws and throat first affected. Patient complains that he has taken cold, and as if he had got a sore throat and stiff neck ; but stiffness and uneasiness soon increase, and extend to the root of the tongue causing difiSculty in swallowing. Tempo- ral and masseter muscles gradually get involved, so that jaw fixed and mouth firmly closed ; lock-jniv or trismus (Tpifw, to gnash with the teeth). When disease proceeds, remaining muvscles of face, trunk, and extremities become implicated Angles of mouth drawn outwards and upwards [risiis sardonicus) ; muscles of neck, back, abdomen, hard and tense, and from time to time violent contractions occur. Spasms never entirely cease except in some cases during sleep : aggravated every quarter of an hour or so, increased cramp lasting for a few minutes and then partially subsiding. — Where strong muscles of back are most affected, they bend body into shape of an arch, so that patient rests upon head and heels, a condition known as opisthotonos ("OTtiaOs. backwards; rsi'i'to, to bend). — When body is bent forwards by strong contraction of the muscles of neck and abdomen, affection termed emprosthotonos ("EfiTtpoaOsv, forwards, and TftVco). — If
250 THEOMBOSIS— TINEA.
muscles are affected laterally, so that body is curved sideways, the disease has been designated pleurofitliotonos {ll%iv(io9Ev, from the side, and -fsi-Vw), or tetanus lateralis.
Frightful suffering caused by tetanic spasms. Face pale ; brows con- tracted; skin covering forehead corrugated; eyes fixed and prominent — sometimes suffused with tears ; nostrils dilated ; corners of mouth drawn back, teeth exposed, and features fixed in a grin — risus sardonicus. Res- pirations performed with difficulty and anguish ; sevei'e pain at sternum ; great thirst, but agony increased by attempts at deglutition ; pulse feeble and frequent; temperature raised ; skin covered with perspiration; patient cannot sleep, or if he dozes it is only for a few minutes at a time. Witli all this suffering, intellect remains clear and unaffected. Death usually occurs between third and fifth days ; partly from suffocation, partly from exhaustion.
Treatment. Empirical and often useless. Full doses of calomel and jalap, until bowels are freely acted on. Inha'ation of chloroform, more or less insensibility being kept up for many hours or even days. Inhalation of nitrite of amyl. Belladonna locally, and internally. Chloral. Quinine in full doses, with or without belladonna. Alcohol. Subcutaneous injec- tions of liquor atropias. 314. Of Calabar bean, of solution of active princi- ple of woorara — the alkaloid curarina. Nicotine (one eighth of a drop to two drops for a dose, repeated at short intervals according to the effect). Powder of Old Calabar bean (one grain to six for a dose). Aconite. Co- nium. Sulphite of soda, magnesia, or sulphurous acid, if disease be thought due to absorption of morbid matters, 48. Prolonged application of ice to spine.
Opium objectionable : produces a state of congestion and polar excite- ment of spinal cord ; yet cases have recovered in India after repeated employment of opium smoking for many days. Bloodletting ; blisters ; cold, hot. and vapor baths ; mercury ; antimony ; colchicum ; large doses of assafoetida; turpentine; digitalis; glonoin ; nitrite of amyl ; musk; iron; hydrocyanic acid ; Indian hemp, — all have been fruitlessly employed. — See Trismus Nascentium.
THROMBOSIS.— By this term (from 0po^/3o5, a clot of blood) is gene- rally understood the partial or complete closure of a vessel, by a morbid product developed at the site of the obstruction. The coagulum, which is usually fibrinous, is known as an autochthonous dot or thrombus.
'I'hrombi mostly met with in diseases attended with exhaustion. Par- ticularly in croup, diphtheria, scarlatina, endocarditis, pneumonia, phthisis, typhus, purpura, erysipelas, hemorrhage, etc. Their formation favored by condition of blood during pregnancy and puerperal state.
Treatment. Variable according to the symptoms. Indications generally are to support the vital powers and allay irritability. Brandy. Rum. Essence of beef, 2, 3. Milk. Brandy and eggs, 17. Ammonia, 361, 371. Ammonia and iodide of potassium. Ether, 367. Quinine, 379. Bark. Opium, 316, 318, 340. Sulphite of magnesia, 48. Pure air. Perfect rest.
THRUSH. — A disease of the mouth occurring in infants. Synon. Aph- tha In f ant um ; Fehris Aphthosa ; Vesiculcie Gingivarum; Milk Thrush. — See Aplithce of Mouth.
TIC DOULOTJRETJX. — Severe attacks of n-euralgic pain in nerves of face. Infra-orbital branches of fifth pair most frequent seat. Synon. Neu- ralgia Faciei ; Painful Tic- — See Neuralgia.
TINEA. — From Tinea, any gnawing or destructive worm. — Applied generally to those cutaneous diseases which are due to presence of epiphytes or parasitic plants. All are contagious. Five varieties : —
TINNITUS AURIUM. 251
1. Tinea Tonsurans. — From Tondeo, to shave, — because of the brittle- ness of tlie afTi'cted hairs. Synon. Porrigo Scutulata; Scalled Head; Herpes 2\jnsurans ; Herpes Circinatus ; Trichosis Furfuracea ; Ring- worm.— A chronic contagious disease, known by decolorization and brittle- ness of affected hairs, scaly eruption, and roundness of diseased patches. Most common on the scalp. The parasite is the Tricopliyton Tonsurans ; the sporules and mycelium of which infiltrate the texture of each hair, while they also spread amono' the epithelial scales.
Tkkatment. »See Tinea Sycosis.
2. Tinea Favosa. — From Favus, a honeycomb. Synon. Favus ; Tinea Lupinosa ; Porrigo Favosa ; Honeycomb Ringvwrm. — Very rare. Most commonly affects the scalp, in form of small cup-shaped, dry, yellow crusts ; each crust containing- a hair in its centre, and resembling a piece of honey- comb. Attended with severe itching : hairs become brittle and fall out : crusts have a mouldy offensive odor, and are often surrounded with lice. The cryptogamic parasitic cause is the Acliorion Schordeimi.
Treatment. See Tinea Sycosis.
3. Tinea Decalvans.— From Decalvo, to make bald. Synon. Porrigo Decalvans ; Alopecia Circumscripta ; Alopecia Areata. — The hair falls off one or more circular or oval spots ; leaving perfectly smooth bald patches. The parasitic fungus is the Microsporon Audouini.
Treatment. See Tinea Sycosis.
4. Tinea Sycosis. — From Sv^o^iat, to become like a fig. Synon. Roseola Ficosa ; Sycosis; Mentagra ; Chimulielk ; Barber's Itch. — Characterized by inflammation of the hair follicles ; causing successive eruptions of small acuminated pustules, which have been said to have a granulated appearance resembling the substance of a fig. Occurs most frequently on chin, and other parts covered by the beard. The parasite is the Microsporon Menta- grophytes.
Treatment. Attention to cleanliness. Removal of hairs with scissors, or extraction by forceps — epilation. Separation of all scabs or incrustations by poultices and simple ointments or oil. Improvement of general iiealth by generous diet; cod-liver oil; bark, quinine, steel. Destruction of para- sitic plant by sulphurous acid lotion, 272 ; creasote or carbolic acid, 270 ; corrosive sublimate, 271 ; a mixture of equal parts of calomel, creasote, and sulphur ointment; diluted citrine ointment, 30.o ; ammoniated mercury and sulphur ointment, 300 ; or iodide of sulphur ointment, 310. In ringworm especially, sulphurous acid spray; or painting with blistering fluid or iodine liniment; or with strong acetic acid; or glacial acetic acid, washing the part directly afterwards. In tinea decalvans, frequent painting with lini- ment of cantharides.
5. Tinea Versicolor. — -From Versicolor {verso and color), that changes
its color. Synon. Chloasma; Pityriasis Versicolor ; Manda Hepatica ; Liver Spot. — Makes its appearance generally on front of chest or abdomen, in form of yellowish patches covered with small branny scales. Caused by a cryptogamic plant, — the Microsporon Furfur.
Treatment. Sulphurous acid lotion, 272. Corrosive sublimate liniment, 271. Thorough cleanliness. Flannel vests to be soaked in boiling water. In obstinate cases, — arsenic, 52.
TINNITUS ATJEIUM.— A distressing noise in one or both ears— usually associated with deafness.
May be due to various affections of auditory apparatus; frequently with- out apparent disease of ear. Sometimes, apparently associated with func- tional derangement of liver, stomach, etc.
252 TONGUE DISEASES.
Treatment. Remove existing disease of ear, or Eustachian tube, or functional derangement.
Faradization and galvanization of muscles of tympanic cavity by means of conductor resting against membrana tympani.
TONGUE DISEASES. — The tongue is exposed to many sources of. dis- ease and injury. A highly sensitive organ : hence, slight dise'ases of its mucous membrane, or of its muscular fibres, are commonly very painful.
1. Glossitis. — From r^nLocra, the tongue ; terminal -itis. Synon. Angina Lingualis ; Ivjiammatio Lingnce. — Inflammation of the tongue a rare affection, now that mercury is seldom used so as to induce salivation. Gene- rally an accompaniment of other diseases, rather than an idiopathic affection.
Symptoms. Fever. Constitutional disturbance. Debility. Anxiety. Pain, heat, and salivation. Color deepened. Swelling sometimes so great that cavity of mouth cannot contain the organ, and it projects beyond the teeth. Swelling may set in rapidly : often produces urgent dyspnoea. Sometimes ends in suppuration.
Tkratment. Castor oil, 164. Castor oil and turpentine enema, 190. Croton oil enema, 191. Chlorate of potash, 61. Application of ice. Pen- cilling with nitrate of silver. Free incisions along upper surface to relieve congestion, or evacuate pus. Tracheotomy, if suffocation threaten.
2. Ulcers of Tongue. — Several varieties : most forms very painful and difficult 10 heal.
(1) Whole of upper part of tongue sometimes superficially ulcerated. Raw surface very tender. Severe, long-continued disorders of digestive organs are chief source of this form. May occur in any disease attended with great exhaustion. To be relieved by gargles of borax, 250. Nour- ishing food, such as can be digested. 'J'onics and stimulants. Pepsine, 420. — (2) Ulcers the result of simple inflammation are usually small, super- ficial, without definite shape, very sensitive. Seated about tip, or near frasiium, rather than at sides. Mild diet. Sim])le aperients, 146, 155, 161, 169. Compound powder of rhubarb. Borax gargles, 250. Application of sulphate of copper. Extraction of carious stumps. Removal of tartar from teeth. — (3) Ulcers from ptyalism easily distinguished by accompanying affections of gums, and fetor of breath. Most readily healed by chlorate of potash, 61. Sulphate of magnesia, 141. Sulphate of soda, 144, 148. Chlorinated soda gargle, 254. Alum and myrrh gargle, 252. Tannin gargle, 251. — (4) Superficial syphilitic ulcers generally attended with similar disease of lips, or other secondary symptoms. Appear at sides of tongue : very sore and intractable. Mercurial vapor bath, 131. Mercurial inunction. Green iodide of mercury and coiiium, 53. Chlorate of potash, 61. Iodide of potassium, 31. Application of nitrate of silver, or sulphate of copper. — (5) Deep syphilitic ulcers generally commence as inelastic indurations or gumraata, which slough in centre. Sores become deep and excavated : edges ragged and sloughy, or thickened and hard. Most com- mon on upper and back part of tongue. Generally accompanied by other tertiary symptoms. Iodide of potassium, 31. Corrosive sublimate gargle, 256. Nitric acid gargle. — (6) Remaining forms of ulceration are either strumous, tuberculous, or cancerous. Occur with other symptoms of these diseases. Require the treatment necessary for constitutional state. Cod- liver oil generally useful.
3. Cancer of Tongue. — May be of Epithelial form : or a firm Scirrhous tumor: or Medullary. Of whichever kind, there is a tendency to speedy ulceration. A foul sloughy sore forms, with ragged everted edges and an indurated base.
Symptoms. Severe pain. Profuse salivation. Cancerous cachexia. —
TONSILLITIS. 253
Difficult articulation and deglutition. Attacks of hemorrhag'e. Great swelling' of whole organ. Sometimes sloughing. Cancerous deposits in sublingual and submaxillary glands : in surrounding tissues. Mouth may get almost filled with an extensive ulcerated fiuigus, threntening suS"ocation. Disease runs a rapid course. Death, generally from exhaustion.
Treatment. Morphia, 815, 343. Opium and belladonna, 344. Subcu- taneous injection of morphia, atropine, or aconitine, 314. Gargle of citric acid (gr. 10 to fl. oz. j). Milk; cream; raw eggs. Essence of beef, 3. — To check hemorrhage, application of powdered niatico leaf; ice ; lemon juice; saturated solution of perchloride of iron. — Removal of tongue, by knife, ligature, or ecraseur. To diminish sensibility and salivation, division of gustatory nerve. Division of nerve, with ligature of corresponding lingual artery.
4. Cracked Tons^ue, Tumors, etc.— (1) Cracked tongue very trouble- some. The clefts or fissures form an irregular series of grooves : they may be a couple of lines in depth. Render eating and speaking painful. AVhere this condition cannot be accounted for by any specific state of system, or by any derangement of alimentary organs, it may often be cured by appli- cation of borax and glycerine, 268. Iodide of potassium, with steel or sarsaparilla, 31, 32. — (2) Surface of tongue occasionally presents pa^c/ies of baldness, i.e., one or more smooth, oval, glossy patches. No ulceration or fissure. Often coexists with psoriasis palmaris : may be indicative of a syphilitic taint. Corrosive sublimate, 27. Red iodide of mercury, 54. Donovan's triple solution, 51. — (3) Warts and condylomata not uncommon diseases of mucous covering of tongue. The former require excision : the latter, anti-syphilitic remedies. — Papillary patclies consist of large tough, brawny, coarsely papillary, and perhaps fissured spots of thickened mucous and submucous tissue ; have been called psoriasis and ichthyosis of tongue; are liable to terminate in cancer. They cause an unpleasant feeling ; thick- ness of speech. Iodide of potassium, ;-)l. Conium, 336. — (4) Hypertrophy, a rare affection of tongne. Sometimes congenital. Enlargement generally becomes so great that mouth is too small ; xonsequently, a large portion of the organ is constantly protruded. In some instances, prolapsed part has reached below the chin. Removal may be accomplished by knife, ligature, or 6craseur. — (5) When frsenum linguae is shorter than usual, the individual is said to be tongue-tied. If movements of tongue be interfered with, the frsenum is to be divided ; the points of scissors being directed downwards to avoid ranine arteries. — (6) Encysted or fatty tumors form in tongue, or beneath it. May require extirpation. — Firm tumors, made up of fibrous and areolar tissue, sometimes grow from tongue. When pediculated they may be snipped off: if any artery be felt in stalk, ecraseur to be used. — (7) Ramda (from Rana, a frog ; because the voice is said to be croaking like a frog's) is a semi-transparent fluctuating swelling, perhaps as large as a walnut, situated under the tongue. It consists of a dilatation of Wharton's duct of submaxillary gland. A seton should be passed through cyst ; or a portion of anterior wall excised.
TONSILLITIS.— From Tonsilla, the tonsil; terminal -itis. Synon. Cynanche Tonsillaris ; Amygdalitis ; Inflammatio Tonsillarum; Quinsy; Inflammatory Sore Throat. — Inflammation of one or both tonsils, with fever.
1. Acute Tonsillitis. — Generally caused by cold and some peculiar con- dition of system. Liability to the inflammation increased, during youth, by repetitions of attacks.
Symptoms. Chilliness or rigors. Smart fever. Redness and swelling of fauces and tonsils. Pain and difficulty of deglutition. Return of liquids through nostrils, on attempting to swallow. Pain along course of Eusta-
254 TOOTHACHE.
chian tube. — May end in resolution in about four days; often goes on to suppuration.
Treatment. Rhubarb and magnesia, 165. Citrate of magnesia, 169. Solution of acetate, or citrate, of ammonia. 348, 349, 362. Carbonate of ammonia, 361, 364. Ammonia and bark, 371. Quinine and nitric acid, 379. Belladonna. Guaiacum. Inhalation of steam of poppy water. Hot spray. Opiate gargles, 253. Linseed or hemlock poultices. Cold wet compress round throat or ice bag. Belladonna and opium to outside of throat, 297. — If an abscess form, it is to be opened cautiously with a sharp- pointed bistoury, the cutting edge being directed towards mesial line of body : in event of hemorrhage, a strong solution of perchloride of iron to be freely applied.
2. Chronic Enlargement and Induration.— May result from acute tonsillitis, or may come on gradually in strumous children and weakly young women. Enlargement often so great that fauces appear to be almost blocked up by meeting of the glands. Thickness of speech. More or less deafness. Difficulty in swallowing. Impediment to full and deep inspira- tions.— Iodide of ammonium, 38. Cod-liver oil. Iodide of mercury ointment externally. Injection of solution of iodine into glands. These remedies failing, — portions of the glands to be excised. Sometimes, entire gland can be shelled out with finger. Applications of nitrate of silver, iodine, or potassa fusa have been recommended.
Cancer of Tonsil may occur as a secondary affection. As a primary disease it is almost unknown. Where suffocation threatens, the prominent part of the gland should be excised if the whole cannot be shelled out.
TOOTHACHE.— Synon. Odontalgia ; Odontodynia ; Dentium Dolor ; Gomphiasis.
1. Toothache from Caries, — Synon. Odontalgia Gariosa; Dental Gan- grene.— Softening and decay of dentine, causing great pain when central cavity of tooth is reached. May be due to original malformation of enamel and bone, to pregnancy, to use of mercury, to depraved secretions with dyspepsia, etc.
Treatment. Removal by scraping of decayed portion, and then stopping with gold, gutta percha, or amalgam of silver and mercury. 'I'emporary stoppings with cotton-wool dip])ed in mastic varnish ; cotton-wool with creasote, etc. Extraction. 'J'roublesome hemorrhage after extraction may set in : — Remove clot from cavity, and sponge the latter dry with lint pushed into it; then plug with cotton-wool soaked in a saturated solution of perchloride of iron, or of tannic acid, or of matico ; and finally add a small compress of lint so as to keep up pressure when the jaws are closed. If necessary, tie up the lower jaw firml}' against the upper, so as to main- tain sufficient pressure. In caries of deciduous teeth extraction unnecessary, unless there be pain or frequent gum-boils.
2. Toothache from Inflammation of Pulp.— Synon. Odontitis; Odon- toplilegmone. — When the pulp has been bared, inflammation may be set up by irritation of food, cold, hot or cold fluids, etc.
Treatment. Aperients, 141, 144, 148, 153. Washing mouth with strong solution of bicarbonate of soda in hot water. Stopping tooth with cotton- wool saturated with creasote, or chloroform, or oil of cloves, or tincture of aconite, or cajuput oil, or camphor in turpentine, or tannic acid in ether. A leech to gum. Chewing horseradish or ginger. Chewing pellitory (pyrethrum). Ginger poultice to face. Extraction. Drilling into pulp cavity (rhizodontrypy) after stopping.
3. Toothache from Necrosis of Fang's. ^The crown and cervix may be healthy, and yet the fangs necrosed. The fangs of stumps get affected in
TORTICOLLIS— TRICFIINIASIS. 255
same way. Abscess forms again and again Instead of necrosis there may be thickening of fang from bony deposit. Even exposure of a fang from recession of the gum causes often severe pain.
Tkeatmkxt. Extraction. Sensibility of a bared fang may be perma- nently relieved by painting with carbolic acid, or nitrate of silver.
4. Toothache from Neuralgia. — Synon. Odontalgia Nervosa; Neu- ralgia Deiitalis. — Not uncommon in early months of pregnancy : incases of disordered health, etc. Rheumatic toothache of same kind.
Treatment. Antacid aperients. Quinine. Ammoniated tincture of valerian and bark. Ammonia and sumbul. Colchicum. Aconite. Iodide of potassium. A leech to tender gum, or scarification. Pother spray to cheek. Removal of accumulated tartar (salivary salts — chiefly phosphate of lime).
TOKTICOLLIS. — From Torqueo, to turn aside; collum, the neck. Synon. Collum Obstipum ; Ceplialoloxia ; Rlieumatismus Cervicis ; Stiff- Neck. — See Wrt/-Neck.
TOXEMIA. — From To^cxbv, a poison ; al^ta, blood. Synon. Toxico- hcemia ; Toxiccemia. — A contaminated state of blood, from absorption of some deleterious matter, — as syphilitic virus, poison of smallpox, typhus, etc.
TRACHEITIS. — From Trachea, the wind-pipe ; terminal -itts. Inflam- mation of the trachea. — See Croup.
TRICHIASIS.— From @pi|, T'p(-;>:65, the hair. Synon. Morbus Pilaris; Trichiasis Ciiiorum ; Trichosis ; Trichia. — An irregular direction of one or more of the eyelashes. The cilia present their points towards the globe of the eye, producing chronic inflammation of the conjunctiva.
Treatment. Misdirected hairs to be drawn out singly, with broad-pointed and well-grooved forceps. Hair follicle to be destroyed by nitrate of silver; frequent dabbing with spirits of wine.
TRICHINIASIS.— From ©pil. t^-^ixoi- a hair, — owing to the hair-like form of the entozoon producing this disease. Synon. Trichina Disease; Trichinosis; Flesh-Worm Disease. — A peculiar febrile helminthic affec- tion, attended with symptoms somewhat resembling those of typoid fever. — • The Trichinas are swallowed in imperfectly cooked pork or raw sausages ; they breed in the intestines, and the young trichinte immediately after being hatched migrate from the bowel in all directions into the muscles. The constitutional symptoms are due to the disturbance excited by the arrival of the parasites in the muscles. Trichinae may exist free in muscular tissue, or in more or less calcified cysts about -^^ of an inch long and j^jj of an inch broad. Young trichina, extracted from cyst, is disposed in two or two and a half coils: straightened out. It measures ^^ of an inch in length, and ^Jjy of an inch in diameter. Fully developed and sexually-mature male trichina measures y\ of an inch : female, ^ of an inch.
Symptoms. Vary in severity according as few or many worms have been swallowed, as well as in proportion to number of the progeny and extent of their migrations. Usually, loss of appetite, general malaise ; followed by nausea, prostration, diarrhoea, and painful stiffness with swelling of muscles of arms and legs. Pain due to immigration of young trichinfe into the muscles. High fever : oedematous swelling about face and eyelids. Frequent pulse. Copious offensive sweats. Diminished secretion of urine : excess of urates and uric acid, but never any albumen or sugar. Stiffness of limbs increases: muscles become painful, tender to touch and greatly swollen. Movements of intercostal muscles in respiration attended with pain, pre-
256 TEISMUS NASCENTIUM— TUBERCULOSIS.
venting sleep. Hiccup, if diaphragm be invaded. Hoarseness and loss of voice, where laryngeal muscles get inhabited. — When a large quantity of trichinous meat has been eaten, patient may lie almost paralyzed in state of great exhaustion. Facial oedema continues a week or ten days : its dis- appearance followed by swelling of feet and legs and trunk. — About com- mencement of fourth week, patient's condition very unfavorable. Pulse and respirations frequent: tongue dry and red: pain severe: sweating profuse: mouth can scarcely be opened : no sleep can be obtained: praecordial anxiety and delirium : death preceded by profound exhaustion. Complications some- times prove fatal earlier, — pneumonia, pleurisy, peritonitis, dropsy, diarrhoea, etc. In favorable cases, symptoms gradually abate ; return of appetite and power of digestion, diminution of muscular pain and swelling, lessening of anaemia : parasites have become encysted in the muscles.
Treatment. Very unsatisfactory. In earliest stage, emetics and pur- gatives. Calomel and jalap, 140. Calomel, as a purgative, in 20 gr. doses. Prussic acid, or laurel water. Quinine. Picrate of potash ? Picric acid {formed by the mixture of carbolic acid and nitric acid) ? Benzole ? Oil of turpentine? Santonin? Tannin? Salts of copper ? For relief of sleepless- ness and sweating, wet-sheet packing, 136. Opium and digitalis, injurious. — Perfect quiet. Broths, gruel, milk, ice, soda-water, brandy and egg mix- ture (17), restorative soup (3). Subsequently, during convalescence, large quantities of nourishing food, wine, etc. Ferruginous tonics.
TRISMUS NASCENTIUM.— From TpJ^co, to gnash with the teeth : Nascor, to be born. Popularly known as Nine-day fits. — A peculiar form of Tetanus, which occurs in infants about second week after birth, and is very fatal. Rare in this country. Eighty yearsagftTwhen Dublin Lying-in Hospital was badly ventilated, it proved one of the most prominent causes of infantile mortality in that institution. Still common in West Indies, where it sometimes seems to rage as an epidemic.
When prevalent, great care necessary to guard newborn child from cold or foul air, improper feeding, imperfect cleansing, or from retention of meconium. Remains of umbilical cord to be properly managed, and not left to charge of an ignorant nurse. In dividing funis at birth, not more than two inches to be left attached to umbilicus. As curative remedies, warm baths, purgatives, and friction of spine with belladonna are the only measures likely to be serviceable.
TUBERCULOSIS.— From Tuherculum, dim. of Tuber, a knob or ex- crescence.
Microscopically, tubercles consist of small cells, embedded in a finely fibrillar or structureless matrix. "Giant cells," large irregular bodies with many nuclei, have been described as characteristic, but these are simply the result of imperfect differentiation. Tubercles mostly arise from prolifera- tion of nuclei in walls of minute vessels, and interfere with circulation in them, causing destruction of tissue.
In guinea-pigs, rabbits, etc., insertion of tuberculous or caseous matter under the skin, or even a seton, gives rise to general tuberculosis, and in man general tuberculosis may usually be traced to infection of the blood by caseous material from an inflamsd and disintegrated gland. Tubercular affections mostly arise in persons of scrofulous constitution, probably because of liability to caseous change.
The most common tubercular diseases are pulmonary consumption, tuber- cular hydrocephalus, tubercular peritonitis, and tabes mesenterica. Precise nature of change in blood unknown; probably the aqueous part is increased in proportion to the solids, while the red corpuscles are especially diminished.
Symptoms. The scrofulous constitution usually associated with dyspepsia, with difficulty in assimilating sugar and fat. Acid eructations, heartburn,
TYxMPANITES— TYPHOID FEYER. 257
flatulence. Paleness and sense of coldness of the body. Tumidity of the abdomen. Intellectual system well developed. San<ruine temperament. Puffiness of the face, with swelling of lips and nostrils. Purulent dischari;es from tiie ear. Vesicular eruptions about the head. Enlargement of tonsils, and glands of the neck. Disagreeable exhalations from skin, especially from feet and axilUe. Feebleness with rapidity of pulse. Genei'al debility. Progressive loss of weight. Susceptibility to attacks of simple fever. When formation of tubercles in progress, temperature usually raised. Signs of disease in the organ invaded.
May set in at any period of life. Liability to it greatest between three and fifteen, and between eighteen and forty.
Its development favored by all conditions which render the blood un- healthy. Malformations of chest. Defective structure of lungs. Diseased nutrition. Sexual excesses.
Treatment. To prevent its transmission : — -Well-assorted marriages to be obtained ; great care to be taken of maternal health during pregnancy ; attention to infant's food and clothing, as well as to the air it breathes. A strumous mother not to be allowed to suckle her child. Avoidance of ill- ventilated, badly drained, or damp houses.
Ctircdive treatment :—'lm^vosQmQ\\\ of the faulty nutrition. The for- mation of healthy blood to be promoted. Special attention to diet, dress, exercise, repose, sexual intercourse, air to be breathed, functions of skin, and powers of the digestive organs. — See Hydrocephalus ; Phtliisis ; Tabes Mesenterica, etc.
TYMPANITES. — From Tympannm, a tambourine or drum ; because the belly, if struck, sounds like a drum when the bowels are distended with air. Synon. Pneumatosis Abdominis ; Aerosis ; Meteorism ; Wind Dropsy. — See Flatulence.
TYPHLITIS.— From Tv^-kh^, blind ; terminal -itis. Synon. Tuphloen- teritis. Inflammation of the Caecum. — See Ccecitis.
TYPHOID FEVER.— From Tv^o?. stupor ; fKoj. appearance. Literally, " like 'J'yphus." — Formerly described as Abdominal Typhus; Febris Pu- trida ; Gastro-bilio'us Fever; Febris Gastrica ; Febris Mesenterica Maligna ; and Night-soil Fever. In the present day, its synonyms are, — Enteric Fever ; Pythogenic Fever; and Typhia. — Maybe defined as an endemic, slightly infectious, or contagious fever ; most prevalent in autumn ; usually communicated through contamination of drinking water, by sewer gases or effluvia from drains, or by actual sewage containing typhoid stools, which are the chief vehicle of the poison. Milk has conveyed the disease, having been contaminated by impure water. — Attacks rich and poor indis- criminately; but is particularly a disease of early youth and adolescence. — It frequently has a duration of 30 days. In many cases it terminates on 21st or 28th day; and occasionally is followed by a relapse.
Symptoms. Usually a period of incubation, varying from 10 to 14, or even 21 days: very rarely the symptoms come on immediately after expo- sure to the poison. — The disorder sets in slowly and insidiously, with languor. In a day or two, there are chills, headache, thirst, pains in limbs, weakness, with a tendency to diarrhoea and sickness. Restlessness; face languid and pale, or marked with a circumscribed flush on each cheek ; urine diminished in quantity; pulse rises to 120 or higher; temperature raised to 103° or 104° F. ; highest in the evening, morning remission of about 2° ; breath offen- sive, often ammoniacal ; tongue at first white, with red edges and tip, later red and glazed, or dry and brown. — Atciommencement of second week, or a day or two earlier, the typhoid rash appears ; rose^colored spots on chest or abdomen; few in number; circular; disappearing on pressure; and fading 17
258 TYPHUS FEVER.
away, to be replaced by a fresh crop. In 10 or 12 per cent, no rash. — After the middle of the second wee'k, tympanites; gurgling in right iliac fossa on Dressiire ; diarrhoea. Stools alkaline and of a pea-soup appearance. Somnolence, delirium, tinnitus aurium, deafness, prostration, bedsores, etc. Attacks of hemorrhage from the ulcerated patches in the ileum, and perfo- ration of the bowel, with fatal peritonitis, to be feared. Congestion of kid- neys. Cerebral or pulmonary complications.
Mortality about 1 in .5 or 6. More fatal to the rich than the poor. A persistent temperature above lOG'^ F., very unfavorable; above 110° a fatal result almost certain. Death usually due to exhaustion, from the protracted febrile condition or from diarrhoea; sometimes to pulmonary or cerebral complications, or to perforation of the bowel and peritonitis, or to hfemoi*- rhage ; occasionally to urcemia. In some cases the patient appears to be overwhelmed by the poison, and dies early with cerebral symptoms, delirium and coma.
Two lesions invariably present,— alterations in the agminated glands or Peyer's patches, and in the corresponding glands of the mesentery. Fre- quently, the patches have undergone ulceration.
Treatmknt. Phrnphtjlactic : — Pure water. Good drainage. No old cesspool to be opened in an inhabited house. Patient's excreta to be passed into a bed-pan containing* Condy's fluid or carbolic acid, 74.
CAtrative : — In most respects the same as for typhus. There are two or three exceptional points: — Avoidance of aperients. Astringents with opium, or, better, opiate enemata, to relieve intestinal irritation and diar- rhoea, 96, 97, 100, 105, lOG, 107. or 113. Cold bath or cold wet pack ; pa- tient put in bath at 60° or 70° for 15 minutes three times a day, afterwards placed in bed lightly covered. Or wrapped in sheet well wet with tepid water, over which a single thin blanket, whenever the temperature rises above 102°, till it falls to the normal point or till shivering sets in. Cold over the abdomen when there is intestinal hiemorrhage ; gallic acid, 103.
Great care during convalescence, lest the cicatrizing ulcers in the ileum be irritated. Quinine. Liquid extract of yellow cinchona. Compound tincture of cinchona. Return to a generous diet to be very gradual : no solid food until all symptoms have vanished.
Remedies which have been recommended: — Creasote. Carbolic acid. Chlorine. Sulphurous acid. Sulphates.
TYPHUS FEVER, — From Tv^o^, smoke ; an expression employed by Hippocrates to denote a lethargic disease, in which the patient is suddenly deprived of his senses, as if thunderstruck. Prior to 1759 typhus was known as Palrid, Pestilential, Malignant, Jail, Ship, or Hospital Fever. — May be defined as, — a contagious infectious fever. Often prevails epide- mically during seasons of general scarcity. The accompaniment of destitu- tion and of over-crowded and ill-ventilated dwellings. Duration from 14 to 21 days.
Symptoms. A period of incubation, varying from one or two to twelve days. Then, rigor, headache, dry and heated skin ; flushed face and heavy dull look; thirst; constipation; stupor; prostration, etc. Towards even- ing, irritability and restlessness; sleepless nights. The typhus rash appears about fifth day ; consists of irregular spots, of a dusky or mulberry hue at first, disappearing on pressure, later forming stains which are not obliterated by pressure, generally very copious; seen on abdomen, chest, and back, but especially ever pectorals near axillae ; spots also generally present on back of wrists. Skin generally dusky, and besides rash often " subcuticular mottling." Rash remains permanent until end of fever ; may be accom- panied by, or become converted into petechiae ; sometimes altogether absent.
During first week, deafness or noises in the ears; injected conjunctiva; ; often constipation, never diarrhoea. Pulse, 80-100. Temperature, 104°
URiEMIA. 259
or 105°, not varying: as in t^yplioid. Brown dry tongue. Wakefulness ; or patient sleeps, and afterwards believes he lias not done so. Urine diminished in quantity; retention very common ; sometimes albuminuria; occasionally complete suppression, with uraemia. In second week, — (jrreat prostration. Muscular tvvitchings. Delirium. Coma, vigil. 'J'he danger may be in- creased by the supervention of acute bronchitis, pleurisy, or pneumonia. Convalescence rapid; usually begins on 13th or 14th day. Sometimes a critical sleep, or sweat, or attack of diarrhoea, or greatly increased flow of urine.
When fatal, death usually occurs between 12th and 20th days. Mor- tality about 1 in every 5 attacked. The greater the age the greater the danger.
'I'reatment. Projihj/Iacfic : — The poor to be supplied with wholesome food, and properly ventilated dwellings. Over-crowding to be pi'eveiited in sleeping-rooms, and lodging houses. Every common lodging house, hospi- tal, workhouse, etc., to be thoroughly cleansed and lime-washed, once a year or oftener. — Clothes and bedding of typhus patients to be disinfected, 74, 75. The patient to be kept scrupulously clean. Not to be taken to the hospital in an omnibus, or street cab. No room where a case has been to be reinhabited until purified with chlorine gas, whitewashed, or repapered, and had the fresh wind blowing through its open doors and windows for many days.
Curative : — Patient to be in a well-ventilated apartment ; free from bed and window curtains, carpets, superfluous furniture ; window to be open at the top. A disinfectant to be used ; chloride of lime, 75 ; chloride of zinc, 79; iodine, 81. A fire to be kept up in the room. A form of quarantine to be maintained strictlj'.
Avoidance of active remedies, at first especially. No specific known for cutting short the disease : quinine fails, and is often injurious. An emetic of one ounce of ipecacuan wine, if case be seen very early. A purgative. — from "'' 80 to 60 grains of compound rhubarb powder. One of the mineral acids, freely diluted, as a daily drink, 857, 858, 359; they are valuable as altera-' tives, if the blood contain an e.xcess of ammonia. Sulphite of magnesia? Cold or tepid sponging. Wet-sheet packing, especially where there is sleep- lessness, 186. Cold lotions to head. Cold affusion, when there is a tend- ency to coma. Warm bath, prolonged for 30 or 45 minutes, if there be great Irritability. Milk diet ; cream ; farinaceous food ; thin broths, well salted ; tea and coffee.
When the powers of life begin to fail, stimulants. Solution of phospho- rus. Wine; gin; brandy; brandy and egg mixture, 17. Strong beef or chicken tea. Cod-liver oil. Administration of the nourishment frequently ; every 80, 45, or 60 minutes. Alcohol to be used carefully when urine is scanty or albuminous. Yeast. Yeast and strychnia. Opium to relieve restlessness. Patient to be kept strictly in recumbent posture. Water-bed. Catheter, if urine be retained.
During convaleficence : — Mineral acids and bark, 876. Quinine and steel, 380. A gradual return to solid food. Country air.
URiEMIA. — From Urea ; a\ua, blood. — To.xgemia from accumulation of urea in the blood, owing to its non-elimination by the kidneys. A mode of terminatk)n_of_any form of kidney disease. Probably two forms ofpoison- ing, where urea clecomposed into carbonate of ammonia " ammoniaimia," and where such decomposition does not occur. The symptorils have also been attributed to serous effusion and consequent ansemia of the brain and not to presence of a poison in the blood. JPerhaps also a poison from in- complete metamorphosis of nitrogenized waste into urea.
Symptoms. Disturbed action of either or both of the great nervous cen- tres. Convulsions, which maj' set in abruptly with little warning, or may
260 URETHRITIS— URINARY CALCULI.
be preceded by great debility, impairment of vision, obstinate vomiting or diarrhoea, somnolence, delirium. Convulsions, followed by coma, but coma may come on gradually without convulsions, preceded however by some of above symptoms. lu uraemic coma, the temperature generally low, there is often twitching of muscles, rarely^tertbr, and patient can commonly be roused at first ; breath has urinous or ammoniacal odor. Albuminuria. Suppression of urine.
Treatment. Hot air or vapor bath. Blanket bath, 136. Wet s^ieet packing, 136. Acid sponging, 138. Saline aperients, 1.52. Jalap and senna, 14.5. 151. Elaterium, 157. Podophyllin, 160. Digitalis. Oroton oil, 168, 191. Castor oil and turpentine enemata. 190. Benzoic acid, 49. Lemon juice. Yinegar. Steel. Arsenic. Sulphite of magnesia. Sul- phurous acid. Chloroform vapor, 313. Stimulants. "^I'ea. Venesection. Cupping over loins. Poultices of linseed and digitalis, or of fresh leaves of fo.xglove, to abdomen.
Dry cupping to nape of neck and loins. Ice to the head.
UEETHEITIS.— From Urethra (OOpfco, to urine) ; terminal -itis. In- flammation of the urethra may be acute or chronic, may arise in male or female, and may occur independently of gonorrhoea or syphilis.
Symptoms. Sense of heat a'ong urethra. More or less pain on urinating. Muco-purulent discharge. Irritability of bladder. Urine may contain an excess of uric acid ; sometimes blood, pus, or rop}^ mucus. Lips of urethral orifice swofferT 'Constitutional disturbance. May^cause retention of urine from spasmodic stricture.
Treatment. Hot hip baths. Fomentations and rest in bed, in acute cases. Unstimulating diet. Demulcent drinks. Opium. Belladonna. Copaiba. AYhen chronic, astringent injections.
UEINARY CALCULI.— From Urma, urine : Calculus (dimin. of Calx), a small stone. Synon. Urobthi. — These concretions are found in kidneys, bladder, or follicles of prostate gland. Very rarely, one or moi^e urinary salts become deposited in ureters, or in urethra: usually, calculi found in these situations have travelled there from kidneys or bladder. Calculous disease much more common in men than women.
Chief Varieties. Uric aciclT' Urate of Ammonia; Fusible calculus (Phosphate of Lime, with Phosphate of Magnesia and Ammonia) ; Mul- berry calculus (Oxalate of Lime) ; Carbonate of Lime ; and, very uncommon forms. Cystic and Xanthic Oxides. Pseude-calculi of fibrin or blood co- agula, or of urostealith (a resinous or fatty substance) are exceedingly rare.
Calculi may consist of only one substance, or of alternate layers of two or more salts — -as of uric acid and oxalate of lime, etc.
Urinary concretions vary much in size. Occasionally, resemble grains of sand so small as to pass with urine. Particles of gravel thus voided may be made up of aggregated crystals of urinary salts — microscopic calculi. In other instances, calculi are as large as a small orange. When a stone has formed in pelvis or kidney, it may, while of moderate size, enter ureter and gradually be forced onwards towards bladder. 'J'he suffering which takes place during transit very great ; popularly known as "a fit of the gravel." As soon as calculus reaches bladder, all pain is over for a time.
Symptoms of Calculus Retained in Kidney. Almost constant back- ache. Bloody urine, especially after exertion. Pus and epithelium of pelvis and kidney, as well as blood-corpuscles seen under microscope. Reflex irri- tation of distant organs. Nervous irritability. Subsecjuently, impaired health, loss of flesh and strength. Foreign body gradually encroaches on true renal tissue : either converts the gland into a large cyst, or sets up suppurative inflammation When large calculi are present in both kidneys, case ends in uragmic toxaemia.
URINARY DEPOSITS. 261
Symptoms of Stone in Bladder. Severe attacks of pain in bladder, perineum, and at g-lans penis, alwaj's bro4ifilit on, or ajri^ravated, by exercise. Frequent micturition, sometimes incontinence of urine : with a feeling that bladder is not thoroughly emptied by the act of urinating. Urine often thick with ropy mucus : sometimes contains pus, or blood. Blood corpus- cles and vesical epithelium under microscope. Act of micturition often suddenly stopped by stone being forced against neck of bladder ; on making any movement, flow of urine returns. Tenesmus : prolapsus of rectum. Stone discovered by use of sound.
'I'reatment of Renal Calculus. Plain diet; nourishing food, milk, cream, raw eggs. Weak brandy or whiskey and water. Free amount of aqueous drinks. Cod-liver oil. Belladonna plasters to loins. AVarni cloth- ing : flannel or chamois leather jacket. — F^ir checking hemorrhage: — Quiet. Gallic acid, 103. Tincture of perchloride of iron, 101, 392. Iron & , ^ alum, 116. Pill of lead and opium. — In uric acvVZ diathesis : — Vegetable LaA'^A^^ * diet: white fish. Avoidance of alcoholic drinks] T'ree use of simple dilu- "-"-"^ ents. Vichy or Carlsbad waters. Acetate of potash. Bicarbonate of pot- ash. Solution of potash. Citrate of potash. — In p/*0'S2:'/i«^«c diathesis : — ■ Animal food. Wine; diluted spirits. Bark. Quinine. Phosphoric acid. Nitro-hydrochloric acid. Steel. Opium. — \n ^^jxluria : — Avoidance ofi garden rhubarb, sorrel salad, and sugar. Nitro-hydrochloric acid. Tepid^^„ or cold bathing. Friction of skin. Warm clothing. Sea air. Attention to digestive organs. — To relieve pain of any form of calculus passing doion ureter : — Hot bath. Chloroform or ether, inhalation of. Opium, in full doses. Morphia injections. Digitalis. Belladonna. Barley water, or any emollient diluent, with spirit of nitrous ether.
Treatment of Vesical Calculus in Males. Opium and belladonna to allay pain. If stone be small, patient to allow urine to accumulate and ' then to discharge it forcibly in hot bath. Introduction of silver catheter with an open end, and washino- out of bladder with warm water. Lithotrity. i . ' /j
Lithotomy. Attempts at solution of calculus (Litholysis) by alkaline and)
saline mixtures in the case of urjcjicm^^alcuji, and by acid solutions for* .^:>., , /f j o.xalate of lime and phosphatic calculi, have hitherto failed. Injecting 'i..- . --'.i-CA^iuX^ solvents into bladder, has not succeeded. Electricity has been employed for disintegrating calculi, but with very doubtful results. That success will ultimately follow attempts at litholj^sis can hardly be doubted.
Treatment of Vesical Calculus in Females. Four methods for removal of stone : — (1) Lithotrity : by far the best plan, as a general rule. (2) Dilatation of urethra by sponge tents, or a three-bladed expanding dilator, or by India-rubber bags, which can be inflated after introduction. Patient to be under influence of chloroform. Apt to be followed by per- manent incontinence of urine. (3) Incision of external urethral orifice, with stretching of canal by three-bladed dilator. May produce incurable incontinence. (4) Vaginal lithotomy : edges of incision into bladder being brought together by silver wire sutures, as in operation for vosico-vaginal fistula.
URmARY DEPOSITS.— Two varieties,— Inorganic and Organic. (1) Inorganic Deposits : — Uijc^^'Jit'^'*^ ^^'i^ '■> amorphous or mixed urates, con- sisting of uric acid coinHiued^witli several bases— ammonia, soda, potash, lime ; urate of soda ; urate of ammonia ; hippuric acPd ; o.xalate of lime ; car- bonate of lime; amorphous phosphate of lime, or bone-earth ; crystallized phosphate of lime, or stellar phosphate; phosphate of ammonia and magnesia, or triple phosphate ; cystine, or cystic oxide ; xanthine, or xanthic oxide ; leucine and tyrosine.
(2) Organic Depjosits : — Epithelium from pelvis of kidney, ureter, bladder, urethra, and vagina ; epithelium from uriniferous tubes, with casts of the tubes (as found associated with albuminuria), such casts or moulds of uri-
262 URTICAEIA— UTERINE CANCER.
niferons tubes being composed of epithelial cells imbedded in coagulable matter, or of an opaque granular matter, or of transparent waxy matter, or of waxy material studded with minute fatty particles, or of blood disks, or of pus corpuscles; molecular fatty matter, as in chylous urine; oil globules, free, or inclosed in cells, or adherent to casts ; pus ; blood ; cancerous and tubercular matter; spermatozoa; and minute confervoid parasitic vegeta- tions.— sarcinaj, yeast or sugar fungus ('rorula cerevisise), mould fungus (Penicilium glaucum), and vibriones.
Soluble stibstances found in morbid urine : — Urea, in abnormal quan- tity ; albumen ; sugar ; biliary coloring matter ; and biliary acids.
TJRTICAIIIA, — From Urtica, a nettle. Synon. Purpura Urticata ; Exanthema Urticatum ; Nettle-Rcifih. — Anon-contagious affection of the skin. One of the Exanthemata. Characterized by formation of prominent patches or wheals (pomphi). pale but with a red areola, which often appear and disappear suddenly: accompanied by heat, burning with tingling, and great itching. Sometimes constitutional disturbance: fever, coated tongue, unhealthy secretions. A chronic intermittent variety ( Urticaria Evanida of Willan), often very troublesome, lasting for months.
Urticaria generally due to derangement of digestive organs, which may be caused by use of shell-fish, mushrooms, cucumbers, cheese, pastry, bad milk, nuts, bitter almonds. Henbane, turpentine, nux vomica, and balsam of copaiba may induce it. yometimes connected with rheumatism or gout, uterine irritation, malaria, dentition, etc.
Treatment. Sulphate of magnesia in acid infusion of roses, 142. Rhu- barb and magnesia, 165. Rhubarb and blue pill, 171. Ammonia and chiretta, 63. Bismuth, 65. Potash and ammonia, 67. Ammonia in effer- vescence. 362. Serpentary with carbonate of magnesia or bicarbonate of soda. Nitro-hydrochloric acid, 378. Steel and ammonia, 401. Steel and citrate of potash, 403. Fepsine, 420. Iodide of potassium and colchicuni (in chronic form). Quinine, 379. Arsenic, 52. Cod-liver oil. Sponging with vinegar and water : equal parts of tincture of arnica, glycerine, and rose-water : equal parts of solution of subacetate of lead, laurel water, glyce- rine, and elder flower water : solution of corrosive sublimate (gr. 5 to fl. oz. viij). Warm or tepid baths. Plain diet, especially evading all substances likely to disagree. Active exercise.
UTERINE CANCER.— From 'Tarspa, the womb: Cancer {xapxlvo?, a crab), a kind of ulcer. Synon. Metro-carcinoma ; Carcinomct Uteri. — Cancer of the womb most frequently met with under form of medullary ulce- ration of lips or vaginal portion of cervix. ■ Very I'arely, infiltration com- mences in mucous or muscular coat of body or fundus of womb. — Medullary cancer most common variety. Scirrhus seldom observed. Cauliflower ex- crescence, or epithelioma, not often met with. Uterine cancer most frequent after the 40th year.
Sy.mptoms. Abundant watery discharge, of a dirty pale-green color, always offensive. Sudden attacks of haemorrhage. Distressing pain ; at first most severe at night, afterwards always present. Nausea and vomiting : flutulence; irregular action of bowels; loathing for food. Painful mental depression. Daily increasing debility, and waste of tissues. Dingy sallow hue of countenance, and pinched anxious expression -cancerous facies. — Uterus found immovably fixed in pelvic cavity. Labia uteri indurated and nodulated at first : subsequently, excavated by an ulcer of a loose spongy character, seated on a hardened base, and surrounded by indurated tissue. Yagina soon gets involved : communications may form between vagina and bladder, or vagina and rectum. Death, in course of second year from com- mencemeut of symptoms, from exhaustion.
UTERINE DISPLACEMEN'IS. 2G3
Treatment. General remedies: — Ammonia anrl hark, 371. Mineral acids and liark, 376. ('itric acid and bark. Phosphoric acid and qninine, 379. Qninine and liclladonna, 383. Zinc and coninm, 413. Cod-liver oil, 389. Nntritions diet: milk and cream, raw eggs, animal food. Light sparkling wines; sherry; brandy. Malt liquors usually increase dyspepsia. Avoid- ance of sexual intercourse. — When stomach is Trritahle :—F^\)?\v\(i. 420. Nitro-hydrochloric and dilute hydrocyanic acids, 378. Ammonia and ether, 3G4. Bismuth, 112. Ice. Cream of tiirtar drink, 356. Chlorate of potash drink, where there is soreness of moulh, 360. Castor oil. Confection of senna with taraxacum, 194. Simple enemata, 188. Belladonna liniment to epigastrium. Sinapisms. Hemlock poultices. — For relief of pain: — Hen- bane, camphor, and hop, 32.5. Opium and henbane, 343. Morphia, chlo- roform, and Indian hemp, 317. Subcutaneous injection of morphia. 314. Opiate enemata. or suppositories, 339, 340. Oxide of zinc and belladoniia pessaries, 423. Use of a frigorific mixture of ice and salt to uterus, by a gutta percha speculum. Injection of carbonic acid gas: of chloroform vapor. Belladonna liniments or plasters to sacrum. Hemlock poultices to pulies and vulva. — For control of hcemorrhage : — Gallic and aromatic sulphuric acids, 103. Cinnamon. 104. Iron alum, 116. Lead and opium, with acetic acid, 117. Turpentine. Digitalis. Application of cold to vulva. Insertion of plug of wool, saturated with solution of perchloride of iron, into ulceration. Injection of solutions of alum and tannic acid, or of infusion of matico. Tannic acid pessaries, 423. Plugging with cotton- wool.— For removal of offensive odor in discharges : — Cleanliness. In- jections of solutions of chlorinated soda or lime ; of creasote and water (fl. drm. j to fl. oz. xx) ; or solution of permanganate of potash and water (fl. drs. iv to fl. oz. xx); of chloride of zinc and water (gr. 20 to fl. oz. xx). Pessary of logwood and cocoa butter (gr. 30 of each). Iodoform pessaries, 423. Padding vulva with muslin bags of vegetable charcoal.
Operations by knife, ecraseur. and ligature rarely useful. Employment of powerful escharotics rarely to be recommended. Bromine; gastric juice. The treatment of cauliflower excrescence, in early stage, perhaps an excep- tion to two foregoing rules.
UTERINE DISPLACEMENTS.— The uterus may be displaced in several ways, giving rise to much discomfort.
1. Prolapsus and Procidentia. — Terms employed to designate a descent of the womb as it exists in two different grades. By " Prolapsus" {Prolabor, to glide forward) is meant that condition in which uterus falls below its natural level in pelvic cavity. By " Procidentia" {Procido, to fall down) is signified the protrusion of uterus beyond vulva. Causes of both conditions the same. Suffering varies chiefly in degree.
Symptoms. Sense of fulness or pelvic weight. Bearing-down pains. Backache. Leucorrhoea. No impediment to menstruation ; nor to concep- tion, as uterus is generally easily replaced when patient is in bed. Irritation of bladder and rectum. In prolapsus, uterus found depressed, perhaps rest- ing on upper floor of perineum. In procidentia, a round or pear-shaped tumor, with os uteri visible at its centre, seen projecting beyond vulva. Labia uteri often excoriated. Vaginal walls may be dry and harsh and cracked ; perhaps ulcerated.
Treatmrnt. General rules : — Artificial support to be afforded to super- incumbent abdominal viscera. Tone to be given to round and broad liga- ments of uterus, to relaxed vaginal walls, to perineum. Removal of compli- cations,— uterine congestion or hypertrophy, cough, constipation, etc.
To effect reposition in procidentia : — Patient to be placed on left side, with knees well flexed : greased uterus to be gently pushed up. Woman may rest on hands and knees, with head lower than pelvis, so as toremove
264 UTERINE DISPLACEMENTS.
superincumbent weight of intestines : womb to be then replaced. Uterus to be firmly encircled with strips of plaster for forty-ei^'ht hours, and patient kept quiet in bed : circumference of tumor being thus reduced, reposition usually effected with ease after removal of plaster. All plans failing, uterus has been removed by ligature applied around the neck of tumor formed by it. .
To support abdominal viscera : — An abdominal belt of common jean. A pelvic belt, with a firm perineal band and pad, — a modification of the T-bandage. Hull's " Utero-abdomlnal Supporter." Bigg's abdominal plate, fixed by steel bands somewhat like a truss.
To give tone to tissues : — Phosphoric or nitric acid, nux vomica, and bark, 376. Tincture of perchloride of iron, 380, 392. 397. Quinine and nux vomica, 387. Strychnia and steel, 408. Astringent vaginal injections, 425. Astringent pessaries, 423. Nitrate of silver to vaginal walls. Cold salt water hip baths. Nourishing diet.
To support uterus : — Oval or globular boxwood, vulcanized India rubber, vulcanite, tin, plated or gilt metal, or gum elastic pessaries. Ring pessa- ries. Pessary of watch spring, covered with thread and solution of gutta percha. Zwanke's pessary. Removal by dissection of one or more longitu- dinal strips of vaginal mucous membrane, bringing edges of wound together with wire sutures. Paring the sides and posterior wall of lower part of vagina, and keeping raw surfaces in contact by quill-suture, so as partly to close vulval opening.
2. Retroflexion and Anteflexion.— Retroflexion {Retro, backwards ; Jleito, to bend) consists of a beiuliiig backwards of uterus, at part where the
neck joins the body ; so that fundus is found between cervix and rectum, os uteri being in normal position. Uterus becomes shaped like a retort. — In anteflexion [Ante, forwards ; Jledo), fundus rests on bladder.
Sy.mptoms. Almost absent when displacement is slight, uterine structures flabb}^ and pelvic cavity more than ordinarily capacious. Considerable suffering where ang-le of flexion is acute, uterine ligaments unduly stretched, circulation through uterus impeded, and fundus immovably pressed on rec- tum or bladder.
Dull wearying backache. '^Fenderness about groins and inside of thighs. Sense of fulness in rectum or bladder. Pain from sexual intercourse : fecun- dation prevented. Dysmenorrhoea. Nausea, loss of appetite, mental de- pression Hysteria. Displacement recognized with certainty by use of uterine sound.
'I'reatment. Replacement by pushing fundus upwards, with or without assistance of uterine sound. Use of intra-uterine stem. Pessaries of bella- donna and iodide of lead or mercurial ointment, 423. Dilatation of uterine cavity and cervix with sponge or sea-tangle tents (426), allowing uterus afterwards to contract in normal position upon a metallic stem. Horseshoe shaped vaginal pessaries. Division of os and cervix with hysterotome, so as to remove contraction of muscular tissue at point of flexion.
3. Retroversion and Anteversion.— In retroversion [Retro, backwards ; verto. to turn) , uterus lies almost transvereely in uterine cavity ; with fundus towards hollow of sacrnm, and os uteri under pubi^- arch. The opposite condition, anteversion [Ante, forwards; verto), is characterized by fundus lying towards bladder, and os uteri in cavity of sacrum.
Symptoms. Backache, bearing-down. Leucorrhcea. Menstruation not interfered with : impregnation not absolutely prevented. In retroversion, pressure of labia uteri on urethra may cause retention of urine, — a common result in pregnancy.
Treatment. Occasional rep^icement. Quinine, steel, and nux vomica, 380. Mineral acids with strychnia. 378. Nourishing food. Injections of alum and sulphate of zinc, 425. Tannin pessaries, 423. Cold sea water
UTERINE HEMOIillHAGE— UTERINE TUMOR. 2fi5
batlis. Avoidance of over-exprtion. straininj? at stool, etc. In displace- ment dnrinti' preg-nancy, reposition best effected with patient resting on hands and knees : chloroform may be required. Use of catheter.
4. Inversion of Uterus. — From In, in ; verto, to turn. Synon. Inversio Uteri. — The uterus is literally turned inside out. Fundus descends throup-h OS uteri ; mucous lining' of cavity of womb becoming the external covering' of tumor, which projects into vagina and generally throug'h vulva. Usually happens directly after labor; but has followed the expulsion of a polypus.
Symptoms. Severe nervous shock. Great depression and faintness. Bearing-down pain. Nausea -and vomiting. Perhaps, hemorrhage. Some- times death from shock, especially if the labor has been difficult. Where the accident has not been detected at time of occurrence, patients have gone on for months, or even years, suffering front bad health, anaemia, repeated attacks of hemorrhage, sacral and pelvic pains, etc.
Treatment. When occurring directly after labor, placenta to be peeled off if it remain attached. Uterus to be firmly grasped, and steady pressure made in upward direction so as to reduce that portion first which has last descended : patient may be under influence of chloroform. — In chronic cases, attempts at replacement may have to be gently persevered with even for an hour or rather longer. Occasionally, the attempt has had to be repeated for many days in succession ; pressure having been kept up during- the intervals by a well-adapted air pessary. All plans failing, uterus has been removed by ligature.
UTEUINE HEMORRHAGE.— Synon. Hcemorrhagia Uteri; Metmr- rhngia; Flooding. — Hemorrhage from uterus at other than catamenial periods. Arises chiefly from: — Cancer of uterus. Fibroid tumors or polypi. Endometritis. Inflammatory diseases of the cervix. Cong-estion of the ovaries. Moles.
Often the precursor of abortion. In latter months of pregnancy, indi- cative of separation of the placenta ; or of placenta prasvia.
Treatment. See Menorrhagia.
UTERIIfE TUMOR. — Synon. iJy.s^'ernjjfM.s; Metrnncus ; Hysferr- phyma ; Metropliyma ; Tumor Uteri. — Of all organic diseases of uterus first manifesting themselves during period of sexual vigor, non-malignant tumors are the most common.
1. Fibroid Tumors. — Consist of outgrowths of uterine tissue. Are single or multiple. Sometimes attain an enormous size. May be developed in any part of uterus. Classified as sub-peritoneal or surface tumors, when just beneath peritoneum ; interstitial or intra-mural tumors, when imbedded in uterine walls ; and submucous or intra-uterine tumors, when pressed into cavity of womb.
Symptoms. Often neither important nor well-marked. AVhen of sufficient size to encroach on pelvic viscera, or to be detected through abdominal wall, symptoms more prominent. Menstrual irregularities, — frequently menor- rhagia. Dull, aching, throbbing pains. Sense of weight and bearing-down. Cramp or numbness in one or both thighs. Difficulty in voiding or in retain- ing ui'ine. Constipation : hasmorrhoids. Enlargement and tenderness of breasts. Attacks of severe hemorrhage in intra-uterine growths: occasion- ally expulsive pains. Tumor detected on careful abdominal manipulation, and vaginal examination.
Treatment. In a large number of cases, the less fibroid tumors are interfered with the better. Great danger from attempting radical cure by enucleation, gouging growth and scooping away portions, or by abdominal section. — Retnedies recommended to produce ahaorption : — Mercury; iodine ; iodide of potassium ; solution of potash. Bromide of potassium,
266 UTERINE ULCERATION.
42. Bromide of ammonium. 37. Chloride of calcium, 35. — For control of hemorrhage :—CovYosi\e sublimate, 27. Gallic acid, 103. Oxide of silver and Indian hemp, 47. Iron alum. 116. Incision of os and cervix uteri. Incision into exposed part of tumor, where it can be easily reached from vagina. — For relief of pressure on pelvic viscera: — Gentle elevation of tumor into false pelvis. Iodide of lead and belladonna pessaries, 423. — For cure of suffering clue to congestion or cedema of groivth: — Bromide of potassium, 42. Kreuznach waters, 484.
2. Polypus of Uterus. — From no?.t)?, many ; Ttov^, a foot : 'Tatspa, the womb. Synon. Mefropoh/pus ; Hysteropolypus ; Polypus of the Womh. — A tumor attached to inner surface of uterus by a pedicle or neck. May occupy uterine cavity, or be in vagina and merely attached to uterus by pedicle. Three varieties: — Fibroid, raucous or gelatinous, and placental.
Symptoms. Profuse menstruation. Irregular attacks of uterine hemor- rhage,— often amounting to tlooding. Profuse leucorrhoeal discharge. Irri- tation of pelvic viscera from pressure. Spasmodic attacks of pain. Debility and loss of flesh, in proportion to amount of discharges. Tumor found on making vaginal examination : if it be in uterine cavity, easily detected after dilating os by sponge-tents.
Treatment. If in vagina : — Tumor to be removed by dividing pedicle with scissors or wire-rope ecraseur. If in utero : — Os uteri to be fully dilated with sea-tangle or sponge tents (426), and tumor subsequently re- moved by division of pedicle with wire-rope ecraseur. Sometimes, can be taken away by torsion, when pedicle is slender.
3. Cysts of Uterus. — Unilocular cysts, or closed sacs, filled with mucus or serum, are occasionally developed in substance of uterus, or just beneath internal mucous lining, or under external serous covering. Sometimes, one part of uterus invaded by cystic growth, while another is the seat of an ordinary fiiaroid tumor. 'I'hese cysts only give rise to inconvenience when they attain such a size as to admit of their detection. If within reach, they may be punctured : if pediculated and pressing into uterine cavity, they can be twisted off after dilating the os uteri with sponge-tents.
UTEEINE ULCERATION".— From 'Tarf'p*, the womb : Ulcero, to cause to ulcerate. Synon. Hystertlcosts ; Uteri Fxulceratio. — As a frequent result of congestion and inflammation of lovs^er part of uterus, various forms of ulceration are found about the cervi.x : —
1. Simple Abrasion. — Synon. Fxcoriation, or Erosion, of Labia Uteri. — Epithelium removed from a part of one or both lips; exposed villi with their looped capillaries conveying a " velvety" feel to the touch. Extent of abrasion easily ascertained with speculum.
Symptoms. Leucorrhoeal discharge. Pelvic and sacral pains. Ovarian irritation. Indigestion : flatulence, with irregular action of bowels. Irre- gular menstruation. Depression of general health.
Treatment. Locally: — Alum or zinc injections, 425. Tepid or warm salt-water hip baths. Iodide of lead and belladonna, or acetate of lead and opium, pessaries, 423. Application of solid nitrate of silver. Undiluted solution of subacetate of lead. Glycerine. CoUodium, 285. Mercurial ointment. Acid solution of nitrate of mercury. Potassa fusa. Scarifica- tion of labia, or application of three or four leeches where there is congestion.
Generally : — Animal food: milk. Claret, sherry, champagne, or brandy and water, — in place of malt liquors. Nitro-hydrochloric acid, 378. Salicin, 388. Quinine, 379. Pepsine, 420. Rhubard and ipecacuanha, 179. Oxide of silver, 47. Arsenic and bark, 52. Iodide of potassium, 31. Cod-liver oil. Moderate exercise in open air.
2. Ulceration of Labia Uteri. — Uterine lips not only more or less de-
VACCINIA— VAGINAL OCCLUSION. 267
prived of dense opilhelimn, but tlie villi with their vascular loops destroyed in patches. Sometimes, proper tissue of uterus involved.
Symi'toms. Thick inuco-i)urulent discharge. Pelvic pains. Backache. Menorrhagia. Anaemia : headache, neuralgia, dirty sallow hue of skin, irregular action of bowels, loss of appetite, etc. Debility : mental depres- sion. Pains increased by walking or sitting upright. Reflex irritation of breasts, bladder, and rectum.
Treatment. Same as for simple abrasion. Warm water or astringent injections night and morning. Tonics. Nourishing food : stimulants. Re- lief to reflex irritation by iodide of lead and belladonna pessaries, 423. Avoidance of sexual intercourse.
3. Syphilitic Affections. — Primary syphilitic sores very rare. Chancre may be situated on lal)ia, within canal of cervix, or on outside and upper part of cervix. — Secondary syphilitic affections of uterus not uncommon. Chief symptoms,— Hypertrophy and induration of vaginal portion of cervix. Abundant muco-pui'ulent discharge from uterus and vagina. Patches of abrasion, or of ulceration, on labia uteri. Menstrual irregularities, — often menorrhagia. Evidence of disease in distant parts. — loss of hair, sore throat, cutaneous eruptions, nodes, etc. Treatment the same as for syphilis generally.
4. Rodent Ulcer.— Synon. Corroding Ulcer. — A severe disease, which has been confounded with epithelial cancer. Very rare before age of thirty : usually commences about " change of life."
Symptoms. Ulceration begins gradually and extends slowly. As it eats away affected tissue, complaint made of pelvic heat and discomfort ; thin serous discharge, occasionally streaked with blood. Debility, pallor, indi- gestion. Subsequently, — burning pains ; attacks of hemorrhage. On ex- amination, an irregularly-shaped ulcer found, with ragged or indurated edges: soi'e excavated, presenting a dry and glossy or a pulpy surface. Uterus not fixed, as in cancer. Sometimes, whole of cervix destroyed. Disease eats its way into body of uterus ; so that entire muscular structure gets destroyed unless death first occur from hemorrhage or peritonitis or exhaustion.
Treatment. Excision, if disease be limited to cervix : otherwise, actual cautery, or potential caustics. Sedative vaginal injections, 42.5. Opium and belladonna pessaries, 423. Arsenic, 52. Cod-liver oil. Tonics. Nar- cotics. Nourishing food.
VACCINIA. — From Vacca, a cow. Synon. Variola Vaccina; Ex- anthema Antivariolosum ; Vacciola ; Inoculated Cow Pox. — A disease produced by inoculation with the virus of cow-pox, such disease affording protection against the contagion of smallpox. Included by Willan in the Vesicular order of skin diseases. — See Coiv-Pox.
VAGINAL OCCLUSION.— From Vagina, a sheath or scabbard.— Inde- pendently of cases where, from arrest of development, vagina is entirely absent, or is considerably malformed, examples of occlusion can be arranged under one of three heads : — ■
(1) Those where there is a morbidly tougli and persistent hymen. If the membrane cannot be ruptured with finger, it must be divided ; reunion being prevented by use of oiled lint. (2 i Where the hymen is hypertrophied and imperforate, so as completely to close vaginal canal from urethra to four- chetle, preventing escape of menstrual fluid. A longitudinal or crucial incision to be made through obstructing membrane. Under such conditions, operations attended with' considerable danger: fatal peritonitis, endome- tritis, or pyfEuiia not uncommon. And (3) cases of imperforate vagina ; whether due to congenital adhesions between opposite walls, to stricture in consequence of inflammation, or to cicatrices consequent on injury. A careful dissection often required to make canal patulous.
268 VAGINAL PEOLAPSUS— VAGINITIS.
VAGINAL PROLAPSUS.— From Vagina, a sheath : Prola.hnrAo fall, or slip out. Synon. Hysteroptosis Vagince; Colpoptosis ; Elytroptosis. — A descent, more or less complete, of the vagina.
Symptoms. Protrusion of the vagina usually accompanied by prolapsus uteri, though it may occur alone. If entire circumference of vaginal mucous membrane be prolapsed, a projecting tumor is found at vulva. Surface may be inflamed and excoriated. Bladder rendered irritable : often, emptied with difficulty.
Cases of partial more common than of complete prolapsus. When anterior wall is alone affected, posterior wall of bladder is drawn down — Vaginal cyfitocele. The posterior wall of vagina and anterior wall of rectum may be protruded — Vaginal rectocele. In the one case, urine is apt to accumu- late in pouch formed by bladder ; in the other, a pocket forms, in which hard faecal masses are retained, causing constipation and sense of weight.
Treatment. Generally : — Nourishing food Rest. Avoidance of strain- ing, and of lifting heavy weights. Quinine, steel, and strychnia, 380. Phosphoric acid, nux vomica, and bark, 376. Phosphate of zinc and steel, or bark, 414. Sulphate of zinc and nux vomica, 409. Colocynth, or aloes, and nux vomica, 175. Olive oil enemata, 188. Castor oil and turpentine eneniata, 190. — Locally: — Cold saltwater hip-baths. Alum and zinc in- jections, 42.5. "i'annin and catechu pessaries, 423. Boxwood, or India-rub- ber pessaries. Diminution of vaginal capacity, by dissecting off one or more strips of mucous membrane, and bringing edges together with inter- rupted suture.
VAGINAL TUMOR.— These growths may consist of :—
Polypus of vagina. Very rare. Produces leucorrhcea, bearing-down, irritability of bladder, etc. May be cured by excision. If any vessel be felt pulsating in pedicle, a ligature should be applied, and tumor snipped off just below it.
Fibrous tumors. Sometimes found imbedded in submucous tissue of vaginal wall. Seldom troublesome : may perhaps cause hemorhagc. Growth can be shelled out with fingers or handle of scalpel, after division of mucous membrane covering it.
Mucous follicular cysts. May be superficial ; formed by dilated follicle, excretory orifice of which has closed. Deep-seated cysts produced by ac- cumulation of contents of interstitial or closed follicles. Either form to be cured by puncture, and application of nitrate of silver to inner walls.
VAGINISMUS. — From Vagina, a sheath; terminal -ismus. — An in- voluntary spasmodic closure of the sphincter muscle of the vagina, with such excessive supersensitiveness of the surrounding tissues as to form a complete barrier to coition (Marion Sims).
May exist as a simple or complicated state. In the first case, no local structural change. Excessive tenderness of vaginal orifice, and of hymen or its remains. Slightest touch causes great agony. In second form, in addition to supersensitiveness, inflammation of follicles about vulva ; or fissure of fourchotte ; or hypertesthesia of entire vaginal mucous lining; or some uterine displacement; or a contracted state of os uteri and cervical canal. — In either form, essential remedy consists in removal of hymen, inci- sion of vaginal orifice, and subsequent dilatation with graduated bougies.
VAGINITIS, — From Vagina, a sheath ; terminal -itis. Inflammation of the vagina may be acute or chronic : —
1. Acute Vaginitis. — Synon. Elytritis ; Colpitis. — Not very common. Morbid action not always limited to mucous membrane : tissues beneath sometimes involved, causing distressing suffering. Arises from violence ;
VARICELLA— VARICOCELE. 269
pressure of foetal head in lingering labor; want of cleanliness with depres- sion of vital powers, etc.
Symptoms. Pain and sense of heat in vagina. Itching about vulva. Irritability of bladder. At first, mucous membrane dry and swollen : secre- tion of mucus checked. Then, creamy mucus, or much purulent matter, or pus is poured out : pain diminishes. Backache ; pains about hips and upper part of thighs ; sense of weight or bearing-down ; smarting and ten- derness. Disease runs its course in seven or eight days, or suljsides into chronic form. — If submucous tissues be involved, there may be rigors, fever, headache, rapid pnlse. severe throbbing pains. Suppuration : abscess bursts into vagina, or pus burrows making its way to perineum on both sides of labia.
Treatment. Hot hip baths. Vaginal injections of warm water. Pes- saries of oxide of zinc and belladonna, or of acetate of lead and opium, 423. Confinement to bed or sofa. Castor oil. Cubebs. Fish diet: eggs, milk, tea, demulcent drinks. — If suppuration occur : — Ammonia and bark, STL Quinine with mineral acids, 379. Opium or morphia, 343. Opium and belladonna, 344. Fomentations or linseed poultices to vulva. Abscesses to be opened if they point.
2. Chronic Vaginitis. — Synon. Catarrhus Gem'falium ; Blennorrlicea Genitalium ; Tlie Wh/tes ; Vaginal Lettcorr/fcea (Asu^oj. white ; /jeui, to flow). — One of the most common diseases to which women (particularly the married) are liable.
Symptoms. Constant or frecpient leucorrhceal discharge — " the whites." Backache; sense of weariness after slight exertion. Loss of appetite; in- digestion; flatulence and constipation. Mental depression. — Exfoliation of epithelial covering of mucous membrane may occur; comes away in flakes, or in masses forming complete casts of vagina.
Treatment. Mineral acids and bark, 376. Nitro-hydrochloric acid, 378. Mineral acids and quinine, 379. Quinine and steel, 380. Phosphate of iron, 405. Gallic acid. Colchicum. Cod-liver oil. Pepsine. — Cold salt water hip baths. Astringent injections, 425. Tannic acid, or sulphate of zinc, or acetate of lead pessaries, 423. Brushing vaginal wails with solution of nitrate of silver, or solution of carbolic acid in glycerine (gr. 10 to fl. oz.j).
VARICELLA. — The dim. of Variola {Varius, spotted). Synon. Va- riola iSpur/a ; Pseudovariolce. — The mildest of the eruptive fevers. Often classed with the Vesicular skin diseases. — See Chicken Pox.
VARICOCELE. — From Fa j'/x, a dilated vein; xi^x-/;, a tumor. Synon. Oscheocele Varicosa ; Spermatocele ; Girsocele (from Kipaoj, a varix ; xrXri). — A varicose condition of the veins of the spermatic cord may arise from any cause which retards upward flow of blood, — as tumors, trusses, consti- pation, corpulence, frequent straining in erect posture, etc. Spermatic veins on left side most frequently affected, owing to their greater length, and greater liability to pressure from a distended colon.
Symptoms. Swelling; pyriform with base on testis. Veins can be rolled under fingers, like worms in a bag. Weight, and aching about groin and loin. Uneasiness or pain about scrotum. Neuralgia of testicle, sometimes atrophy. Mental depression.
Treatment. Palliative :- — A regular action of bowels to be insured by attention to diet, mild aperients. Improvement of general health: mineral acids, nux vomica, etc. Bathing scrotum with salt water night and morn- ing. Firm support with a suspensory bandage. Invagination of loose skin of scrotum through a padded steel ring. Radical cure: — Obliteration of the veins. To be accomplished either by a spring truss ; or by passing
270 VAEIOLA— YERTIGO.
ligatures of silver or iron wire subcutaneously, so as only to divide the veins; or by passing a hare-lip pin underneath the veins, and then twisting a figure of 8 suture over it, or by arresting circulation at two points by means of hare-lip pins, and dividing veins between them ; or by Ricord's ligature and bridge. None of these proceedings free from risk.
VARIOLA. — From Varins, spotted. Synon. Pestis Variolosa.- — A very contagious eruptive fever ; the frequency and severity of which have been greatly diminished by the discovery of vaccination. Included by Willan in the Pastular order of skin diseases. — See Smallpox.
VASCULAE TUMORS OF URETHRAL ORIFICE.-Synon. Ure- tliral Haemorrhoids. — Not uncommon in females; very rarely, vascular tumors have been found at orifice of male uretlira.
In women, external orifice of meatus urinarius is the most frequent seat of vascular tumor. Excrescence varies in size from that of a pin's head to that of a date stone. Exquisitely sensitive, often causing irritability of bladder with pain on passing water. To be cured by excision and subse- quent application of actual cautery to submucous base. Or a ligature may be applied, passing a tenaculum through base and tying tightly round it. Chloroform usually necessary for either operation. Patient to be in posi- tion for lithotomy. Chromic acid as escharotic said to be effectual. Acid solution of nitrate of mercury, or potassa fusa, sometimes employed. Nitrate of silver worse than useless.
VENEREAL DISEASE.— From Venus, the Goddess of Love. A term generally applied to those disorders which result from impure connection. — See Gonorrhoea; Syphilis, etc.
VERRUC-ffi. — From Verruca, a wart. Synon. Ecphyma Verruca ; Veyetations ; Warts. — Consist of collections of hypertrophied cutaneous papillas ; each papilla being separate and merely covered with thin cuticle, or a bundle of papilla being bound together by an excess of dry and hard scaly epithelium.
Treat.ment. Excision. Nitrate of silver. Glacial acetic acid. Acid solution of nitrate of mercury. Creasote. Carbolic acid. Savin. Chro- mic acid, 196. Tincture of perchloride of iron.
VERTIGO. — From Verto, to turn round. Synon. Circnmgyratio ; Giddiness ; Swimming of the head. — A transitory sense of giddiness, of whirling round, or of falling. Surrounding objects appear to be in motion : sufferer loses his balance for a moment or two, and is in danger of falling unless he can grasp some object. Usually followed by headache : occasionally by nausea.
Often a symptom of incipient disease of brain. Sometimes betokens gene- ral weakness ; or a poison in blood, as opium or tobacco or alcohol ; or some cardiac, hepatic, renal, gastric, or intestinal affection. Any disturb- ance of cerebral circulation will induce giddiness. In mild form of epilepsy, giddiness, and a fit of absence (epileptic vertigo) are prominent symptoms. Swimming in head, a forerunner of apoplexy and paralysis. Paroxysmal attacks not uncommon in the aged, either without obvious cause, or from disease, of coats of cerebral arteries, or from passive venous congestion.
Tonic and antispasmodic remedies more frequently called for than those of a lowering nature. Chalybeates when there is ansemia. Purgatives, spare diet, blisters behind ears, out-door exercise if there be evidence of active arterial congestion. Small doses of corrosive sublimate in simple vertigo of old people.
VESICAL IRRITABILITY. 271
VESICAL INFLAMMATION— From Vesica, the urinary bladder: Inflammo, to iuHarae. Syiioii Cystitia ; Cystophlogia ; I'iflammatio Vtaicce. — Inflammation of the bladder may be acute or chronic: —
1. Acute Cystitis, — From Kucmj, a bladder; terminal -«'(!/.s. — A severe disease which may arise idiopatiiicaliy ; or may supervene on chronic inflam- mation, irritation of a calculus, external injiuy, disease of pelvic viscera, etc. Mucous lining' of neck and bas-fond of bladder more frequently attacked than all the coats.
Symptoms. Shiverino;. Fain over bladder. Heat of urethra : constant desire to pass urine, which comes away in small quantities. High fever. Nausea. Constitutional disturbance : menial depression. Bladder can per- haps be felt as a small rounded tender tumor. Severe pain, extending to perineum and down thighs; increased by abdominal pressure, rectal or vaginal examination. Tenesmus. — Unless resolution occur, — unbearable pain. Constant calls to micturate ; urine expelled in drops ; or retention. Urine becomes fetid and alkaline: contains shreds of fibrin entangling pus and blood corpuscles. Great prostration. Cold clammy sweats. Low muttering delirium. Fatal exhaustion.
Treatment. Opium. Opium and belladonna, 344. Aconite. Hot hip baths. Fomentations. Linseed or hemlock poultices. Castor oil. JMuci- laginous fluids. Catheterism. Wine, brandy, cream, raw eggs, essence of beef, etc., as soon as indications of exhaustion commence. Injection into bladder of one or two grains of morphia in an ounce of water.
2. Chronic Cystitis.— Synon. Cystirrhoea ; Cystorrhoea ; Blennor- rhoea Urinalis ; Tenetimus Vesicce Macosus ; Catarrhas Veaicce. — This form of inflammation common. Sometimes follows an acute attack : more frequently due to gout, retention of decomposing urine, irritation of urine charged with saline diuretics, foreign substances in bladder, or to extension of inflammation from rectum or uterus, etc.
Symptoms. Often slight. Feeling of indisposition. Increased sensi- bility of bladder walls. Frequent micturition. Urine scanty, with per- haps a small quantity of mucus or pus : sometimes loaded with viscid ropy mucus.
Treatment. Catheterism, unless bladder can be thoroughly emptied at will. Washing out bladder with warm water ; or with solutions of henbane, morphia, opium, or some astringent. Opium and belladonna suppository, 340. Oxide of zinc and belladonna vaginal pessaries, 423. Belladonna plaster to sacrum. Benzoate of ammonia, 40. Infusion of bearberry (in- fusum uvas ursi). Infusion of buchu. Decoction of pareira. Decoction of couch-grass. Cubebs, in small doses. Demulcent drinks : barley water, infusion of linseed, etc. Animal food : milk or cream : raw eggs. Alcoholic stimulants.
VESICAL IRRITABILITY. — From Vesica, the urinary bladder. Synon. Impatientia Vesicce ; Gyderetliismus. — Irritability of the bladder is said to exist when there is an unnaturally frequent desire to pass urine. May arise from organic disease of kidneys, bladder, prostate gland, or urethra: vascular tumor of female urethra; pressure of enlarged or dis- placed uterus ; irritation of hismorrhoids, or intestinal worms ; presence of a tumor or calculus in bladder; or simply from some irritating constituents in the urine or functional derangement of kidneys, bladder, stomach, or nervous system.
Symptoms. Desire to micturate comes on suddenly and frequently: urine may have to be passed every fifteen or thirty minutes. Inability to resist desire: if attempted, uneasiness or aching pain. Total amount of urine seldom increased in quantity. Bladder diminishes in size. General health suffers from the annoying irritation.
272 VESICAL TUMORS.
Urine always to be examined. If preternaturally acicl or alkaline; if loaded with urates, pliospliates, or oxalates; or if it contain pus, albumen, sugar, or any other morbid material, — disease must be traced to its orioin.
Treatment. Dilute nitro-hydrochloric acid, belladonna, and pareira, 378. Solution of potash and buchu, 69. Ferruginous tonics. jDecoclion of couch-grass or triticum repens (oz. 1 of underground stem to water fl. oz. xx). Opiate or belladonna suppositories, 340. Oxide of zinc and bella- donna pessaries (for women.), 423. Tincture of cantharides. Tincture of benzoin. Infusion of bearberr3^ Colchicum. Cod-liver oil. — Warm or tepid salt-water baths. Local application of carbonic acid gas. Avoidance of stimulants. Substitution of cocoa for tea and coffee. Mucilaginous diluents. — See Enuresis.
VESICAL PARALYSIS.— From Vesica, the urinary bladder. Synon. Ct/sioparati/sis ; Cystiiplegia ; Acystinervia. — The muscular coat of bladder may become paralyzed from some influence confined to this viscus; disease of nervous centres, inducing simultaneous loss of power in other organs ; or from constitutional debility. Liable to occur in the course of any acute disease in advanced life, when unless discovered and treated at once it is a serious complication.
Symptoms. Unlike the rectum, the bladder retains its contents when paralyzed. When distension becomes great, urine dribbles away by urethra ; hence, incontinence of urine often an indication of retention. Enlargement in hypogastrium and bladder felt above symphysis pubis. Urine loaded with mucus : alkaline : offensive ammoniacal odor. Pain at neck of bladder : as distension gets great, the walls lose their sensibility. Severe constitu- tional disturbance. Frequently, death from coma or exhaustion.
Treatment. Use of catheter : bladder to be slowly but thoroughly emptied. Tepid or cold water injections. Ergot of rye. Strychnia or nux vomica. Arnica. Aloetic purgatives. Hipbaths. Galvanism, cold douche, or blisters to lower part of spine.
When disease of nervous centres exists, symptoms can only be relieved as they arise. — See Enuresis.
VESICAL SPASM. — From Vesica, the urinary bladder. Synon. Cys- tosjjasmus ; Isclttiria Spasmodzca. — Spasmodic attacks of pain in bladder. May arise from vesical calculus or tumor; diseases of rectum and uterus; abscess of kidney ; ulceration or other organic disease of bladder, prostate gland, etc.; abnormally acid urine; excessive venery ; hysteria; or from use of irritating diuretics — cantharides, oil of juniper, savin.
Symptoms. Severe pain at lower part of abdomen, extending to urethra. Involuntary micturition : sometimes retention of urine with urgent desire to micturate. Tenesmus. — When of long continuance, death has resulted with symptoms of suppression of urine.
Treatment. Relief of spasm : — Hot baths. Hemlock poultice. Poppy- head fomentations. Linseed poultice with camphor to perineum. Opium and belladonna suppository, 340. Ether and opium draughts, 85. Mucila- ginous drinks.
Removal of cause : — Colchicum. Quinine. Citrate of potash. Regu- lation of diet: avoidance of stimulants, tea, and coffee. Warm clothing. Avoidance of violent exercise or sexual intercourse. Appropriate remedies for renal abscess, calculi, etc.
VESICAL TUMORS. — From Vesica, the urinary bladder. — The growths which may be developed on the walls of the bladder are; — Warty or polypoid fibrous bodies ; villous or vascular growths ; and malignant tumors.
Symptoms. AVhatever the nature of the tumor, the symptoms resemble
VOMITING AND RETCHING. 273
those causpfl by calculus. Frequent micturition. A painful sense of ina- bility to empty l)la(l(ler. Urine may be bloody, or purulent, or ammoniacal and loaded with mucus.
Malii^nant more common than innocent growths. Medullary cancer, or epithelioma, more frequent than scirrhus. Cancerous deposit generally primary; but may result from extension of disease from rectum, prostate, uterus, or vagina. Suffering very great. Urine bloody : perhaps cancer- cells may be found.
Treatmknt. Relief of prominent symptoms. Narcotics, to ease pain. Astringents, to check hajmorrhage. Nutritious food.
Polypoid fibrous, and pendulous villous growths, have been removed by ligature from female bladder, owing to ease with which urethra can be dilated.
VILLOUS CANCER.— From F//Zus, shaggy hair.— A variety of medul- lary and perhaps of epithelial cancer, occurring most frequently on mucous membrane of urinary bladder. The histories coincide with those of medul- lary cancers. — See Cancer.
VITILIGO. — From Vitulus, a calf; terminal -{go. — A rare disease, said to produce a glistening veal-like appearance of skin. — Two varieties : — Vitiligoidea plana and V. tuberosa, which may occur separately or combined. In former, irregular yellow patches are observed, slightly elevated and hard; in latter, isolated or confluent tubercles, ranging from the size of a pin's head to that of a large pea; generally symmetrical ; upper eyelids a favorite seat. Possibly there may be some connection between this skin disease and derangement of the liver.
Vitiligo sometimes confused by authors with lepral alphoides, or with hipus non-exedens. Other writers seem to regard the appearances as merely due to a diminution of pigment, without any change of texture ; making it of same nature as leucoderma. No remedy for it at present known.
VOMITING AND RETCHING.— Synon. Emesis ; Sickness of the Stomach; Spewing. — Vomiting (from Vomo) is due to forcible and repeated contractions of abdominal muscles, the diaphragm being fixed by closure of the glottis ; the stomach is thus compressed against the dia- phragm, and by this force together with its own contraction, the pylorus being closed and the cardiac sphincter relaxed, the gastric contents are expelled upwards. In retching there are fruitless attempts to empty the stomach, the cardiac sphincter being contracted; or the stomach is empty.
Sickness arises in many diseases: i.e. cerebral, spinal, pulmonary, renal, biliary, pancreatic, gastric, intestinal, or uterine and ovarian disorders. It may be due to sympathetic irritation of pregnancy. To irritation of pneumogastric nerve. 'I'o ingestion of poisonous or irritating substances : drunkenness. To blood-poisoning, as in ichorhajmia : continued and erup- tive fevers, especially at their onset. To acute or chronic peritonitis, par- ticularly if gastric peritoneum be involved ; or to the pressure of the fluid in ascites. 'I'o ileus, intussusception, strangulated hernia, etc. Or it may occur as an idiopathic affection, — no other morbid state being discoverable.
Symptoms. Vary with the cause. Some prominent distinctions are shown in following table : —
Gastric or Hepatic Vomiting. 1. Preceded by nausea, which is relieved, at all events, temporarily, by the discharge of the stomach's contents. 18
Cerebral or Sympathetic Vomiting. 1. Little or no nausea. Retching continues, often in spite of stomach being empty. Directly any fluid or solid is taken, it is rejected.
274
VOMITING AND EETCHING.
Gastric or Hepatic Vomiting.
2. Vomit consists of partially digested food, biliary matters, and offensive secretions. Sometimes acid water ; pus ; blood.
3. Loss of appetite, or even a dis- gust for food.
4. Tongue coated ; breath foul ; conjunctivpe often yellowish ; head- ache secondary in point of time.
5. Headache : chiefly frontal, per- haps not severe on right side, seldom lasting more than twenty-four hours, and often relieved by vomiting.
6. Griping abdominal pain ; fetid eructations; diarrhoea; unhealthy watery stools.
7. Retching; increased salivation ; more or less abdominal tenderness ; faintness or exhaustion.
8. Frequently an increase of vom- iting at 4 A. M., especially in hepatic disease.
Cerebral or Sympathetic Vomiting.
2. Vomit consists of unaltered food. Of frothy mucus. Never pus or blood. Sometimes a con- siderable quantity, sometimes only a tinge of bile.
3. Appetite remains. Frequently a desire for food immediately after vomiting.
4. Tongue clean ; breath pure ; conjunctiviB colorless, or only inject- ed ; headache primary.
5. Headache severe ; chiefly over vertex and occiput. May be con- stant for days. May be altogether absent.
6. No eructations of foul air. Generally, obstinate constipation ; or stools solid and healthy. .
7. Stomach emptied without effort; no increase of saliva; no abdominal tenderness ; little or no fatigue or faintness after vomiting.
8. Perhaps, the most severe at- tacks are experienced about 7 A. M.
Treatmicnt. General remedies: — Attention to diet: bland simple nourishment in very small quantities at a time. Cold water; ice to suck ; cherry water ices; milk and water; milk and soda water; gruel; milk arrowroot; water arrowroot with small quantities of brandy; beef-tea; veal, chicken, or mutton broth ; white fish : weak iced brandy and water ; champagne; sparkling Moselle or Hock; light Hungarian wines. Nu- trient enemata, 21, 23. Aperient enemata, 188, 189, 190. Calomel in purgative doses (grs. 5 to 10). Calomel, blue pill, or mercury with chalk, as alteratives. Taraxacum, 227, 228. Seidlitz powders, 169. Podo- phyllum, 160. Carbonate of magnesia. Tartaric or citric acid. White bismuth, 65. Charcoal biscuits. Coffee. Carbonic acid. Citrat-e of ammonia, potash, or soda in effervescence, 348, 362, 403. Dilute hydro- cyanic acid, 70, 86, 377. Laurel leaf water (aqua laurocerasi, min. x to XXX). Dilute nitro-hydrochloric acid, 378. Sulphurous acid. Creasote, 41, 90. Carbolic acid. Rectified pyroxylic spirit (spiritus pyroxylicus rectificatus, min. v to xl). Carbonate of ammonia. Aromatic spirit of ammonia. Infusion of tincture of calumba. Cinnamon. Spirit of chloro- form. Three or four drops of chloroform on a lump of sugar. Spirit of ether. Nitrate of silver. Sulphate of copper. Oxide of silver, 47. Salicin, 388. Sulphite of soda, 48. Small doses of ipecacuanha wine (one or two minims frequently]. Opium. Belladonna. Pepsine, 420.
Locally : — Sinapisms over epigastrium. 'I'urpentine stupes. Blisters. Seton. Issues. Hemlock poultices. Linseed poultices. Wet compress, 136. Belladonna, opium, warm, galbanum, pitch, or chalybeate plaster. Chloroform on lint. Ether spray. Extracts of belladonna and poppies, 297. Dry cupping. Leeches.
Sympathetic vomiting in pregnancy, uterine or ovarian disease, etc. : — Ice to suck freely. Soda water. Champagne : sparkling Hock or Moselle. Pepsine, 420. Tincture of iodine in small doses. Bromide of potassium. Strong coffee before rising in the morning. Infusion of cloves. Lemon juice. Oxalate of cerium (gr. 3 to 5 in powder or pill). Drop doses of
TULYAL PRURITUS. 275
ipecacuanha wine every four hours. Rectified pyroxylic spirit. White bismuth. Laurel water. Effervescing draughts with caliimba, cascarilla, etc. Setons, issues, sinapisuis, stimulating liniments, turpentine stupes, or repeated flying blisters to epigastrium. Leeches to os uteri, if there be congestion : nitrate of silver, if there be excoriation or ulceration. Vaginal pessaries of iodide of lead and belladonna, 423. In very severe cases, the induction of premature labor. Subcutaneous injection of morphia.
Hysterical vcnnitivg : — Sunibul, 369. Nu.x vomica, or strychnia, 387, 407,408. Assafffitida, 89, 190. Valerian, 87,363, 41 i. Shower baths. Dry cupping over stomach and margins of lower ribs.
*S'ea-.sic/i«e.s,s .- — Recumbent posture. Ammonia. Brandy. Whisky. Chloroform by inhalation, or a few drops on sugar. Oxalate of cerium. Subcutaneous injection of morphia. Tight belt round the body. Chap- man's ice bags to spine.
See GciHtritia ; Gastric ulcer ; Gastric cancer j Cholera; Hceinatemesis; Obstruction of Boivels, etc.
VULVAL CANCER. — From Vulva, a covering, — or perhaps as if Va.lcie, folding doors.- — Any part of external genitals, or of vaginal walls, inaj' become the seat of malignant disease. Occurs primarily, or second- arily. Epithelial cancer more common than other forms. Relief may be given by excision, where disease is confined to external labia. — See Cancer.
VULVAL CORRODING ULCER. — Synon. Vulval Esthiomenos {'EaOico, to corrode or eat away). — An inveterate and progressive ulceration of external genitals. Probably of same nature as Rodent ulcer.
Symptoms. An intractable ulceration, which commences on some part of external genitals, and gradually creeps over vulvo-anal region : surrounding structures have a tendency to become hj-pertrophied. As ulcpr heals in one direction, it extends in another: process of repair accompanied by for- mation of a firm burn-like cicatrix, which has a tendency to cause contrac- tion of vaginal or anal orifice. Suffering very slight for several months: until vaginal orifice becomes fissured by it, or mouth of urethra gets in- volved, there is no pain during sexual intercourse or micturition. For a long time, general health not affected ; menstruation occurs regularly ; neitfier loss of strength nor flesh. But unless a cure be effected, profuse discharge ultimately proves very weakening; appetite fails; dyspepsia; attacks of colliquative diarrhoea; sometimes, hemorrhage.
Death seldom occurs until after lapse of eight or ten years. May be due to peritonitis ; erysipelas ; stricture of recium ; hemorrhage ; or fatal exhaustion.
Treatment. Thorough excision ; with extirpation of any tubercular excrescences, if present. Use of tents or bougies, as parts heal, to prevent undue contraction of vaginal and anal orifices. Efficacy of potential caustics very doubtful. Nourishing food. Cod-liver oil. Daily hip baths. Ano- dyne lotions.
If there be any suspicion of syphilitic taint, — Iodide of potassium, 31. Green iodide of mercury, 53. Red iodide of mercury, 54. Donovan's triple solution, 51. Mercurial vapor bath, 131.
VULVAL PRURITUS.- From Vrdva, a covering: Prtirio, to itch.— Irritation of the vulva may be simply a local affection; or a symptom of some disease, — excoriation of labia uteri, onset of carcinoma, etc. Not uncommon in advanced life : sometimes troublesome during pregnancy.
Symptoms. Itching, tingling, formication, or smarting about vulva: in- creased by stimulants and warmth. The scratching resorted to produces ii-ritating excoriations and scabs about vaginal labia, perineum, vestibule, and mons Veneris. The constant annoyance Causes general irritability, restlessness at night, loss of appetite, etc.
276 VULVAL TUMORS.
Pruritus not to be confounded with irritation from prurigo, presence of lice, follicular vaginitis, eczema, or from crops of small boils.
Treatment, (reiiera//?/ .•—Sulphate of soda and sulphur, 148. Sulphur and magnesia, 153. Compound powder of rhubarb. Rhubarb and blue pill, 171. Steel and sulphate of soda, 180, 181. Pepsine, 420. Nitro- hydrochloric acid, 878. Phosphoric acid and nux vomica, 376. Quinine, 379. Quinine and belladonna, 4.5. 'I'ar capsules, 36. Arsenic, .52. Cor- rosive sublimate, 27. Colchicum, 46. Copaiba. Camphor. Tincture of In- dian hemp. — Plain animal food, milk, eggs: avoidance of alcohol, tea, coffee.
Locally: — Tobacco lotion, 265. Lotion of corrosive sublimate and mor- phia, 271. Lotion of acetate of lead and pruss!c acid, 263. Lotion of morphia and solution of potash, 266. Lotion of borax, morphia, and gly- cerine, 268. Painting vulva with mixture of equal parts of belladonna and aconite and chloroform liniments. Cod-liver oil. Olive oil. Nitrate of silver. Lime liniment. Clycerine and rose-water (one part to eight). Calomel ointment. Equal parts of red oxide of mercury ointment and cod- liver oil. Carbonate of lead ointment. Hip baths. Vaginal injections of plain water; or of solution of lead and poppies, 425.
If there be excoriation of labia uteri it must be healed. In carcinoma, relief may be given to irritation by pessaries containing oxide of zinc and belladonna, 423.
VULVAL TUMORS. — From Vulva, a covering, — or perhaps as if Valvoi., folding doors. Several varieties of morbid growths are met with about the vaginal labia : —
1. Encysted Tumors. — Have their origin in connective tissue of vaginal labia ; or'in one of lobules of vulvo-vaginal gland ; or in entire gland. The tumor feels firm but elastic.
Symptoms. When about size of walnut, discomfort on walking. Pain after intercourse. Irritability of bladder. Tenderness about time of cata- menial periods. Inflammation and suppuration of cyst walls may occur, converting tumor into an encysted abscess.
Treatment. Simple incision, seldom followed by permanent cure. Ex- cision of portion of cyst wall. Evacuation of contents, afterwards rubbing cyst walls with niti-ate of silver, or iodine liniment. Introduction of seton through entire swelling. Cyst to be dissected out. Sensibility to be removed by ether spray (Richardson).
2. Fibrous Tumors, etc. — Occasionally developed in one of the labia majora ; more rarely about perineum. They vary in size from that of a hazel nut to that of an orange.
Fatty tumors sometimes met with in same situations. May become pediculated.
The only remedy for either form of growth is excision. Sensibility to be removed by ether spray.
3. Warty Growths. — Usually scattered about labia, nymphae, vestibule, perineum, and around anus: sometimes appear in large clusters. They give rise to irritation, and offensive moisture.
Removal with scissors necessary. Sensibility to be destroyed with ether spray. Hemorrhage, if any, requires application of solution of perchloride of iron. Escharotics painful and inefficient.
4. Hypertrophy of Labia. — May occur to an enormous extent : some- times constitutes a form of elephantiasis. ^Enlargement often due to syphi- litic taint.
Treatment. Red iodide of mercury, 54. Mercurial vapor bath, 131. Iodide of potassium, 31. Iodide of iron, 32. Excision seldom successful without constitutional treatment.
VULVITIS. 277
5. Abscess of Labia. — May occur from a blow, forcible sexual ititercourse, irritation of <;on(n-r]ioeal or acrid leucorrhoeal discharjjes, etc. Produces throbbing pain, heat and swelling, constitutional disturbance.
A free incision will be needed. Rest. Ammonia and bark, 371. Cod- liver oil. Animal food.
6. Pudendal Haematocele. — Synon. Labial Thi-ombus ; Sanguineous Tumor of Vulva. — Extravasation of blood into areolar tissue of one of the labia majora, nymphaj, or vaginal walls may occur from injury : from rupture of a vessel during parturition.
Symptoms. Considerable elastic swelling. Pain. Tumor sometimes bursts : if small, clot may be absorbed.
Treatment. Puncture; followed by application of pads and a T-bandage to prevent further hemorrhage. I>atter may also be prevented by lint saturated with solution of perchloride of iron.
VULVITIS. — From Vulva, a covering; terminal -z'^z's. Synon. Tnfiam- matio Vuivce. — Several forms of troublesome inflammation may attack the vulva : —
1. Simple Vulvitis. — Not very uncommon from want of cleanliness, excessive intercourse, venereal taint, or irritation of adjoining structures — rectum or uterus.
Symptoms. Pain and tenderness. Swelling. Mucous discharge. Heat or scalding during micturition. Aching about loins, groins, and thighs. Constitutional disturbance.
Treatment. Seidlitz powders. Effervescing citrate of magnesia. Cold hip baths. Alum or lead lotions. Avoidance of stimulants.
2. Gangrenous Vulvitis. — Has on a few occasions prevailed as an epidemic amongst lying-in women.
Symptoms. Commence three or four days after delivery, with vomiting and diarrlicea, or fever and abdominal pains, or with slight hemorrhage. Prostration, anxiety. Edematous redness of vulva. Disease progressing, pultaceous plates form on interior of vulva, somewhat like diphtheritic membranes. Separation of plates does not occur until end of first or second week : small suppurating wounds left. Disease may extend to uterus, causing gangrene. Peritonitis.
Treatment. Mineral acids and bark, 376. Quinine, 379. Quinine and steel, 380. Opium. Cod-liver oil. Essence of beef. Milk, cream, raw eggs. Brandy or port wine. Locally: — Fomentations. Yeast poultices. Application of strong hydrochloric acid.
3. Follicular Inflammation of Vulva.— Synon. Follicular Vaginitis. — An accumulation of sebaceous matter, or an inflammation of the sebaceous follicles scattered over mucous membrane of vulva. Both sides of vaginal entrance usually affected; with tissues within nymphae and at base of clitoris. — Very intractable. Most common during pregnancy and about change of life.
Symptoms. Paris found more or less inflamed: studded with numerous raised vascular points, sometimes having specks of ulceration on summits. Soon, the points coalesce, forming a strip of highly injected mucous mem- brane: subsequently, vascularity disappears, tissues lopking as if covered with white paint (Oldham). Disturbance of general health. Constriction of sphincter vaginae muscle. Leucorrhcea : irritation and smarting of geni- tals. Sexual intercourse very painful. Pains in back and thighs.
Treatment. Locally : — Avoidance of caustics and astringents. Morphia and hydrocyanic acid lotion, 266. Tobacco lotion, 26.5. Glycerine and lime-water, 286. Lime liniment. Iodide of lead and belladonna ointment, 293. Acoaitine and calomel ointment, 296. Hydrocyanic acid and atropia
278 WASTING PALSY— WEIGHT OF BODY.
ointment, 306. Hemlock poultices. Wai-ra hip baths, containing extract of poppies and soda.
Generally : — Plain nourishing food. Avoidance of seasoned dishes: tea, coffee, wine, and beer. Milk. Brandy and soda water. Arsenic and bark, 52. Mineral acids and bark, 376. Nitro-hydrochloric acid, 378. Quinine with aconite, 379. Corrosive sublimate and sarsaparilla, 27. Cod-liver oil. Change of air.
4. Pudendal Erythema. — Generally from want of cleanliness, or from excessive exhalation of moisture in stout middle-aged women, the surfaces of the labia and perineum and upper part of inside of thighs become the seat of an erythematous eruption. Parts of a bright red color: sensation of heat and great discomfort. Sevei'e forms may end in erysipelas.
Trkatmknt. Non-stimulating diet. Removal of any derangement of general health. Great attention to cleanliness. Bathing with dilute solu- tion of subacetate of lead. Dusting with oxide of zinc, or powdered sper- maceti. Fuller's earth, a common domestic remedy.
5. Infantile Lencorrhoea.- — An irritation or subacute inflammation of mucous glands of vulva, producing a muco-purulent or purulent discharge — May occur from irritation of worms or teething: sometimes as a complica- tion during progress of one of eruptive fevers.
Symptoms. Derangement of general health : children often strumous, badly fed, etc. There may be only a mucous discharge, with irritation of surrounding parts : if disease extend up vagina, profuse purulent discharge, heat and pain during micturition, excoriation of surrounding parts, perhaps aphthous ulceration. Caution necessary, lest disease be wrongly attributed to gonorrhoeal infection, or to violence in attempting a rape. Fatal sloughing, or gangrenous ulceration of vulva, very rare. — In diphtheritic vulvitis, tough false membranes formed on inner surface of labia. Effects of diphtheritic poison very seldom confined to vulva. — Scarlatinal vaginitis, attended with exfoliation of patches of epithelium.
Treatment. Plain nourishing food : milk. Bark. Quinine and steel. Cod-liver oil. Glycerine. Chemical food, 405. Chlorate of potash. Warm hip baths. Fomentations. Alum or subacetate of lead lotions. Sea bathing.
WASTING PALSY. — A degeneration of the voluntary muscles, pro- ducing complete loss of power. — See Paralysis.
WEIGHT OF BODY.— The following table shows the normal weight in proportion to height. Loss of weight an early symptom in phthisis. A slow and gradual fall, more serious than a rapid and irregular diminution : a steady loss ahuays precedes tuberculosis (Dr. Hutchinson) : —
|
Exact stature. Ft. in. |
Mean Weight. St. lbs. lbs. |
Weight iner eased hy 7 per cent. St. lbs. lbs. |
|
|
■ 5 1 . . . |
. . 8 8 or 120 . . , |
, . . 9 2 or |
128 |
|
5 2 . . . |
. . 9 0 " 126 . . . |
. . 9 9 " |
135 |
|
5 3 . . . |
. . 9 7 " 133 . . . |
, . . 10 2 " |
142 |
|
5 4 . . . |
. . 9 13 '• 139 . . . |
. . 10 9 " |
149 |
|
5 5 . . . |
. . 10 2 " 142 . . . |
. . 10 12 •' |
152 |
|
5 6 . . . |
. . 10 5 " 145 .. . |
. . 11 1 " |
155 |
|
5 7 . . . |
. . 10 8 " 148 . . . |
. . 11 4 " |
158 |
|
5 8 . . . |
. . 11 1 " 155 . . . |
. . 11 12 " |
166 |
|
5 9 . . . |
. . 11 8 " 162 .. . |
. . 12 5 " |
173 |
|
5 10 . . . |
. . 12 1 " 169 . . . |
. . 12 13 " |
181 |
|
5 11 . . . |
. . 12 6 " 174. . . |
. . 13 4 " |
186 |
|
6 0 |
. . 12 10 " 178 .. . |
. . 13 8 " |
190 |
WRY-NECK— YELLOW FEYER. 279
This reads : — A man of 5 ft. 8 in. should weigh, in his clothes, 11 st. 1 lb. or 155 lb. (14 lb. = l stone); he may exceed this by 7 per cent., and so attain 11 st. 12 lb., or IGG lb., without afifectiiio^ his vital capacity; beyond this amount his respiration becomes diminished. According- to M. Quete- let the average weight of the clothes at different ages is one-eighteenth of the total weight of male body, and one-twenty-fourth of that of female.
WRY-NECK. — Synon. Torticollis. — A distortion, in which the head is drawn down to one side (often the right), and the face directed to the oppo- site. Due to contraction of one sterno-mastoid muscle. Paralysis of one muscle, allows the other to overpower its fellow. Inflammation, or rheuma- tic spasm of one muscle may cause it to contract unduly. Sometimes the affection is owing to lateral curvature of spine ; to caries of cervical verte- brte ; to tumors and enlargement of cervical glands ou one side ; or to con- traction of cicatrix left by a burn or ulcer.
'J'reatment. Injia'mmalory or rheumatic variety : — Rest. Fomenta- tions or hot bathing. Turkish bath. Ammonia and bark. Aconite or belladonna. Iodide of potassium with tincture of actea racemosa. Perma- nent form: — Apparatus to produce and maintain extension. Division of cicatrix, if present. Subcutaneous division of sternal or clavicular attach- ments of sterno-mastoid muscle, or of both. Excision of a portion of the trunk of the external branch of the spinal accessory nerve (Campbell de Morgan). — Paralytic variety: — Friction, blisters, irritating liniments, or galvanism to palsied muscle. Tenotomy ou sound side sometimes recom- mended. Improvement of general health.
XANTHELASMA. — A yellow discoloration of the skin usually occur- ring in small, well-defined patches on the upper eyelid. Sometimes asso- ciated with functional or organic affections of liver.
YELLOW FEVER.- — ^ Synon. Pestilentia Hcemagastrica ; Bulam Fever; Mai de Siam; Ti/phns later odes ; Bilious Remitting Yellow Fever; Black Vomit; Yelloio Jack. — An acute and very dangerous fever; accompanied with jaundice, severe headache, and vomiting of black matter. Almost limited to warm climates. Not of unfreqnent occurrence in sea-port towns of the West Indies, Africa, southern part of Spain. May be conveyed to temperate climates, but does not spread in them. May occur sporadically or epidemically. Probably not directly contagious, but locality poisoned. Male sex more obnoxious to the disease than tha female. One attack generally gives permanent immunity against another.
Symptoms. Often commence suddenly with languor, loss of appetite, giddiness, headache, mental depression. Sometimes begin with coldness of the surface, or distinct rigors; followed by fever which continues for a few hours. In a third class of cases, there is prostration from the first, -svithout febrile reaction; stupor, coma, and convulsions soon following. When there is decided fever, it generally becomes aggravated towards night ; pulse gets quick, skin hot and dry, eyes congested and painful, face flushed. Distressing headache ; perhaps confined to one temple. Pains in back and limbs ; in large joints. Irritability of stomach : tenderness on pressure; sense of tightness about praecordia ; nausea, followed after a few hours by constant vomiting and retching. Thirst, with desire for cold drinks. Urine diminished in quantity ; of a dark red color. Constipation; stools free from bile. Distressing restlessness ; mental anxiety ; sleepless- ness ; perhaps, active delirium. — At the end of second or third day, severity of symptoms greatly diminishes : patient feels much relieved : face gets slightly jaundiced : skin becomes moist, and there are copious bilious stools. Ill favorable cases, convalescence firmly established. More frequently im- provement of short duration. After some twenty-four hours, epigastric
280 ZONA.
tenderness is afrgravated : jaundice increases and spreads over body : tend- ency to stupor : pulse becomes feeble, irregular, and slow — perhaps as low- as thirty beats in the minute : tongue gets foul and dry : respiration em- barrassed : hiccough, thirst, nausea, vomiting, etc. are constant. Unless symptoms remit, grumous blood is vomited— black vomit: urine is sup- pressed or simply retained : skin becomes of a dark-brown hue : dark-colored blood effused in patches under skin, or exudes from nose, gums, anus, vagina, etc. : most offensive tarry-looking stools. There are now all the features of a most malignant fever : almost imperceptible pulse ; slow or stertorous breathing; involuntary evacuations; difficulty of deglutition and articulation ; suppressed or bloody urine ; with formation of buboes or patches of gangrene. Death takes place, preceded by coma or convulsions ; or patient retains consciousness to the close.
Usual duration from 3 to 9 days. Mortality about 1 in' 3. Death from overpowering effect of poison on the system, exhaustion, ursemia, or apo- plexy.
■"I'reatment. Prophylactic : — Removal of all nuisances : thorough ven- tilation and fumigation of narrow courts, cellars, docks, holds of ships, etc. Cleanliness on board ship : pumping out of foul bilge water. — Individuals exposed to risk, to live on plain nourishing food, avoiding the abuse of alcoholic drinks and sexual excesses: to have a due amount of sleep: to promote healthy action of skin, kidneys, intestinal canal : to have warm clothing : not to venture out early in the morning with the stomach empty. The special efficacy of strong coffee, quinine, and inunction with lard or oil, doubtful.
Curative: — From the commencement until convalescence is firmly estab- lished the recumbent posture to be strictly maintained : bed to be placed in centre of well-ventilated room : great attention to be paid to cleanliness. The indications presented by the urgent symptoms to be observed. The disease cannot be cured, but the patient may be guided through it. Simple diet: — Arrowooot, barley water, ice and iced water, tea, lemonade, broth, champagne, spruce, seltzer water, brandy and water. Podophyllum. Sul- phate of magnesia and senna. Calomel with quinine, or julap. Quinine. Bark. Sulphate of beberia. Tincture of perchloride of iron. Nitro-hy- drochloric acid. Morphia in a small dose. Turpentine. Creasote. Liquor potassae. Chlorine mi.xture. Chlorate of potash. Preparation of oxygen.
Blisters or sinapisms to nucha. Cold to the head. Compression of the temporal arteries, for relief of cephalalgia. Prolonged use of warm bath, or of wet sheet. Nitro-hydrochloric acid bath, 120: followed by use of sheet wrung out of the bath water. Sinapisms or turpentine stupes to epigastrium. Venesection : if at all, only in early stage.
Avoidance of ammonia; the blood often strongly ammoniacal. Alcoholic stimulants to be used cautiously, when kidneys are much congested.
ZONA.— From Zona, a belt. Synon. Herpes Zoster; Shingles.- — That form of herpes in which the vesicles, with their inflamed patches, are ar- ranged in the form of a band encircling half the circumference of the body. — See Herpes.
APTENDIX OF FOPxMULi^.
In prescribiiifr a medicine, attention must be paid to the following' points : — Age, Sex, Temperament, Habit, Condition of System, Climate, and Season of the year. The operation of most drugs is materially influenced by the form in which the medicine is given, the purity of the preparation, the time of day at which the dose is taken, and the condition of the stomach as regards the presence or absence of food. The succeeding fbrinulse are for Adults, unless the contrary is stated. The doses may, except in the case of mercurials and narcotics, be reduced by attention to this table : —
For an adult, suppose the dose to be .... 1 or gr. 60.
Under 1 year, will require only l-12th or gr. .5.
" 2 " " l-8th or gr. 74-.
" 3 " " l-6th orgr. 10"
" 4 " " l-4th or gr. 15.
" 7 " " l-8d or gr. 20.
" U " " 1-half orgr. 30.
" 20 " " 2-3ds or gr. 40.
Above 21, the full dose.
" 65, the dose must be diminished in the inverse gradation of the above.
Children bear as large doses of mercury as adults; but they are much more susceptible to the influence of opiates. Consequently, opium must be given in very minute doses to them. Females, also, from their more deli- cate organization and greater sensitiveness, require smaller quantities of powerful medicines than males. This is particuiai'ly the case during the periods of menstruation, pregnancy, and lactation.
The skill of the physician is shown by the administration of the proper remedy, in the ])roper quantity, at the proper time. A druggist's appren- tice can tell what agents will purge, vomit, or sweat; but a man must be practically conversant with disease to be able rightly to apply his thera- peutical resources to the exigences of any particular case. Instead of introducing medicines into the system by the stomach, it is often more advisable to do so by the rectum, or by the skin, or by the lungs, or by injections into the areolar tissue. Absorption takes place from the rectum as speedily and surely as from the stomach ; and hence purgatives emetics, narcotics, tonics, and nutrients may be admirably administered as enemata. The skin offers a mechanical impediment to absorption; but still poultices and fomentations, plasters, liniments and ointments, and medicated vapor or water baths are all valuable remedies. If the cuticle be removed by a blister, and the medicine applied to the denuded dermis in its pare state or incorporated with lard or mucilage, its action will be rapid. The system is quickly and thoroughly affected by the inhalation of medicated vapors, or of substances reduced to an impalpable powder. Subcutaneous injections must be employed with great caution ; since by this plan none of the medi-
282 APPENDIX OP FORMULA.
cine is lost, neither is it altered or dilntecl by the contents of the stomach, as happens wlien drugs are taken by the mouth. — In only exceptional cases can there be any advantage in procuring absorption through the conjunc- tiva, the nasal or pituitary membrane, or the mucous coat of the vagina ; but in these exceptional cases the benefit is often very great. — Injection into the veins is loo dangerous to allow of its being practised except as a last resource in grave diseases. — such as epidemic cholera, snake-bite, etc.
The practitioner will do well to bear in mind the following rules : — (1) When a disease is progressing favorably towards recovery, it is unwise to interfere with the spontaneous effort at cure by the administration of drugs. The end and aim of treatment is not only to restore health, but to do so safely and speedily and pleasantly. — (2) Where drugs are needed, and there is a choice of remedies, employ that one which will be the least dis- tressing at the time, and subsequently the least injurious to the constitu- tion.— (3) Put the medicine into that form in which it can be most easily taken. When possible, especially with children, cover the disagreeable taste of the draught by syrups, etc. — (4) If there be an idiosyncrasy with respect to any special medicine — such as mercury, arsenic, iodide of potas- sium, opium, strychnia, or nux vomica, quinine, assafcetida, turpentine, etc. — avoid administering it. "^Jliat a peculiarity of constitution, causing an extreme susceptibility to the influence of certain drugs and foods and odors, sometimes exists, cannot be disputed. It is as certain that it can seldom be safely combated. — (5) Attend to the condition under which the patient will be at the period of the medicine's action ; e. g., it will be worse than useless to give a sudorific to an individual obliged to be in the open air soon after taking it. — (6) Be careful that the various agents in the pre- scription are not incompatible with each other, unless it be desired to form some new or particular compound. Chemical incompatibility, however, is by no means synonymous with therapeutic inertness; for experience tells us that certain unchemical compounds — perchloride of mercury and tincture of bark, gallic acid and tincture of opium, calomel and compound ipecacu- anha powder, etc. — are all valuable preparations in curing diseases. — (7) Remember that, if a disease be incurable, it may still admit of great alleviation. Hence it is cruel to give up any case ; although, at the same time, the patient is not to be deceived by false promises. — (8) Never order, or sanction the use of, a quack medicine ; i. e., one the composition of which is kept a secret. — (9) Bearing in mind the weakness of human nature, as well as the prejudices and superstitions which are current, it is not only necessary to give good advice, but pains must be taken so to impress the patient and attendants that the- necessary treatment may be thoroughly carried out. Hope and confidence are no mean remedial agents; and in many chronic diseases, at least, the individual who has faith will recover more speedily, casteris paribus, than he who is shy of belief — (10) Simply to prescribe drugs, without regulating the diet and general management of the patient, is to omit a most important duty. In acute diseases plain directions must be given as to the ventilation and warmth of the sick-room, the amount of light, the position of the bed (not to be placed in a corner), the degree of quiet to be maintained, the avoidance of excitement and whispering, the exclusion of visitors, the cleanliness of the sufferer, and the nature and quantity and times for administration of food. No cooking whatever should be permitted in the sick-room. In cases of long illness, when the patient can be moved without risk, it is often desirable to have two beds in the room, — one to be occupied during the day, the other at night. Every precaution must be taken to prevent the spread of infectious disorders. Soiled linen, dirty water, etc., must be immediately removed. And, in all instances, the evacuations ought to be passed in a bed-pan or night-stool containing some disinfectant material (carbolic acid, perman- ganate of potash, sulphate of iron, etc.). — (11) While it is allowed that the
ALIMENTS. 283
following' formula; may ofton be employed unaltered with p^reat advantage, yet it is not supposed that tliey will usually be prescribed with servile exactness; for it should never be forgotten that all medicines of any power have to be adapted to the requirements of the special ease under treatment. It lias been quaintly but truly observed, that a bundle of ready-made re- ceipts in the hands of the routine practitioner, is but a well-equipped quiver on the back of an unskilful archer. — And, (12) In watching the restoration of a sick man to health, it is a mistake to attribute the improvement too confidently to the action of the medicine prescribed ; for it may not have been taken, or it may not have been absorbed, or its properties may have been destroyed by adulteration, or it may have even proved injurious — recovery occurring in spite of it.
The succeeding formula3 have been written in accordance with the rules, preparations, etc., of the British Pharmacopoeia of 1867. For the sake of convenience they are arranged in twenty-one classes, running thus : —
1. Aliments. I 12. Gargles and Inhalations.
2. Alteratives and resolvents.
3. Antacids.
4. Antiseptics.
5. Antispasmodics.
6. Astringents.
7. Baths.
8. Cathartics and Anthelmintics
9. Caustics and Counter-irritants. [ 19. Electro-therapeutics.
10. Diaphoretics and Diuretics. | 20.° Climates for Invalids.
11. Emetics and Expectorants. i 21. Mineral Waters.
The symbolic formuke employed here and there in this volume, have been represented according to the new method of notation.
13. Lotions, Liniments, CoUyria, and
Ointments.
14. Narcotics and Sedatives.
15. Refrigerants and Salines.
16. Stimulants.
17. Tonics.
18. Uterine Therapeutics.
I. ALIMENTS.
1 . Extracts and Essence of Beef.
Extract of Beef. — Take one pound of rumpsteak, mince it like sausage meat, and mix it with one pint of cold water. Place it in a pot at the side of the fire to heat very slowly. It may stand two or three hours before it is allowed to simmer, and then let it boil gently for iifteen minutes. Skim and serve. The addition of a small teaspoonful of cream to a teacupful of this beef-tea renders it richer and more nourishing. Sometimes it is pre- ferred when thickened with a little flour or arrowroot.
Essence of Beef. — Take one pound of gravy beef free from skin and fat, chop it up as fine as mincemeat, pound it in a mortar with three tablespoon- fuls of soft water, and let it soak for two hours. 'J'hen put it into a covered earthen jar with a little salt ; cementing the edges of the cover with pud- ding paste, and tying a piece of cloth over the top. Place the jar in a pot half full of boiling water, and keep the pot on the fire for four hours. Strain off (through a coarse sieve, so as to allow the snuiller particles of meat to pass) the liquid essence, which will amount to about five or six ounces in quantity. Give two or more teaspoonfuls frequently. In great debility, diphtheria, typhus, exhaustion from hemorrhage, etc.
The Extract of Meat Lozenges, as sold by Allen and Hanbury, can sometimes be taken when the stomach is too irritable to retain beef-tea. Each lozenge contains half its M-eight (or about eighteen grains) of pure Extract of Meat made after Liebig's process. This quantity corresponds to the soluble constituents of an ounce and a quarter of solid flesh, and
284 APPENDIX OF FORMULA.
will afford the sustaining and restorative effect of soup or heeftea made from that quantity of meat. — A good broth may be made by dissolving four of these lonzenges in a vvineglassful of boiling water, or better still, of home- made beef-tea, adding a little salt and pepper to taste.
Excellent meat essences of various kinds and concentrated beef-tea are also prepared by Brand and Gillon, which are more trustworthy than domestic preparations, and are often invaluable in emergencies.
IjIebig's Extract of Meat is a valuable preparation. It is of uniform strength, one pound being the product of thirty-four pounds of pure mus- cular tissue. 'I'his corresponds to about forty-five pounds of butcher's meat (including fat. bones, connective tissue, etc.) ; so that the carcase of a good ox very seldom yields more than ten pounds of extract. It must not be supposed, however, that the extract is in any way the equivalent of the meat from which it has been obtained, or that it contains all the elements for nutrition. It is rather a stimulant than a food from which tissues can be built up. and may be injurious if relied on exclusively or taken in too large quantity and in a highly concentrated form. One ounce of this ex- tract will make four pints of excellent beef-tea; each pint representing the soluble ingredients of rather more than half a pound of beef. Besides mixing the extract with water it will often be advantageous to add it to common beef-tea, to vegetable soups, to a mixture of brandy and eggs, or to wine. Sometimes invalids will eat it spread on bread and butter, or on toast, like a potted meat.
2. Preparations of JRatv Meat.
Raiv Meat Juice. — Good beefsteak is cut into small portions and pounded in a mortar. Water is added to an amount not exceeding the volume of the pounded meat and the juice is strained off by compression through muslin or a fine sieve.
Raio Meat Pulp is prepared by rubbing the pounded meat through a sieve without the addition of water.
Raw meat can sometimes be assimilated when no other food is borne. The juice will be taken by some patients without disguise, or it may be given with beef-tea, or in malaga or malmsey wine. The pulp also may be made into sandwiches.
Other methods of disguising it are as follows : —
Yvon's Process. — Raw meat, 250 pts. Blanched sweet almonds, 75. Bitter almonds, 5. Sugar, 80. Pounded up in marble mortar to pulp, which may be brought to the fluid form by adding water. Or raw meat. 50: sweet almonds, 16; bitter almonds, 1; sugar, 16; beaten up, water added, passed through sieve. Or, grated raw meat, 100: sugar, 40; wine, 20 ; tincture of cinnamon, 3 ; sugar and meat pounded ; wine and tincture added ; has consistence of marmalade. See also F. 3.
3. Restorative Soirp for Invalids.
Take one pound of newly killed beef or fowl, chop it fine, add eight fluid ounces of soft or distilled water, four or six drops of pure hydrochloric acid, 30 to 60 grs. of common salt, and stir well together. After three hours the whole is to be thrown on a conical hair sieve, and the fluid allowed to pass through with slight pressure. On the flesh residue in the sieve pour slowly two ounces of distilled water, and let it run through while squeezing the meat. 'J'here will be thus obtained about ten fluid ounces of cold juice (cold extract of flesh), of a red color, and possessing a pleasant taste of soup ; of which a wineglassful may be taken at pleasure. It must not be warmed (at least, not to a greater extent than can be effected by par- tially filling a bottle with it, and standing this in hot water) : since it is
ALIMENTS. 285
rendered muddj' by heat or by alcohol, and deposits a thick coagiilum of albumen with the coloring matter of blood. — It, from any special circum- stance (such as a free secretion of gastric juice), it is deemed undesirable to administer an acid, the soup may be well prepared by merely soaking the minced meat in plain distilled water.— Children, ami even adults, will fre- quently take the raw meat simply minced or grated, when they are suffer- ing from great debility. One teaspooaful of such meat may be given every three or four hours. If found disagreeable, all unpleasantness can be removed by thoroughly mixing in a mortar two parts of pounded white sugar with one part of meat.
This modification of 'Likbiq's formula is very valuable in cases of con- tinued fever, in dysentery, and indeed in all diseases attended loith great prostration and iveakness of the digestive organs. When the flavor is thought disagreeable, it may be concealed by the addition of spice, or of a xoineglassful of claret to each teacupful of soup.
4. Digestive Milk and Soluble Meat.
Milk, five ounces; pepsine, five grains; dilute hydrochloric acid, thirty minims. Digest in a water bath at a temperature of 120 deg. F. for two hours, after which neutralize the acid by twelve grains of carbonate of soda, and sweeten with pure sugar.
Useful for children who are unable to digest milk, and in ca^es of ex- treme irritability of stomach. — Sir William Jenner.
Soluble ilieaf.— About two pounds of lean meat, chopped into pieces, are put into a china pan, with a quart of water, containing half a fluid drachm of strong hydrochloric acid. The pan is put into a Papin's kettle, perfectly sealed and subjected to maceration for about fifteen hours. The contents are then crushed in a mortar until they constitute an emulsion, and put back into the kettle again for about fifteen hours. The substance thus obtained must be then completely neutralized with bicarbonate of soda, and evapo- rated afterwards to the consistency of pap. When thus prepared, this solu- ble meat is generally accepted by patients. Milk and pounded biscuit may, however, be added for the sake of variety, and in order to avoid too great . uniformity of food. — Dr. Marcet.
5. Liebiff's Food for Infants and Invalids.
Half an ounce of wheaten flour (that called " seconds" is the most suit- able), an equal quantity of malt flour, 7^ grains of bicarbonate of potash, and an ounce of water, are to be well mixed. Add five ounces of cow's milk, and put the whole on a gentle fire. When the mixture begins to thicken, it is to be removed from the fire, stirred for five minutes, heated and stirred again till it becomes quite fluid, and finally made to boil. After separating the bran by passing the mixture through a sieve, it is ready for use.
To save the trouble of weighing, it may be remembered that a tablespoon- ful (heaped up) of wheaten flour weights nearly half an ounce, and a heaped dessertspoonful of malt flour is equal to the same. This soup is as sweet as milk; and after boiling, may be kept for 24 hours without undergoing any change. — This is an excellent food for infants who cannot be suckled. It is slightly aperient ; so that children under one year of age can seldom take more than two meals of it in the day. Where there is a tendency to diar- rhoea, twenty grains of prepared chalk may be substituted for the potash. The proportion of blood-forming and heat-producing elements is the same as in woman's milk (1 : 3.8) ; while the quantity of alkali is equivalent to that in human milk.
The solid parts of this food are sold, ready mixed in packets, by Mr.
286 APPENDIX OF FORMULA.
Hooper of Pall Mall East and Grosvenor Street, Mr. Cooper of 26 Oxford ►Street, as well as by many other chemists. Barley malt can also be pro- cured from every brewery. It may be ground in a common coffee mill ; the coarse powder being passed through a sieve to remove the husks.
6. Eggs, Cream, and Extract of Beef.
Wash two ounces of the best pearl sago until the water poured from it is clear. Then stew the sago in half a pint of water until it is quite tender and very thick : mix with it half a pint of good cream and the yf^lks of four fresh eggs, and mingle the whole carefully with one quart of good beef-tea, which should be boiling. Serve. This nourishing broth is very useful in inany cases of lingering convalescence after acute disease.
7. Mutton or Veal Broth — Beef-tea.
Take of mutton or veal or beef one pound and a half, cold water one quart, a little salt, and rice two ounces. Simmer for four hours, boil for a few minutes, strain and serve. Another excellent plan for making beef-tea is as follows : — Take one pound of beef minced very fine, and put it into a com- mon earthenware teapot with a pint and a half of cold water. Stand the pot on the hob, so that it may simmer for at least three hours. About three quarters of a pint of good beef-tea will be thus obtained.
Take one pound of mutton, one pound of veal, half a chicken (with the bones well broken), one calf's foot, and two quarts of water. Stew slowly down to one quart. To be flavored with pepper and salt, and taken cold as a jelly, or as a warm broth. The chicken can be omitted if desired.
Beef-tea as ordinarily made, and preserved meat juice of all kinds, are palatable but not very nutritive drinks. A pint of fitie beef-tea contains scarcely a quarter of an ounce of anything but water. Nevertheless, if these fluids are of small value as mere nutrients, perhaps the osmazome and salts they contain may possess the property, like tea and coffee, of diminishing the waste of the tissues. It has been proved that dogs die slowly if fed on bread and gelatine alone ; but when greatly reduced by this diet they soon regain flesh and strength if two ounces of meat tea be daily added to it.
Gruel mixed luith heef-tea is nourishing. It is made thus : — Take two
tablespoonfuls of oatmeal with three of cold water, and mix them thoroughly.
Then add a pint of strong boiling beef tea (or of milk) ; boil for five minutes,
■^tirring well to prevent the oatmeal from burning; and strain through a
hair sieve. — An excellent simple restorative during convalescence from
■ acute disease before solid food can he taken.
8. Spruce Beer.
The essence of spruce is prepared by boiling down to concentration the young branches of the Black Spruce Fir (Abies Nigra). 'J'ake of this essence half a pint; bruised pimento and ginger, of each four ounces ; water three gallons. Boil for five or ten minutes: then strain, and add eleven gallons of warm water, a pint of yeast, and six pints of molasses. Mix, and allow the mixture to ferment for twenty-four hours. It is an admirable antiscorbutic, and is an agreeable and wholesome drink in warm iveather. This drink ivas found very efficacious by Captain Cook. Dr. Robert Barnes suggests that it shoidd be used in the Merchant Service instead of rum, which has no antiscorbutic virtue.
9. Tapioca and Cod Liver.
Boil a quarter of a pound of tapioca till tender, in two quarts of water; drain it in a cullender, then put it back in the pan ; season with a little salt and pepper, and half a pint of milk, and put over it one pound of fresh cod
ALIMENTS. 287
liver cut in eight pieces. Set the pan near the fire to simmer slowly for half an hour, or a little more, till the liver is quite cooked. Press on it with a spoon, so as to get as much oil into the tapioca as possible. After taking away the liver, mix the tapioca. If too thick, add a little milk, then boil for a few minutes ; stir round, add a little salt and pepper, and serve. — Alexis Soyer. Tapioca thus cooked is nourishing and easily digested.
10. 77^6 Bran Loaf.
The formula used by Mr. Camplix, in Diabetes, is as follows : — Take a sufficient quantity (say two or three quarts) of wheat bran, boil it in two successive waters for ten minutes, each time straining it through a sieve, then wash it well with cool water (on the sieve), until the water runs off per- fectly clear; squeeze the bran in a cloth as dry as possible, then spread it thinly on a dish, and place it in a slow oven — if put in at night, let it remain until the morning, when, if perfectly dry and crisp, it will be fit for grinding. ^J'he bran thus prepared must be ground in a fine mill, and sifted through a wire sieve of sufficient fineness to require the use of a brush to pass it through ; that which does not pass at first ought to be ground and sifted again, until the whole is soft and fine.
Take of this bran-powder three ounces troy, three fresh eggs, one ounce and a half of butter, and rather less than half a pint of milk ; mix the eggs with part of the milk, and warm the butter with the other portion ; then stir the whole well together, adding a little nutmeg and ginger, or any other agreeable spice. Immediately before putting into the oven, stir in first thirty-five grains of sesquicarbonate of soda, and then three drachms of dilute hydrochloric acid. The loaf thus prepared should be baked in a basin (previously well buttered) for about an hour or rather more.
Biscuits may be prepared as above, omitting the soda and hydrochloric acid and part of the milk, and making them of proper consistence for mould- ing into shape.
If properly baked, the loaves or biscuits will keep several days ; but they should always be preserved in a dry place, and not be prepared in too large quantities at a time. Various biscuits are also made for use iu diabetes, from almonds, gluten, etc.
II. White Wine Whey and Caudle.
White Wine Whey. — To half a pint of boiling milk, add one or two wine- glassfuls of sherry or Madeira. The curd is to be sepaT-ated by straining through a fine sieve or piece of muslin. Sweeten the whey with refined sugar.
Caudle. — Beat up one Qgg with a wineglassful of sherry, and add it to half a pint of fine hot gruel. Flavor with sugar, nutmeg, and lemon peel. Ill insomnia ivith debility.
Beat up two tablespoonfuls of cream in a pint of thin gruel. Add to this one tablespoonful of curaQoa or noyeau, and a wineglassful of sherry. Flavor with sugarcandy, and let half a tumblerful be taken, cold, at intervals.
12. Ferruginous Chocolate.
Spanish chocolate 16 oz. ; carbonate of iron half an ounce. Divide into once-ounce cakes. One to be dissolved in half a pint of hot milk, and taken night and morning, hi ana;mia, amenorrhoea, etc.
13. Iceland Moss and Quinine Jelly.
Take of Iceland moss (Cetraria), and Irish moss (Chondrus crispus. Car- ragheen), each one ounce. Boil slowly for three quarters of an hour in a
288 APPENDIX OF FORMULAE.
pint and a half of milk, strain through nuislin, and add three ounces of white sugar dissolved in one ounce of the compound tincture of quinia (equal to eight grains of the salt). A dessertspoonful to be taken frequently in the course of the day. In phthisis, tabes mesenterica, etc.
14. Lime Water and Milk.
R. Liquoris Calcis Saccharati, min. 20-90, vel Liquoris Calcis, fl. oz. 1-4; Lactis, fl. oz. 4. Mix. This compound ivill sometimes he retained when all'other food is ejected. As a variety, milk and soda water in equal projjortions may also he ordered. See F. 73.
It may be well to remember that the addition of grs. 1.5 of Bicarbonate of Soda to the quart of fresh milk not only prevents it from turning sour for several hours, but renders it more digestible.
15. Artificial Ass's and Goat's Milk.
Take half an ounce of gelatin, and dissolve it in half a pint of hot barley water. Then add an ounce of I'efined sugar, and pour into the mixture a pint of good new cow's milk.
Chop an ounce of suet (that of the calf is the best) very fine, tie it lightly in a muslin bag, and boil it slowly in a quart of new milk. Sweeten with white sugar, or a glass of any liqueur. An excellent aliment in some cases of ta,hes mesenterica, etc., where the unpleasant odor of goat's milk pre- vents its heincj taken.
16. Milk, Flour, and Steel.
Beat up carefully one tablespoonful of flour, one raw egg. and about twenty grains of the saccharated carbonate of iron, with half a pint of new milk : flavor with nutmeg and white sugar. To be taken for lunch with a biscuit. In the early stages of tubercidosis the Author has found this mixture very valuahle.
17. Brandy and Egg Mixtures.
Take the whites and yolks of three eggs and beat them up in five ounces of plain water. Add slowly three ounces of brandy, with a little sugar and nutmeg. This form is preferable to that in the British Pharmacopoeia for 1867 ; which form contains an insufficient quantity of egg, while it is spoilt for sensitive stomachs by the cinnamon water it is mixed with. Two table- spoonfuls should be given every four or six hours. In some cases of great prostration the efficacy of the mixture is much increased by the addition of one drachm of the tincture of yellow cinchona to each dose.
When the stomach is very irritable the following will often be useful : — Take a tablespoonful of cream and beat it up thoroughly with the white of a new-laid egg. Add slowly to the frothy mixture thus obtained, one table- spoonful of brandy in which a lump of sugar has been dissolved.
Let the white and yolk of an egg be beaten up in a wineglassful of water, with 15 drops of brandy and white sugar. Two eggs thus treated, in the 24 hours will serve for the food of an infant brought up by hand.
18. Bread Jelly.
Take a quantity of the soft part of a loaf, break it up, cover it with boiling water, and allow it to soak for some hours. The water — containing all the noxious matters with which the bread may be adulterated— is then to be strained off completely, and fresh water added ; place the mixture on the fire, and allow it to boil for some time until it becomes smooth ; the water is then to be pressed out, and the bread on cooling will form a thick jelly.
ALIMENTS. 289
Mix a portion of this with sugared milk and water, for use as it is wanted. — Dr. Churchill. A good food for infanta at the time of weaning . for children ivilh acute disease, etc.
19. Nutritious Demulcent Drinks.
Mix together half a pint of Mucilago Acacia3, Mistura Amygdalae, and pure milk ; sweeten with sugarcandy or honey; and add one large table- spoonful of any liqueur. Allow the whole to be taken during the day. — Or, a large pinch of isinglass may be boiled with a tumblerful of milk, half a dozen bruised almonds, and two or three lumps of sugar. To be taken warm once or twice in the day.
These drinks are very grateful in cases of tonsillitis, ulceration of the -pharynx, etc. ; cdso in some cases of debility, with irritability of the stomach, and a tendency to diarrhoea.
20. Indian Sarsaparilla and Barley Water.
R. Syrupi Hemidesmi, fl. oz. 2 ; Glycerini, fl. oz. 1 ; Decocti Hordei, fl. oz. 9. Mix, and direct one tablespoonful to be taken frequently. An agree- able demulcent, slightly alterative, and diaphoretic mixture. Useful in the eruptive fevers, and for inflammations of the mucous membranes.
21. Beef -Tea and Cream Enema.
An excellent nutritious enema can be made by mixing together from four to eight ounces of strong beef-tea, an ounce of cream, and half an ounce of brandy, or an ounce and a half of port wine. It may be administered twice or thrice in the course of twenty-four hours. In ccoses of acute gastritis, carcinoma of the stomach, obstinate vomiting, etc., where it is necessary to avoid giving food by the mouth.
Another form may run thus : — Take four or six ounces of restorative soup prepared without any acid (P. 3), one ounce of cream, two teaspoonfiils of brandy, and either fifteen minims of liquid extract of opium, or ten grains of citrate of iron and quiuia.
22. Cod-Liver Oil and Bark Enema.
Take four ounces of milk, one ounce of port wine, half an ounce of cod- liver oil, two drachms of tincture of yellow cinchona, and twenty minims of lic|uid extract of opium. Mix. To be administered every twelve hours.
23. Quinine and Sohition of Beef Enema.
Take one tablespoonful of brandy, five grains of sulphate of quinia, one teaspoonful of glycerine, two tablespoonfuls of cream, and from four to eight ounces of restorative soup (F. 3). Mix. This enema can be admin- istered every six or eight hours. Where the rectum is very irritable, or it is necessary to relieve pain, from fifteen to twenty minims of the liquid ex- tract of opium may be advantageously added.
In all nutrient enemata Liebig's extract may be advantageously substi- tuted for domestic beef-tea, the solid particles floating in which are not absorbed. The value of milk also when given by the bowel is doubtful. "When nutritive enemata are required for any length of time the rectum should be occasionally washed out by a copious injection of warm water to prevent irritation by accumulation and decomposition of uuabsorbed re- siduum.
19
290 APPENDIX OF FORMULJD.
II. ALTERATIVES AND RESOLVENTS.
24. Compotind Pill of Calomel and Opium.
R. Pilnlse Hydrargyri Sabchloridi Compositas, gr. 5 ; Extract! Opii, gr. ^. Make a pill, and direct it to be taken every night or night and morning.
In disorders dependent on a venereal taint.
25. Calomel and Opium.
R. FTydrargyri Subchloridi, gr. 2; Pulveris Opii, gr. \; Confectionis Eosse Gallicae. sufficient to make a pill. To be takea every four hours. As an alterative, ivhen it is wished to get the system quickly under the influence of mercury.
26. Mercury and Conium, or Quinine.
R. Hydrargyri cum Greta, gr. 2 ; Extract! Conil, gr. 3. Mix, and form a pill to be taken three times a day. In syphilitic tubercular diseases.
R. Hydrargyri cum Greta, gr. 1-3; Quiniae Sulphatis, gr. 1; Bxtracti Gentiante, gr. 1. Mix, and iorm a pill, to be taken three times a day. A convenient form of administering mercury in secondary syphilis, and little liable to give rise to troublesome salivation.
27. Perchloride of Mercury, or Corrosive Sublimate.
R. Hydrargyri Perchloridi, gr. 1 ; Ammonii Ghloridi, gr. 5 ; Extract! Sarsse Liquid!, fl. drs. 12 ; Decoct! Sarsas Gompositi, ad fl. oz. 12. Mix. Direct, — "Two small tablespoonfuls to be taken three times a day." In confirmed constitutional syphilis; as loell as in some forms of eczema, prurigo, follicular vaginitis, chronic metritis, etc.
R. Hydrargyri Perchloridi. gr. 1 ; Glycerini, fl. oz. 1 ; Tincturse Cin- chona Goraposit83, ad fl. oz. 3; Olei Menthae Piperita?, min. 25. Mix. Direct, — " One teaspoont'ul in a wineglassful of water three times a day." In constitutional syphilis, some forms of hemorrhctge, and certain varie- ties of vertigo.
R. Hydrargyri Perchloridi, gr. 1 ; Bxtracti Opii, gr. 3-6 ; Guaiaci Resinse, gr. 100; Glycerin!, sufficient to make a mass. Divide carefully into twenty-four pills, and order two to be taken three times a day. In some varieties of chronic rheumatism, secondary syphilis, and skin dis- eases.
28. Mercury, Squills, and Digitalis.
R. Pilulse Hydrargyri, gr. 1-3 ; Digitalis Foliae, gr. ^ ; Pulveris Scillse, gr. 1|. Mix, and form a pill to be taken twice or three times a day. As an alterative and diuretic, in some cases of dropsy.
29. Bromide of Mercury and SarsapariUa.
R. Hydrargyri Bromidi, gr. ^; Extract! Sarsaj Liquid!, fl. drs.' 2 ; De- coct! Sarsaa Gompositi, fl. drs. 10. Mix. To be taken three times a day. In sypjhilitic lepra, and obstinate secondary syphilitic eruptions.
30. Podophyllum Peltatum, or May-apple.
R. Podophylli Resinse, gr. ^-| ; Pulveris Ipecacuanhse, gr. ^ ; Extract! Gentianse, gr. 3. Mis. Make a pill, to be taken twice or thrice daily. In syphilis, scrofula, jaundice from suppression, skin diseases, etc. Asa simple alterative it is perhaps as valuable as mercury, loithout possessing any injurious qualities. One or two grains of quinine may be advan- tageously added to each pill, ivhere there is general debility. See F. 160.
ALTERATIVES AND RESOLVENTS. 291
3L Iodide of Potassium Mixtures.
R. Potassii lodidi, gr. 20-30 ; Tincturoe Serpentarioe, fl. drs. 3 ; Misturse Guaiiiei, ad fl. oz. 8. Mix. One-sixth part to be taken three times a day. Valuable in chronic and gonorrhoeal rheumatism, in lumbago, some forms of neuralgia, etc.
R. Potassii lodidi, gr. 30; Potassse Bicarbonatis, gr. 60; Tinctnrse Hyoscyami, fl. drs. 3 ; Infusi Cinchonge Flavor, ad fl. oz. 8. iVlix. One- sixth part three times a day. In chronic rheii,matism with an abundance of liUiates in the urine i as well as in some cases of eczema, etc.
R. Potassii lodidi, gr. 2 ; Vini Colchici, min. 1.5; TincturtB Aconiti, min. 3-8 ; lulusi Rliei, fl. oz. 1. Make a draught, to be taken three times a day. In acute and suppressed and chronic gout.
R. Potassii lodidi, gr. 3-.5 ; Spirittis Ammonise Aromatici, min. 40; Tincture Belkxdonnoe, min. 5-1.5 ; Tincturas Cinchoua? Compositse. fl. drm. 1 ; Aquce Menthae Piperitse, ad fl. oz. 1^. Make a draught. To be taken three times a day. In some cases of asthma the Author has found re- marl'ahle benefit from this formula.
R. Potassii lodidi, gr. 1.5-30; Vini Colchici, min. 90; Tincturse Hyos- cyami, fl. drs. 6 ; Magnesia; Sulphatis, gr. 240; Infusi Anthemidis, ad fl. oz. 8. Mix. One-sixth part three times a day. In some instances of gout with fever and constipation, and in chronic pleurisy with effusion. Also in cases of lead and mercurial poisoning occui'ring in gouty sub- jects.
R. Potassii lodidi, gr. 60; Tinctnrse Rhei, fl oz. 1; Extract! Sarsae Liquidi, fl. oz. 2. Mix. Label, — " A small teaspoouful in a wineglassful of water three times a day." Ii syphilitic skin diseases, in nodes, and in follicular inflammation of the pharyngo-laryngeal iuucous membrane, etc.
R. Potassii lodidi, gr. 100-400 ; Ammonias Carbonatis, gr. 30 ; Tincturae Aurantii, fl. oz. 1^, Aqua3, ad fl. oz. 6. Mix. A tablespoonful to be taken three times a day in a wineglass of water, or with two ounces of Decoction of Sarsaparilla. In syphilitic disease of the nervous system or severe forms of tertiary syphilis. Large doses of the Iodide of Potassium cere better borne after meals.
R. Potassii lodidi, gr. 30-120; Glycerini, fl. oz. 1; Tinctnrse Aconiti, min. 20 ; Vini Ipecacuanhse, fl. drs. 2 ; Succi Taraxaci, fl. drs. 6 ; Decocti SarssB Compositi, ad fl. oz. 8. Mix. One-sixth part three times a day. In severe gonorrhoeal rheumatism, tertiary syphilis, secondary spreading syphilitic ulcers, bronchocele, scrofulous sores, aneurism, etc.
R. Potassii lodidi, gr. 15; Tincturae Assafcetidse, min. 90; Tincturae Senegae, fl. drs. 3 ; Syrupi Mori, ad fl. oz. 3. Mix. Label, — " One tea- spoonful every two, three, or four hours." For a child about two years old, suff^ering from croup. Also in cases of infantile pneumonia.
R. Potassii lodidi, gr. 24; Liquoris Ammoniaj Acetatis, fl. oz. 1; Vini Ipecacuanhae, min. 40 ; Spiritus Chloroformi, fl. drs. \^ ; Tinctura Cam- phora Compositai, fl. drs. 4 ; Aqua, ad fl. oz. 8. Mix. An eighth part to be taken every three or four hours. In Bronchitis and Pneumonia.
32. Iodide of Ammonium.
R. Ammonii lodidi, gr. 3-15 ; Infusi Cinchonae Flavae, fl. oz. 1-2. Make a draught. To be taken twice or thrice daily before food. Very
valuable in strumous enlargement of the absorbent glands. The dose is to be graduated according to the patient's age. At the time this medicine is given internally , an ointment of the iodide of ammonium (gr. 60 to lard oz. 1) should be rubbed into the swellings night and morning.
292 APPENDIX OF FORMULA.
33. Iodide of Sodium.
R. Sodii lodidi, gr. 60; Decocti Sarsae Compositi, fl. oz. 8. Mix. One- sixth part three times a day. ^.5 an antisyyhilitic where the iodide of potassium disagrees. Moreover, it will sometimes effect a cure after the latter has failed to be of use.
Iodide of Sodium or of Ammonium may be substituted for Iodide of Po- tassium ill the formulae of No. 31.
34. Iodide of Iron Mixtures.
R. Ferri lodidi, gr. 6-18 ; Glyceriiii, fl. drs. 12 ; Infusi Calumbse, ad fl. oz. 8. Mix. One-sixth part three times a day. In the early stages of tuberculosis, and in strumous idcers, where the stomach ivill not tolerate cod-liver oil.
R. Potassii lodidi, gr. 30; Ferri et AmmoniiE Citratis, gr. 60; Aqute Destillatas, fl. drs. 2 ; Glycerini, fl. drs. 6 ; Olei Menthae Piperitae, miu. 10 ; Olei Morrhuae, ad fl. oz. 6. Mix. One tablespoonful after the two chief meals of the day.
R. Potassii lodidi. gr. 12 ; Ferri et Quinite Citratis, gr. 30; Tincturae Aconiti, min. 2.5 ; Infusi Chiratae, fl. oz. 6. Mix. One-sixth part three times a day. In chronic rheumatism with debility, etc.
R. Tincturae Ferri Perchloridi, Tincturaj lodi, aa min. 10; Aquae Cam- phorae, fl. oz. 1. Make a draught, to be taken three times a day. Useful in strumous affections of the cerviccd glands, mesenteric disease, and some cutaneous disorders.
R. Syrupi Ferri lodidi, Extracti Sarsas Liquidi, aa fl. oz. 1. Mix. Di- rect,— " One teaspoonful in two tablespoonfuis of water three times a day." In chronic rheumcUism, old-standing venerecd affections, etc.
R, Potassii lodidi, gr. 3-8 ; Ferri et Ammoniae Citratis, gr. 20 ; Sj^rupi Papaveris, fl. drs. 3 ; Infusi Quassise, ad fl. oz. 4. Mix. One tablespoonful three times a day. For children ivith tabes mesenterica. Useful cdso for strumous subjects loho have had ascarides.
35. Iodide of Potassium and Mercury.
R. Ammoniae Carbonatis, gr. 30; Potassii lodidi, gr. 20-120; Tincturee Aconiti, min. 30 ; Tincturae Chloroformi Compositee, fl. drm. 1 ; Tincturee Cinchonaj Flavae, fl. drs. 6 ; Aqute MenthiB Piperitae, ad fl. oz. 8. Mix. Direct, — " One-sixth part three times a day — viz., at 9 a. m., 2 p. m., and 7 p. m." At the same time, — ■
R. Hydrargyri lodidi Viridis, gr. 2; Extracti Opii, gr. 1; Extracti Hyoscyami, gr. 6. Mix, divide into two pills, and order one to be taken every night at 11 o'clock as long as the mixture is continued. Very useful in many forms of constitutioncd syphilis, luith sleepless nights.
R. Potassii lodidi, gr. 24-150; Hydrargyri Biniodidi, gr. ^ ; Tincturae Cinchonas Composita;, fl. oz. 1; Aquas, ad fl. oz. 8. A sixth part to be taken twice or three times a day. In some forms of constitutional syphilis.
36. Mercury and Chalk, with Dover's Powder., etc.
R. Hydrargyri cum Creta, Pulveris Ipecacuanh^e Compositi, aa gr. 5. Mix, and make a powder to be taken every eight or twelve hours. In diarrhoea xoith unhealthy secretions, and in mild dysentery.
R. Sodae Bicarbonatis, Hydrargyri cum Creta, aa, gr. 2 ; Magnesiae Car- bonatis, gr. 5. Mix, and make a powder to be taken every other night.
ALTERATIVES AND RESOLVENTS. 293
An alterative and aperient for children, toliere there is great acidity of the secretions.
R. Hydrargyri cum Creta, frr. 1-2; Pulv. Rhei, Sodae Bicarbonatis, aa jjr. 2-4. Mix, and make a powder to be taken every nip:ht or every other night. An alterative and aperient for children ivhen the stools are pale, or di(,ring fever ishness attending dentition, etc.
37. Cyanide of Mercury.
R. Hydrargyri Cyanidi, gr. 1 ; Extracti Opii, gr. 4; Extract! Conii, gr. 40. Mix thoroughly, divide into sixteen pills, and order one to be taken night and morning. For long-standing syphilitic eruptions, ulcers, sore throats, etc. A lotion or gargle can be used at the same time, made with six grains of the Cyanide of Mercury to a pint of water or of infusion of linseed.
38. Tar pills aiid Capsules.
R. Picis Liquidse, oz. 1 ; Pulveris Aromatici, oz. ^. Mix, divide into five-grain pills, and order two or three to be taken three times a day.
Tar Capsules are made, each containing about six grains of tar. Two or three may be taken for each dose, thrice daily. In some chronic skin diseases, eczema, pruritus of the anus, and chronic catarrhal affections.
39. Benzoate of Ammonia.
R. Ammonias Benzoatis, gr. 10-20; Syrupi Anrantii Floris, fi. drm. 1 ; Aquas, ad fl. drs. 12. Mix for a draught, to be taken three times a day. In chronic bronchitis, hepatic congestion ivith deficient serine, chronic in- flammation of the Madder with alkaline urine, and in cases attended tcith copious excretion of phosphates.
40. Creasote.
R. Creasoti, min. 20-40 ; Pulveris Aromatici, gr. 80; Mucilaginis Acacise, sufficient to form a mass. Divide into twenty pills, and order one or two to be taken three times a day. In some forms of neuralgia, chronic bron- chitis, and obstinate vomiting unconnected with inflammation or organic disease — such as sea-sickness. After taking creasote for a short time, the xirine occasionally assumes a dirty or broivnish-black color. Inunction with tar may give rise to the same effect. Under these circumstances, creasote has been obtained from the urioie by distillation.
In the officinal Mistura Creasoti the unpleasant flavor is tolerably well disguised by the Spirit of Juniper. Dose of the mixture, fl. oz. 1-2. See F. 90.
41. Bromide of Potassium.
R. Potassii Bromidi, gr. 20-40 ; Aquae Camphorae, fl. oz. 3. Mix for a
draught, to be taken every night at bedtime. For insomnia ivithout any apparent cause, epileptic and epileptoid seiztires,paroxysmcd vertigo and headache, etc.
R. Potassii Bromidi, gr. 60-1.50; Potassii lodidi, gr. 12 ; Potassis Bi- carbonatis, gr. 40 ; Tincturae Aurantii, fl. drs. 6 ; Infusi Auranti Compositi, ad fi. oz. 8. Mix. One-sixth part, on an empty stomach, night and morn- ing. The favorite remedy for epilepsy (1865).
R. Potassii Bromidi, gr. 30-60; Tincturae Valeriance Ammoniatfe, fl. drs. 6; Aquae Champhopae, vel Infusi Chiratse, ad fl. oz. 8. Mix. One-sixth part three times a day. In hysteria, insomnia due to nervous irritability, functional disturbance of the uterine functions, spermatorrhoea from bad habits, etc.
294 APPENDIX OP FOEMUL^.
R. Pulveris Gnaiaci, ^r. 40; Potassii Bromidi, j^r. 30; Magnesise Car- bonatis, gr. 60. Mix. Divide into six powders, and order one to be taken three times a day in a little mucilage, or cream, or honey. Useful in cases where it is required to exert a sedative action on the sexual organs.
42. Bromide of Ammonium.
R. Ammonii Bromidi, gr. 12-60; Infusi Aurantii, fl. oz. 8. Mix. Direct, — " One-sixth part to be taken three times a day, an hour before meals." Recommended hy Sir G. D. GiBB/or diseases in ivhich the nervous system is functionally involved, — as ep/lepsy, etc. It is a valuable absor- bent in glandular enlargevients, and in excessive corpidency ; while it has also a peculiar soothing influence upon the mucous membranes.
B. Ammonii Bromidi, gr. 24; Aquae, fl. oz. 2. Mix. One teaspoon- ful in a small cup of sweetened tea three times a day. For an infant ivith whooping cough.
43. Guaiacum Mixtures.
R. Tincturag Guaiaci Ammoniatte, fl. drs. 4 : Tincturas Aconiti, min. 30; Muciliginis Tragacanthge, Aquae Cinnamomi, aa fl. oz. 4. Mix. Two table- spoonfuls twice or three times a day. In the chronic rheumatism of old and weak people. Also in some skin diseases lohere there is a strumous taint.
R. Extracti Opii Liquidi, min. 30; Tincturse Quini^, fl. drs. 6; Misturae Guaiaci, ad fl. oz. 8. Mix. One-sixth part three times a day. /??, chronic skin diseases. Guiaicum has cUso been highly extolled in tonsillitis, but for this is best taken in lozenges.
R. Sulphuris SublimatiB, oz. 2 ; Potassae Tartratis Acidae, oz. 1 ; Pulveris Rhei, gr. 120; Guaiaci ResiuiB, gr. 60; Mellis, lb. 1; Myristicae, unum in pulverera redacti. Mix thoroughly, and order two teaspoonfuls to be taken • night and morning until the whole is consumed. This compound was for- merly in much repute for the cure of chronic rheumatism ; being said to be especially useful in old-standing cases, lohen the skin is initctive and the intestinal glands, etc. torpid. It was well knoton under the name of the " Chelsea Pensioner."
R. Tincturas Nucis Vomicae, min. 95 ; Extracti Cinchonfe Flav« Liquidi, min. 80 ; Misturae Guaiaci, fl. oz. 12. Mix. One-eighth part twice a day. In habitucd constipation from a sluggish condition of the intestincd walls.
44. Quinine and Ipecacuanha^ or Belladonna.
R. Quiniae Sulphatis, gr. 8; Pulveris Ipecacuanhae, gr. 24; Pulveris Ipecacuanhae Compositi, gr. 30; Glycerini, sufficient to form a mass. Di- vide into sixteen pills, and order two to be taken every three or four hours. In subacute dysentery, occurring in tropical regions. See P. 384.
R. Quiniae Sulphatis, gr. 2 ; Extracti Belladonnae, gr. ^ ; Extracti Opii, gr. |~1 ; Extracti Hyoscyami, gr. 2. Make a pill to be taken every six or eight hours. In neurcdgia, severe pruritus of the vulva, carcinoma, etc. See P. 383.
45. Chloride of Calcium., etc.
R. Calcii Chloridi, gr. 200 ; Tincturae Belladonnas, fl. drs. 4; Tincturae Aurantii, fl. drs. 12; Aquae, fl. oz. 1. Mix and label, — "One teaspoonful in a wineglassful of water three times a day, — at 10 a. m., 4 p. m., and bed- time." In fibroid tumors of the iderus, luhen they are painful or cause much sense of weight and backache. Also, in bronchocele, enlargement of cervical glands, scrofula, etc.
ALTERATIVES AND RESOLVENTS. 295
R. Calcii Cliloridi. "^r. 300; Siicci Conii, fl. oz. 3; Glycerini piiri vel Tinctnne Cardainomi Compositas, fl. oz. 1. Mix and label, — "One teaspoon- ful in a wincglassfiil of water three limes a day."
46. Colchicum, etc.
R. Hydraro:3'ri Subchloridi, Extract! Colchici Acetici, Extracti Aloes Barbadensis, Piilveris Ipecacnanhse, aa gr. 1. Make a pill, to be taken every four hours until the bowels are well acted upon. In gout with con- gestion of the liver.
R. Extracti Colchici Acetici, Extracti Aconiti. aagr. 1 ; Pilulag TTydrar- gyri, gr. 3. Make a pill, to be taken every night at bedtime. In gout, loith deficient action of the liver.
R. Potassse Citratis, gr. 120 ; Vini Colchici, fl. drs. 1-2 ; Liquoris Mor- phine Hydrochloratis, fl. drm. 1 ; Aquae Camphorse, ad fl. oz. 8. Mix. One- sixth part every six hours. In some forms of gout, tvhere there is great restlessness with hut little constitutional depression.
R. Spiritfls Ammonise Aromatici, fl. drs. 6 ; Vini Colchici, fl. drs. 2-4; Tincturse Anrantii, ad fl. oz. 2. Mix. Direct, — "One teaspoonful in half a bottle of soda-water, three times a day."
47. Oxide of Silver.
R. Argenti Oxidi, gr. 1-2 ; Pulveris Aromatici, gr. 2 ; Extracti Can- nabis Indicse, gr. k ;. Glycerini, sufficient to make a pill. To be taken three times a day. Of doubtful efficacy in di/spepsia, pyrosis, hcemoptysis, me- norrhagia, diarrhopa. etc. One-third of a grain of Extract of Opium can be added to each pill, if needed.
48. Sulphurous Acid.
R. Acidi Sulphurosi, min. 30-fl. drm. 1; Aquae, ad fl. oz. 2. Mix for a draught, to be taken every two or three or four hours. In ichorhcemia, diphtheria, maJignard scarlet fever, typhus, etc.
R. Sodae Sulphitis, gr. 30-60; Infusi Quassise, fl. oz'. 1^. Mix, and make a draught to be taken three times a day. Sir AVilliam Jenner. In
diseases of the stomach, accompanied hy the formation of the sarcince ventricnli. The patient should eat unfermented bread ivhile taking this medicine.
The Sulphide of Magnesia maybe given in doses varying from 20 to 40 grains, dissolved in one or two ounces of water, every two or three or four hours, with the object of neutralizing blood poisons. It is richer in sul- phurous acid than the sulphite of soda, is more stable, and has a much more agreeable taste. 'J'his salt has been strongly recommended by Dr. Polli, of Milan, in cases of pyaemia, typhus, puerperal fever, hospital gangrene, dissecting wounds, glanders, cholera, etc.
49. Benzoic Acid.
R. Acidi Benzoici, gr. 3-20; Glycerini, sufficient to form one or more pills. Administered in proper doses, three or four times a day, this remedy is useful in jaundice from suppressed aciion of the liver. It has also been recommended in some cases of incontinence of urine in children. See F. 246.
50. Turpentine Mixtures.
R. Olei Terebinthinfe, fl. dr. 1-3; Syrupi Scillae vel Syrupi Tolutani, fl. oz. 1 ; Tincturse Camphorse Conipositae, fl. drs. 3 ; Mucilaginis, ad fl.
296 APPENDIX OF FOEMUL^. .
oz. 3. Mix. A dessertspoonful to be taken three or four times a day.
Useful in chrome bronchitis with profuse muco-jyurulent expectoration.
B. Olei Terebinthinse, fl. oz. 1; Vitelli Unius Ovi ; beaj,t together and add gradually Misturse Amygdalae, fl. oz. 4; Syrupi Aurantii, fl. oz. 2 ; Tincturae Lavandulae Compositgg, fl. drs. 4; Olei Cinnamomi, guttag 4. Mix. Two tablespoonfuls to be taken three times a day. Carmichael. — Recommended in iritis, where the use of mercury is contraindicatecl.
R. SpiritCis ^Etheris, fl. drs. 2 ; Olei Terebinthinae, fl. drs. 1^; Mucila- ginjs Acacias, fl. oz. 3 ; Aquae Cinnamomi, ad fl. oz. 6. Mix. Direct, — " One-sixth part three times a day." To prevent the formation of gall- stones, or to aid in dissolving them. The utility of this mixture is doubtful.
R. Olei Terebinthinae, fl. drs. 13^-3; Syrupi Limonis, fl. drs. 6; Mucila- ginis Tragacanthae, fl. oz. 3 ; Aquae, ad fl. oz. 6. Mix. Direct, — " One- sixth part every four or six hours." Useful in some formes of hcemate- mesis. hcemoptysis, epistaxis, purpura hcemorrhagica, etc. Its effects must be watched, so that it may be discontinued directly any unpleasant re>^ults- — such as strangury or severe vomiting — arise. If the symptoms are very urgent the first dose of the turpentine may consist of fl. drs. 4-6, beaten up tvith mucilage ; the succeeding doses beitig according to the formula. In some cases the turpentine may be advantageously given witlx gallic acid, or the tincture of the perchloride of iron, or with the acid infusion of roses, or tvith the dilute nitric acid. A drop of creasote with each dose materially lessens its tendency to cause nausea.
R. Terebinthinae Chiae, gr. 2 ; Pulveris Ehei, gr. 3; Saponis duri, suffi- cient to make a pill. To be taken twice a day. See also F. 102.
51. Donovan'' s Triple Solution.
R. Liquoris Hydriodatis Arsenici et Hydrargyri, min. 20-30; Tincturae Zingiberis, fl. drm. 1 ; Aquae, fl. oz. 1. Make a draught, to be taken twice a day, directly after meals. Useful in secondary syphilis, psoriasis, etc.
52. Arsenical Mixtures.
R. Liquoris Arsenicalis, min. 3; Tincturae Lupuli, min. 30; Infusi Quas- sife, fl. oz. 1. Make a draught, to be taken three times a day, directly after meals. Very useful in many obstinate cutaneous diseases. In ague the quantity of arsenic must be trebled. Under any circumstances, the dose shoidd be diminished directly the tongue gets thoroughly coated tvith a silvery-looking fur, or the conjunctivae become irritable, or diarrhoea sets in, or gastric pain is complained of.
R. Liquoris Sodee Arseniatis, min. 3-5; Vini Colchichi, min. 10; Tinc- turae Cinchonae Compositae, fl. drm. 1 ; Tincturae Aconiti, min. 5 ; Aquae, ad fl. oz. 1. Mix. To be taken three times a day, directly after meals. In some forms of chronic rheumatism,, etc.
R. Quinife Sulphatis, gr. 20; Liquoris Arsenici Hydrochlorici, min. 90- 130 ; Acidi Sulphurici Aromatici. fl. drs. 2 ; Syrupi Zingiberis, ad fl. oz. 3. Mix. Label,- — " One teaspoonful in two tablespoonfuls of water directly after breakfast, dinner, and tea." In severe neuralgia, cliorea, chrome rheumatism, asthma, hay fever, and intermittent fever . See P. 381, 399.
R. Liquoris Arsenicalis, min. 30 ; Tincturae Cantharidis, fl. drm. 1 ;
Tincturae Aurantii, fl. drs. 6; Potassii lodidi, gr. 18-30; Infusi Aurantii, ad fl. oz. 6. Mix. One-sixth part directly after the two chief meals.
Valuable in some inveterate cutaneous diseases, as lupus, eczema, pso- riasis, etc.
ALTEEATIVES AND RESOLVENTS. 297
R. Liqnoris Sodo3 Arseniatis, fl. clrs. 1^; Succi Scoparii, fl. oz. 3. Mix. One teaspoonful three limes a day, in a wineglassful of water. In some .cases of dropsy from chronic renal disease.
R. Acidi Arseniosi, gr. 1; Pnlveris Zingiberis. gr. 40 ; Extracti Jalapge, gr. 20 ; Pnlveris Tragacantlias Compositi, gr. 30 ; Confeftionis Rosae Ca- ninae, gr. 10. Mix very intimately, divide into twenty pills, and order one to be taken three times a day, immediately after meals. In psoriasis, chronic eczema, and other cases where -it -is desirable to administer arsenic in a solid form.
53. Green Iodide of Mercvry.
R. Hydrargyri Todidi Viridis, gr. 12; Extracti Lnpnli, gr. 60; Extracti Opii, gr. 2-.5. Mix. Divide into twenty-four pills, silver them, and order one to be taken three or four times in the day. — The green iodide of mer- cury (Syn. Iodide of Mercury. Hg I) will cure some of the p-ustular and tiihercular diseases of the skin, as well as certain secondary venereal ulcerations, when all other means fail. See F. 33.
R. Hydrargyri lodidi Viridis, gr. 6; Extracti Conii. gr. 30. Mix. Di- vide into six pills, and order one to be taken every night at bedtime. In small secondary syphilitic ulcers about the tongue.
54. Red Iodide of Mercury.
R. Hydrargyri Todidi Rubri, gr. 1-2; Morphise Hydrochloratis, gr. 1; Extracti Gentianas, vel Extracti Conii, gr. 40. Mix. Divide into twelve pills, and order one to be taken twice a day. Four or six ounces of the Compound Decoction of Sarsaparilla may be taken with each pill, or an ounce of the Guaiac Mixture. Useful in the scome eases as demand the green iodide of mercury. Tlie red iodide (Syn. Biniodide of Mercury, Hg I,) is, however, less likely to cause gastric irritation.
R. Hydrargyri Perchloridi, gr. 1 ; Ammonii Chloridi, gr. 30; Potassii Todidi, gr. 40 ; Extracti Sarsse Liquidi, fl. oz. 4 ; Decocti Sarsas, ad fl. oz. 8. Mix and label, — ■" One small tablespoonful (or one-sixteenth part} in a wineglassful of water three times a day." — This formula gives a conve- nient extemporaneous mode of exhibiting the red iodide of mercury m a fluid form.
R. Hydrargyri lodidi Rubri, gr. 3; Potassii Todidi, gr. 60-120; Spiritus Vini Rectificati, fl. drm. 1 ; Syrupi Zingiberis, fl. drs. 4; Aqufe Destillatse, fl. drs. 12. Mix. Label, — " Thirty drops three times a day in a wineglass- ful of water." Mr. LA^■GST0N Parker says — and' the Author can confirm the remark — that this remedy, used in co-njunction loith the mercurial vapor bath, prod-uces excellent results in some obstinate forms of tubercu- lar disease of the skin; as ivell as in secondary venereal ulcerations, proving intractable after the employment of other remedies.
55. Red Iodide of Mercury and Arsenic.
R. Hydrargyri lodidi Rubri, gr. 1 ; Potassii Todidi, gr. 120 ; Liquoris Arsenicalis, fl. drs. 1^; Tincturte Lavandula; Compositse, fl. oz. 2 ; Spirittis Chlornformi, fl. drs. 4; Aquaj, ad fl. oz. 12. Mix; and direct, — " One table- spoonful to be taken three times a day, immediately after food." — In psoria- sis, and some inveterate squamous and tubercular and ulcerous affections of the skin.
298 APPENDIX OF FORMULA.
56. Puccoon and Iodide of Arsenic.
R. SangninariiE Can.idensis, gr. 12 ; Arsenici lodidi, gr. 2 ; Extract! Conii, gr. 40. Mix carefully, divide into twenty-four pills, and order one to be taken three times a day. Said to he beneficial in cases of cancer ?
57. Chloride of Bro7nium.
R. Bromidi Ohloridi, guttas 3-4; Pulveris Glycyrrhizse, gr. 60. Mix intimately, and divide into twenty pills. One to be taken twice or thrice daily. Recommended hy Landolfi in cancer.
58. Bael and Spirit of Chloroform.
R. Extract! Bel^e Liquidi, fl. oz. 2 ; SpiritCis Chloroformi, fi. oz. 1. Mix. Direct, — " One teaspoonful in a cup of barley water three or four times a day." — Has been found useful in diarrhoea and dysentery.
59. Nitrate of Silver.
R. Argenti Nitratis, gr. 1; Extracti Hyoacyami, gr. 3. Make a pill. To be taken every twelve hours, on an empty stomach, for about ten days. In cases of idiopathic jaundice dependent upon g astro-duodenal disturb- ance rather than on disease of the liver.
R. Argenti Nitratis, gr. 3-12; Micaj panis, gr. 30. Divide into twelve pills, and order one to he taken three times a day. In progressive loco- motor ataxy, etc. See F. 419. ^J'he gums should be watched, as the gin- gival mucous membrane becomes discolored before the skin is affected. There is consequently time to prevent the latter by discontinuing the silver salt.
60. Chloride of Ammoniurn.
R. Ammonii Chloridi, gr. 80-106; Syrupi Hemidesmi, fl. oz. 1 ; Infusi Geutianse Compositi, ad fl. oz. 8. Mix. Two tablespoonfuls every six hours In some forms of chronic rheumatism, chronic bronchitis, pleurodynia myalgia, neuralgia, etc.
R. Liquoris Ammonias Acetatis, fl. drs. 2-4 ; Ammonii Chloridi, gr. 15 Infusi Dulcamaras, fl. oz. 2. Make a draught to be taken every four hours In some varieties, of rheumatism, phlegmasia dolens, thrombosis, etc., where the fibrin of the blood is in excess. 'J'he efficacy of this remedy is increased by giving 120 or 200 grains of the Acid I'artrate of Potash (Syn. BiTARTRATE OF Potash) in half a pint of water, early in the morning.
R. Ammonii Chloridi, gr. 20 ; Extracti Taraxaci, gr. 15 ; Tinctura; Gen- tianse Compositse, fl. dr. 1 ; Infusi Sennas, ad fl. oz. 2. Make a draught, to be taken twice or thrice daily. In some cases of ascites dependent on cir- rhosis, in jaundice, in diminished secretion of bile, etc.
61. Chlorate of Potash.
R. Potassse Chloratis, gr. 120 ; Aquas Camphorse, vel Infusi Cinchonse Flavae, fl. oz. 8. Mix. One-sixth part every four or six hours, with two tablespoonfuls of water. In inflavimatory affections of the mouth, etc.
R. Potassae Chloratis, gr. 90 ; Spiritfis ^theris, fl. drs. 3 ; Infusi Chiratse, ad fl. oz. 4. Direct, — " One tablespoonful in a wineglassful of water three times a day." — In tonsillitis, glossitis, etc.
R. Potassae Chloratis, gr. 120. Label, — "This powder to be dissolved in one or two pints of lemonade, or of barley water, to form a day's drink." In cases of aplithce, fever, blood-poisoning, sloughing of any of the tissues, ovarian disease, etc.
ANTACIDS. 299
III. ANTACIDS.
62. Carbonate of Magnesia.
R. Maofnesise Carbonatis. o-r. 80 ; Extract! Opii Liquid!, min. 30 ; SpiritGs ^theris. tl. drs. 3; Aqiiaj MentlifE Viridis, ad fl. oz. 6. Mix. One-fourth part occasionally. Useful luhere there is much oppression from flatulence.
R. Magnesise Carbonatis, Sodse Bicarbonatis, aa gr. 15 ; Infusi Serpen- tarise, fl. drs. 12. Make a draught, to be taken twice or thrice daily. In chronic urticaria.
63. Ammonia and Chiretta or Gentian.
R. Ammonise Carbonatis, gr. 5; 'I'incturaj Aurantii, fl. drm. 1; Tnfusi Chiratse, fl. oz. 1 ; Aquge, ad fl. oz. 2. Make a draught to be taken night and morning. A good remedy in dyspepsia, iviih acid eructcUions and debility.
R. Sodfe Bicarbonatis, gr. 120; Spiritfts Ammoniee Aromatic!, fl. drs. 2 ; Tincturfe Zingiberis. fl. drm. 1 ; Infusi Gentianfe Compositi, ad fl. oz. 8. A sixth part to be taken three times a day. Useful in dyspepsia, with acidity.
64. Preparations of Lithia.
R. Lithia3 Carbonatis. gr. 3-6 ; Aquse, fl. oz. 3. Make a draught to be taken twice a day. Dr. Garrod speaks highly of this remedy in cases of the uric acid diathesis and in chronic gout. Where uric acid gravel is being voided, it causes a marked improvement. The carbon cde of lithia exists in many of the continentcd springs — as those of Carlsbccd. Marien- bad, Kreuznach, Aix-la-Chapelle, Kissingen, Ems, Vichy, Baden-Baden, etc.
R. Lithiae Citratis, gr. 60; Aqnse Destillatas, fl. drs. 10; Tinctnr£e Car- damom! Compositse, fl. drs. 2. Mix and label, — " One teaspoonful in a tumblerful of soda water every morning before breakfast." In the gouty dicdhesis. To ward of attacks.
R. Lithiae Citratis, Magnesise Carbonatis, aa gr. 10. Make a powder to be taken twice daily. In chronic gout.
65. Bismuth, with Magnesia or Soda.
R. Bismuthi Carbonatis, Magnesias Carbonatis, aa gr. 10. Make a pow- der to be taken in half a bottle of soda water three times a day.
R. Bismuthi Subnitratis, gr. 15; Sodse Bicarbonatis, gr. 12; Pulveris Tragacanthse Compositi, gr. 60. Make a powder, to be taken twice or thrice in the twenty-four hours, in a wineglassful of brandy and water.
R. Bismuthi Trisnitratis, gr. 120; Magnesise Carbonatis, gr. 60; Acidi Hydrocyanic! Diluti, min. 18-30; Pulveris Tragacanthae Compositi, gr. 90 ; Tincturse Calumbse, fl. drs. 3-6 ; Aqus, ad fl. oz. 6. Mix. A table- spoonful to be taken three times a day half an hour before food. Useful in flatulent dyspepsia with gastralgia.
R. Liquoris Bismuth! et Ammonise Citratis, fl. drm. 1 ; Infusi Quassiae, fl. oz. ]. Make a draught to be taken three times a day. One drachm of the solution of bismuth is equal to twenty grains of the powder. These preparations are very usefid in pyrosis, gastrodynia, acid eructcdions, nausea and sickness, and many diseases of the stomach, ccecum, etc. See also F. 112.
300 APPENDIX OF F0RMULJ5.
R. Bismnthi Subnitratis, gr. 720; Maffnesise Carbonatis, oz. 2 ; Caleis Carbonatis Prsecipitati, oz. 3 ; Sodse Bicarbonatis, gr. 1800 ; Saccliari Albi, oz. 14; Acacige Gummi, gr. 220 ; Mucilaginis Acacife, fl. oz. 1 ; Aquae Eosse, sufficient to make a mass. Divide into 360 lozenges, and dry them with a moderate heat.
Each lozenge contains two grains of snbnitrate of bismuth, two and a half grains of magnesia, and five grains of bicarbonate of soda. From one to six lozenges may be taken for dose. They check heartburn and acrid eructations better than the officinal bismuth lozenges.
66. Chalk Mixture and Hops.
R. Tincturse Lupuli, fl. drs. 6; Tincturse Cardamomi Compositae, fl. drs. 4; Vini Ipecacuanhse, fl. drs. 2; Extracti Opii Liquidi, min. 25; Misturae Cretfe, ad fl. oz. 6. Mix. One tablespoonful every three or four hours. In diarrhoea due to acidity of the primce vice.
67. Potash and Ammonia.
R. Potassae Bicarbonatis, gr. 120 ; Spiritljs Ammonise Aromatici, fl. drs. 3; Tincturae Aconiti, min. 30; Infusi Lupuli, ad fl. oz. 8. Mix. One-sixth part three times a day. In gastrodynia.
68. Ammonia, Potash, and Bark.
R. Ammoniae Carbonatis, gr. 30; Potassae Chloratis, gr. 90; Extracti Opii Tjiquidi, min. 30; Decocti Cinchonae Flavffi, fl. oz. 8. Mix. One-sixth part three times a day. In debility ivith acid secretions.
69. Solution of Potash and Buchu.
R. Liqnoris Potassae, min. 10-15 ; Tincturas Hyoscyami, min. 40 ; In- fusi Buchu, fl. drs. 12. Make a draught to be taken three times, a' day. In catarrh and irritahility of the bladder.
70. Soda, Morphia, and Dilute Hydrocyanic Acid.
R. Sodae Bicarbonatis, gr. 15; Liqnoris Morphias Hydrochloratis, min. 15; Acidi ITydrocyanici Diluti, min. 5; Infusi Cascarillae, fl. oz. 1. Make a draught, to be taken immediately. In gastrodynia. etc., after the stomach has been emptied by an emetic. In aoigina pectoris, immediately after a paroxysm.
71. Potash and Aloes.
R. Potassae Bicarbonatis, oz. |; Tincturae Chiratse, fl. drs. 2; Decocti Aloes Compositi, fl. oz. 8. Mix. Take one-sixth part early every morning. In chronic gout.
72. Bicarbonate of Potash.
R. Potassas Bicarbonatis, gr. 30; Aquae, fl. oz. 2. Make a draught to be taken every two hours. In acute rheumatism. This medicine to be contimied until the joints are free from pain. It generally renders the urine alkaline in tiventy-four hours.
73. Potash and Lime Water.
R. Liquoris Potassae, min. 15-45; Liquoris Caleis Saccharati, min. 20 -60. Mix. To be taken in a cupful of beef-tea, or of milk, two or three times a day. See F. 14.
ANTISEPTICS. 301
IV. ANTISEPTICS.
Disinfectants or Deodorants.
The most useful agents are — chloride of lime, quick lime, carbolic acid, the carbolates of lime and magnesia, and permanganate of potash. In cer- tain cases the perchloride of iron, sulphate of iron, ammonia, iodine, bromine, nitrate of lead, and chloride of zinc are applicable ; or chlorine gas ; or sul- phurous acid gas (obtained by sprinkling powdered sulphur on a few bright red coals in a shovel, or by burning part of a stick of sulphur in a crucible or in a pipkin), may be employed ; or powdered charcoal, or dry earth, can be tried.
No nightstools or bedpans should be used, especially in hospitals, without their containing the solution of permanganate of potash, or of carbolic acid, or some chloride of lime, or chloride of zinc, or half an ounce of tincture of iodine. The first agent has the advantage of not being corrosive ; but the last is one of the most efficacious. — To remove quickly any unpleasant smell from the sick-room, dried lavender or cascarilla bark may be burnt ; while the door and window must be opened, so as to allow of a free current of pure air.
To disinfect linen and washing apparel they should be soaked in a mix- ture of two ounces of the solution of permanganate of potash to the gallon of water; being afterwards put into boiling water. Woollens, bedding, or clothing may be thoroughly purified by exposing them for about two hours, iu an oven, to a temperature of 220*^ F.
74. Lister's Antiseptic Methods and Preparations.
The striking results obtained by Lister's Antiseptic treatment in surgical operations make it important that it should be generally understood.
The agents employed are Carbolic, Boracic, and Salicilic Acids, chiefly the first, and the process is based upon the supposition that particles capable of setting up septic change are everywhere present. The skin of the part, all instruments, all sponges, the hands of the operator are soaked or dipped in a 2^ or 5 per cent, solution of carbolic acid. Before and during the operation, a cloud of spray of a 2J- per cent, (or one in forty) solution of carbolic acid is directed upon the part. Carbolized catgut ligatures and sutures are to be employed. The wound, if large, is sponged over with a solution of chloride of zinc, 40 grains to the ounce (De Morgan). Free escape of serum and other fluids is to be provided for by carbolized drainage tubes.
For dressings carbolized gauze is used, prepared by saturating gauze with a mixture of carbolic acid, paraffin, and resin in a closed hot box or chamber. Over the wound is placed "protective" thin oil-silk, the direct contact of carbolic acid being too irritating; over the "protector" and extending far beyond it all round, is applied the gauze, eight or more layers in thickness, there being between the two outermost of these a layer of oil-silk or hat lining, or other thin impermeable material (best colored, so as to be con- spicuous), to prevent the discharges from soaking straight through, and compel them to travel in the gauze to the margin of the dressing. The whole is to be carefully secured by a gauze bandage.
The precautions during the operation protect the wound from septic particles in the air or on the instruments. Then the dressing being applied, the heat of the body volatilizes the carbolic acid contained in the gauze, which forms an antiseptic atmosphere between it and the skin, and prevents putrefaction of the discharges.
A joint is freely laid open and explored with the finger, or a large psoas abscess is incised and drained by tubes without any fear of fever being set
302 APPENDIX OF FORMULAS.
up. When an abscess has been opened the discharge in a few days becomes serous in character and scanty in amount, but the greatest care is required in these cases.
When a wound, as a compound fracture, has been exposed to air or to other septic contamination, great care is required to destroy or remove the septic particles.
75. Chlorine Gas.
As a fumigating agent, antiseptic, and disinfectant chlorine stands un- rivalled. The ingredients for producing it should be contained in saucers placed in the higher parts of tlie room, as the gas which is developed will descend by its density, and soon become mixed with the surrounding air. Dr. Faeaday adopted the following method at the Millbank Penitentiary : — One part of common salt was intimately mixed with one part of the black or binoxide of manganese, and placed in a shallow earthen pan ; two parts of oil of vitriol previously diluted with two parts by measure of water, were then poured over it, and the whole stirred with a stick. Chlorine continued to be liberated from this mixture for four days.
Another plan for causing the free evolution of chlorine gas is the addition of half a pint of hydrochloric acid, mixed with* a quarter of a pint of water, to a quarter of a pound of finely-powdered black oxide of manganese. Or the gas may be generated by dropping a few grains of chlorate of potash, everj' now and then, into a glass containing some strong hydrochloric acid. Whichever mode is adopted for producing this disinfectant, it is necessary while employing it that the doors, windows, and chimney of the room be kept carefully closed for some hours.
The Chlorides of Lime and Soda, M'hen exposed to the air, gradually absorb carbonic acid and give off chlorine. Hence either of these salts can be used as disinfectant agents. Cloths, dipped in an aqueous solution of chloride of lime, may be hung up in an inhabited room to fumigate it ; the quantity of chlorine given off being too small to be mischievous. It was probably in reference to these salts, that Abernethy said of disinfectants, — " they are sometimes very useful, very useful indeed ; for they make such an abominable stink that the patient is obliged to have the windows opened."
76. Solution of Chlorinated Soda.
R. Liquoris Sod* Chloratae, min. 40-120 ; Extracti Opii Liquidi, min. 30 ; AquEe Camphorae, ad fl. oz. 8. Mix. Two tablespoonfuls three times a day. In gangrene of the lung, loio fever, etc. It not only relieves the fetor, hut acts as an alterative, etc. If necessary the opium can be omitted.
77. To Prepare Chlorine for Internal Administration.
Put sixty grains of finely powdered chlorate of potash in a strong pint bottle, and pour upon them two drachms of strong hydrochloric acid. Close the mouth of the bottle until the violent action ceases, when gently add one ounce of water, and agitate well ; add another ounce, again shake, and con- tinue this process until the bottle is full. Afterwards keep the bottle in the dark. The mixture is to be made fresh every day. One or two tablespoon- fuls may be taken frequently according to the age. An adult may use the whole pint in the twenty-four hours.
The dose of the officinal Liquor Chlori is from min. 30 to fl. drs. 2 in a wineglassful of water, several times daily. Useful in scarlet fever, typhus, diphtheria, chronic affections of the liver, etc.
ANTISEPTICS. 303
78, Permanganate of Potash.
The permanganate of potash is an excellent disinfectant, and is the basis of CoiNdy's Antiseptic Flnid. The latter is double the strength of the officinal Liquor Potasses Permanganatis.
From 1 to 6 fl. drs. of the solution of permanganate of potash in one pint of water, may be applied to all kinds of suppurating sores. 'J'he Author has frequently ordered such a lotion with great benefit to destroy the horribly offensive odor of a malignant ulcer; or for the same purpose in suppurating scalds and burns. I'he solution should be made only of such strength as to be borne without any pain or even uneasiness. It must be frequently syringed over the sores, since contact with lint and sponges decomposes it. Linen is stained by it, but the discoloration may be removed by sulphate of iron. As a wash for stinking feet, or for the removal of offensive odors from the hands after handling morbid specimens, etc., the liquor ought to be used in the proportion of one fluid drachm to the ounce of distilled water. As an injection in cancer of the uterus, the strength ought not to be greater than half a fluid ounce to one pint of water. To deprive night-chairs of offensive odor, a wineglassful of Condy's fluid should be mixed with two pints of fresh or salt water, and put into the pan previous to its use.
79. Chloride of Zinc.
This substance is a most powerful caustic, which has long been used to destroy cancerous and other growths. It has been administered internally — dose, gr. 1, largely diluted — but without any benefit. It forms, however, a valuable disinfectant gargle — gr. 10 to water fl. oz. 8; or in still larger proportions it is a most efficacious antiseptic. Sir W. Burnett's Disin- fecting Fluid consists of gr. 25 of this salt to water fl. drm. 1. For use, about one ounce of this solution is added to two pints of water. To disin- fect a sick-room, a piece of flannel three or four feet square is to be moist- ened with a solution thus made, and frequently waved through the air. Some of it should also be placed in the close-stools and bedpans.
80. Chlorinated Lime Lozenges.
R. Calcis Chloratse, gr. 60; Sacchari Albi, oz. 4 ; Amyli, oz. 1 ; Olei Menthie Piperitge, fl. drm. 1 ; Pulveris Tragacanthse Compositi, gr. 120 ; Aquae Menthge Piperitae, sufficient to form a mass. To be divided into lozenges of twenty grains each. One may he taken frequently to remove fetor of the breath, luhether due to mercury or other causes. The officinal Trochisci Potass^ Chloratis can colso he used for the same parpose.
81. Lodine.
This agent has been recommended for disinfecting and deodorizing pur- poses by Wynn Williams, Campbell de Morgan, Nunn, and Richardson. Two hundred grains are placed in a common chip box and suspended over the patient's bed, or they may be put into a cup or saucer on the mantel- shelf. If desired, the metal may be at once volatilized and the vapor dif- fused through the apartment, by placing it on a heated fire-shovel or saucer, since the iodine attacks iron. In rooms occupied by smallpox patients the air may be kept free from smell by using iodine in this man- ner,— probably the strongest proof which could be adduced of the value of this simple and manageable remedy.
R. Tincturfe lodi, fl. drs. 6; Aqute Destillatai, ad fl. oz. 8. Mix. Useful as a lotion to unhecdthy idceratio7is with offensive discharges.
304 APPENDIX OF FORMULAE.
82. Extract of Logic ood.
R. Extracti Hsematoxyli, oz. 1 ; Olei Thfiobromse, Adipis Benzoati, aa oz. ^. Mix. This is an excellent disinfectant ivhen applied to malignant sores or suppurating ivounds. The remedy is equally efficacious vjhen used as a lotion or poioder. If any hcemostatic be needed, the logioood may be co^nbined loith tannin or perchloride of iron.
83. Sulphurous Acid and Quinine.
R. Acidi Sulpliurosi, fl. drs. 6 ; Tincturse Aurantii, fl. oz. 1 ; Tincturfe Chloroformi Compositfe, min. 90; Quiiiise Sulphatis, gr. 12-18; Aqute ad fl. oz. 6. Mix and label, — " One-sixth part, with two tablespoontuls of water, every six or eight hours." In pycemico, erysipelas, glanders, typjhus, dissecting wounds, etc.
84:. Lavender and Camphor,
R. Spiritus Camphorse, min. 20; Spiritus Lavandulae, fl. drm. 1 ; Muci- laginis Tragacanthse, fl. drs. 7. Make a draught. To be taken every six or eight hours by a nervous attendant in a sick-room. Its efficacy may be increased by the occasional addition of a glass of pjort wine.
V. ANTISPASMODICS.
85. Ether Mixtures.
R. Spiritus iEtheris, min. 40-fl. drm. 1 ; Extracti Opii Liquidi, min. 10-15; Tincturge Castoi;ei, fl. drm. 1; Aquae Menthae Piperitae, ad fl. drs. 12. Make a draught. To be taken occctsionally [especicdly at bedtime) when there are paroxysms of pain from structural disease.
R. SpiritCis vEtheris, Spiritus Chloroformi, aa fl. drs. 3 ; Tincturae Cardamomi Compositae. fl. drs. 6; Spiritfis Myristicse, fl. drs. 2; Olei Carui, min. 12 ; Mucilaginis Tragacanthae, fl. oz. 3 ; Aquae Menthae Piperitae, ad fl. oz. 8. Mix. Two or three tablespoonfuls occasionally, when there is great oppression from flatulence. ,
R. SpiritCis >3i]theris, min. 90 ; Spiritfis Ammonise Aromatici, fl. drs. 2 ; Tincturte Belladonnse, min. 30 ; Tincturte Cantharidis, min. 80 ; Tincturae Chloroformi Composite, min. 40 ; Aquas Camphorae, ad fl. oz. 4. Mix. Label, — " Two tablespoonfuls every half-hour until the pain is relieved." In spasmodic diseases, angina pectoris, etc.
86. Ammonia Mixtures.
R. Spirittis Ammoniae Aromatici, fl. drm. 1; Acidi Hydrocyanici Diluti, min. 3-5 ; Syrupi Zingiberis, fl. drm. 1 ; Aquae Carui, ad fl. drs. 12. Make a draught, to be taken twice or thrice a day if there be flatulence or lan- guor. In dyspepsia, or debility with irritable stomach. See F. 67, 68.
R. Tincturae Assafcetidae, fl. drs. 2 ; Ammoniae Carbonatis, gr. 20 ; Aquae Camphorae, ad fl. oz. 4. Mix. One or two tablespoonfuls occasionally, when the patient is feeling languid or hysterical.
R. Spiritus Amraonige Aromatici, min. 30 ; Magnesiee Carbonatis, gr. 20 ; Spirit&s Chloroformi, fl. drm. 1 ; Aquae Menthae Piperitae, ad fl. drs. 12. Make a draught. To be taken occasionally. In severe colic.
R. SpiritCis Ammoniae Aromatici, min. 75 ; SpiritQs ^theris, fl. drm. 1 ; Tincturae Belladounae, min. 12 ; Acidi Hydrocyanici Diluti, min. 8 ; Syrupi,
ANTISPASMODICS. 305
ad fl. oz. 2. Mix. One teaspoonful in the same quantity of water every four hours. Fur a child two years old tvitli whooping cough.
87. Valerian Draught.
R. Tincturaj Valei'ianse Ammoniatse, min. 40: Infusi Valerianas, fl. oz. 1. Make a draught. To be taken occasionally. In hysteria.
88. Lobelia., Ether., etc.
R. Tincturae Lobelias yEtherte, fl. drs. 3; Vini Ipecacuanhse, fl. drs. 2 ; Mistnraj Ammoniaci, ad fl. oz. 6. Mix. Two tablespooufuls every six hours. In the dyspnoea of asthma, tvhen there is vesicukcr emphysema.
89. Asscffcetida and Chiretta.
R. Tincturaj AssafcetidaJ. fl. drs. 2 ; Spiritfls Ammoniaa Aromatici, fl. drs. 3; Tinctura; Chiratte, fl. drs. 7. Mix. Direct, — " Sixty drops in a wine- glassful of water every two or three hours, until the paroxysms cease." In hysteria.
90. Aconite and Oreasote.
R. Tincturae Aconiti, min. 4.5; Misturte Creasoti, ad fl. oz. 8. Mix. One-sixth part three times a day. In some cases of obstinate sickness, such as occurs during pregnancy and in hysteria. See F. 41.
91. Nitric Acid Mixture.
R. Aeidi Nitriei Diluti, fl. drs. 12 ; Tincturae Cardamomi Compositae. fl. drs. 3; Syrupi, fl. oz. 3^; Aquae, fl. oz. 1. Mix. One or two small tea- spoonfuls every two hours. Sir G. D. Gibb states that nitric acid is a specific in the treatment of whooping cough, curing the disease infro'\n two to fifteen days. He recommeiids this foi'mida.
92. Sulphate of Zinc and Belladonna.
R. Zinci Sulphatis, gr. 8 ; Extract! Belladonnag, gr. 2 ; Aqufe, fl. oz. 4. Mix. Half an ounce four times a day. Dr. Fuller. — For a child above three years of age tvith ivhooping cough. Every other day the strength of the mixture may be augmented in the proportion of one dose. The belladonna, it is said, can be thus gradually increased to closes of five grains withoid any mischief. See F. 326.
93. Valerianate of Quinia.
R. Quinine Valerianatis, gr. 12-20 ; Extract! Gentianje, gr. 40. Divide into twelve pills, silver them, and order one to be taken three times a day. In hysteria, and ctnalogous nervous disorders.
94. Stramonium, Colchicum, and Digitalis.
R. Potassae Citratis, gr. 120; Tincturae Stramoiiii, fl. drm. 1; Tincturae Colchici Seminis, fl. drs. 2 ; Infusi Digitalis, fl. oz. 2 ; Aquae Meathae Pipe- ritae, ad fl. oz. 8. Mix. One-sixth part three times a day. In irregular gout, with dyspnoea or violent palpitation, and a full pulse.
95. Sumbid and Ether.
R. Sumbuli Radicis, gr. 240 ; Spiritus ^theris, fl. oz. 4. Macerate in a stoppered bottle for seven days, and then filter. Dose, min. 20-30. In
neuralgia, hysterical fits, etc. 20
306 APPENDIX OF FORMULA.
VI. ASTRINGENTS.
96. Rhatany Mixtures.
R. Tinctnrse Ehei, fl. drs. 3; Infusi Cramerise, fl. oz. 8. Make a mix- ture, and order one-sixth part to be taken every six or eight hours. A valuable astringent in common diarrhoea.
R. Extracti Kramerias, gr. 20 ; Aquas, fl. drs. 12. Make a draught. To be taken three times a day. In hcematuria, passive -intestinal hemor- rhage, etc.
R. Potassse Chloratis, gr. 60 ; Titicturse Kramerise, fl. drs. 6 ; Aquae ad fl. oz. 8. Mix. One-sixth part three times a day. In relaxation of the huccal mucous membrane, elongation of the uvula, sponginess of the gums, etc.
97. Catechu Mixtures.
R. Tincturce Catechu, fl. drs. 3-6 ; Pulveris Gretas Aromatici, gr. 90 ; Olei Mentha^ Piperitge, miii. 6 ; I^xtracti Opii Liquidi, niin. 30 ; Mistnr^ Cretse, ad fl. oz. 8. Mix. One-sixth part after every relaxed motion. Efficacious in checking simple diarrhoea. In some instances half an ounce of castor oil should be given fou,r hours before commencing this mixture.
R. Tincturse Catechu, fl. drm. 1 ; Acidi Sulphuric! Aromatici, min. 15; Olei Mentha Piperita?, min. 1 ; Infusi Catechu, fl. oz. 1. Mix. To be taken two or three times a day.
R. TincturfE Catechu, fl. drs. 3; Spiritfis Chloroformi, fl. drs. 6; Ex- tracti Belas Liquidi, fl. drs. 12 : Infusi Maticas, ad fl. oz. 6, Mix. Two tablespoonfuls to be taken three or four times a day. In chronic diar- rhoea and dysentery.
R. Extracti Belse Liquidi, fl. drs. 1-2; Syrupi Gummi Rubri, fl. dr. 1 ; Aquse, fl. oz. 1. Mix. To be taken three or four times a day. In chronic dysentery.
R. Pulveris Catechu Compositi, gr. 30; Pulveris Cretse Aromatici cum Opio, gr. 20. Make a powder. To be taken night and morning.
98. Vegetable Charcoal.
R. Carbonis Ligni, Theriacse, aa oz. 1. Mix. Direct one teaspoonful to be taken three or four times a day. In some cases of chronic diarrhoea, when the irritation is kept up by fecal fermentation. In fetid eructa- tions. The clictrcocd should be recently prepared. Charcoal biscuits are also useful.
99. Tannin and Nitric Acid.
R. Acidi Tannici, gr. 30; Acidi Nitrici Diluti, fl. drm. 1; Tincture Lupuli, fl. drs. 4 ; Infusi Gentianas, ad fl. oz. 8. Mix. Direct, — " One- sixth part three times a day." To restrain secretion in chronic bronchial catarrh, in phthisis whe^i the cavities are large and the tuctlls throiu out considerable quantities of purulent matter, in nervous debility, and in most cases luhere an astringent is reqiured. When a ferruginous tonic is indicated, the above mixture may be given night and morning, and some preparation of steel in the middle of the day.
ASTRINGENTS. 307
100. Aromatic Suljyliuric Acid and Opium,.
R. Acitli Sulphurici Aromatici, fl. drs. 2; Tinctnrse Cainphoras Compos- itae, fl. oz. 1; AqutB Ciaiuimonn, acl fl. oz. 8. IVIi.v:. Label, — "One-sixth part three times a day, about an hour before each meal."
101. PercMoride of Iron.
R. Tincturgs Ferri Perchloridi, min. 1.5 ; Acidi Hydrochlorici Piluti. min. 10; Aquae Aurantii Floris, fl. drs. 12. Make a draught. To be taken every six hours. In some cases of epistaxis, heviorrhage from the stomach, etc.
102. Oil of Turpentine.
R. Olei Terebinthinse, min. 10-20; Misturse Amygdalae, 9. oz. 1. Make a draught. To be taken every hour. In severe hcemopti/sis, especially where the individual is tveak and cachectic.
R. Olei Terebinthinae, min. 10 ; Tinct. Opii, min. 10 ; Muciliginis Aeacife, fl. drs. 4; Aquge, ad fl. oz. 1 Make a draught. To be taken every two or three hours. In hemorrhage from the boiuel in enteric fever.
R. Mueilaginis Acacige, fl. drs. 4; Sodse Bicarbonatis, gr. 10; Olei Tere- binthinie, min. 10; Olei Anethi, min. 1: Aquae Destillataa, ad fl. drs. 12. Make a draught. To be taken thrice daily. In passive hcematemesis. See F. 50.
103. Gallic Acid.
R. Acidi Gallic!, gr. 10-15; Aquae Destillatte, fl. drs. 12. Make a draught. To be taken every four hours.
R. Acidi Gallici, gr. 4; Ext racti Cannabis Indicae. gr. J-; Confectionis Ros« GallicEe, gr. 1. Make a pill. To be taken every night at bedtime. To check the night-sioeats in phthisis.
R. Acidi Gallici, gr. 8; Morphiae Hydrochloratis, gr. \; Confectionis Rosae Gallicie, sufficient to make two pills. Label, — " 'J'o be taken every night at bedtime." To relieve the cough and night-siveats of phthisis.
R. Glycerin! Acidi Gallici, fl. drs. 6-10 ; Acidi Sulphurici Diluti, fl. drs. 2 ; Extract! Ergots Liquidi, fl. drs. 3 ; Aquae Ciunamomi, ad fl. oz. 8. Mis and label, — " One-eighth part every four or six hours." hi uterine hemor- rhage, lohether due to cctncer, polypus, simple idcerafioti, or djlahby con- dition of the loalls.
R. Acidi Gallici, gr. 15-25; Acidi Sulphurici Aromatici, min. 15-20; Tincturae Cinnamomi, fl. drs. 2 ; AqujE Destillatae, ad fl. oz. 2. Make a draught. To be taken every four hours until the bleeding ceases. In pro- fuse menorrhagia, hoimoptysis, hcematemesis, etc.
R. Acidi Gallici, gr. 12 ; Pulveris Ipecacuanha Compositi, gr. 5. Make a powder. To be taken every eight or twelve hours. A valuable astringent in hemorrhage from the hc7igs, stomctch, intestines, or kidneys.
104. Cinnamon Mixtures.
R. Tincturae Cinnamomi, fl. drs. 6; Acidi Nitrici Diluti, fl. drs. 2. Mix, and label, — " Thirty drops in a wiueglasful of water every two hours." Useful in passive hemorrhages from the kidneys, bladder, iderits, etc.
\i. Tincture Cinnamomi, fi. drs. 2 ; Spiritus Ammonia Aromatici, fl. drs. 2; Decocti Haematoxyli, ad ti. oz. 6. Mix. One-fourth part after every relaxed motion.
308 APPENDIX OF FORMULA]:.
R. Tincturse Cinnamomi, fl. drs. 2 ; Aquae Cinnamomi, fl. oz. 1. Make a draught. To be taken thrice daily. In menorrliagia especially, but also in other varieties of passive hemorrhage.
105. llatico and Rhatany.
R. TincturDB Kraraerise, fl. drs. 12 ; Syrupi Papaveris, fl. drs. 6 ; Infnsi Matioas, ad fl. oz. 8. Mix. One tablespoonful every three hours. In the diarrhoea of tubercidar phthisis.
106. Sulphate of Copper and Opium.
R. Cupri Sulphatis, Extracti Opii, aa gr. I; Extracti Gentianse, q. s. Make a pill. To be taken three or four times a day. In obstinate diar- rhoea.
107. Nitrate of Silver and Opium.
R. Argenti Nitratis, gr. ^; Extracti Opii, gr. 2. Make a pill. To be taken night and morning. In very obstinate diarrhoea tohere opium agrees with the system. See F. 59.
108. Kino and Logwood.
R. Tincturse Kino, fl. drs. 6; Vini Ipecacuanhse, fl. drs. 2; Decocti Hsematoxyli, ad fl. oz. 8. Mix. One-sixth part three times a day. In chronic dysentery, diarrhoea, abundant secretion of mucus from lining membrane of colon and rectum, etc.
109. Qkiscarilla and Squills.
R. Tincturse Scillse, fl. drs. 1^-2 ; Acidi Sulphurici Aromatici, fl. drm. 1 ; Liquoris Morphise Hydrochloratis, min. 30; Infusi Cascarillee, ad fl. oz. 8. Mix. One-sixth part three times a day. In chronic bronchitis ivith pro- \fuse expectoration.
110. Alum and Syrup- of Red Poppy.
R. Aluminis, gr. 30; Syrupi Rhoeados, fl. drs. 3; Aquae, ad fl. oz. 2. Mix. One teaspoonfiil every two or three hours. In the catarrh of in- fants, where the secretion from the bronchial tubes is excessive.
111. Oxide of Zinc.
R. Zinci Oxidi, gr. 12 ; Extracti Conii, vel Hyoscyami, gr. 18. Make a mass, divide into six pills, and order one to be taken every night at bed- time. For the relief of night sweats in phthisis and other exhausting diseases, there are few remedies more serviceable than the foregoing.
R. Zinci Oxidi, gr. 2 ; Morphiae Hydrochloratis, gr. J; Extracti Anthe- midis, gr. 3. Make a pill, to be taken night and morning.
112. Preparations of Bismuth.
R. Bismuthi Carbonatis, gr. 60 ; Syrupi Papaveris, fl. drs. 4 ; Mucilaginis Tragacanthaj, fl. oz. 4 ; Aquai, ad fl. oz. 8. Mix. One-sixth part every six or eight hours. Useful in checking the diarrhoea of phthisis, typhoid fever, etc.
R. Bismuthi Carbonatis, gr. 80; Pulveris Kino Compositi, gr. 30; Tinc- turiB Cinnamomi, fl. drs. 3; Mucilaginis "J'ragacanthae, fl. oz. 4; Aquae, ad fl. oz. 6. Mix. One-sixth part every four hours.
R. Bismuthi Subnitratis, gr. 100. Divide into six powders, and order one to be taken every night at bedtime in a teacupful of milk arrowroot
ASTRINGENTS. 309
witli one -tablcspoonful of brandy. In all cases lohere the use of hismidh is indicated tuith a stimulant. See F. 65.
113. Astringent Enemata.
R. Olei Terebinthinge, min. 30; Tinctnne Kino, fl. drs. 2 ; Extract! Opii Liqnifli, min. 10-25 ; Mncilaginis Amyli, fl. oz. 2. Make an enema. To check the purging in tyi)hoid fever. It may he employed twice or thrice in the tioentyfour hours, if necessary.
R. BiFmuthi Subnitratis, gr. 20; Tinctnrre Catechu, fl. drm. 1 ; Liquoris Morphia3 Hydrochloratis, min. 30; Mucilaginis Amyli, fl. oz. 2. Mix for an enema. To check the purging of phthisis, fever, etc. It may he administered every tivelve hours.
114. Chloroform, Opium', and Castor Oil.
R. Cliloroformi, min. 6-12 ; Tincturse Camphoras Composite!, fl drs. 2 ; Olei Ricini. fl. drs. 3 ; Mucilaginis Tragacanthce. fl. drs. 3. Make a draught, to be taken immediately. In choleraic diarrhoea.
115. Alum and Sulphuric Acid.
R. Aluminis, gr. 100 ; Syrupi Rhoeados, fl. drs. 6 ; Infusi Rosre Acidi. ad fl. oz. 8. Mix. Two tablespoonfuls every six hours. In passive hem,or- rhage. Also in some cases of lead colic:
116. Ammonia Iron- Alum, etc.
R. Ferri Ammonio-Sulphatis, gr. 30-60; Aqnte Destillatge. fl. oz. 8. Mix. One-sixth part every six or eight hours. An excellent astringent in some forms of hcematemesis, haemoptysis, etc.
R. Aluminis, gr. 90 ; Ferri Sulphatis, gr. 20 ; Quiniee Sulphatis, gr. 4 ; Acidi Sulphuric! Diluti, fl. drm. 1 ; Syrupi Limonis, fl. oz. 1 ; Aqute Pestil- latse, ad fl. oz. 8. Mix and label,—" One-eighth part to be taken three times a day, after food, in a wineglassful of water."
117. Lead and Acetic Acid.
R. Plumbi Acetatis, gr. 5-10; Extracti Opii, gr. \-h; Confectionis RosEe Gallicse, sufficient to make two pills. To be taken every two or three hours, with the following draught:— R. Acidi Acetici Diluti. fl. drs. 2; Aquse Cinnamomi, fl. drs. 6. Mix. In severe hannoptysis. — The acetate of lead is inferior to gallic acid as an astringent, unless given in larger doses than are commonly employed. According to the Author's experi- ence, this lead scdt may he prescrihed in 5, 10, or even 20 gr, doses, ivitli great advantage, in cases of iderine hemorrhage requiring prompt sup- pression. As doses of ten grains, repeated every four hours for forty- eight or sixty hours, have given rise to attacks of colic, the Author has not ventured on the large quantities (60 to 180 grs.) recommended hy Dr. C. K. Irwin.
118. Cold as a Local Astringent.
The best and cheapest freezing mixture is made with ice and common salt in equal parts. Any of the following, however, will prove useful : —
310 APPENDIX OF FORMULA..
MISTUKES. PARTS. THEKM. SINKS.
Cliloride of Ammonium . . . 5 |
,Nitre 5 V From 50° to 10° Fahr.
Water 10 1
Nitrate of Ammonia .... j | prom 50O to 40 Fahr.
Water 1 j
Snow 2 I
Common Salt 1 ]
Snow or Ice 12
Common Salt 5 V From 18° to - 25° Fahr.
Nitrate of Ammonia . . ^ . 5 )
r I From 32^ to-40 Fahr.
VII. BATHS.
119. Temperature of Simple Baths.
BATH. WATER. VAPOR. AIR.
The Cold . . 33° to 65° Fahr. " Cool . . 65° to 7.^^ " Temperate 7.5° to 85°
" Tepid . . 85° to 92° . . . 90° to 100° . . . 96° to 106° " Warm. , 92° to 98°. . . 100° to 115° . . . 106° to 120° " Hot . . 98° to 112° . . . 115° to 140° . . . 120° to 180°
120. Nitro-HydrocMoric Acid Baths.
R. Acidi Nitrici, fl. drs. 12; Acidi Hyrochlorici, fl. oz. 1-3; Aqua? Calidfe, C. 30. Mix. To be prepared in a wooden. bath. The patient should remain in it from ten to twenty minutes. U'^efiil in cases tuhere the liver is inactive, — as in invalids from tropical climates.
R. Acidi Nitrici, fl. drs. 4; Acidi Hydrochlorici, fl. oz. ; Aqu^e Calid;©, C. 4. Mix. For a footbath. In dyspepsia, to'th derangement of the liver and constipation. To he used in a ivooden or earthemvare vessel.
121. Alkaline Bath.
R. Sod?e Carbonatis, lb. 1 ; Aqufe Ferventis, C. 30. Mix. In the lithic acid diathesis, chronic squamous diseases of the skin, chronic rheuma- tism, etc.
122. Conium and Starch Bath.
R. Extract! Conii, oz. 1; Pulveris Amyli, lb. 1; Aqufe Ferventis, 0. 30. Mix, for a bath. In certain skin diseases attended with abundant scurf itching. A simple starch bath without any conium is very soothing to the skin when covered with an irritating rash.
123. Grea.sote Bath.
R. Creasoti, fl. drs. 3 ; Glycerini, fl. oz. 4 ; Aquae Ferventis, C. 30. Mix. In squamous disease of the skin.
124. Iodine Baths.
R. lodi, gT. 60 ; Potassii lodidi, oz. \; Liquoris Potassag, fl. oz. 2 ; Aquse Calidge, C. 30. Mix. In scrofula, chronic rheumatism, secondat y syphilis, and certain skin diseases.
BATHS. 311
125. Sulphur Baths.
I^. Potassns Sulphurate, oz. 4; AqujE Calidae, C. 30. Mix. Useful in scabies, lead colic, paralysis from lead, etc.
]^. Potassoe SnlphnratiB, oz. 4; Sodae Hyposulphitte, oz. 1; Acidi Sul- phurici, fl. drm. 1 ; Aquas Calidae, C. 30. Mix.
126. Iron, or Oak Ba?^k Baths.
^. Ferri Sulphatis, oz. J; Aquae, C. 4. Mix. Especially useful for strumous and rickety children.
^. Qnercfis Contusfe, lb. ] ; Aquffi Calidfe, 0. 2. Mix. Boil for half aa hour, and add the strained decoction to three g-allons of warm or tepid water. To be used every morning. For delicate children, etc.
127. Salt-water Baths.
:^. Salis Marini (vulgo, "Bay Salt"), lb. |; Aquce Tepidse. 0. 4. Mix. Make a sponge bath to be used every morning. In general debility, chronic rheumatism, etc. The surface of the body should he thoroughly rubbed with afle.th brush and coarse toioels.
Vf.. Salis Marini, lb. 2 ; Magncsiae Sulphatis, oz. 3; Potassii lodidi, gr. 120 ; Liquoris Oalcis Ohloratas, fl. oz. 1^ ; Aquae, C. 30. Mix.
128. Arsenical Baths.
I^. Sodae Carbonatis, oz. 4; Sodae Arseniatis. gr. 20-36; Aquae Calidae, C. 30. Mix. In rheumatoid arthritis, skin diseases, etc.
^L. Sodii Chloridi. oz. 1 ; Sodae Sulphatis, oz. 1 ; Sodae Carbonatis, oz. 2 ; Sodae Arseniatis, gr. .^2 ; Aquae Calidai, C. 30. Mix.
I^. Potassae Sulphuratae, oz. 4; Sod^ Arseniatis, gr. 30-40 ; Aquae Calidae, C. 30. Mix.
129. Borax Bath.
1^. Boracis, oz. 4; Glycerini. fl. oz. 3 ; Aquae Calidce, C. 30. Mix. In some squamous and other irritctble diseases of the skin.
130. T/ie Turkish Bath.
The general effect of a hot air bath is to increase the force and rapidity of the circulation, and to induce free perspiration ; but if too hot or too prolonged the determination of blood to the skin and lungs becomes so great, that the brain suffers. There is then consequently a lowering of the circulation, with depressed nervous power. A temperature varying from 110° to 165° will usually suffice; while if the perspiration is efficient and continuous, and the sensation agreeable, the patient may remain in the calidarium for from forty to sixty minutes. The bath is always to be taken before a meal — when the stomach is empty. — A Turkish bath is useful in removing local congestions, in clearing the poi'es and in inducing a healthy condition of the skin and mucous membranes, in eliminating noxious matters from the blood, and in imparting a sense of elasticity and vigor to the system. Hence it may be recommended in dropsy due to renal or hepatic disease, in gout and rheumatism, in many cutaneous affections, in albuminuria, in certain forms of neuralgia, in some cases of obesity, and so on. It is injurious when there is any obstruction to the circulation, or when the heart or vessels are affected with fatty degeneration, or when there are any symptoms of
312 APPENDIX OF FOEMULJ^..
disease of the nervous centres, or when there is a tendency to vertigo or syncope, as well as in advanced life. VVonien who are pregnant, or who are menstruating, ought not to have recourse to it.
131. Mercurial Vapor Bath.
The patient is seated on a chair, and covered with an oil-cloth lined with flannel which is supported by proper framework. Under the chair are placed a copper batla containing water, and a metallic plate on which is put from sixty to one hundred and eighty grains of the bisulphuret of mercury, or the same quantity of the gray oxide, or of the red oxide of this metal. In syphilitic affections of the skin, testes, and bones, from five to thirty grains of the green iodide of mercury may be employed ; or a mixture of twenty grains of the green iodide with ninety grains of the bisulphuret often proves efficacious. Under the bath and plate, spirit-lamps are lighted. The patient is thus exposed to the influence of three agents — heated air, steam, and the vapor of mercury. At the end of five to ten minutes perspi- ration commences, which becomes excessive in ten or fifteen minutes long-er. The lamps are now to be extinguished ; and when the patient has become moderately cool, he is to be rubbed dry. He should then drink a cup of warm decoction of guaiacum or sarsaparilla, and repose for a short time.— Langston Parker. In constitutional si/philis tvlien mercury is indicated. This method of introducing mercury into the system may also he adopted with benefit in other diseases, in place of administering the metal by the mouth.
Mr. Henry Lee's mode of proceeding is more simple, and is the one which the Author has frequently adopted with great success. A convenient appa- ratus is used, made by most instrument makers, consisting of a kind of tin case containing a spirit-lamp. In the centre, over the flame, is a small tin plate, upon which from fifteen to thirty grains of calomel are placed ; while around this is a sort of saucer filled with boiling water. The lamp having been lighted, the apparatus is placed under a common cane-bottom chair, upon which the patient sits. He is then enveloped, chair and all, in one or more large blankets; and so he remains well covered up, for about twenty minutes, when the water and mercury will be found to have disappeared. About five minutes afterwards he may put on his shirt and go to bed ; but it is better not to use a towel, since it can only be disadvantageous to wipe off the calomel deposited on the skin.
132. Gelatine Bath.
Take of Gelatine, or Common Glue, lb. 1 ; dissolve in a little boiling, water, and then add twenty gallons of hot water to form a bath. 'J'his bath can oft-times be made more efficacious by soaking in it one or two pounds of bran confined in a muslin bag. In eczema, and other irritable cxdaneous affections.
133. Mustard Footbath.
'Sf.. Pulveris Sinapis, oz. 2-4; Aquae Calidfe, C. 4. Mix, for a footbath. In congestions of the head and chest, headache, languid circulation, as well as in some cases of amenorrhma, etc.
134. Cold Affusion.
The patient is seated in an empty bath, and from four to six buckets of cold water (about 40° Fahr.) are poured over his head and chest from a height of two or more feet. He is then quickly dried, and replaced in bed. The colder the water and the greater the height from which it is poured, the more stimulating the effect. Affusion, as thus practised by Dr. Ourrie,
BATHS. 313
proved very valuable in the treatment of typlius. It may be resorted to Aviien the temperature of the body is permanently above its normal (about 98.4° Fahr.) .standard, when there is no feeling of chilliness, when the body is not wholly bathed in sweat, when there is not much irritability of the nervous sj'stem, and when there is g-reat stupor. The effect is to lower the temperature, to lessen the frequency of the pulse and respiration, to render the tongue moist and soft, to diminish or remove the stupor, to procure sleep, and sometimes to produce a critical perspiration. Cold affusion can seldom be resorted to with safety more than once in every twenty-four hours.
When it is desirable to apply a douche-hath to one or more of the joints, it is only necessary to affix two or three yards of large-sized India rubber tubing to the tap of a cistern. The patient must sit in an empty bath, into which the water may fall as it plays upon the limb. The reaction is greater after the use of hot and cold douches alternately, than after the employment of water of only one temperature.
135. The Shalloio Bath.
The patient sits in a bath some six feet long, with a depth of water (tem- perature 60° to 80° Fahr.) varying from 8 to 12 inches. The extremities and trunk are well rubbed by an assistant, while water is gently poured over the head. The duration of the bath ought to vary from five minutes to three-quarters of an hour, until the temperature of the body is lowered. The colder the water and the shorter the stay in it, the more stimulating and less sedative will be the effect. This bath is less exciting than the cold affusion, and is chiefly indicated where the latter would be improper, — i. e., where there is much nervous irritability. It is also better for women, who can seldom bear the cold affusion.
As a substitute for the shallow bath the dripping-sheet is sometimes used. The patient stands upright in an empty bath, while the attendant, placed at his back, suddenly envelops him in a sheet dipped in cold water. The surface of the body is rapidly rubbed by the servant's flat hands for some three minutes, until the bather is in a glow; when a dry sheet is quickly substituted for the wet one, and the rubbing continued. The whole process should be over in five or six minutes.
136. Wet Sheet Packing., etc.
The patient is closely enveloped in a sheet which has been dipped in cold or tepid water and well wrung out. Or a long towel is wrung out of tepid water and applied along the whole length of the back, while another simi- larly prepared is laid over the chest and abdomen. In either case the patient is then carefully wrapped in a blanket, covered with three or moi'e blankets, and has a down coverlet tucked over all. He should remain thus for 30, 4.5, or 60 minutes, lying on his side, or in a semi-recumbent position ; the duration being timed by the sedative effect produced. The sweating is not generally excessive. But the water, urea, and chloride of sodium of the urine are slightly increased ; this increase being considerable when the sheet is continued for four hours. At the conclusion the shallow bath may be used for two or three minutes, as a tonic.
The Wet Pack as a Cooling Agent. — When it is desired to bring down the temperature, as in the treatment of enteric fever, the patient is envel- oped in a dripping sheet and lightly covered by a single blanket, or in extreme cases left without any other covering than the wet sheet, which must be kept moist. The temperature must be taken at brief intervals in the mouth, rectnni, or vagina, and when it falls to the normal point, or sooner should a distinct rigor occur, the patient should be removed from the pack.
314 APPENDIX OF FORMULA.
A blanJcef-bath affords an easy means of inducing sweating. A blanket is wrung out of hot water, and wrapped round the patient. He is to be packed in three or four dry blankets, and allowed to repose for thirty minutes. The surface of the body should then be well rubbed with warm towels, and the patient made comfortable in bed.
The loei compress consists merely of a roll of flannel or calico, dipped ia cold water and wrung out, and then applied around the seat of pain. Over this a piece of waterproof cloth is worn. The compress is kept on night and day.
137. The Warm Bath as a Cooling Agent.
The warm bath at a temperature of 9.5° Fahr. must prove a coolinff agent to the body of a fever patient at 100° or 105°. The immersion should con- tinue from fifteen minutes to an hour or longer. Its sedative effects I'ender it valuable where the nervous system is irritable.
The temperature may, however, be lowered to 70° or 65° by the addition of cold water while the patient is in the bath. This has proved effectual in saving life in cases of hyperpyrexia during acute rheumatism, enteric fever, etc. The temperature of the patient must be observed continuously, and when it has fallen to 102°, or thereabouts, or when shivering conies on, he must be removed to bed. Enteric fever, moreover, has been extensively treated by baths of low temperature with considerable success.
In cases of delirium tremens with high fever, cold superfusion may be used while the patient is held in the warm bath. From twenty to thirty buckets of cold water are to be poured slowly over the head ; hot water being continually added to the bath to maintain its heat at 95°. I'his treatment may frequently be counted upon to produce sound sleep.
138. Acid Sponging.
One part of vinegar is to be added to two or three^ parts of cold water, and the body well sponged with the mixture. Simple tepid water may sometimes be advantageously used. The patient being weak and unable to move, the sponging must be done by degrees -.—i. e., the arms, chest, back, and legs are to be rapidly washed and dried. In many cases of fever, inflammation, scarlatina, etc.
VIII. CATHARTICS AND ANTHELMINTICS.
139. The Common Black Draught.
'Sf.. Magnesise Sulphatis, gr. 120; Manns, gr. 160; Tincturse Sennse. fl. drs. 2 ; Infusi Senna, ad fl. drs. 12. Make a draught. To be taken early in the morning. One ounce and a half of the officinal Compound Mixture OF Senna is equivalent to the foregoing.
140. Calomel, Jalap, and Epsom Salts.
^.. Hydrargyri Subchloridi, gr. 5 ; Pulveris Jalapae, gr. 15. Make a powder. To be taken immediately; with the following draught three hours afterwards : —
^.. Magnesias Sulphatis, gr. 120 ; Mannse, gr. 60 ; Tincturas Jalapaj, fl. drs. 2; Aquae Carui, ad fl. drs. 12. Mix. A good active purgative in head affections, etc., as ivell as at the commencement of many acute
diseases.
CATHARTICS AND ANTHELMINTICS. 315
1-11. The White Mixture of Hosj)itals.
I^. Ma.o'nesia? Sulphutis, oz. ]^ ; Mag-nesias Carbonatis, gr. 120 ; Aquas Metitliaj Piperita^, fl. oz. 8. Mix. 'I'he addition of two fliiidrachms of Colchicum wine is sometimes advantageous. One-sixth part early every morning.
142. Epsom Salts and Sulphuric Acid.
I^. Magnesise Sulpliatis, oz. 2; Acidi Sulphuric! Aromatici. min. 90; Tinctnras Hyoscyami, fl. drs. 6 ; Infusi Quassias, ad fl. oz. 8. Mix. One- sixth part two or three times a day. In painter's colic, copper colic, etc.
I^. Magnesise Sulphatis, oz. ^ ; Infnsi Hosse Acidi, fl. oz. 2. Make a draught. To be taken early in the morning. In mild febrile affections xvith much constipation.
143. Glauber'' s Salts and Sulphuric Acid.
1^. Sodae Sulphalis. gr. 120; Ferri Sulphatis, gr. 3 ; Acidi Sulphurici Piluti, min. 1.'); Tincturse Hyoscyami, min. 40; Infusi Calumbis, fl. oz. 2. Make a draught. To be taken the first thing in the morning. In obstinate constipation with debility. Also in some varieties of hemorrhage ivhere an aperient is needed, — as purpura, hcematemesis, etc.
'Sf.. Sodfe Sulphatis, gr. 240 ; Acidi Sulphurici Diluti, fl. drm. 1 ; Infusi Gentianae Compositi, fl. oz. 6. Mix. Three tablespoonfuls to be taken daily, after luncheon or dinner. In habitual constipation with flatidence.
144. Glauber'' s Salts and Taraxacum.
Vf. Soda3 Sulphatis, gr. 120; Sncci Taraxaci, fl. drm. 1; Pecocti Taraxaci, fl. oz. 2. Make a draught. To be taken every morning before breakfast. In constipation tvith deficient secretion of bile. The taraxacum is a good vehicle for the sulphate of soda, even if it is incapable of influencing the secretion of bile. See F. 148.
145. Aloes, Senna, and Jcdap.
'Bf.. Tincture Sennas, 'J'incturag Jalapas, aa fl. drs. 2 ; Infusi Senna?, fl. oz. 2 ; Decocti Aloes Compositi, ad fl. oz. 8. Mix. Two tablespoonfuls to be taken night and morning.
146. Rhubarb, Gentian, and Senna.
I^. Tincturas Rhei, fl. drs. 2 ; Spiritfis Ammonige Aromatici, min. 40 ; Infusi Gentianae Compositi, Infusi Sennse, aa fl. drs. 7. Make a draught. To be taken every morning an hour before bi'eakfast. A mild aperient in gouty dyspepsia.
147. Nitric Acid, Senna, and Taraxacum.
Vf. Acidi Nitrici Diluti, min. 90; Spiritus JEtheris Nitrosi, fl. drs. 2 ; Sucei Taraxaci, fl. drs. 12 ; Tincturse Sennse, fl. oz. 4; Infusi Gentianaa Compositi, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily. In dyspepsia ivith debility and constipation. Also in passive hepatic con- gestion, in amenorrhoea with a loaded liver, etc.
148. Alkcdine Aj^erients.
I^. Decocti Aloes Compositi. Infusi Gentianas Compositi, aa fl. oz. 4 ; TincturaB Nucis Yomicse, fl. drm. 1 ; Liquoris Potassse, fl. drs. 2. Mix.
316 APPENDIX OF FORMULA.
One-sixth part, with two or three tablespooiifuls of water, early every morning. Useful in bilious headaclie.
V^. Sodse Sulphatis, oz. 1^; SodiB Phosphatis, oz. 1 ; Syrupi Zingiberia, fl. drs. 6 ; Aqiiai ad fl. oz. 8. Mix. Three large tablespoon fu!s imme- diately ; the dose to be repeated after two hours, unless the bowels should be freely acted on.
Vf.. Sodfe Sulphatis, Sulphuris Pra^cipitati, aa oz. IJ. Mix. Label, — " One teaspoonful in a tumblerful of milk and water early in the morning." In rheumatoid arthritis, chronic rheumatism, sciatica, "pruritus, etc.
149. Phosphate of Soda and Aloes.
Vf.. Extract! Rhei, gr. 10; Sodse Phosphatis, gr. 60; Decocti Aloes Oompositi, fl. drs. 6 ; Aquse MenthoB Viridis, ad fl. oz. 2. Make a draught. To be taken occasionally at bedtime. In some forms of chronic gout, jaundice from gallstones, etc.
150. Aloes, Seniia, and Epsom Salts.
'9f.. Vini Aloes, fl. drs. 2 ; Infnsi Sennse, fl. drs. 14; Magnesise Sulphatis, gr. 240. Mix. Half of this mixture to be taken about 7 o'clock in the morning, and the remainder two hours after breakfast, if required.
151. Jalap and Senna.
I^. TinctursB Sennse, fl. oz. 1; Tincturse Jalapje, fl. drs. 2; Yini Colchici, fl. drm. 1; Aquae Pimentse. fl. oz. 2. Mix. Label, — -'• Half of this draught immediately, and the remainder in six hours, if necessary."
I)l. Pulveris Jalapae Compositi, gr. 30-60; Syrupi Sennae, fl. drm. 1; Aquae Camphorse, fl. drs. 15. Make a draught. To be taken early every morning. In dropsy.
'Sf.. Jalapse Resinse, gr. 3; Extracti Hyoscyami, gr. 2. Mix into a pill, to be taken at bedtime. An ounce and a half of the Compound Mixture of Senna should be administered on the following morning. In dropsy and in hepatic disease where an active purgative is needed.
152. Saline Purgative, ivith Antimonial wine.
'Bf.. Yini Antimoniale, fl. drm. 1 ; Magnesise Sulphatis, gr. 160 ; Liquoris Ammonise Acetatis, fl. drs. 12 ; Syrupi Papaveris, fl. drs. 6 ; Aquse 0am- phorae, ad fl. oz. 8. Mix. One-sixth part two or three times in the twenty- four hours. Simple fever with constipation. In hepatic congestion, etc.
153. Sulphur and Magnesia.
]^. Magnesias Carbonatis, gr. 20 ; Sulphuris Prascipitati, gr. 25 ; Sodse Bicarbonatis, gr. 10; Pulveris Zingiberis, gr. 3. Make a powder. To be taken early in the morning in a tumblerful of milk. A valuable aperient for delicate females subject to rheximatism. Also in prurigo, and some other skin diseases.
154. Steel and Aloes.
'^.. Ferri Sulphatis Oranulatse, gr. 2 ; Pilulas Aloes et Myrrha3, gr. 3. Make a pill, to be taken thrice daily after meals. In amenorrhoea, chlo- rosis, hysteria with constipation and debility, etc. See F. 421.
155. Pepsine and Aloes.
I^. Pepsinse Porci, gr. 32; Extracti Aloes Barbadensis, gr. 4-8; Glycerini, sufficient to make a mass. Divide into eight pills, and order one to be taken
CATHARTICS AND ANTHELMINTICS. 317
every day at dinner. To prevent them from adhering to each other, these pills should either be silvered or coated -with lyoopodium — the delicate and tasteless powder contained in the spore cases of Lycopodinm selago and Lycopodium clavatum. Valuable in gastric and duodenal dyspepsia, some diseases of the rectum, certain forms of suppressed menstruation, etc.
^.. Extract! Aloes, gr. 1 ; Extracti Belladonnae, gr. ^. Make a pill to be taken daily after dinner or supper.
156. Aloes and Galbanum.
I^. Pilulaj Aloes et Myrrhag, Pilulae Assafoetidag Compositae, aa gr. 5. Make two pills. To be taken night and morning. In hysteria with attacks of flatulent colic, and in some forms of amenorrhoea ivith constipation.
157. Elaterium, or Wild Cucumber.
Vf.. Liquoris Ammonise Acetatis, fl. drs. 9; SpiritQs ^theris Nitrosi. fl. drs. 4; Elaterii, gr. 1; Syrupi Zingiberis, fi. drs. 3. Mix. Direct, — "Two small teaspoonfuls in a wineglassful of water every two hours, until the bowels are freely acted on." In early stccges of acute dropsy loith albu- minuria.
I^. Elaterii, gr. 1^; Pulveris Capsici, gr. 9; Hydrargyri Subchloridi, gr. 12; Extracti Hyoscyami, gr. 18. Make a mass, divide into twelve pills, and order two to be taken for a dose. If a very active purgative is required, the quantity of elaterium may he doubled. The capsicum prevents the nausea which this drug often produces.
]^. Elaterii. gr. 1; Digitalis Folise, gr. 2-4; Extracti Gentianee, gr. 12. Divide into four pills, and order one to be taken every night. In dropsical effusions, and ivhere it is desirctble to jyroduce copious ivatery stool.
158. Gamboge and Galbanum.
'Bf.. Pilulce Cambogise Compositge, Pilulse Assafoetid^ Compositse. aa gr. 5. Make two pills. To be taken every night at bedtime. A good drastic hydragogue cathartic, acting chiefly upon the small intestines.
159. Calomel ccnd Jalap, etc.
1^. Hydrargyri Subchloi'idi, gr. 2-3 ; Pulveris Scammonise Compositi, gr. 4; Pulveris Aromatici, gr. 5. Mix, for a powder to be taken at bedtime. A vcduable purgative in the cerebral affections of children : also in cases of threadworm.
^.. Hydrargyri Subchloridi, gr. 2 ; Extracti Jalapse, gr. 8. Make into two pills, and order them to be taken at bedtime. In cerebral affections, etc.
'Bf.. Hydrargyri Subchloridi, gr. 5; Pulveris Jalapse Compositi, gr. 20-40. Make a powder, to be taken every night at bedtime. A good hydragogue cathartic. The calomel increases the effect of the jalap and acid tartrate of potash [cream of tartar).
I^. Hydrargyri Subchloridi, gr. 2; Pulveris Rhei, gr. 20; Jalapse Resinge, gr. 2 ; Pulveris Zingiberis, gr. 4. Mix. To be taken as a bolus, in a little "wafer paper, at bedtime.
160. Podophyllum Peltatum, or May-apple.
I^. Podophylli Resinse, gr. |-; Pulveris Rhei, gr. 5 ; Extracti Hyoscyami, gr. 3. Make two pills. To be taken every night at bedtime. As a purga- tive in jaundice from suppression, in torpid liver, and in dropsy, from cardiac or renal or hepatic disease. Podophyllin produces copious
318 APPENDIX OF FORMULA..
bilious stools ; but it is rather uncertain, and is apt to gripe unless com- bined ivith henbane.
^. Podophylli Resinae, gr. 6; Piilveris Zingiberis, gr. 20; Jalapas Resinse, gr. 10; Digitalis Folias, gr. 3; Extracti Hyoscyami, gr. 14. Make a mass, divide into twelve pills, and order two to be taken every other night at bed- time. As a drastic purgative in dropsy. See F. 30.
161. Ain7nonia and Rhuharh.
]^. SpiritGs Ammonise Aromatici, fl. drs. 4 ; Tincturse Rhei, fl. oz. 2 ; InCusi Rhei, ad fl. oz. 8. Mix. One-sixth part to be taken night and morning.
162. Gentian, Ether, and Rhuharh.
IJi. Tincturse Rhei, fl.oz. 1; Tincturas Gentianas Compositse, fl. oz. 2 ; Spiritus Ammoniee Aromatici, Spiritus J]]theris, aa fl. drs. 4; Aquas Pimentse, fl. oz. 4. Mix. Two tablespoonfuls to be taken occasionally. In cases of cohc. flatulence, nausea, or Ictnguor, where a luarm stomachic aperient is needed.
163. Hellebore and Colchicum.
'Bf.. Tincturee Hellebori (Phar. Lond. 1851), min. 30; Vini Colchici, min. 25; Tincturse Rhei, fl. drs. 2 ; Aquae Camphorae, ad fl. oz. 2. Make a draught. To be taken occasionally early in the morning. Usefid in gout, chronic rheumatism, etc.
164. Castor Oil.
^. Olei Ricini, fl. drs. 2-4. To be taken occasionally about 11 A. M. The taste of castor oil is entirely destroyed by mixing it with a teacupful of well-salted and peppered beef-tea.
I^. Mucilaginis Tragacanthfe, fl. oz. 2; Aquae Cinnamomi, fl. oz. 3; Olei Ricini, fl. drs. 12 ; Tiuctura^ Rhei, Syrupi Aurantii, aa fl. drs. 6 ; Tincturse Opii, min. 30. Mix. One-eighih part every three houi's. In dysentery, when there are scybala in the rectum. Also ivhere an aperient with a sedative is indiccded.
165. Rhuharh and Magnesia, or Soda.
'Sf.. Magnesia Carbonatis, gr. 120 ; Pulveris Rhei, gr. 60 ; Yiui Ipe- cacuanhae, fl. drs. 2 ; Pulveris Aromatici, gr. 40 ; Aquae Menthte Piperita^, fl. oz. 8. Mix. Three tablespoonfuls to be taken every morning.
^L. Pulveris Rhei, Sodas Bicarbonatis, aa gr. 20 ; Infusi Rhei, fl. oz. 1. Make a draught. To be taken early in the morning, with two or three tablespoonfuls of water, twice or thrice a week. For gouty and rheumatic subjects.
The officinal Pulvis Rhei Compositus, in doses of 20 to 120 grains, is a valuable mild aperient where the intestinal secretions are deranged or diminished in quantity. It is commonly knoion as Gregory's poiuder.
166. Epsom Salts and Sulphate of Iron.
Vf.. Magnesiae Sulphatis, gr. 120 ; Ferri Sulphatis, gr. 4; Acidi Sulphuric! Diluti, min. 15 ; Extracti Quassias, gr. 20 ; Aquce Pinient,ae, fl. oz. 2. Make a draught. To be taken early in the morning. In constipation loith general debility.
C ATHLETICS AND ANTHELMINTICS. 319
167. Colocynth and Tartarated Antimony.
I^. Pilnlae Colocynthidis et Hj'o?cyami, gr. 50 ; Antimonii Tartarati, gr- 4. Divide into twelve pills, and order one to be taken every niglit at bed- time. ^1 valuable puryalrve -in tlie cerebral congestions of strong sub- jects.
168. Croton oil.
I^. Olei Crotonis, min. 1-2 ; Olei Caryophylli, min. 2 ; Micae Panis, sufficient to make a pill. 'J'o be taken immediately, and repeated in two hours if necessary.
I^. Olei Crotonis, min. 2 ; Olei Theobroma3. gr. 30. Make a sup- pository. To be introduced into the rectum early in the morning — about 5 A. M.
I^. Olei Crotonis, min. 1-2 ; PilulaB Colocynthidis Compositse, gr. 30 ; PiluliB Assafoetidaj Compositge, gr. 60. Make a mass, divide into eighteen pills, and order three to be taken every night at bedtime. Jn cases of sciatica, obstinate neuralgia, etc., with constipation.
169. Seidlitz Powder .
^. Sodaj Bicarbonatis, gr. 40 ; Sodaj Tartarata^ gr. 120. Mix, and make an effervescing draught with thirty-seven grains of Tartaric or Citric Acid dissolved in a tumblerful of water.
The officinal Effervescent Citro-Tartrate of Soda, in doses of a couple of teaspoonfuls, in a small tumblerful of cold or tepid water, is a very agree- able and mild aperient.
170. Purified Ox Bile.
Vf. Ammonise Carbonatis, gr. 34; Fellis Bovini Purificati, gr. 36. Make a mass, divide into twelve pills, silver them, and order one to be taken three hours after each of the principal meals. In di/spepsia with nausea, con- stipation and a deposit of urates in the urine.
I^. Jalapge Resinas, gr. 6-18 ; Fellis Bovini Purificati, gr. 24; Olei Carui, min. 10. Pilulae Assafoetidae Oompositse, gr. 18. Make a mass, divide into twelve pills, and order two to be taken every night two hours after supper. To prevent an ctccumulation of feces, lohen the large intestines are torpid. Also lohere there is a deficiency of bile.
I^. Pilulge Colocynthidis et Hyoscyami, Fellis Bovini Purificati, Extracti Lupuli, aa gr. 20. Make a mass, divide into twelve pills, silver them, and order one to be taken every day three hours after dinner. In constipation with flatidence and imperfect digestion of the food.
'Bf.. Magnesige Carbonatis, gr. 30; Tineturge Jalapse, fl. drs. 2 ; Tincturse Sennse, fl. oz. 1 ; Fellis Bovini Purificati, gr. 30 ; Aquas Camphorse, ad fl. oz. 4. Mix, and label, — "Half of this mixture immediately, and the re- mainder in three hours if necessary." A valuable purgative when the rectum is blocked tip by hardened feces.
Capsules containing pig's bile, evaporated to dryness, have been pre- pared according to the directions of Dr. Harley. Each capsule contains five grains of prepared bile, — equal to one hundred grains of liquid bile fresh from the gall bladder. Two or three are to be taken for a dose, about two hours after a meal ; when, stomachal digestion being nearly completed, the chyme is ready to pass into the duodenum. The capsules imbibe moisture in the stomach ; and then, in their soft swollen condition, gene- rally get ruptured as they pass through the pylorus. In this way the bile
320 APPENDIX OF FORMULAE.
is mingled with the chyme at the same time that the intermixture happens in the healthy organism. In jaundice from long-continued obstruction. Also in some forms of duodenal dyspepsia arising from sedentary habits.
171. RMiharh, Mercury, and Henbane, or Ipecac.
I^. Pilulas Hydrargyri [vel Hydrargyri cum Greta), Pilulse Rhei Com- positse, Extracti Hyoscyami, aa gr. 20. Mix, divide into twelve pills, and order two to be taken occasionally at bedtime.
I^. Pilulse Hydrargyri, gr. 12 ; Pulveris Ipecacuanhse. gr. 12 ; Pilulse Rhei Conipositse, gr. 24. Mix, and divide into twelve pills. Two to be taken occasionally at night. Where a stronger purgative is required the compound colocynth may be substituted for the compound rhubarb pill in either formida.
172. Sulphate of Magnesia.
~9f.. Magnesise Sulphatis, gr. 180; Vini Colchici, min. 15; Infusi Sennae, Infusi. Gentianae Gompositi, aa fl. oz. 1. Make a draught, to be taken early in the morning. In gouty or rheumatic habits, with a deficient secretion of bile.
173. Colocynth and Assafoetida.
]^. Pilulre Golocynthidis et Hyoscyami, Pilulse Assafoetidse Compositse, aa gr. 5. Mix into two pills. To be taken occasionally at bedtime. In co7istipation with flatulence. A valuable purgative for hypochondriasis.
174. Gamboge, Aloes, and Blue Pill.
1^. Pilulae Cambogise Compositae, gr. 5 ; Pilulse Hydrargyri, gr. 3. Make two pills. To be taken night and morning. In dropsy from cardiac or hepatic disease ivhere a drastic purgative is required.
175. JV^ux Vomica with Rhubarb, Aloes, etc.
Vf.. Extracti Nucis Vomicae, gr. 3 ; Pulveris Ipecacuanhae, gr. 6 ; Pilulae Rhei Gompositas, vel Pikila3 Aloes et Assafoetida, gr. 40. Make a mass, divide into twelve pills, and order two to be taken every alternate night at bedtime. In habitual constipation fro')n atony of the coats of the bowel, with deficient secretion of intestinal mucus.
Vf.. Extracti Nucis Yomicas, gr. 2 ; Extracti Aloes Barbadensis, gr. 6 ; Extracti Rhei, gr. 20. Mix and divide into six pills. One to be taken every day at dinner. In torpor of the colon, some diseases of the rectum, etc.
^L. Extracti Hyoscyami, gr. 40 ; Pilulae Golocynthidis Gompositae, vel Jalapae Resinas, gr. 20 ; Extracti Nucis Vomicae, gr. 3. Mix and divide into twelve pills. One pill to be taken every night. In habitual constipation. They may be continued for about ten days. See F. 378, 387, and 409.
176. Rhubarb and Magnesia for Infants.
Vf^. Pulveris Rhei, gr. 1.5; Magnesias Garbonatis, gr. 60; Aquae Anethi, fl. drs. 12. Mix, and order one teaspoonl'ul to be taken every two hours until the bowels are freely acted on.
177. Sulphate of Zinc and Nux Vomica.
^.. Zinci Sulphatis, gr. 24 ; Extracti Nucis Vomicae, gr. 2 ; Extracti Anthemidis, gr. 30. Mix, divide into twelve pills, and order one to be taken three times a day. For habitual constipation, after the bowels have been
CATHARTICS AND ANTHELMINTICS. 321
cleared out loith a purgative of calomel and colocyntli. The pills shoidd be taken immediately after meals, for two or three weeks. They ought to he discontinued gradually.
178. Quinine and Rkuharh.
^.. QiiiniiB Sulphatis, gr. 2; Extract! Lupnli, gr. 5; Pilulae Rhei Com- posita;, gr. 3. Mix iuto two pills, and order them to be taken every day at dinner. Useful in some forms of dyspepsia, tvith want of tone.
179. Ipecacuanha, Rkuharh, and Oxide of Silver.
^.. Pulveris Ipecacuanhas, gr. 1; Pulveris Rhei, gr. 3; Argenti Oxidi, gr. I ; Conf'ectionis Rosas Caninas, sufficient to form a pill. A good dinner pill where there is uneasiness and oppression after meals, the result of slow digestion.
180. Steel, Glauher's Salts, etc.
]^. Ferri Sulphatis Granulatse, gr. 10 ; Sodse Sulphatis, Magnesise Sul- phatis, aa oz. 1; Sodii Chloridi, gr. 120; Aqute, 0. 1. Mix. Four table- spoonfuls in a tumblerful of warm water early in the morning. A rough zmitation of the Cheltenham Waters. Useful in debility with constipation.
181. Steel, Glauher's Salts, and Soda.
;^. Sodse Bicarbonatis, gr. 60; Sodii Chloridi, gr. 4; Sodas Sulphatis. gr. 10 ; Magnesiae Sulphatis, gr. 3; Ferri Sulphatis, gr. ^-1 ; Aquas, 0. 1. Mix. By adding forty grains of Citric Acid an efifervescing water is produced. A rough imitation of the Vichy Wcders. In some forras of chronic gout, etc.
^. Sodas Sulphatis, gr. 120-240; Sodas Carbonatis, gr. 20; Sodii Chloridi, gr. 15 ; Cretae Preparatae, gr. 10 ; Ferri Carbonatis Saccharatae, gr. 15. Make a powder, and direct it to be taken early in the morning in half a pint of water. An imitation of the Carlsbad Waters.
182. Kamela, as an Anthehni^itic.
I^. Pulveris KameliE, gr. 60-180, vel Tincture Kamelee, fl. drs. 2; Syrupi Aurantii, fl. drs. 2 ; Mucilaginis Tragacanthas, fi. drs. 12; Aquas, ad fl. oz. 3. Make a draught. To be taken early in the morning. A purgative should be administered six hours afterwards. Kamela is an orange-red resinous substance found adhering to the capsules of the Rottlera tinctoria, and is imported from India. Strongly recommended in tapeworm.
183. Turpentine, as an Anthelmintic.
^. Olei Ricini, fl. drs. 4; Olei Tei'ebinthiuEe, fl. drs. 3; Mucilaginis Traga- canthas, fl. drs. 4; Syrupi Zingiberis, fl. drm. 1; Aqu«, fl. drs. 4. Make a draught, to be taken early in the morning. Ii tapeiuorm, etc.
184. Kousso, as an Anthelmintic.
^. Cusso, in pulvere, gr. 240 ; Mellis Depurati, sufficient to make an electuary. Label, — " Half of this electuary to be taken early in the morn- ing, and the remainder six hours afterwards." In tapeworm.
The officinal Infusum Cusso may also be taken in the same way, in doses of fl. oz. 4^8.
185. Santonin, as an Anthelmintic.
I^. Santonini, gr. 2-6 ; Sacchari Lactis, gr. 15. Make a powder. To be taken early in the morning, suspended in a tablespoonful of cream. The 21
322 APPENDIX OF FORMULA.
patient ought to have fasted for twelve hours previously. The dose may be repeated daily for eight or ten days, if necessary : and its exhibition should be followed at the end of six hours by the administration of an ounce of the Compound Decoction of Aloes. A specific for the ascaris lumb?'i- coides. Less useful for the tcenia solium and oxyuris vermicidaris. The patient should he warned that after a few doses the sight sometimes be- comes perverted, so that objects seein to acquire a blue or yellow or some other color. One-third of a grain of the resin of podophyllum added occa- sionally to the dose of santonin appears to increase its efficacy.
186. Pomegranate^ as an Anthelmintic .
^.. SpiritHs ^theris, min. 30-60; Decocti Granati Radicis, fl. oz. 1-2. Make a draught. To be taken every thi-ee hours until four doses have been used.
I^. Granati Eadicis Oorticis, gr. 180 ; Pulveris Sabadillse, gr. 6 ; Pulveris Aromatici. gr. 60. Mix, and divide into six powders. One to be taken every two hours until the whole is consumed. More active than the pre- ceding. A saline purge should be given after the last dose.
187. Male Fern, as an Anthelmintic.
Vf.. Extracti Filicis Liquidi, min. 20-40 ; Syrupi Zingiberis, fl. drs. 2 ; Mucilaginis Tragacanthte, fl. oz. 2 ; Aquae, ad fl. oz. 4. Make a draught. To be taken early in the morning; only liquid nourishment having been allowed the previous day. Four hours afterwards a purgative dose of castor oil or compound decoction of aloes should be administered. Especially useful for destroying tapeworms.
188. Simple Enemata.
I^. Sodii Chloridi, oz. 1 ; Decocti Hordei, fl. oz. 12. Mix, to form an Enema. In simple constipation, to destroy oxyurides, etc.
IBf.. Olei Olivse, fl. oz. 6-8. To be vrarmed and then injected into the rectum. It should be retained for twelve or eighteen hours. Very useful in structural disease of the large bowel, impaction of hardened faeces, etc.
^.. Olei Olivae, fl. drs. 12 ; Magnesise Sulphatis, gr. 220 ; Decocti Hordei, ad fl. oz. 12. Mix, for an Enema. The officinal Enema Magnesia Sul- phatis contains one ounce of Epsom salts and one ounce of olive oil, to fifteen ounces of fluid starch.
^.. Saponis Mollis, oz. 1 ; Aquas Calidee, fl. oz. 12. Mix, for an Enema.
189. Castor Oil and Rue Enema.
I^. Olei Rutae, min. 6 ; Olei Ricini, fl. oz. 1 ; Tincturae Assafoetidise, fl. drs. 2; Decocti Avenee, fl. oz. 7. Mix. Exceedingly useful in flatulent colic.
190. Castor Oil and Turpentine Enema.
]^. Olei Ricini, fl. drs. 12 ; Olei Terebinthinae, fl. drs. 4 ; Tincturae Assa- foetidae, fl. drs. 2 ; Decocti Avente, ad fl. oz. 12. Mix. In obstinate con- stipation. It shoidd be throion up into the boiuel by means of a long tube like that of a stomach-pump.
191. Croton Oil Enema.
'Sf.. Olei Crotonis. min. 6 ; Olei Ricini, fl. oz. 1 ; Olei Terebinthinae, fl. drs. 2 ; Decocti Hordei, ad fl. oz. 6. Mix. In obstinate constipation. It should be retained for three or four hours, if possible.
CAUSTICS AND COUNTER-IRRITANTS. 323
192. Steel and Aloes Enema.
IJi. Tincturse Ferri Perchloridi, fl. drs. 1-3; Extract! Quassias, gr. 5 ; Extract! Aloes Barbadensis, gr. 2 ; Iiifusi Quassise, M. oz. 8. Mix. To de- stroy oxi/urtdes. It has often seemed advantageous to the Author to ad- minister a dose of calomel and scammony at the same time.
193. Tobacco Enema.
Vf.. Tabaci Communis, gr. l.o ; Aquae Bullientis, fl. oz. 8. Mix. To he
employed cautiously in some exceptional cases of strangidated hernia, obstinate constipation, etc.
194. Purgative Electuaries.
I^. Confectionis Sennas, Potassse Tartratis Acidee, Extract! Taraxaci, aa oz. 1. Mix. One teaspoonful to be taken occasionally, an hour before breakfast. In constipation with inactive liver, or hcemorrhoids.
IJl. Confectionis Piperis, Syrupi Sennae, Confectionis Sulphuris, aa oz. 1 ; Pulveris Jalapse, gr. 30. Mix. One teaspoonful every morning. In con- stipation with chronic rheumatism.
^.. Confectionis Sulphuris, oz. 2 ; Extract! Taraxaci, oz. 1. Mix and label, — " One teaspoonful daily before breakfast." In many diseases of the rectum.
^.. Confectionis Sennse, oz. 2 ; Confectionis Scammoni*, Syrupi Zingi- beris, oz. 1; Ferri Carbouatis Saccharatae, gr. 220 Mix. One teaspoon- ful early every morning. In some forms of constipation and want of tone.
IX. CAUSTICS AND COUHTER-IREITANTS.
195. Acid Solution of Nitrate of Mercury.
Vf.. Liquoris Hydrargyri Nitratis Acidi, fl. drs. 2 ; Pulveris Tragacanthae Compositi, sufficient to make a mass. To he applied as a paste over the surface to he destroyed. Instead, it is sometimes better to apply the caustic fluid itself for certdin cases of cancer or lupus. The solution may cdso be carefully used to sloughing ulcers, boils, small ncevi, etc. It is to be very lightly painted on by means of a glass brush, or a glass rod.
196. Chromic Acid.
]^. Acidi Chromici, gr. 60 ; Aquae, fl. drs. 4. Mix. To destroy warts, small growths of epithelial cancer, etc.
197. Chloride of Zinc, etc.
I^. Bromii Chloridi, Zinci Chloridi, Auri Chloridi, Antimonii Chloridi, of each equal parts. Mix into a paste of sufficient thickness with flour or powdered liquorice. To destroy cancerous groivths. Commonly knoiun as Landolfi's paste.
^L. Sanguinariae Canadensis, oz. ^-1 ; Zinci Chloridi, oz. |-2 ; Aquae, fl. oz. 2 ; Farinae, sufficient to make a paste. Mix. The paste thus formed shoidd have the consistence of treacle. This is the caustic lohich ivas employed by Dr. Fell.
I^. Zinci Chloridi, gr. 30-60 ; Farinae, gr. 120 ; Aqu* Destillatae, suffi- cient to form a mass. To be applied over the diseased surface. Or it may be made into sticks or fifeches, and kept dried ready for use. An effectual
324 APPENDIX OF FOEMUL^.
method of removing a cancerous tumor is to introduce a portion of such a stick into an incision made in tlie mass.
198. Swper sulphate of Zinc.
Take half a fluidonnce of sulphuric acid, and saturate it with sulphate of zinc, previously dried and powdered. Sir J. Y. Simpson recommended that this caustic should be used by dipping a pen in it, and then drawing lines across the tumor, so as to eat through the skin in a few minutes. The fissures thus made are to be filled with the paste ; renewing the scratching and caustic every day or two. In this way, five or eight days may suffice for the removal of a good-sized tumor. By this combination also we can penetrate deeply without hardening the parts, and without fear of producing hemorrhage. — This is a very valuable caustic, and has heen found particularly useful by the Aidhor for the removal of can- cerous tumors of the breast, etc. The pain which it produces luill be best mitigated by employing the subcutaneous injection of morphia (F. 314) at each application.
199. Arsenical Mucilage.
R. Acidi Arseniosi, Pulveris Acacise, aa oz. 1 ; Aquae, fl. drs. 5. Mix. The late Dr. W. Marsden spoke highly of this caustic in epithelioma ; but the Author has had no experience tvith it, inasmuch as he prefers less dangerous applications. If employed, hoiuever, the affected part shotdd be painted over with the mixture night and morning ; taking care rigorously to limit the appMcation to the diseased parts, and not to let it extend over more than one superficial inch at a time. As the part sloughs, its separation is to be aided by bread and loater poidtices ; tvhile after all the disease has been got rid of in consequence of the repeated applications of the mucilage, a carrot poidlice is to be applied during the night, and a tveak black wash [calomel gr. 60 to lime-water one pint) dwing the day until the part is healed.
200. Lime and Arsenic Poivder.
B. Calcis Recentis, oz. |- ; Arsenici Sulphureti Flavi, gr. 20; Pulveris Amyli, gr. 180. Mix to form a powder. To be used very cautiously as a depilatory powder. The apjAication is not free from danger.
201. Hed Oxide of Mercury Powder.
R. Hydrargyri Oxidi Rubri, Aluminis, aa gr. 60. Make a powder. To be sprinkled over exuberant and spongy granulations.
202. Carbonate of Copper Ointment.
R. Cupri Carbonatis, gr. 60; Adipis Preparati, oz. ^. Mix, to form an ointment. Devergie. — In chronic eczema and impetigo of the scalp lohere stimidating applications are required.
203. Dupuytren'' s Arsenic and Calomel Powder.
R. Acidi Arseniosi, gr. 12 ; Hydrargyri Subchloridi, oz. 1. Mix. In
ulcerated lupus. Must be very caiUiously used.
204. Vienna Caustic.
R. Potassa^ Causticse, Calcis, aa oz. 1. Mix thoroughly. This paste is dilided with alcohol, and applied with a spcUula over a small surface. It is identical with the Potassa cum calce of the London Pharmacopoeia —1836.
DIAPHORETICS AND DIURETICS. 325
205. Iodine Paint.
R. lodinii, <rr. 40 ; Potassii lodidi, gr. 30 ; Spiritfls Yini Rectificati, fl. oz. 1. Mix. To he applied with a camel's hai7^ pencil. Very useful in many chronic pains, etc.
R. lodinii, Potassii lodidl, aa grs. 20 ; Collodii, fl. oz. 1. Mix.
R. lodinii, gr. 120 ; Olei Petrolei Albi, fl. oz. 1. Mix. To be applied ivith a firm brush. Very useful in ringioorm ; hvo or three applications, at intervals of eight or ten days, ivill frequently effect a cure.
The officinal Linimextum Iodi may also be used, but it must be diluted with from one to three parts of spirit or glycerine or tincture of aconite.
206. Bromine and Iodine.
R. Bromi, min. 5; Iodi, gr. 18 ; Tincturffi Iodi, fl. oz. 1. Mix very cautiously so as to avoid all risk of an explosion. To be employed to cancerous and rodent ulcers.
207. Croton Oil Liniment.
R. Olei Crotonis, min. 30 ; Olei Olivte, fl. drs. 2. Mix, for a liniment.
To produce ruhefaction and a pustular eruption, lohere counter-irritation is required for the relief of diseases of interned organs. The officinal liniment is only I part to 7, and is scarcely strong enough.
208. Blistering and Epispastic Papers.
These papers of M. Albespeyre have long been used in this country with great advantage, though they are less appreciated than in France.
Thej' consist of — an epispastic paper for dressing blisters ; a dulcifying paper for issues, causing neither smell nor pain ; and blisters formed of an adhesive cloth without a plaster.
The Epispastic Paper, for dressing blisters, is prepared of four degrees of strength, under the designation of No. 1 feeble. No. 1, No. 2, and No. 3. No. 1 feeble possesses the least strength, and is suitable as a dressing for persons of irritable temperament, and for children. No. 1 has rather more salve spread upon it, and is adapted for patients whose blister^have risen well. No. 2 is employed for those whose blisters do not draw sufficiently, and require stimulating. Whilst No. 3 possesses a still stronger power, and is used only in cases where the blister has a tendency to dry up. They all maintain an abundant discharge, without pain or heat ; prevent the formation of false membranes ; produce do irritation of the urinary pas- sages ; and cause no disagreeable smell.
The blisters— applied by the adhesive black side- — readily adhere to the skin, producing vesication in tw*o hours (twelve at the furthest); and, if necessai'y, the same piece put on four or five times always gives rise to the blistering effect. They are, however, less required by the British practi- tioners than they were prior to 1867, because there is now an excellent officinal Charta Epispastica.
X. DIAPHORETICS AHD DIURETICS.
209. Nitre and Ipecacuanha.
R. Potassse Nitratis, gr. 60, vel Potassse Citratis, gr. 120; Yini Ipe- cacuanhfe, fl. drs. 2 ; Syrupi Hemidesmi, fl. oz. 1 ; Decocti Hordei, ad 0. 1. Mix. One small teacupful to be taken every two or three hours. In severe catarrh with sore throat.
326 APPENDIX OF FOEMUL^.
210. Antimony and Opium.
R. Yini Antimonialis, fl. drs. 1-2 ; Liqnoris Ammonias Acetatis, fl. drs. 12; Extract! Opii Liquidi, min. 30; Aqnse Camphorae, ad fl. oz. 8. Mix. One-sixth part three times a day. Each fiuidrachm of the wine contains one-quarter of a grain of antimony.
211. Nitrate of Potash and Ammonia.
R. Potassse Nitratis, gr. 120; Liquoris Ammonise Acetatis, fl. drs. 18; Spiritus Ammonise Aromatici, fl. drs. 3 ; Tincturse Aconiti, min. 30 ; Aquje, ad fl. oz. 8. Mix. One-sixth part every four or six hovxrs. In pneumonia, and many other acute injlammcdions. Sometimes it is preferahle to give only the Solution of Acetcde of Ammonia diluted with wcder [tivo or three fiuidrachms to two ounces).
212. Ether and Ammonia.
R. Potass* Nitratis, gr. 30-60; Spiritas ^theris Nitrosi, fl. drs. 3; Liquoris Ammouiae Acetatis, fl. drs. 12 ; Aquae Camphorse, ad fl. oz. 8. Mix. One-sixth part three or four times a day. In the early stage of many febrile and inflammatory disorders.
R. Ammonias Carbonatis, gr. 18-30 ; SpiritCis Chloroformi, fl. drs. 3; Yini Colchici, min. 30 ; Liquoris Ammoniie Acetatis, fl. drs. 20 ; Mucilaginis Tragacanthae, fl. oz. 4; Aquse, ad fl. oz. 8. Mix. One-sixth part every four hours. Valuable in some forms of pneumonia, gouty inflammation, etc.
213. Dover'' s Powder and Antimony., etc.
R. Pulveris Ipecacuanhge Compositi, gr. 5 ; Antimonii Tartarati, gr. \. Mix, and make a powder to be taken every six hours.
R. Pulveris Opii, Pulveris Ipecacuanhae, aa gr. 1 ; Potassse Nitratis, gr. 8. Make a powder, to be taken every night at bedtime. An improvement on the ordinary Dover's powder.
214. Senega and Giiaiac.
R. Tincturae Guaiaci Ammoniatas, fl. drs. 3-6 ; Mucilaginis Tragacanthae, fl oz. 3. Mix thoroughly together, and then add, — Infusi Senegae, ad fl. oz. 8. Three tablespoonfuls to be taken thrice daily. Useful in the latter stages of bronchitis, tonsillitis, etc. The action is diaphoretic, diuretic, stimu- lant, and expectorant.
R. Tincturse Guaiaci Ammoniatae, fl. drs. 2; Yitelli Ovi, 1. Beat thoroughly together, and then add, — Misturae Amygdalae, fl. oz. 4. Direct, one-half to be taken twice a day. In chronic rheumatism.
215. Benzoate of Ammonia and Juniper.
R. Ammonias Benzoatis, gr. 60-120 ; Syrupi Hemidesmi, fl. oz. 1 ; Spiritfis Juniperi, fl. drs. 6 ; Aquas, ad fl. oz. 8. Mix. One-sixth part three times a day. As a diuretic in dropsy and gout. In cases where the urine is loaded with phosphates. Also in catarrhal inflammation of the bladder with alkaline urine.
216. Ipecacuanha and Syrup of Poppies.
R. Yini Ipecacuanhae, fl. drs. 2; Syrupi Papaveris. fl. drs. 3 ; Mucilaginis Tragacanthae, fl. oz. 1 ; Aquas, ad fl. oz. 3. Mix. One teaspoonful every two or three hours. An infantile cough mixture.
DIAPHORETICS AND DIURETICS. 327
217. Antimony and J'pecacuanlia,
R. Villi Antimonialis, min. 75; Viiii Ipecacuanhas, fl. drs. 2; Syrupi Rhoeados, fl. drs. 3; Liqnoris Ammoiiife Acetatis, fl. drs. 2 ; Aquae, ad fl. oz. 6. Mix. A small tablespoonful every two hours. A clep7'essmg mix- ture for children two or three years of age.
218. Ipecacuanha and Syrup of Poppies.
R. Yini Ipecacuanhfe, fl. drs. 2; Syrupi Papaveris, fl. drs. 3; Liquoris Amnionise Acetatis, fl. drs. 4 ; SpiritCis iEtheris Nitrosi, fl. drm. 1 ; Aquae, ad fl. oz. 2. Mix. One teaspoonf'ul every two or three hours. In the early stage of infantile fever, severe catarrh, bronchitis, and pneumonia.
219. Squills, Digitcdis, Broom, etc.
R. Potassae Acetatis, gr. 120; Syrupi Scillre, fl. drs. 6; Spirit<is iEtheris Nitrosi, fl. drs. 3 ; Tincturas Digitalis, min. 30-fi. drm. 1 ; Succi Scoparii, fl. drs. 6 ; Aquas, ad fl. oz. 8. Mix. One-sixth part every six or eight hours. As a diuretic in dropsy dependent upon disease of the heart, liver, or peritoneum.
R. Tincturse Scillae, fl. drs. 2; Tincturae Camphors Compositae, fl. drs. 4; Liquoris Ammonias Acetatis, fl. drs. 12 ; Decocti Scoparii, ad fl. oz. 8. Mix. One-sixth part three times a day. Diuretic and diaphoretic. In dropsies unaccompanied hy inflammation, and not due to renal disease.
R. Spiritfis Juniperi, fl. drs. 4; Potassae Tartratis Acidse, oz. 1 ; Decocti Scoparii, ad fl. oz. 12. Mix. One-sixth part three times a day. Diuretic and laxative.
R. Pulveris Scillos, gr. 6 ; Digitalis Folise, gr. 8-12 ; Pilulas Hydrargyri, gr. 30. Make a mass, divide into twelve pills, and order one to be taken night and morning with a wineglassful of the Decoctum Scoparii. See F. 224.
R. Liquoris Potassaj, fl. drs. 1-2; Spiritiis ^Etheris Nitrosi, fl. drs. 6 ; Tinctures Croci. fl. drs. 3 ; lufusi Digitalis, fl. drs. 12 ; Syrupi, fl. drs. 6 ; Aquas, ad fl. oz. 8. Mix. One-sixth part three times a day. A valuable diuretic in some forms of cardiac and hepatic dropsy.
220. Copaiha Resin.
R. Resinae Copaibas, gr. 90 ; Spiritus Vini Rectificati, fl. drs. 2 ; Spiritfis Chloroformi, fl. drm. 1 ; Misturae Acacias, fl. oz. 1 ; Aquas, ad fl. oz. 6. Mix. One-sixth part three times a day. As a diuretic in ascites.
221. Nitre, Juniper, and Ether.
R. Potassae Nitratis, gr. 60 ; Spiritus Juniperi, fl. drs. 1-2; Spiritfis ^theris Nitrosi, fl. drs. 3; Decocti Chimaphilas (Phar. Lond. 18.51), ad fl. oz. 8. Mix. One-sixth part every six hours. A ionic and stimidcding diuretic. In scrofida, atonic dropsies, catarrhal inflammation of the bladder, and some skin diseases.
222. Buchu, and Cream of Tartar.
R. Potassae Tartratis Acidas, gr. 180 ; Infusi Buchu, fl. oz. 8. Mix. One- sixth part three times a day. Diuretic and laxative. In irritable condi- tions of the bladder, owing to excess of uric acid in the tirine. Also in chronic rheumatism, dropsy, and some cidaneous diseases.
328 APPENDIX OF FORMULA.
223. Buchii, Borax, and Pareira.
R. Boracis, gr. 40; Tincturse Bucliu, fl. drs. 6 ; Extract! Pareirse Liquidi, fl. drs. 6 ; Decocti Pareirae, ad fl. oz. 8. Mix. One-sixth part every six or eight hours. In chronic catarrh of the bladder, calculous affections, etc.
224. Digitalis, Squills, etc.
R. Potassse Citratis, gv. 200; Tincture Scillae, fl. drs. 2; Yini Colchici, fl. drs. l^ ; Liqnoris Ammonise Acetatis, fl. drs. 12 ; Infnsi Digitalis, fl. oz. 3 ; Aqute Menthae Piperitse, ad fl. oz. 8. Mix. One-sixth part three times a day. Diuretic and sedative. In some forms of dropsy loith disease of the mitral valves.
R. Digitalis Folise, Pulveris Scillse, aa gr. 12 ; Extract! Taraxaci, gr. 36. Make a mass, divide into twelve pills, and order one to be taken twice a day. Valuable as a diuretic in mitral, but injurious in aortic, disease. See F. 219.
225. Z^rea.
R. UreEe, gr. 5-15 ; Syrnpi Anrantii, fl. drm. 1 ; Aquge, fl. oz. 2. Make a draught, to be taken every six hours. Recommended by the Author as a diuretic in dropsy due to cardiac disease. See Medical Times and Gazette, 8 May, 1852.
226. Cantharides and Nitrous Ether.
R. Tincture Cantharidis, fl. drs. 1-2 ; SpiritQs Athens Nitrosi, fl. drs. 3; Spiritds Juniperi, fl. drs. 4; SjTupi Zingiberis, fl. drs. 6; Aquae, ad fl. oz. 8. Mix. One-sixth part three times a day. May be cautiously tried in some cases of suppression of urine. Also in some skin diseases.
227. Taraxacum and Nitric Acid.
R. Acidi Nitrici Diluti, fl. drm. 1 ; Succi Taraxaci, fl. drs. 6; Decocti Taraxaci, ad fl. oz. 8. Mix. One-sixth part three times a day. Laxative, alterative, and diuretic. Especially useful in disease of the liver unac- companied by inflammation.
228. Cream of Tartar and Taraxacum.
R. Potassae Tartratis Acidae, oz. 1; Extract! Taraxaci, gr. 30 ; Decocti Taraxaci, fl. oz. 8. Mix. One sixth part three times a day. In jaundice independent of hepatitis or obstruction of the duct of the gall bladder.
229. Oil of Juniper.
R. Olei Juniperi, min. 20; Syrupi Limonis, fl. drs. 6; Mucilaginis Aca- ciae, adfl. oz. 4; Aquae, ad fl. oz. 12. Mix. One-sixth part every six or eight hours. The oil of juniper has not only a diuretic action, but it is also a diaphoretic and an emmenagogue and a cathartic. In too large doses it may cause itijiammation of the bladder.
230. Conium, Digitalis, and Calomel.
R. Digitalis Foliae,_ Hydrargyri Subchloridi, aa gr. 5; Extracti Conii, gr. 60. Make a mass, divide into fifteen pills, and order one to be taken three times a day. As a sedative and diuretic in dropsy from cardiac disease.
EMETICS AND EXPECTORANTS. 329
XI. EMETICS AND EXPECTORANTS.
231. Depressing Emetics.
R. Antimonii T.artarati, gr. 1-2; Tpecacuanliae, fl. drs. 2; Aquas, ad fl. oz. 2. Make a drang-ht, to be taken immediately. Its action should he aided hy the free administration of warm water.
R. Antimonii Tartarati, gr. 1 ; Pulveris Ipecacuanlige, gv. 20. Make a powder. To be taken in honey or cream, or as a bolus in wafer paper.
R. Vini Tpecac-uanlia3, fl. oz. 1. To be taken when it is desired to induce vomiting. For children one fluid drachm, in tea or sweetened luater, will generally suffice.
Chloride of Apomorphia, in doses of gr. \ by the mouth, or of gr. ,'5 in- jected subcutaneously, is a prompt and unfailing emetic.
232. Stimulant Emetics.
R. Pulveris Sinapis, oz. ^] Aquae, fl. oz. 3. Make a draught. To be taken immediately.
R. Cupri Sulphatis, gr. 10; Aquae, fl. oz. 3. Make an emetic draught.
R. Zinci Sulphatis, gr. 20-40 ; Aquce, fl. oz. 3. Mix.
233. A Warm Emetic.
R. Pulveris Ipecacuanha, Ammonise Carbonatis, aa gr. 20; Tincturse Lavandula3 Compositse, fl. drm. 1; Aquae, fl. oz. 2. Make a draught. After taking it a tumblerful of Infusion of Chamomile Flowers (Infusion of An- themidis) should be drunk. Suggested by a formula of Dr. Bruitt's. In the incijyient stages of fever, erysipelas, etc.
234. Tartar Emetic Mixture'.
R. Antimonii Tartarati, gr. 2 ; Syrupi Rhoeados, Aquae, aa fl. drs. 4. Mix and label, — " One teaspoonful every two hours, in a wineglassful of water, until there is nausea." — As a de'pressant to the circidating and nervous systems.
235. Ammojiia and Senega.
R. Ammonise Carbonatis, gr. 30; Spiritfis ^theris, fl. drs. 3; Tincturae Scillae. fl. drs. 2 ; Tincturae Camphora; Compositas, fl. drs. 2-4 ; Tincturae Lavandulae Compositas, fl. drs. 6 ; Infusi Senegae, ad fl. oz. 8. Mix. Two tablespoonfuls every four hours. In the chronic bronchitis of old people.
R. Spiritus Ammonire Aromatic!, fl. drs. 4; SpiritCis Armoracire Com- positi, min. 60; Tincturse Senegae, fl. drs. 6; Aquae Camphoras, ad fl. oz. 8. Mix. One-sixth part every six hours. A valuable stimulating expectorant in some cases of chronic bronchitis.
R. Ammoniae Carbonatis, gr. 12 ; Vini Ipecacuanhas, min. 40 ; Tincturae Senegae, fl. drs. 2 ; Syrupi RhcEados, fl. drs. 3 ; Aquas, ad fl. oz. 3. Mix. One dessertspoonful every two or three hours. An excellent stiviidating expectorant for young children recovering from croup. In hooping cough, where the bronchi are loaded with mucus.
236. Squills, Nitric Acid, and Barh or Steel.
R. Syrupi Scillas, fl. drs. 6; Acidi Nitrici Diluti, fl. drm. 1; Tincturae Hyoscyami, fl. drs. 3-6; SpiritCis Chloroformi, fl. drs. 2 ; Infusi Ciuchonae
330 APPENDIX OF FOEMULiE.
Flavag, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily. In chronic catarrh with dehility and restlessness.
R. Syrupi Scillas, fl. drs. 6; Tinctnraj Ferri Miiriatis, fl. drm. 1; Tincturse Camphors Composilse, fl. drs. 3-6; Spiritfis Chloroform i, fl. dr. 1; Aqnse, ad fl. oz. 6. Mix. One-sixth part three times a day. In chronic catarrh tvith dehility. Sometimes 5 or 10 drops of Oleum Terebinthiuse may be added with advantage.
237. Ammoniacum and Opium.
R. Tincturag Scillse, fl. drs. 2 ; Extracti Opii Liqiudi, min. 20-30 ; Syrupi Tolutani. fl. drs. 6; Mistiirse Ammoniaci, ad fl. oz. 6. Mix. One-sixth part three times a day. A sedative and expectorant mixture in the chronic hronchitis of elderly people.
238. Sarsaparilla and Squills.
R. Extracti Sarsae Liquidi, Synipi Scillse, aa fl. drs. 12. Mix, and label, — " One teaspoonful in a teacupful of barley water frequently durinj? the day." An agreeable demxdcent and expectorant in inflammation of the mucous membranes about the throat and air passages.
239. Squills, Ammonia, and Morphia.
R. Syrnpi Scillse, fl. drs. 6; Spiritvls Ammonise Aromatici, fl. drs. 3; Liquoris Morphi Hydrochloratis, fl. drm. 1 (equivalent to half a grain of the salt); Infusi Serpentariae, ad fl. oz. 8. Mix. One-sixth part twice or thrice a day. In chronic catarrh.
240. Antimony and Ether.
R. Vini Antimonialis, fl. drs. 1^; SpiritCls ^theris, fl. drs. 3; Mucilaginis Tragacanthse, fl. oz. 3; Aquae, ad fl. oz. 6. Mix. One-sixth part every four days. The quantity of antimonial loine shoidd be doubled when it is desirable to induce a feeling of nausea.
241. Ipeccccuanha and Indian Sarsaparilla.
R. Yini Ipecacuanhse, fl. drs. 2 ; Syrupi Hemidesmi, fl. drs. 3 ; Mucilaginis Acacise, fl. oz. 1; Aquae, ad fl. oz. 2. Mix. One teaspoonful every two hours. For children threatened with an attack of croup or bronchitis.
R. Vini Ipecacuanhae, fl. drs. 2; Syrupi Hemidesmi, fl. oz. 1 ; Infusi Lini, ad fl. oz. 8. Mix. One-sixth part every four hours. An emollient and expectorant in catarrh.
242. Indian Tobacco and Hemloch.
R. Tincturae Lobelite ^thereae, fl. drs. 3; Syrupi Papaveris, fl. drs. 6; Tincturae Conii Fructus, fl. drs. 2-4; Misturae Amygdalae, ad fl. oz. 6. Mix. One-sixth part every four hours. In spjasmodic cough, and some forms of asthma.
243. Squills and Hemlock or Hyoscyamus.
R. Pilulae Scillae Compositfe, Extracti Conii, aa gr. 30. Mal^e a mass, divide into 12 pills, and order two to be taken every night at bedtime. In
chronic catarrh ivhen opium is objectionable.
R. Syrupi Scillae, fl. drs. 6 ; Spiritus vElheris Nitrosi, Tincturae Hyos- cyami. aa fl. drs. 3; Infusi Rosae Acidi, ad fl. oz. 8. Mix. One-sixth part every six hours. In influenza, catarrh, etc.
GARGLES AND INHALATIONS. 331
244. Nitrous Ether, Ipecacuanha, and Hemlock.
R. Villi Tpecacnaiiliae, fl. drs. 1|; SpiritCis -^tlieris Nitrosi, fl. drs. 6; Sncci Conii, fl. drs. 3; Infiisi Scnegae, ad fl. oz. 8. Mix. One-sixth part every six hours. In chronic bronchitis, tuhen an expectorant and sedative is required.
245. Dulcamara and Stramonium.
R. Tincturse Scillse, fl. drs. 2; Tincinra3 Stramonii, fl. drs. IJ; Infusi Dulcamarse, ad fl. oz. 8. Mix. One-sixth part three times a day. In chronic catarrh and rheumatism, especially tuhere the secretions of the skin and kidneys are deficient.
246. Benzoic Acid and Squills.
R. Acidi Benzoici, gr. 40 ; Synipi Scillie, Syrupi Rhoeados, aa fl. drs. 12. Make a linctus, of which one small teaspoonful is to be ordered to be tal\ea every four hours. In chronic bronchial affections tvith suppressed action of the liver. See F. 49.
247. Opium and Squills.
R. Syrupi Scillse, Syrupi Papaveris, Syrupi Tokitani, Mucilaginis Tra- gacanthse, aa fl. drs. 4. Make a linctus, of which a teaspoonful is to be directed to be taken frec[uently.
R. Syrupi Scillae, fl. drs. 10; Tincturse Conii. fl. drs. 2; Tincturas Cam- phoriB Conipositfe, fl. drs. 4. Make a linctus, and order one teaspoonful to be taken when the cough is troublesome. See F. 346, 347.
XII. GAEGLES AND INHALATIONS.
248. Hydrochloric Acid Gargle, etc.
R. Acidi Hydrochlorici Diluti. fl. drs. 3; Mellis Depurati, oz. 1; Infusi RosfB Acidi, ad fl. oz. 8. Mix. In tonsillitis after the acute stage, a,nd in relaxed sore throat.
249. Zinc and Rhatany Gargle.
R. Ziuci Sulphatis, gr. 20 ; Syrupi Mori, fl. drs. 4; Glycerini, fl. oz. 1 ; Infusi Kramerise, ad fl. oz. 8. Mix. For relaxation of the uvula and fauces.
250. Borax Gargles.
R. Boracis, gr. 160; Tincturffi Myrrhae, fl. oz. 1 ; Aquae, ad fl. oz. 8. Mix. Useful in aphthae and ulcerations aboid the fauces.
R. Boracis, gr. 120; Glycerini, fl. oz. 1. Mix. To be painted over the gums, tongue, etc., with a camel's-hair pencil. In aphthce. It is preferable to the officinal Borax Honey, as the sugar of the latter favors the forma- tion of fungi.
R. Boracis, gr. 60; Glycerini, fl. drs. 12 ; Aquae Rosae, ad fl. oz. 4. Mix. To he painted over the tongue in some forms of idceration, fissure, etc.
R. Boracis, gr. 180 ; Syrupi Scillse, fl. drm. 1 ; Aquse, ad fl. oz. 8. Mix. As a gargle in chronic inflammation of the fauces.
332 APPENDIX OF FORMULA.
251. Tannin Gargle.
R. Acidi Tannici, Gjr. 20; SpiritCls Vini Gallici, fl. oz. 1; Aqnse Cam- pliorse, ad fl. oz. 8. Mix. The officinal Tannic Acid Lozenges may be used at the same time.
R. TinctnrEe Mja-rhge, fl. drs. 4; Acidi Tannici, gr. 35 ; Eau de Cologne, fl. drs. 12. Mix. The gums are to he sponged with this 'preparation three or four times a day in cases of chronic gingivitis, ulceration, loosening of the teeth, etc.
252. Alum Gargles.
R. Aluminis Exsiccati, gr. 80; Tincturte Myrrhse, fl. oz. 1 ; Aquae, ad fl. oz. 8. Mix. In mercurial salivation, ulceration about the mouth and fauces, etc.
R. Aluminis Exsiccati, gr. 60 ; Tincturse Capsici, fl. drs. 3 ; Syrupi Mori, fl. oz. 1 ; Aqute Eosse. ad fl. oz. 8. Mix. In hoarseness, sore throat, etc., with relaxation of the uvula or tonsils.
253. Opium and Belladonna Gargle.
R. Tincturse Opii, fl. drs. 2 ; Tincturas Belladonnge, fl. drs. 3; Aquas Cam- phorge, ad. fl. oz. 8. Mix. To he used frequently in acute tonsillitis.
254. Chlorinated Soda Gargle.
R. Liqnoris Sodse Chloratse, fl. drs. 6; Aquas, ad fl. oz. 8. Mix. In
ulcerated sore throats, profuse salivation, etc. It may also be used as a lotion to foul gangrenous idcers, as well as to the seat of irritation in prurigo.
255. Creasote Gargle.
R. Creasoti, min. 20; Mucilaginis Tragacanthse, fl. oz. 3; Aquas, ad fl. oz. 8. Mix.
R. Creasoti, min. 20 ; Tincturse Lavandulas Compositae, Tincturas Myi'rhse, aa fl. drs. 4; Syrupi Limonis, fl. drs. 12; Aquae, ad fl. oz. 8. Mix. /7^ chronic inflammation of the throat, dyspho7iia clericorum, etc.
256. Corrosive Sublimate Gargle.
R. Hydrargyri Perchloridi, gr. 2; Acidi Nitrici DiJuti, min. 30; Tinc- turse Myrrhse, fl. oz. 1 ; Aquae Destillatae, ad fl. oz. 8. Mix.
R. Hydrargyri Perchloridi, gr. 3; Glycerini, fl. oz. 1; Extracti Conii, gr. 60 ; Aquas Destillatae, ad fl. oz. 8. Mix. Useful in syphilitic affections of the tongue and throat. The patient must use one tablespoonful at a time, and shoidd be cautioned against sivalloioing it.
257. Permanganate of Potash Gargle.
R. Liquoris Potassae Permanganatis, fl. oz. 1 ; Potassse Chloratis, gr. 100 ; Aquae Destillatae, ad fl. oz. 8. Mix. In diphtheria, ulceration of fauces, etc.
258. Sulphite of Soda,.
R. Sodae Sulphitis, gr. 60; Aquae Destillatae, fl. oz. 1. Mix. To be fre- quently applied by means of a camel's-hair pencil to the mucous membrane of the mouth and fauces. In cases of aphthce.
GARGLES AND INHALATIONS.
333
259. Iodine Inhalation.
R. Tincturse lodi, min. 30; Aquse Calidse, fl. oz. 4. Mix. The vapor is to be cautiously inhaled. In some canes of laryngeal phthisis, diph- theria, etc.
In severe coryza great relief is given by holding a small bottle of Tinc- ture of Iodine under the nose. The warmth of the hand suffices to vaporize the iodine.
Mix. In To he used with a common
Mix. In ozcena and
2G0. Turpentine and Creasote Inhalations.
R. Olei Terebinthinge, fl. oz. 1 ; Aquae Calidae, ad fl. oz. 6 chronic bronchitis ivith excessive secretion. ■inhaler.
R. Creasoti, min. 30 ; Aquae Bullientis, fl. oz. 8 other affections of the nostrils, pharynx, etc.
261. Hydrocyanic Acid Inhalations.
R. Acidi Hydrocyanic! Diluti, min. 20; Tincturse Hyoscyami, Tincturse Lupuli, aa fl. oz. 1 ; Aquae Calidse, ad fl. oz. 8. Mix. In phthisis, ulcer- ation of the larynx, etc. Can he used loith any common inhaler.
R. Acidi Hydrocyanici Diluti, min. 15 ; Spiritfis Chloroformi, fl. drs. 3-6 ; Aquae Bullientis, fl. oz. 8. Mix. In laryngitis, oedema, of the glot- tis, etc.
262. Atomized Fluids for Inhalation.
The following drugs may be used in the form of spray, tioned is to be added to one ounce of water : —
The dose meu-
Acidum Carbolicum Acidum Sulphurosum
grs. 1 to 2
|
fi |
drs. |
2 to 8 |
|
Acidum Tannicura . . |
grs. |
3 to 12 |
|
A lumen Exsiccatura . |
grs. |
3 to 20 |
|
Aqua Laui'ocerasi . . |
min. |
5 to 20 |
|
Argenti Nitras . . . |
grs. |
1 to 3 |
|
Boras |
grs. |
5 to 20 |
|
Extractum Belladonnae |
gr. |
ito 1 |
|
Extractum Conii . . |
grs. |
5 to 10 |
|
Extractum Cannabis |
||
|
Indicse |
gr. |
^to 1 |
|
Extractum Opii . . . |
gr. |
^to 2 |
|
Ferri Ammonio-Sul- |
||
|
phas |
grs. |
3 to 6 |
Hydrargyri Perchlori- dum
Liquor Arsenicalis . ,
Liquor Calcis Saccha- ratus .... fl.
Oleum Terebinthinse .
Potassse Chloras . .
Potassae Permanganas
Potassi Bromidum . .
Potassi lodidum . .
Sodii Chloridum . .
Tiuctura Ferri Per- chloridi
Tinctura lodi . . .
Tinctura Opii . . .
Zinci Sulphas . . .
min. 3
drs. min. grs. grs.
OTS.
1 1
5 2 2
grs. 2 grs. 5
min. 5 min. 1 min. 3 grs. 3
to 1 to 8
to 4 to 5 to 10 to 4 to 10 to 10 to 40
to 30 to 15 to 20 to 15
The best instruments for dispersing the finest spray are — Dr. Siegle's, in which steam is applied as the dispersing medium : a modification of this apparatus, made by Krohne and Sesemann, of 241 Whitechapel Road : Dr. Bergson's or Dr. Andrew Clarke's double handball spray producer : Mr. Maunder's single handball.
Atomized medicated fluids may he advantageously used in affections of the lining membrane of the nose, mouth, and fauces. In croup and diphtheria: Syphilitic affections of pcdate ancl throat: Laryngitis: Tonsillitis : Oedema of the glottis : Tubercidar or syphilitic ulcerations of larynx : Hoarseness and loss of voice : Whooping cough : Asthma : Haemoptysis: Bronchitis: Phthisis. During their application the patient
334 APPENDIX OF FORMULA.
should make deep and long inspirations and expirations. Except in acute cases one application daily will suffice. In addition to the drags mentioned above, pure glycerine may be used ; or olive oil, or even cod-liver oil ; or plain warm water; or the undiluted sulphurous acid (in diphtheria).
XIII. LOTIOKS, LINIMENTS, COLLYRIA, AND OINTMENTS.
263. Hydrocyanic Acid Lotions.
R. Acidi Hydrocyanic! Diluti, fl. drs. 3; Plumbi Acetatis, gr. 60; Spiritfis Rectificati, fl. oz. 1 ; Aquae Sambuci, ad fl. oz. 8. Mix. In
impetigo, prurigo, etc.
R. Liquoris Potassae, fl. di's. 2 ; Acidi Hydrocyanici Diluti, fl. drs. 1^; Glycerini, fl. oz. 1 ; Aquse Rosse, ad fl. oz. 8. In some cases of pityriasis.
R. Liquoris Ammonise Acetatis, fl. oz. 1 ; Acidi Hydrocyanici Diluti, fl. drs. 11^ ; Infusi Tabaci (made with sixty grains of Bird's-eye tobacco), ad fl. oz. 8. Mix. To be sponged twice or thrice daily over the seat of irritation. In pruritus about the emus, vulva, etc.
R. Hydrargyri Perchloridi, gr. 3 ; Acidi Hydrocyanici Diluti, fl. drs. 2 ; Misturaa Amygdalse, ad fl. oz. 8. Mix. To check irritation in prurigo and other skin diseases of limited extent.
264. Astringent Lotions.
R. Glycerini, fl. oz. 1 ; Liquoris Plumbi Subacetatis, fl. drs. 2 ; Spiritus Rectificati, fl. drs. 4 ; Aquae Roste, ad fl. oz. 8. Mix. In eczema, ecthyma, pityriasis, etc.
R. Zinci Sulphatis, gr. 16 ; Spiritds Rosmarini, Tincturae Lavandulae Compositae, aa fl. drs. 2 ; Aquae, ad fl. oz. 8. Mix. The common "Red Lotion" of Hospitals. Very useful for strumous and other ulcers.
R. Potassae Chloratis, gr. 80; Aquae, fl. oz. 8. Mix. For many ill- conditioned ulcers.
R. Acidi Citrici, gr. 120; Aquae, fl. oz. 8. Mix. For cancerous sores. Also as a gargle in cancer of the tongue or tonsil. It relieves pain, and encourages cicatrization.
265. Anodyne Lotions.
R. Tincturee Aconiti, fl. drs. 12 ; Aquae, ad fl. oz. 4. Mix. In acide superficial pain, hypercesthesia of skin, gout, pruritus, etc.
R. Tabaci Communis (Bird's-ej'e tobacco), gr. 120; Aquae Bullientis, 0. 1. Infuse for an hour, and strain. To be freely used in pruntis of the vulva or anus.
R. Tincturae Belladonnae, fl. oz. 1 ; SpiritCis Ohloroformi, fl. oz. 2 ; Aquae Destillatee, ad fl. oz. 8. Mix.
R. Bxtracti Belladonnas, gr. 120; Glycerini, fl. oz. 1. Mix. To be painted over the seat of pain in neuralgic diseases, and in limited in- flammations. The mixture is to be made of double the strength, if re- quired as an application to the breasts to check the secretion of milk.
266. Alkaline and Anodyne Lotions.
R. Liquoris Morphiae Hj^drochloratis, fl. oz. 1^; Liquoris Potass^, fl. drs. 2 ; Glycerini, fl. oz. 1 ; Aquae Laurocerasi, fl. oz. 1 ; Aquae Sambuci, ad fl. oz. 12. Mix. For the relief of pruriginous affections.
LOTIONS, LINIMENTS, ETC. 335
R. Potassfe SulphuratfB, gr. 90 ; Liquoris Potassos, raia. 30 ; Tiiicturse Acouiti, fl. drs. 4 ; Aquaj Destillate, ad fl. oz. 12. Mix.
2G7. Acid and Anodyne Lotion.
R. Acidi Acetici, fl. drs. l^; Morphite Acetatis, gr. 10; Viui Colchici, fl. oz. 3. Mix. To he applied over the inflamed joint in gout, on a piece of lint covered with oiled silk.
268. Borax or Soda, and Glycerine Lotions.
R. Boracis, gr. 60-120 ; Glycerini, fl. oz. 1 ; Aqute Sarabuci, ad fl. oz. 8. Mix. An excellent local pcUliative m mcotiy of the squamous diseases of the skin.
R. Boracis, gr. 200; Morphise Hydrocliloratis, gr. 10; Glycerini, fl. oz. 1 ; Aqute Rosse, ad fl. oz. 8. Mix. In obstinate pruntas of the vulva. The parts to he sponged twice or thrice in the twenty four hours with this lotion, previously washing them with glycerine [or honey) soap and warm loater.
R. Sodas Carbonatis, gr. 120 ; Aqnae Sarabuci, fl. oz. 7 ; Glycerini, fl oz. 1. Mix. To allay the itching attendant on many skin dit^eases, healing idcers, etc.
269, Iodine Lotions.
R. Tinctoras lodi, fl. oz. 1 ; Glycerini, fl. drs. 12 ; Aquaj Destillatge, ad fl. oz. 8. Mix. For indolent and scrofulous idcers, etc.
R. Liniraenti lodi, fl. drs. 4; Tincturse Aconiti, fl. oz. 1; Aquae Destil- latfB, ad fl. oz. 8. Mix. In some cases of chronic peritonitis ; ch'onic pleurisy loith effusion ; chronic effusions into joints, etc. See F. 81.
270. Creasote or Carbolic Acid, and Glycerine.
R. Creasoti, min. 3.5 ; Glycerini, fl. drs. 12 ; Aquae, ad fl. oz. 8. Mix, for a lotion. In pityriasis, etc.
R. Acidi Carbolici, gr. 100; Glj'cerini, fl. oz. 1; Aquse, ad fl. oz. 8. Mix, for a lotion. Iti parasitic and pruriginous affections.
R. Glycerini Acidi Carbolici, fl. oz. 1; Aquse, fl. oz. 4. Mix. The af- fected part to be sponged with this lotion three or four times in the 24 hours. In all parasitic skin diseases.
271. Corrosive Sublimate Lotions.
R. Hydrargyri Perchloridi, gr. 8-16; Aquae Sarabuci, fl. oz. 8. Mix.
Usefid in tinea favosa, and other parasitic skin diseases.
R. Hydrargyri Perchloridi, gr. 10 ; Amraonii Chloridi, gr. 60; Acidi Hydrocyanic! Diluti, min. 100; Liquoris Morphias Hydrocliloratis, fl. oz. 2. Mix. Label, — " One teaspoonful to be added to a wiueglassful of water to form a lotion." In pruritus of the vulva or anus.
R. Hydi-argyri Perchloridi, gr. 4; Acidi Nitrici Diluti, min. 30 ; SpiritCls Yini Eectificati, fl. drs. 4 ; Acpiae Sambuci, ad fl. oz. 8. Mix and label,— " To be sponged upon the spots and rough surfaces night and morning." In chloasma, some forms of acne, etc.
272. Sidphurous Acid and SulpJiocyanide Lotion.
R. Acidi Sulphurosi, fl. oz. 2 ; Aquae Destillatae, fl. oz. 6. Mix. In skin diseases depjendent on a parasitic plant.
336 APPENDIX OF FORMULA.
R. Acidi Sulphurosi. Glycerini, aa fl. oz. 1. Mix. In ringviorm, favus, and for the destruction of parasitic lichens. Should be paiated over the affected parts.
R. Potassii Sulphocyanidi, gr. 240 ; Glycerini, fl. oz. 1; Aquae, fl. oz. 7. Mix. In ringworm, etc. To be well rubbed into the diseased patch, after careful washing and drying, and also applied on lint. Dr. Gke.
273. Cold Lotions.
R. Liquoris Ammoniae Acetatis, fl. oz. I ; Spiritds Rectificati, fl. oz. 2 ; Aquae Rosee, ad fl. oz. 8. Mix. As an evaporating lotion in inflamma- tion of the membranes of the brain. To be applied after the scalp has teen shaved.
R. Ammonii Chloridi, oz. ^ ; Spiritfis Rectificati, fl. oz. 1 ; Acidi Acetici Diluti, fl. drs. 12 ; Aquaj, ad fl. oz. 8. Mix.
274. Absorbent Lotions.
R. Zinci Oxidi, gr. 160 ; Aquae Rosae, ad fl. oz. 8. Mix. Useful in im- petigo, eczema, etc.
R. Zinci Oxidi, gr. 160; Mucilaginis Tragacanthae, Aqute Destillatae, aa fl. oz. 4. Mix,
275. Solutions of Arnica.
R. Tincturae Arnicae, fl. drs. 1-6 ; Aquae Destillatae, ad fl. oz. 8. Mix. As a lotion in sprains, contusions, and burns.
R. Tincturae Arnicae, fl. drs. 2 ; Tincturae Belladonnae, fl. oz. 1 ; Linimenti Saponis, ad fl. oz. 8. Mix, for an embrocation.
276. Mercurial Liniments.
R. Linimenti Hydrargyri, fl. oz. 2; Linimenti Belladonnas, Linimenti Opii, aa fl. oz. 1. Mix. In syphilitic tubercles, nodes, etc.
R. Hydrargyri Perchloridi, gr. 6; Acidi Nitrici Diluti, min. 90; Aquae Laurocerasi, fl. drs. 2 ; Glycerini, fl. oz. 1 ; Aquae Destillataa, fl. oz. 8. Mix.
To be used every night in cases of chloasmcc, syphilitic nodes and erup- tions, etc.
R. Unguenti Hydrargyri, oz. 1 ; Glycerini, fl. oz. 1 ; lodi, gr. 120 ; Olei Olivae, fl. oz. 2. Mix. To be gently rubbed over syphilitic nodes.
'211 . Rubefacient Liniment.
R. Pulveris Capsici, gr. 30; Olei Macis, min. 30; Linimenti Terebinthinae, fl. oz. 3 ; Linimenti Camphorae Compositi, ad fl. oz. 8. Mix. As a liniment to the chest in some cases of bronchitis.
278. Stimulating Liniment.
R. Linimenti Saponis, Linimenti Opii, Linimenti Camphorae Compositi, aa fl. oz. 1 ; TinctunB Arnicae, fl. drs. 2. Mix. To he applied round the throat, on a strip of flannel, in subacute tonsillitis, common sore throat, etc.
279. Ccmiphor Liniment and Opium, etc.
R. Linimenti Camphorae Compositi, fl. oz. 2; "Tincturas Opii, Tincturae Belladonnas, aa fl. drs. 4. Mix. To be rubbed over the scrobiculus cordis to check obstincde nausea and vomiting, pain, etc.
LOTIONS, LINIMENTS, ETC. ' 337
280. Iodide of Potassium, Liniment.
R. Potassii lodidi, vel Ammonii lodidi, gr. 40 ; AqiiEe, fl. drs. 4. Mix, and add — Gh'cerini, fl. oz. 1. Useful in some glandular enlargements, as loell as for dispersing the chalkstones of gout.
281. Belladonna and Aconite Liniment.
R. Linimenti Belladonnoe, Linimenti Aconiti, aa fl. drs. 4; Linimenti Camphoraj Compositi, fl. oz. 3. Mix. The seat of pain to be rubbed with tliis liniment for ten minutes at bedtime. In pleurodynia, chronic rheu- matism., and painful nervous affections.
For the same class of cases a good liniment may be made with one part of belladonna liniment, one of opium liniment, and four of turpentine lini- ment.
R. Linimenti Belladonnas, fl. drs. 3; Glycerini, fl. drs. .5 ; Linimenti Saponis, fl. oz. 2. Mix. The spine to be rubbed with this liniment night and morning for five minutes. In hooping cough. May be used for a child five years old.
282. ChlorofoDn, Belladonna, and Aconite Liniment.
R. Linimenti Cliloroformi, Linimenti Aconiti, Linimenti Belladonnpe, Linimenti Opii, aa fl. drs. 4; Linimenti Saponis, fl. oz. 2. Mix. To be rubbed into the painful part night and morning. In neuralgic and rheu- matic pains of great severity.
283. Cod-Liver Oil Embrocations.
R. Olei Morrhuas, fl. drs. 14; Spiritus Ammonise Aromatici, fl. oz. 1 ; Tincturaa Opii, fl. drs. 2 ; Olei Lavandulse, min. 30. Mix. One-half to be well rubbed over the chest and abdomen, night and morning. In phthisis and other cases lohere the use of cod-liver oil is indicated, hut tvhere the stomach loill not hear it.
R. Olei Morrhuee, fl. oz. 1 ; Olei Cajuputi, fl. drm. 1. Mix. To be rubbed over the chest at bedtime. The caj\iput oil well disguises the smell of this embrocation.
284. Caoutchouc Sohition.
Take some thin pieces of India rubber, or of gutta percha, and dissolve them in chloroform. A good protective solution. To he painted over superficial excoriations, threatened hed-sores, etc.
285. Collodiiwi Paints.
R. CoUodii, fl. oz. 1 ; Olei Palmas, min. 20; Anchusa3 Radicis, sufiBcient to give color. — A good artificial cuticle, which when spread on the skin will not crack, may also be formed by mixing two parts of glycerine with one hundred of collodion. — The ofiicinal Collodium Flexile consists of one fluid drachm of castor oil, one hundred and twenty grains of Canada balsam, and six fluid ounces of collodion. — Edher preparation may he used as a varnish m various cutaneous affections, excoriations, or superficial hums.
R. Collodii Flexilis, fl. drs, 4 ; Morphise Acetatis, gr. .5-20. Mix. To he painted over the course of the affected nerve in neuralgia. 22
338 APPENDIX OF FORMULA.
286. Glycerine and Lime- Water, etc.
R. Glycerini, fl. oz. 1 ; Pulveris Trag'acanthse Compositi. gr. 120 ; Mellis Depiirati, gr. 120; Liquoris Calcis Saccharati, fl. oz. l^- Misturse Amyg- date, ad fl. oz. 8. Mix. A good bland embrocation in canes of herpes, superficial burns, chapped hands, excoriations, etc.
The officinal Linimentum Calcis, consisting of equal parts of olive oil and lime-water, is also useful in some of the above-mentioned cases. For chapped hands the Glycerine o^ Starch is an excellent preparation.
R. Linimenti Aconiti, fl. drs. 2 ; Linimenti Calcis, fl. drs. 10. Mix. In
vulval pruritus.
R. Acidi Carbolici, gr. 60-120 ; Linimenti Calcis, fl. oz. 8. Mix. To
prevent suppuration in burns, etc.
287. Ammonia and Cantharides, etc.
R. SpiritGs Ammonife Aroraatici, Spiritus Rosmarini, Glycerini, aa fl. oz. 1; 'IMncturse Cantharidis. fl. drs. 3-6; Aquas Eosse, ad fl. oz. 8. Mix.
To be gently brushed into the scalp night and morning, tvhen the hair is falling oj^ after fever or any severe illness.
A more elegant embrocation may be made by adding two fluid drachms of Tincture of Cantharides to two ounces of Eau de Cologne.
R. Balsami Tolutani vel Peruviani, gr. 120 ; Olei Rosmarini, min. 20 ; Tincturse Cantharidis, fl. drs. 4; Olei Ricini, fl. oz. 1 ; Adipis Praeparati, oz. 1. Mix. A valuable p)omade in cases of baldness folloioing ringworm, pityriasis, or tinea decalvans. It should be brushed into the scalp night and morning.
288. Sulphate of Atropia.
R. Atropige Sulphatis, gr. 1 ; Aquaa Destillatas, fl. drs. 4. Mix. Dila- tation of the pupil is effected most speedily and is longest maintained by a solution of this kind. A full drop must be placed in the eye by means of a cameVs-hair pencil: the effect ivill be produced in from fifteen to twe^ity minutes, and loill sometimes continue for seven or eight days.
The officinal Liquor Atropine Sulphatis contains half a grain of the salt in each drachm. It is preferable to the Liquor Atropife for ophthalmic purposes ; inasmuch as the spirit which is used in the latter to keep the alkaloid in solution causes considerable pain to the eyes when it is applied.
Discs of gelatine impregnated with atropine are prepared according to the instructions of Mr. Ernest Hart and Mr. Streatfeild. These discs dissolve and act very efficiently when placed in contact with the moist con- junctiva. A piece, one-fifth of an inch square, contains as much of the Sulphate of Atropine as a drop of the solution of two grains to the ounce of water.
289. Ahmi Coagulum.
Take the whites of two eggs and shake them with fragments of alum to form a coagulum. Useful loh en painted under t}ie eyelids to produce con- traction in trichiasis, entropion, etc.
290. Sedative CoUyria.
R. Extract! Belladonnse. gr. 2-4; vel Extracti Opii, gr. 2-5; vel Mor- phise Hydrochloratis, gr. 1-2 ; vel Acidi Hydrocyanic! Diluti, min. 10 ; vel Tincturae Acouiti, min. 5-30 ; Aquae Destillatae, fl. oz. 1. Mix.
LOTIONS, LINIMENTS, ETC. 339
29 L Astringent Collyria.
R. Zinci Snlpliatis, gr. 2-4; vel Aliiminis Bxsiccati, gr. 1-4; vel Tinc- turag Ariiicaj, niiii. 5-30 ; vel Ciipri Snlpliatis, gr. 1-4; vel Argent! Nitratis, gr. 1-4 ; vel Liquoris PJiimbi Subacetatis, raiu. 10 ; vel Cadmii Sulphatis, gr. 1-3 ; Aqua3 DestillatiB, fl. oz. 1. Mix.
R. Zinci Oxidi, gr. 60 ; Aquae Rosse, fl. oz. 8. Mix. For an eye water, to be used night and morning.
292. Iodide of Potassium Collyrinm.
R. Potassii lodidi, gr. 6-8 ; Aquas Destillatse, fl. oz. 1. Mix. To remove stains of nitrate of silver from the conjunctiva.
293. Iodide of Lead Ointments.
R. Plumbi Todidi, gr. 60 ; Unguenti Atropias, gr. 60-120 (eacb ounce contains eight grains of the alkaloid) ; Unguenti Simplicis, ad oz. 1. Mix. In some malignant indurations.
R. Plumbi lodidi, gr. 90; Unguenti Cetacei, oz. 1 ; Linimenti Bella- donnas, vel Linimenti Aconiti, fl. drm. 1. Mix. For malignant and 'pain- ful strumous ulcers.
294. Sulphate of Zinc Ointment.
R. Zinci Sulphatis Exsiccatae, gr. 120; Unguenti Simplicis, oz. 1. Mix. Very useful in some forms of lupus, rodent ulcer, etc. The officinal Ai,UMEN ExsiccATUM may be employed in the same cases.
295. Tar and Citrine Ointment.
R. Unguenti Picis Liquidse, oz. 1^; Unguenti Cetacei, oz. 1; Unguenti Hydrargyri Nitratis, oz. \. Mix. In lepra, psoriasis, chronic eczema, etc.
296. Aconitine Ointments.
R. Unguenti Aconitse, oz. \ {= to grs. 2 of the alkaloid) ; Unguenti Hy- drargyri Subchloridi, oz. 1-2. Mix. In some forms of neuralgia.
R. Unguenti Aconitse, gr. 120. In severe neuralgia. A small portion is to be painted over the nerve, bid it must not be used where there is the slighted abrasion.
297. Belladonna and Opium.
R. Extracti Belladonnse, Extract! Opii, aa gr. 60; Aquae Laurocerasi, fl. drs. 4 ; Extracti Papaveris, oz, 3. IVIix. To be painted over the seat of inflammation in pleurisy, peritonitis, gout, gastric disease, etc. A fomeutation flannel, or hot linseed pcmltice, or-xuet compress is to be ap- plied; being separated from the extracts by a sheet of tissue paper.
R. Extracti Belladonnae, gr. 120; Extracti Papaveris, oz. 2; Syrupi Papaveris, fl. oz. 1. Mix and label, — " To be painted over the seat of pain, which is then to be covered with water dressing or a bread and water poul- tice. Poison." For inflammation of the absorbents, lymphatic glands, gcdlstone disease, peritonitis, etc.
298. Mercurial and Belladonna Ointments.
R. Unguenti Hydrargyri, gr. 10; Unguenti Atropise-, gr. 30. For re- lieving cases of severe nocturnal pain around the orbit. It is to be rubbed into the temple just before the pain may be expected.
340 APPENDIX OF FORMULA.
I^. Linimenti Belladonnse, fl. drs. 2 ; Unguenti Hydrargyri Subchloridi, oz. 1. Mix. In syphilitic tubercular diseases.
299. Corrosive Sublimate Ointment.
Vf.. Hydrargyri Percliloridi, gr. 5 ; Ungnenti Simplicis, oz. 1. Mix. In
parasitic diseases of the skin or scalp. Especially useful in ringioorm. May he used, as a pomatum, ivith a drop or two of otto of roses, to per- fume it, in scalp diseases ivhere the presence of a parasitic fungus is feared.
300. Carbolic Acid Ointment.
I^. Acidi Carbolici, gr. 25-40 ; Unguenti Zinci, oz. 3. Mix. As a dress- ing for irritable sores or burns, or skin, eruptions loith offensive dis- charges.
301. Creasote and Red Oxide of Mercury.
^.. Creasoti, min. 10 ; Unguenti Hydrargyri Oxidi Rubri, gr. 120 ; Un- guenti Simplicis, gr. 360. Mix. In parasitic diseases of the skin, the idcerations of rupia, etc.
302. Red Iodide of Mercury Ointment.
Vf. Hydrargyri lodidi Rubri, gr. 8; Unguenti Simplicis, oz. 1. Mix. In chronic glandular tumors, a small portion rubbed in every night proves very useful. The officinal ointment is double the strength of the foregoing, and hence it causes paiii and blistering.
303. Croton Oil and Lard.
^.. Olei Crotonis, min. 15 ; Adipis Prteparati, oz. ^. Mix. One-fourth part to be rubbed into the skin every eight hours, until an abundant pus- tular eruption is produced. Useful as a counter irritant.
30 i. Ver atria Ointment.
"Sf^. Unguenti "Veratriae, Unguenti Cadmii lodidi, aa oz. 1. Mix. In chronic rheumatism, chronic gout, etc.
305. Diluted Citrine Ointment.
I^. Unguenti Hydrargyri Nitratis, gr. 40-120 ; Unguenti Cetacei, gr. 240. Mix. As a stimulant and alterative in chronic skin diseases. May be applied to the edges of the eyelids in ophthalmia to prevent their ctdhering at night.
306. Comjjound Spermo.ceti Ointments,
'Sf.. Acidi Hydrocyanici Diluti. fl. drm. 1; Unguenti Atropias, gr. 120; Unguenti Cetacei, oz. 1. Mix. Bi cutaneous diseases attended xvith pain and itching.
'Bf.. Balsami Peruviani, gr. 60 ; Unguenti Cetacei, oz. 1. Mix. In slight excoriations.
'^. Balsami Peruviani, gr. 60 ; Unguenti Cetacei, oz. 2 ; Alkannge Tinc- torife Radicis, gr. 60; Olei Rosae (Otto of Roses), min. 10. Mix. Useful as a lip salve and as an application to chapped hands and sore nipples.
'Sf.. Iodoform!, gr. 40; Unguenti Simplicis, oz. 1. Mix. A soothing ointment for burns, scalds, irritable ulcers, chancres, boils, etc.
NARCOTICS AND SElfATIVES. 341
307. Belladonna and Iodide of Potassium.
Vf.. Linimenti Bellacloniife, fl. drs. 2 ; Ungueiiti Potassii loclidi, oz. 1. Make an ointment. 'I'lie Liniment of Aconite may be substituted for the Belladonna, if desired. In painfid chronic tumors, neuralgia, etc.
308. Iodine and Cod-Liver Oil Ointment.
^. Unguenti lodi, Olei Morrhuse, aa fl. drs. 4. Mix. Useful ivhen rubbed upon the throat in hronchocele ; as luell as when applied to strumous glands, rcnsuppurating buboes, and the tumid bellies of children with mesenteric disease.
309. Bole Armeniack and Lead.
I^. Boll Armense Rubrse, Piumbi Oxidi Semivitrei. aa gr. 30 ; Camphorge, gr. 5; Cera; Flavas, gr. 180; Adipis Prasparati, gr. 360. Mix. To be spread on thick linen. Several German physicians speaJc of this as an efficacious application fo7^ preventing and curing bed sores.
310. Compound Sulphur Ointments.
^. Unguenti Creasoti, Unguenti Sulphuris, aa oz. ^. Mix. In pity- riasis, and some other chronic cutaneous affections.
'^. Sulphuris lodidi, gr. 12; Unguenti Simplicis, oz. 1. Mix. In acne, applied thrice daily. The officinal iodide of sulphur ointment is one-third stronger.
I^. Sulphuris lodidi, gr. 12; Sulphuris Prascipitati, gr. 20; Olei Amyg- dalae Aniaraj, min. 5; Adipis Prgeparati, oz. 1. Mix.
'^. Unguenti Hydrargyri Ammoniati, gr. 120; Unguenti Sulphuris, gr. 360. Mix. A good antiparasitic ointment.
311. Bismuth and Morphia Ointment.
I^. Bismuthi Subnitratis, oz. 1; Morphise Acetatis, gr. 6 ; Adipis Ben- zoati, oz. 3. Mix. For irritable idcers and eruptions, piles, etc.
312. Iodide of Cadmium Ointment.
I^. Cadmii lodidi, gr. 60; Adipis Praeparati, oz. 1; Linimenti Aconiti, fl. drs. 2. Mix. Superior to iodide of potassium ointment for rubbing into tender and enlarged strumous glands, nodes, etc.
I^. Unguenti Cadmii lodidi, oz. 2 ; Unguenti Atropiae, oz. 1. Mix. To
be rubbed into painful strumous and glandular swellings.
XIV. NARCOTICS AND SEDATIVES.
313. Ancesthetics.
The chief Ana?sthetics which have hitherto been i^sed in the practice of medicine are chloroform, ether, and nitrous oxide. As the emploj'ment of one or other of these agents is often indicated in calculous nephralgia, gall- stone colic, some cases of cancer, neuralgia, maniacal delirium, convulsions, the paroxysmal dyspnoea of infantile laryngismus and diphtheria and croup, as well as in spasmodic diseases generally, a few words on their mode of administration may not be out of place.
The principal advantages of inhalation are these : — That by means of the immense surface offered by the air-cells of the lungs for absorption, a deeper
342 APPENDIX OF FORMULA.
and more rapid effect is induced than it would be safe or easy to effect by other means. At the same time, the digestive functions are less interfered with than when narcotics are given in the ordinary way.
In every form of inhalation (with the exception of the nitrous oxide, ether, and perhaps of the bichloride of methylene) the anaesthetic should be freely diluted with common air, and no attempt made to produce rapid narcotism ; while the breathing ought to be allowed to go on quietly and naturally. The patient should be tranquil, fearless, and usually in the recumbent posture. If false teeth are worn, they are to be removed ; since if there be any strug- gling, or sickness, or cough, the plate may become separated from the gums and be drawn into the pharynx, or may get to the back of the fauces and produce asphyxia by pressing on the glottis. And then the administrator of the narcotic agent, while watching the respiration and the countenance, had better also keep his finger on the pulse. For if the breathing becomes stertorous, or if it stop, or if it appear difficult and the pupils become widely dilated, or if there is evidence that the circulation is getting weak and faltering, the inhalation must be completely suspended ; while, if more serious symptoms follow, the body should be gently and gradually turned over to the left side, so as to allow of the region of the heart and the left side of the face resting upon the couch. According to Mr. Bader, this practice has been found very efficient at Guy's Hospital in removing dan- gerous symptoms.
Chloroform was introduced into practice by Sir James Y. Simpson, of Edinburgh, in November, 1847. The vapor of this hot, sweet, heavy liquid may be inhaled by individuals of all ages, from infants under one year to persons as old as ninety; and in almost all states of the system. The ex- ceptional cases which preclude its employment, at all events in medical practice, are instances of marked blood-poisoning, of far advanced cardiac or pulmonary or cerebral disease, and perhaps of habitual drunkenness. It may be administered from an apparatus such as the late Dr. Snow recom- mended ; but Sir James Simpson always used a simple napkin folded into the shape of a funnel. A crumpled handkerchief in a tumbler forms a convenient inhaler; or a still more convenient inhaler is formed by a piece of lint made into a cone, upon the apex of which the chloroform can be dropped as required. Mr. Clover emjiHoys a bag containing an admixture of air and chloroform vapor in definite proportion. But in whatever way it is exhibited care must be taken that it does not come into contact with the lips and nose ; since it produces painful excoriations. Chloroform should also be given slowly and cautiously; and it acts best before breakfast, or when the patient's stomach is empty. If administered immediately after food, sickness is sure to result. According to Dr. Snow, about four cubic inches of vapor, or rather more than five grains, of chloroform to each hundred cubic inches of air, is the proportion most suitable for causing in- sensibility to surgical operations; but according to the Report of the Chlo- roform Committee of the Royal Medical and Chirurgical Society the proportion of vapor should not exceed three and a half per cent. As a general rule, however, in medical and obstetric cases it need only be used in a more diluted form. When an overdose has been given, the patient should be made to inhale ether, as it counteracts the depressing action which chloroform exerts on the heart. Or artificial respiration, performed in the manner to be presently described, may be resorted to; the success of which will depend upon the extent to which the heart and the muscles of respira- tion have been paralyzed by the chloroform. AVhen death occurs, it arises from the failure of the functions of respiration and circulation. Respiration generally ceases, and then the heart's action stops. Dr. Snow gave this anaesthetic in 4000 or more cases, with the loss of only one person while inhaling it; and amongst these were patients with heart disease, phthisis, and several who had suffered from apoplexy. It has been computed that
NAECOTICS AND SEDATIVES. 343
duriiio; the Crimean war chloroform was administered 40,000 times, death resulting in only one case.
JElher (first used as an anaesthetic in September, 1846, by Dr. W. T. G. MoKTON, of Boston, Massachusetts) is thoujiht to be a safer agent for in- ducing narcotism than chloroform ; but although it is so, still it must be given with caution. 'I'he disadvantages of ether are the longer time and large quantity of the agent required, the struggling excited, and the disagreeable irritation of the throat produced. About one fluid ounce is usually inhaled by an adult in becoming insensible; though not more than half this quantity is absorbed, the remainder being thrown back from the lungs. Some of the disadvantages may be avoided by first inducing insen- sibility by nitrous oxide, and then giving ether to keep it up. An excellent anaesthetic for obstetric practice may be made with equal parts of ether and chloroform.
Aviylcne is made by distilling araylic alcohol (obtained from crude fusel oil, or oil of potato spirit) with chloride of zinc. In the present state of our knowledge, it is not advisable to resort to this agent. Dr. Snow seems to have administered it in 238 cases, and to have had two deaths from it.
In October, 1867, Dr. Richardson recommended the use of the Bichlo- ride of Methylene as a general anaesthetic. He did so on these grounds amongst others: (1) The sleep produced by it is as deep as that by chlo- roform, but more natural and agreeable, (2) The second degree of narcotism is shorter than with other anaesthetics. (3) When the effects are fully developed, the narcotism is very prolonged and is easily reproduced. (4) The final escape of the bichloride from the organism is rapid: hence the recovery from its influence is sudden. It rarely produces headache, sickness, or any sense of exhaustion. (5) When it destroys life, it does so by equally paralyzing the organs of respiration and circulation. (6) It combines with ether and with chloroform in all proportions. And indeed, in its properties generally, it seems to resemble a compound of these two agents.
Dr. Richardson has also shown that by saturating Ether tvith Chloride of Methyl an anaesthetic is formed. The product has, however, the disad- vantage of not being a very stable compound; and hence he does not at present recommend its employment.
The Tetrachloi'ide of Carbon has been employed for producing anaes- thesia during surgical operations, for abolishing the pains of parturition, for the relief of neuralgia and hay fever and toothache, for the induction of sleep, as well as for subduing excessive palpitation of the heart Dr. Sansoji says that amylene and the tetrachloride of carbon have an analogous action. He does not recommend the latter where such anaesthesia as is necessary for a surgical operation is required ; but thinks a mixture of six parts of chlo- roform and one of tetrachloride may prove valuable. The latter, in its pure state, can be used where it is only necessary to relieve pain without destroy- ing consciousness: to this extent its action is that of a stimulant, anodyne, and hypnotic.
The inhalation of Nitrous Oxide to prevent the pain of surgical opera- tions was suggested by Sir Humphry Davy in 1799, when he ascertained that its respiration produced effects analogous to those caused by drinking fermented liquors — usually a transient intoxication, or violent exhilaration. These effects were shown in popular lectures at the Adelaide Gallery, in London, somewhere about 1840. In 1844, Dr. Colton administered it to an American dentist— Horace Wells, and painlessly extracted one of his teeth. The introduction of -ether inhalation by Dr. Morton', in 1846, with- drew professional attention from the nitrous oxide. The latter has, however, again been introduced into practice, and is now being largely employed by
344 APPENDIX OF FORMULJ^].
dentists. Dr. Colton is said to have given it in twenty-eight thousand cases without an accident. The great advantages of this gas over other aniEsthetics seem to be its safety; the fact that it induces insensibility in from 60 to 180 seconds; that the complete insensibility lasts for about half a minute; while in about a couple of minutes afterwards there is restoration to consciousness without any sickness or faintness. Nitrous oxide is inhaled undiluted with atmospheric air : when used mixed with air it causes a pro- longed stage of exhilaration — whence it was known as "laughing gas."
An excellent anfesthetic, which has been very largely used by the Author, can be made by mixing equal parts of pure Chloroform and Ether. No special apparatus is required for its employment : though the flannel mask recommended by Dr. Skinner, with the drop bottle, will be found convenient. The only precaution necessary is that there should be no in)pediment to the free admission of air. — The Chloroform Committee of the Royal Medical and Chirurgical Society has recommended a mixture composed by measure of three parts of ether, two of chloroform, and one of alcohol. That this is safer than pure chloroform cannot be doubted ; but it has seemed to the Author less useful than this agent with an equal quantity of ether.
In apparent death from any anajsthesic, artificial respiration, after the plan recommended by Dr. Sylvester, ought to be tried. 'J'he body is to be laid on its back, with the head and shoulders slightly raised. 'I'he mouth and nostrils are to be cleansed from mucus ; and the tongue should be drawn firmly forwards so as to keep the tip well protruded at the side of the mouth. Then the operator is to compress, for two or three seconds, the front and sides of the chest by the patient's own arms. Thus the medicated vapor will be partly expelled from the lungs ; while upon the pressure being suddenly removed, the elastic walls of the chest will expand, and give the primary impetus to respiration. To assist expansion to the utmost the ribs should be drawn upwards by means of the pectoral muscles. This is effected by the operator grasping the arms just above the elbows, and drawing them upwards until they nearly meet above the head. Then they must be lowered, and replaced at the sides ; at the same time making moderate pressure with them for a couple of seconds against the chest walls. This process is to be repeated fifteen times in the minute. At the same time the face ought to be well fanned. No attempt should be made to administer stimulants by the mouth.
In some instances, galvanism of the phrenic nerve, diaphragm, and inter- costal muscles would be useful in keeping- up the movements of respiration ; one pole of the battery being applied over the outer edge of the sterno-mastoid muscle just above the clavicle, while the other is pressed deeply into the seventh intercostal space. The diaphrag-m must be made to contract and relax alternately, by interrupting the currents at different intervals.
While attempts are thus being made to oxygenate the blood, an assistant is to rub the limbs from the extremities towards the heart. If no respiratory efforts supervene, the face and chest are to be dashed with cold water, or with hot and cold water alternately. When success follows this plan the temperature of the body must be maintained by friction, hot blankets, the warm bath, etc.
314. Morphia, Atropine, Aconitine, etc., for Subcutaneous Injection.
The solution of Acetate of Morphia as used for injection under the skin can be well made by mixing ten grains of this salt with one fluid drachm of distilled water. It is unnecessary to rub up the salt with hot distilled water and acetic acid, subsequently neutralizing the latter with liquor potasse. The solubility of the acetate of morphia in water is 1 in 6; of the hvdrochlorate, 1 in 20.
NARCOTICS AND SEDATIVES. 345
Each six minims of a solution thus made will contain one grain of acetate of morphia. For first injections not more than one minim and a half should be nsed; as it is certain that this narcotic acts more powerfully when thus employed, than when taken into the stomach. In diseases which are con- tinuously painful, the ease given by an injection will last for about twelve hours. To relieve the suffering of advanced cancer, etc., the injection may be advantageously given, night and morning, for many months.
A solution of Bimeconate of Morphia for hypodermic injections is pre- pared by Mr. Peter Squire. Each minim of this concentrated solution is equivalent to min. L6 of the officinal tincture of opium, or to one-sixth of a grain of acetate of morphia.
The subcutaneous injection of morphia often causes troublesome nausea and retching, which may continue for 18 or 20 hours. 'I'his unpleasant result can be obviated, according to Dr. John Harley, by administering a small quantity of atropine ( gV of ^ grain) with the morphia.
The subcutaneous injection of Atropine is sometimes useful in cases of intestinal obstruction, asthma, tetanus, neuralgia, chorea in the adult, etc. Great caution is necessary: not more than two minims of the officinal Liquor Atropi« (= to gr. g'g), or of the Liquor Atropite Sulphatis, should be employed at first. During a severe paroxysm of asthma, the use of two minims of the liquor atropife mixed with the same quantity of the morphia solution will often produce satisfactory results. The good effect is increased in some cases by having recourse to this injection while the patient is un- conscious from the inhalation of a mixture of ether and chloroform.
Chloroform may be used in the same manner. The injection of ten or fifteen minims often effects a cure for the time in pleurodynia, neuralgia, sciatica, etc. It has the disadvantage of sometimes producing an irritable ulcer, which may be slow in healing.
A solution of Aconitine may be m.ade thus: Aconitite, gr. 1; Spiritus Rectificati, min. 10; Aqua3 Destillatre, ad fl. drs. 2. Mix. For first injec- tions not more than two minims should be employed: the dose may after- wards be safely increased to four minims (gr. 1-30). It is better, though not absolutely necessary, to make the injection at the seat of pain. The local tingling which follows is often severe ; but this is of no consequence compared to the neuralgic pain for which it is used.
315. Morphia Draughts, etc.
R. Liquoris Morphise ITydrochloratis. min. 30 (= to gr. | of the salt); Syrupi Limonis, fl. drm.»l; Tincturse Hyoscyami, fl. drm. 1 ; Aquae Cam- phorge, fl. oz. 1. Mix. To be taken at bedtime. In insomnia with pain.
R. Liquoris Morphia Hydrochloratis, min. 15-30 ; Spiritus Chloroformii, fl. drm. 1 (= to min. 3 of chloroform) ; Spiritiis ^^theris, min. 30 ; 'J'incturae Belladonnse. min. 20 ; TinctursB Cardamomi Compositas, fl. dr. 1 ; Aquae, ad fl. oz. H. Mix. To be taken every two hours (the patient being watched) until the pain ceases. Useful in facilitating the passage of gallstones.
R. Liquoris Morphife Hydrochloratis, min. 40 ; Acidi Hydrocyanici Diluti, min. 20 ; Syrupi Scillae, fl. drs. 6 ; Tincturte Benzoini Compositae, fl. oz. 1 ; Mucilaginis Acaciae, ad 9. oz. 6. Mix. One tablespoonful every three or four hours. In many irritable coughs.
316. Chloral Draught.
Hydrate of Chloral is an excellent hypnotic, and is supposed by Lie- breich to be decomposed by the alkaline blood, yielding chloroform as the active agent. It has a nauseous taste, and sometimes causes vomiting, and
346 APPENDIX OF FORMULA.
on this account is usually disguised for administration. The dose is from 20 to 60 grains, and it should be given when the patient is settled in a posi tion for sleep.
Croton Chloral, also introduced by Liebreich, is supposed to have special influence on pain in the region of the fifth nerve.
1^. Chloral Hydrate, gr. 20-60 ; Syrupi Tolutani vel Aurantii, fl. dr. 1 ; Aqus Menthse Piperitis, ad fl. oz. 1 or 1^. Mix, for a night draught.
317. Chloroform and Opium, or with Morphia and Indian Hemp.
'2f.. Chloroformi, min. 6-10 ; Extracti Opii Liquidi, min. 15-30 ; Tincturse Belladonnas, min. 10-20; Syrupi Rhoeados, fl. drm. 1; Mucilaginis Traga- canthas, fl. oz. 1. Mix, for a night draught. In severe colic, and other spasmodic disorders.
"E^. Liquoris Morphise Hydrochloratis, min. 20 ; Tinctura? Chloroformi Compositae, min. 30 ; Tincturge Cannabis Indicte, min. 20 ; Pulveris Traga- canthaj Conipositi, gr. 80 ; SpiritCis ^theris, min. 40; Acidi Hydrocyanic! Diluti. min. 4; Tincturas Hyoscyami. fl. drm. 1; Aquae, ad fl. drs. 12. Mix, for a night draught. In many chronic diseases attended with pain or restlessness.
The medicine called Chlorodyne probably consists essentially of chloro- form, Indian hemp, morphia, and hydrocyanic acid. In the Canada Lan- cet (15 October, 1864) Dr. W. E. Bowman gives the following formula for its preparation : — Take of Chloroform, half a fluid ounce ; Sulphuric Ether, ninety minims; Oil of Peppermint, eight drops; Resin of Indian Hemp, six grains ; Capsicum, two grains. Mix, shake occasionally, and allow it to stand for a few days. Take of Muriate of Morphia, sixteen grains, dis- solved by the aid of heat in two fluid drachms of water; to which, when cold, add of Scheele's Hydrocyanic Acid, sixty-five minims; Perchloric Acid, one fluid drachm ; Treacle, two fluid ounces. Add this gradually to the first mixture, and then make the whole measure four fluid ounces by the addition of treacle or water. — Each dose of thirty minims contains of chloroform min. 4, ether min. 1^, extract of hemp gr. 1-lOth, hydrochlorate of mor- phia gr. I, and of Scheele's acid min. 1.
Mr. Squire gives for Chlorodyne a formula which contains no Indian Hemp or Capsicum, and a smaller dose of Morphia. Mr. Ed. Smith assigns to it the following composition : —
'^L. Chloroformi, fl. dr. 4 ; Morphia3 mur., gr. 20 ; ^ther. rectif., fl. drs. 2 ; 01. Menthse Pip., min. 8 ; Acidi Hydrocyanic! dil.,,fl. drs. 4 ; Tinct. Capsici, fl. drs. 6 ; Mist. Acaciae, fl. oz. 1 ; Tberiacse, ad fl. oz. 5.
318. Brandy and Egcj Mixture., ivith Opium.
^. Misturse SpiritQs Vini Callici (see F. 17), fl. oz. 1 ; Extracti Opii Iviquidi, min. 5-10; Spiritds Chloroformi, min. 30. Mix. To be taken every four hours. In exhaustion from pain.
319. Tolu and Camphorated Opium.
'Sf.. Tincturse Tolutanse, fl. drs. 2 ; Syrupi Tolutani, fl. oz. 1 ; TincturtE Camphorge Compositse, fl. drs. 4 (= to gr. 1 of opium) ; Mucilaginis Tragacanthfe, ad fl. oz. 8. Mix. Two tablespoonfuls three times a day. For old people, lohere the mucous secretion from the bronchi is excessive.
320. Cimicifuga Racemosa, or Black Snakeroot.
I^. Tincturae Acteae Racemosae, min. 30-fl. drs. 2 ; Aquae, ad fl. oz. 1. Mix, for a di'aught. To be administered everv three or four hours until
NARCOTICS AND SEDATIVES. 347
nausea ensues or the pulse becomes lowered. This drug possesses nar- cotic and eliminative properties : and is useful in chronic rheumatism, lumbago, chorea, obscure nervous pains, and in backache from uterine disturbance.
321. American Hellebore.
I^. Tincturte Veratri Viridis (a saturated solution), min. 5-10 ; Aquae, fl. oz. 1. Mix. This draught may be given every three hours, adding one drop of tincture to each dose, until the pulse becomes sufficiently lowered or nausea is produced. The latter is readily counteracted by small doses of morphia. It is a valuable artericd sedative: and is particularly iised by American physicicLns in inflammations of the lungs, pleura, or peritoneum, and in acute rheumatism.
322. Lobelia and Ether.
Vf^. Spiritus Ammonise Aromatici, fl. drs. 2 ; Tincturaj Lobeliee ^therse, fl. drs. 3-6 ; Tincturte Aconiti, min. 30 ; Aquas Camphorse, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily. As a sedative in some cases of asthma.
323. Stramonium and Henbane.
'Bf.. Extract! Stramonii, gr. 3 ; Extract! Hyoscyami, gr. 20 ; Extract! Lupuli, gr. 40. Mix, and divide into twelve pills. One to be taken every four hours until relief is obtained. In chronic disorders attended with suffering, in diseases of the nervous system accompjanied ivith pain and restlessness, and in the dyspnoea of phthisis and emphysema.
Vf.. Tincturse Stramonii, fl. drs. 1-2 ; Tincturae Hyoscyami, fl. drs. 3-6 ; Tiucturae Cantharidis, fl. drm. 1 ; Spiritus Chloroform!, fl. drs. 3 ; Aquee, ad fl. oz. 8. Mix. One-sixth part three times a day. In some cases of asthmct.
324. Opium and Ipecacuanha.
"Sf.. Extract! Opii, Pulveris Ipecacuanhse, aa gr. 1 ; Potassse Nitratis, gr. 8 ; Glycerin!, sufficient to make a mass. Divide into two pills, and order them to be taken at bedtime. A good narcotic and diaphoretic. It is preferable to the officinal Compound Powder of Ipecacuanha, as the nitrate of potash acts better than the sulphate.
^.. Yin! Ipecacuanhse, fl. drs. 2|; Extract! Opi! Liquid!, min. 30; Syrup! Tolutani, fl. drs. 5 : Mucilaginis Tragacanthse, fl. oz. 1. Mix. One tea- spoonful every two or three hours. In chronic cough.
325. Henbane, Camphor, and Hop.
Vf.. Extract! Hyoscyami, gr. 40-60 ; Camphoras, Lupulinse, aa gr. 20. Mix, divide into 18 pills, and order three to be taken every night at bed- time. An excellent sedative for hysterical and hypochondriacal patients suffering from sleeplessness. Useful also in some forms of insanity.
'^L. Spirit(as Camphorse, min. 30 ; Tincture Hyoscyami, Tincture Lupuli, aa fl. drm. 1 ; Mucilaginis Acacise, fl. oz. 1. Mix, for a draught to be taken at bedtime.
326. Belladonna. Atropia.
'Sf.. Extract! Belladonnse, gr. 5 ; Zinc! Sulphatis, gr. 30 ; Extract! Gen- tianse, gr. 90. Make a mass, divide into 20 pills, and order one to be taken three times a day. In cases luhere a sedative and tonic action is to be
348 APPENDIX OF FORMULA.
produced. Especicdly useful in some diseases attended with irritahility of the urinary organs. Also in many spasmodic coughs. See F. 92.
R. Extracti Belladonnas, <?r. \; Extracti Quassise, srr. 2. Mix into a pill, to be taken night and morning. In epilepsy. Requires to he given for a long period.
R. Tincturse Belladonnte, min. 10-1.5; SpiritCis Ammotiiae Aromaticse, min. 20 ; Aquae, fl. oz. 1. Mix To be taken three or four times a day. In heart disease, ivith irritability and palpitation.
R. Camphorae, gr. 5 ; Extracti Belladonnae, gr. ^ ; Extracti Conii, gr. 4 ; Spiritfis Eectificati, sufficient to make two pills. To be taken every night at bedtime. , /n spermatorrhoea; cnnviUsions ; as loell as in certain spasmodic affections of the air passages.
R. Liquoris Atropise, fl. drs. 2. One drop (= gr. 1-120) in a table- spoonful of brandy and water, night and morning. In epilepsy. The dose to be increased by one drop every second or third week. A preparation of zinc may be given at the same time, if desired.
327. Camphor., Opiimi, and Blue Pill.
R. Campliorae, gr. 5 ; Extracti Opii, gr. 1; Pilulse Hydrargyri, gr. 4. Mix, divide into two pills, and order them to be taken at bedtime. In restlessness ivitli congestion of the liver and irritability of the sexual organs. Also in venereal sores ivith nocturncd emissions.
328. Codeia and Assafcetida.
R. Codeiae, gr. ^ ; Pilulae Assafoetidae Compositae, gr. .5. Mix into a pill, to be taken every night at bedtime. Especicdly usefid in attacks of spasmodic cough, dyspnoea, etc.
329. Morphia and Assafcetida.
R. Morphiae Hydrochloratis, gr. 2; Assafoetidae, gr. 30; Camphorae, gr. 20. Make a mass, divide into twelve pills, and order one to be taken at bedtime. A good stimidant and antispasmodic.
330. Aconite with Guaiacum, Mercury, or Opium.
R. Tincturae Aconiti, min. 20-40; Spiritus ^theris, fl. drs. 4 ; Misturae Guaiaci, ad fl. oz. 8. Mix. One-sixth part every six hours. As an ano- dyne, stimidant, and alterative in chronic rheumatism, neuralgia, etc.
R. Extracti Aconiti, gr. 1-3 ; Pilulae Hydrargyri Subchloridi Compositae, gr. 3. Make into a pill, and order it to be taken every night at bedtime. In sleeplessness from a syphilitic taint.
R. Extracti Aconiti, Extracti Opii, aa gr. 8; Extracti Hyoscyami, gr. 16. Mi'x, and divide into eight pills. One to be taken every four, six. or eight hours. In some acute inflavumcUions, — as peritonitis, pleurisy, ovaritis, etc.
331. Opium and Sugar of Milk.
R. Pulveris Ipecacuanhae Compositi, gr. 1 ; Sacchari Lactis, gr. 120. Mix, and divide into four powders. One to be taken every night, beaten up in a teaspoonful of cream. A safe opiate for infants from two to six weeks old.
R. Tincturae Opii, min. 1 ; Sacchari Lactis, oz. ^ ; Mucilaginis Traga- canthas. Aquae Anethi, aa fl..drs. 4. Mix. One teaspoonful twice or thrice in the twenty-four hours. To relieve the painful diseases of early life.
NARCOTICS AND SEDATIVES. 349
332. Tincture of Henbane.
R. Tinctnraj Hyoscyami, fl. oz. 1. One teaspoonful in a wineglaPsful of water every night at bedtime. The dose may be gradually increased until from one to three fluid ounces can be taken every night. In some forms of eptleps!/.
333. American Wild Cherry.
R. Tincturaj Pruni Virginiange, fi. drs. 3-6 ; Aquas, ad fl. oz. 8. Mix. One-eighth part every four or six or eight hours. The dose of the Infusion is one ounce, at the same intervals. As a sedative and tonic in cases of cardiac lueakness toith inefficient action ; in vcdvidar disease luith dda- tation ; mitral regurgitation ; chronic bronchitis with vcdvidar disease or dilated ventricles ; atonic dyspc'psia ; intestinal irritability, etc. The action is less powerful than that of digitalis ; but it is often better borne, and can be continued for a longer time. After a course of the American Wild Cherry, quinine and steel will often prove useful, though previously they may have been injurious.
334. Preparatio7is of Digitcdis.
R. Infusi Digitalis, fl. drs. 12 ; Aquae Anethi, ad fl. oz. 8. Mix. One- sixth part every two, three, or four hours. Recent experiments tend to prove that digitalis is a cardiac stimulant and tonic for a time. In feeble and irregular action of the heart this drug proves of greed value ; as it also does in dilatation and hypertrophy of the left side of the heart. Digitalis is very serviceable in cardiac dropsy, ivhen there is a feeble and frequent and irregular pulse, ivith a scanty secretion of high-colored urine ; inasmuch as it gives increased force to the heart's contractions, ivhile it has a diuretic action on the kidneys. Digitcdis had better be avoided in examples of fatty degeneration of the heart. In some cases of delirium tremens large doses have a very good effect.
R. Tincturte Digitalis, fl. drs. 1-2 ; Tincturse Cardamomi Composita;, fl. drs. 6; Acidi Hydrocyanici Diluti, min. 20; Aquae Camphorfe, ad fl. oz. 8. Mix. One-sixth part three times a day. In some forms of cardiac disease with irritability of the stomach.
B. Acidi Sulphuric! Aromatici, fl. drs. 2 ; Tincturse Digitalis, fl. drm. 1; Extracti Opii Liquidi, min. 30; Infusi Chiratae, ad fl. oz. 8. Mix. One- sixth part three times a day.
335. Hemlock and Henbane, etc.
R. Extracti Conii, Extracti Hyoscyami, Pilulae Ehei Compositae, aa gr. 3. Mix, and divide into two pills. To be taken at bedtime. To relieve sleeplessness with constipcdion. In some forms of asthma.
R. Extracti Conii, Extracti Hyoscyami, Pilulae Hydrargyri, aa gr. 3; Pulveris Ipecacuauhae, gr. 1. Mix, and divide into two pills. To be taken at bedtime.
336. Hemlock and Dover^s Powder.
R.' Extracti Conii, gr. 36 ; Pulveris Ipecacuanhas Compositi, gr. 24. Mix, and divide into twelve pills. One to be taken every three or four hours. To relieve the pain arising from malignant disease.
337. Henbane and Indian Hemp, etc.
R. Extracti Cannabis Indicas, gr. ^-1; Extracti Belladonnte, gr. |; Extracti Hyoscyami, gr. 4. Make into a pill. To be taken every twelve
350 APPENDIX OF FORMULiE.
or twenty-fonr hours. The efficacy of this pill can sometimes be increased by giving with it a draught containing some spirit of chloroform or spirit of ether.
338. Iodoform Pills and Suppositories.
R. lodoformi, gr. 2-6 ; Extracti Conii, gr. 4. Mix. Divide into two pills, and order them to be taken at bedtime. In painful diseases of the stomach. The Author has once or twice fonnd a full dose of iodoform relieve a •paroxysm of asthma.
B. lodoformi, gr. 3-8; Olei Theobromse, gr. 20. Mix, for a suppository. As a local ancesthetic in cancerous and other painful diseases of rectum. The anodyne action of Iodoform is uncertain.
339. Narcotic Enemata.
B. Liquoris Morphise Acetatis, min. 20-60; Tincturse Catechu, min. 40 ; Vini Ipecacuanhas, min. 30 ; Mucilaginis Amyli, fi. oz. 2. Mix. The bowel should be washed out with warm water before the administration of this enema. In diarrhoea, tenesmus, strangury, etc.
R. Extracti Opii Liquidi, min. 20-fl. drm. 1 ; Tincturte BelladonniE, min. 15-30 ; Mucilaginis Amyli, fl. oz. 2. Mix. In cancer of uterus, rectum, etc.
340. Opiate Suppositories.
R. Pulveris Opii, gr. 1-2 ; Saponis Duri, gr. 10. Mix, for a suppository. To allay pain or irritation about the pelvic viscera.
R. Extract! Opii, gr. 1-3; Extracti Belladonnse, gr. ^ ; Olei Theobromfe, gr. 20. Mix into a suppositoi-y. Especially useful in diseases of the bladder, uterus, and rectum.
341. Lettuce Opium.
R. Lactuc^arii, gr. 8-10. To be divided into two pills, to be taken at bedtime. A doubtfid narcotic. Has been chiefly used as an anodyne in phthisis, or where opium cannot be borne.
342. Indian Hemp, Aconite, and Ether.
R. TincturiE Cannabis Indicse, min. 20; SpiritCis Juniperi, min. 30; SpiritCis yEtheris, min. 45 ; 'J'inctur^ Aconiti, min. 10 ; Mucilaginis Acaciaj, .adfl. drs. 12. Mix, for a draught. To be taken at bedtime. In neuralgic dysmenorrhoea, etc.
343. Op>ium, or Morphia, and Henbane.
R. Extracti Opii, gr. 1-4, vel Morphite Hydrochloratis, gr. ^-1 ; Extracti Hyoscyami, gr. 5. Make into two pills, to be taken at bedtime. For the relief of severe pain, and to afford sleep in lingering diseases.
344. Opium and Belladonna.
R. Extracti Opii, gr. 1; Extracti Belladonnfe, gr. |; Extracti Conii, gr. 3. Make into a pill, to be taken every three or four hours. In intestinal obstruction. And in other cases lohere it is necessary to relieve severe pain ivithoid inducing constipation. The belladonna also increases con- siderably the hypnotic action of the opium.
345. Opium and Capsicum.
13c. Extracti Opii, gr. 1-2 ; Capsici Fructus, gr. 2 ; Extracti Hyoscyami, gr. 4. Make into two pills, to be taken every night at bedtime, /n those
REFRIGERANTS AND SALINES. 351
diseases %vhere opium is needed, hid tvhere it is not ivell borne, oiuing to its producing headache, sicJaiess, etc. The stimidcding effect of the cap- sicum will often ward off these unpleasant results.
346. Mofjikia and Squill Linctus.
^.. Syrnpi Scillas, Syrupi Rlioeados, aa fl. drs. 10; Aqnse Laiirocerasi, mill. 25 ; 'I'iiictui'fe Benzoini Composita3, fl. drs. 3 ; Liquoris Morphiie Hydro- chloratis, fl. drm. 1. Mix. and label,— '" A small teaspoont'ul to be taken frequently if the cough is troublesome."
347. Compound Linctus.
I^. SpiritQs Chloroformi. fl. drs. 3 ; Vini Tpecacuanhfe, fl. drs. 2 ; Liquoris Morphise Acetatis, fl. drm. 1; Acidi Hydrocyanici Diluti, min. 15; Tincturae Conii, fl. drs. 2; Syrupi Tolutani, ad fl. oz. 3. Mix, and label, — " One tea- spoonfnl every two or three hours, until the cough is relieved." See F. 246, 247.
XV. REFRIGERANTS AND SALINES.
348. Saline Draughts.
'Pf.. Sodse Bicarbonatis, gr. 20; Aquae Laurocerasi, min. 10; Syrupi Limonis, fl. drm. 1; Aquaj, ad fl. oz. 2. Mix. An eifervescing draught is to be made by the addition of a tablespoonful of lemon juice, or of eighteen grains of citric acid. To be taken every four or six hours. In fever vnth nausea.
I^. Spiritvis ^theris Nitrosi, fl. drs. 4 ; Liquoris Ammonise Acetatis, fl. drs. 12-18; Vini Colchici, fl. drm. 1; Aquas Oamphorae, ad fl. oz. 8. Mix. Two tablespoonfuls every four hours.
I^. Potassag Nitratis, gr. 40, vel Potassse Citratis, gr. 100 ; Vini Anti- monialis, fl. drm. 1; Liquoris Ammoniae Aceiatis, fl. drs. 14; AqujE Oam- phorae, ad fl. oz. 8. Mix. One-sixth part every four hours.
349. Saline with Excess of Ammonia.
T^. Liquoris Ammoniae Acetatis, fl. drs. 10 ; SpiritCis Ammonife Aromatici, fl. drs. 3 ; Syrupi Limonis, fl. drs. 6 ; Tincturas Aconiti, min. 30 ; Aquas, ad fl. oz. 8. Mix. One-sixth part every four hours. In the early stages of fever, tonsillitis, acide pneumonia, etc.
350. Dr. Stevens' Saline Mixture.
I^. Sodii Chloridi, gr. 20 ; Potassae Chloratis, gr. 7 ; Soflse Carbonatis, gr. 30. Aquae, fl. drs. 12. Mix. To be taken every half hour. In mcdig- nant cholera.
351. Colchicum and Magnesia.
'Sf.. Vini Oolchici, fl. drs. \h; Magnesias Oarbonatis, gr. 120; Spiritus Animouiie Aromatici, fl. drs. 3 ; Tincturse Hyoscyami, fl. drs. 4-6 ; Aquae Camphoras,, ad fl. oz. 8. Mix. One-sixth part night and morning. In slight cases of gout, etc.
352. Colchicum, and Chlorate of Potash.
I^. Vini Colchici, fl. drs. 2 ; Potassae Chloratis, gr. 120 ; Liquoris Ammo- nias Citratis, fl. drs. 20; Aquae Camphorae, ad fl. oz. 8. Mix. One-sixth part three times a day. In gout with heat and dryness of the skin.
352 APPENDIX OF FORMULA..
353. Borax and Nitric Ether.
^.. Boracis, gr. 80 ; SpiritQs J^theris Nitrosi, fl. drs. 3 ; Syrupi Papaveris, fl. drs. 6 ; Infusi Lini, ad fl. oz. 8. Mix. One-sixth part every six liours.
354. Ammonia, Chlorinated Soda, and Serpentary.
^.. Ammoniae Carbonatis, gr. 30 ; Liquoris Sodae Chloratae, fl. drm. 1 ; Infusi Serpentarise, fl. oz. 8. Mix. One-sixth part every six hours. As a diaphoretic and stimulant in the low stage of continued fever. See F. 368.
355. Bicarbonate of Potash Drink.
^. Potassse Bicarbonatis, oz. \-h\ Syrupi Linionis, fl. oz. I; Aquas, ad 0. 2. Mix, for the day's drink. Very useful in the uric acid diathesis, in acide rheumatism, etc. A drink called " Constitution ivater" owes its efficacy to the bicarbonate of potash it contains.
356. Cream of Tartar Drink.
IJ:. Potassse Tartratis Acidse, oz. 1 ; Olei Limonis, min. 15 ; Sacchari Albi, oz. 2; Aquse Bullientis, 0. 2. Mix. To be used when cold, as a common drink. In simple fever, with constipation and great thirst.
357. Hydrochloric Acid Drinks.
'Bf.. Acidi Hydrochloriei Diluti, fl. drs. 2-3; Mellis Depurati, oz. 1; Decocti Hordei, O. 2. Mix, for the daily drink. In typhus, etc.
^.. Acidi Hydrochloriei Diluti, fl. drs. 2 ; Potassae Ohloratis, gr. 180 ; Syrupi Zingiberis, fl. oz. 1; Decocti Hordei, 0. 2. Mix. A valuable drink in some cases of fever.
358. Saline Lemonade.
^. Sodii Chloridi, gr. 200 ; Potassse Ohloratis, gr. 240 ; Sodae Tartaratae, gr. 100 ; Soda3 Fhosphatis, gr. 50 ; Succi Limonis I'ecentis, fl. oz. 6 ; Syrupi Limonis, fl. oz. 14; Aquae, 0. 7. Mix. To be taken ad libitum, iced or not as is most agreeable, i7i cholera and choleraic diarrhoea.
359. Phosphoric Acid Drink.
'Bf.. Acidi Phosphorici Diluti, fl. drs. 3 ; Glycerini, fl. oz. 1 ; Decocti Hordei, O. 2. Mix.. An efficacious drink for assuaging thirst in some diseases attended luith nervous exhaustion. It was recommended by Dr. Paris and Sir Thomas Watson as useful in diabetes ; but according to Griesingkr it positively increases the quantity of sugar excreted.
360. Chlorate of Potash Drinks.
^.. Potassae Ohloratis, gr. 60; Syrupi Hemidesmi, fl. oz. 1; Aquae, 0. 1. Mix. In the eruptive fevers, some infiammatio7is, etc.
I^. Potassife Ohloratis, oz. 1 ; Potassae Bicarbonatis, oz. 2-4. Mix, and divide into eight powders. One to be dissolved in a pint of barley water for the day's drink. In acute rheumatism.
STIMULANTS. 353
XVI. STIMULANTS.
3C)1. Ammonia and Bitters.
I^. Ammonias Carbonatis, gr. 30 ; Spiritfls Mj-risticse, fl. drs. 2 ; Tinctiirse Chlorofonni Compositte. fi. drm. 1; 'J'incturaj Cardamomi Conipositse, fl. drs. 6; Inf'usi Caryophylli, ad fl. oz. 8. Mix. One-sixth part every four or six hours. In debility vntli nausea and flatulence. Also in- erysipelas, ton- sillitis, scarlet fever, etc.
^. Spiritfls Ammonias Aromatici, fl. drs. 3 ; Tincturos Lnpuli, fl. drs. 6 ; SpiritCls JEtheris. fl. drs. 3; 'I'incturae Gentiante Compositas, fl. oz. 1 ; Infusi Sennse, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily. In plios- phuria toiih constipation.
^^. Spiritfls Ammonias Aromatici, fl. drs. 3 ; Aqnas Laurocerasi, fl. drm. 1 ; Sodis Bicarbonatis, gr. 60 ; Tincturje Calumbje, fl. drs. 6 ; Aquae Anethi, ad fl. oz. 8. Mix. One-sixth part two or three times a day. To relieve nausea, or vomiting, tv?th heartburn.
^.. TinctursB Valerianae Ammoniatse, fl. drs. 3; Tincturse Rhei, fl. drs. 6; Tincturai Lavandulae Compositte, fl. oz. 1 ; Aqnaj Pinientas, fl. oz. 8. Mix. One-sixth part when oppressed with languor or faintness. In hypochondri- asis and hysteria.
362. Ammonia in Effervescence.
I^. Ammonias Carbonatis, gr. 120 ; Acidi Hydrocyanici Diluti. min. 20 ; Tincturse Cardamomi Compositse, fl. drs. 6 ; Infusi Aurantii, ad fl. oz. 8. Mix. One-sixth part to be made into an effervescing draught with one tablespoonful of fresh lemon juice, or with eighteen grains of citric acid. To be taken twice or thrice daily. In irritability of the stomach, ivith depression.
'^.. Spiritfls Ammoniae Aromatici, fl. drs. 4 ; Potassae Bicarbonatis. gr. 320 ; Spiritfls Chloroformi, fl. drs. 2 ; Tincturse Hyoscyami, fl. drs. 3; Infusi Cascarillse, ad fl. oz. 8. Mix. One-sixth part every four hours, made into an effervescing draught with one tablespoonful of lemon juice. In irritable stomach ivith undue acidity of the secretions.
363. Formiate of Ammonia.
I^. Ammoniae Formiatis, gr. 30 ; Aquae, fl. oz. 8. Mix. One-sixth part three times a day. Recommended by Dr. Ramskill tn chronic paralytic disease, accompanied by genercd torpor. Also in reflex paralysis, and in some forms of epilepsy. It is contra-indicated luhere there is active disease in the iiervous centres, and tn cases luhere the stomach is irritable.
364. Phosphate of Ammonia and Ether.
I^. Ammoniae Phosphatis, gr. 60-100; Spiritfls JEtheris, fl. drs. 3; Infusi Caryophylli, ad fl. oz. 8. Mix. One-sixth part three limes a day. In de- bility with a tendency to gout or rheumatism. Also in hypochondriasis.
365. Hydrochloric Acid and Ether.
Vf.. Acidi Hydrochlorici Diluti, fl. drm. 1; Spiritfls JEtheris, fl. drs. 3; Syrupi Aurantii, fl. drs. 6 ; Infusi Aurantii, ad fl. oz. 8. Mix. Oue-sixth part every six hours. In continued fever, and in cases tvhere the expired air is ammoniacal. 23
354 APPENDIX OF FORMULA.
366. Cajvput Oil and Cloves.
R. Olei Cajnputi, min. 5; Pnlveris Tragacanthse Compositi, gr. 60; AquEC Destillatse, fl. drs. 2. Beat thoroughly together, and add — lufusi Oaryophylli, fl. drs. 10. Mix. To be taken occasionally. In hysteria, flatulent colic, and many spasmodic diseases.
R. Olei Cajupiiti, min. 4; Sacchari Lactis, gr. 120. Beat up thoroughly, and add — Decocti Aloes Compositi, fl. oz. H. Mix. To be taken occa- sionally, early in the morning. As a stimidant and laxative ivliere there is a tendency to flatulence and a loaded rectum.
367. Ether and Brandy.
R. SpiritQs ^theris, fl. drs. 3; Spiritus Yini Gallici, fl. drs. 12; Infusi Cinchonse Flavas, ad fl. oz. 8. Mix. One-sixth part every four or six hours. At the commencement of convcdescence from many acitte diseases.
R. Spiritus Chlorofornii, fl. drs. 6 ; Misturse Spiritfis Vini Gallici (F. 17), fl. oz. 8. One-sixth part every six hours. In the stages of low fever ivith restlessness..
368. Solution of Chlorinated Soda.
R. Liquoris Sodse Chloratse, fl. drs. 1-2; Syrupi Tolutani, fl. oz. 1; TinctursB SerpentariiB, fl. drs. 6 ; Aquae, ad fl. oz. 8. Mix. One-sixth part every six hours. In low fever this mixture tvill clean the tongue, promote the action of the skin and kidneys, correct the offensive state of the evacua- tions, and rouse the patient. See F. 354.
R. Liquoris Sodfe Chloratse, fl. drm. 1 ; Tincturse Cinchonas Compositse, fl. drs. 6 ; Spiritfis Vini Gallici, fl. drs. 12 ; Tincturte Cantharidis, min. 40 ; Aqua3, fl. oz. 8. Mix. One-sixth part every three or four hours. In low fever, with great prostration.
369. Sumbul, Quinine, Hop, etc.
R. Tincture Sunibulis, fl. drs. 1-3; Infusi Lupuli, ad fl. oz. 8. Mix. One-sixth part three times a day. In some cases of hysteria, epilepsy, threatened delirium tremens, etc., tvhere a stimidant and antispasmodic IS needed. See F. 95.
R. 'J'inctursB Quinise, Tincturse Rhei, Tincturse Lupuli, aa fl. drs. 4. Mix. One teaspoonful in a wineglassful of water twice a day. In dyspepsia from weakness of the digestive organs, and constipation. See F. 385.
370. Preparations of Oxygen.
Bartii's Patent Oxygen Water is sold in bottles which contain nearly half an imperial pint of distilled water, with about 13.5 cubic inches, or 4.6 grains, of gaseous oxygen. The contents of two, three, or four bottles may be taken daily. Said to promote digestion, to render the secretions and excretions healthly, to improve the condition of the blood, and possi- bly to control the nervous force.
Peroxide of Hydrogen may be 'regarded as water supersaturated with oxygen. A solution charged with ten volumes of oxygen is usually era- ployed ; the dose varying from fluid drachms 1-4, in two ounces of water, two or three times a day. Said to be useful in diseases attended with dysp7ioea, — as chronic bronchitis, pulmonary condensation, valvular cardiac disease luith congestion of the lungs, some forms of asthma, laryngitis, hooping cough, etc. Also in dyspepsia, congestion of the liver, possibly in diphtheria and croup, as luell as in strumous and other
TONICS. 355
ulcerations. It appears likewise to favor the action of steel and cod-liver oil ; which remedies, hoxvever, should not he given at the same hour that the peroxide is administered.
Oxygen Gas can be best inhaled by using a large vulcanite bag filled with oxygen and air — 1 to 4. This mixture is to be inhaled for half an hour once or twice a day ; slowly inspiring it at short intervals, and filling the lungs as much as possible.
Messrs. Robbins & Co. have prepared a powder which they call the " Patent Oxygenator." On placing a wineglassful of this material in the vase of Dr. Beigel's Universal Inhaler, and pouring over it half a pint of boiling water, pure oxygen will be evolved. Inhalation may be practised once or twice a day, for ten or fifteen minutes at a time.
XVII. TONICS.
371. Barh and Ammonia.
R. AmmoniEe Carbouatis, gr. 30 ; Tincturse Lavandulae Composifje, fl. oz. 1 ; Infusi Cinchona Flavte, ad fl. oz. 8. JVIix. One-sixth part every six hours.
R. Ammonise Phosphatis, gr. 60 ; Tincturai Aconiti, min. 40 ; Tincturse Ciuchonae Compositse, fl. drs. 6 ; Aquae JMenthae Piperitse, ad fl. oz. 8. Mix. One-sixth part three times a day.
R. Ammonife Carbonatis, gr. 30: Extracti Opii Liquidi, min. 30; Spiritfis ^theris, fl. drs. 3; Decocti Cinchonse Flavas, ad fl. oz. 8. Mix. One-sixth part every three or four hours'. In cases ivhere it is feared that a deposition of fibrin has taken place in the heart or one of the large vessels.
R. Spiritfis Ammonise Aromatici, Spirit&s Chloroformi, aa fl. drs. 7 ; Liquoris Morphise Hydrochloratis, fl. drs. 2 ; Extracti CinchonjE Flavfe Liquidi, fl. drs. 4; Tincture Cinchonse Flavse, ad fl. oz. 3. Mix. Direct, — '• One teaspoonful in a wineglassful of Port wine three times a day." In certain cases of phthisis this mixture is very useful, especicdly in con- junction tvith cod-liver oil and a liberal diet.
372. Ammonia, Barh, and Rhubarb.
R. Spiritus Ammonise Aromatici, fl. drs. 4 ; Extracti Cinchonse Flavse Liquidi, fl. drs. 1^ ; Tincturse Rhei, fl. drs. 4 : Infusi Ehei, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily. In nervous depression, etc., tvith constipation.
373. Bark and Liquor Potassce.
R. Liquoris Potassse, fl. drs. 3 ; Tincturse Cinchona3 Compositse, fl. drs. 6 ; Decocti Cinchonse Flavse, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily. In debility attended loith the lithic acid diathesis.
374. Bark and Serpentary.
R. Tincturse Cinchonse Compositse, fl. oz. 1; 'I'incturse Aconiti, min. 30 ; Tincturse Serpentarise, vel Tincturse Acteas Racemosse, fl. drs. 3 ; Aquse Mentha Piperitas, ad fl. oz. 8. Mix. One-sixth part three times a day. In some cccses of chronic rheumatism, lumbago, and rheumatoid arthritis.
356 APPENDIX OF FORMULA.
375. Bark and Hemlock.
R. Tincturse Cinchonae Compositae, fl. drs. 6 ; Succi Conii, fl. drs. 4 ; Aquae Pimentae, ad fl. oz. 8. Mix. One-sixth part three times a day. In.^ chronic diseases attended toith debility a7id pctin.
376. Acid Mixtures and Bark.
R. Acidi Sulphuric! Aromatici, fl. drs. 2 ; Syrupi Aurantii, fl. oz. 1 ; Tinctnrae Cinchonas Compositag, fl. drs. 6 ; Infusi Cinchonae Flavae, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily, on an empty stomach. Ei^pecicdly uneful in depressing disorders accompanied ivith occasioned attacks of hemorrhage.
R. Acidi Phosphorici Diluti, fl. drs. 1^; Syrupi Aurantii, fl. drs. 6 ; Tincturae Cinchonae Compositae, fl. oz. 1 ; Infusi Aurantii, ad fl. oz. 8. Mix. One-sixth part three times a day. In debility, loith nervous irri- tability.
R. Acidi Nitrici Diluti, vel Acidi Phosphorici Diluti, fl. drs. I5-; Tincturse Nucis Vomica;, fl. drm. 1 ; Extracti Cinchona; Flavae Liquidi, fl. drs. 2; AquEe Mentha Piperitae, ad fl. oz. 8. Mix. One-sixth part three times a day, two hours before each meal. In genercd weakness, ivith nervous exhaustion.
R. Acidi Acetici Glacialis, min. 20-35 ; Tincturae Belladonnse, Extracti Cinchonae Flavae Liquidi, aa drs. 4 ; Tincturae Cardamomi Compositae, fl. oz. 2. Mix and label, — " One small teaspoonl'ul in a wineglassful of water two or three times a day." After opierations on cancerous groivths, to prevent recurrence ; effect doubtful.
Use Ext. Sarsae Liq. as vehicles for tonics when there is any fear of old syphilitic taint.
377. Acid Mixtures with Calumba, etc.
R. Tincturae Calumbae, fl. drs 6; Acidi Sulphurici Aromatici, fl. drs. 1^ ; Syrupi Aurantii, fl. oz. 1 ; Infusi Aurantii, ad fl. oz. 8. Mix. One- sixth part three times a day, when the stomach is empty.
R. Acidi Hydrochlorici Diluti, fl. drs. 1| ; Acidi Hydrocyanici Diluti, min. 20 ; Infusi Chiratae, ad fl. oz. 8. Mix. One-sixth part three times a day, immediately before the meals. As a stomachic, especicdly in the dyspepsia of goiUy subjects.
R. Succi Linionis Recentis, fl. drs. 12 ; Syrupi Limonis, fl. oz. 1 ; Infusi Chiratae, ad fl. oz. 8. Mix. One-sixth part three times a day. Where there is debility ivith a threatening of rheumatic fever. In cancer of the stomach, etc.
Glycerine mixed with tonics, especially preparations of steel, increases their efficacy and obviates their constipating effects.
378. Nitro- Hydrochloric Acid Mixtures,.
R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. li-3; Tincturse Chiratae, fl. drs. 3; Tincturae Aconiti, min. 30; Syrupi Aurantii, fl. oz. 1; Jni'usi Aurantii, ad fl. oz. 8. Mix. One-sixth part three times a day, an hour before each meal. In oxaluria, dyspepsia, rheumatoid arthritis, etc.
R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. 2 ; Acidi Hydrocyanici Di- luti, min. 25 ; Succi Taraxaci, fl. drs. 6 ; Tincturae Gentianae Compositae, fl. oz. 1 ; Infusi Sennae, ad fl. oz. 8. Mix. One-sixth part twice or thrice daily. Jn dyspepsia, tvith sluggish action of the liver. The efScacy of this
TONICS. 357
mixture may often be increased by givins^ with each dose a pill containing one or two grains of sulphate of zinc and four of extract of gentian.
R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. 2 ; Liquoris Strychnia, min. 30-fi. drni. 1; SpirilCis Chloroformi, fi. drs. 6; Tincturte Zingiberis, fl. drs. 3; Aquaj, ad tl. oz. 8. Mix. One-eighth part, with a large tablespoonful of water, three times a day. In any form of fandional 'paralyaifi after all the appreciable causes are remedied. Also in ohsfinate debility, Jiypo- chondriasts, atonic, dyspepsia, diabetes insipidus, alkaline urine, etc.
R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. 1^; Tincturse Belladonnae, fl. drm. I ; Extracti Pareiras Liquidi, fl. drm. 1 ; L)ecocti PareirsE, ad fl. oz. 8. Mix. One-sixth part, with one of the following pills, every six hours : —
R. Acidi Benzoici, gr. 30; Glycerini, sufficient to make a mass. Divide into six pills, and silver them. In incontinence of urine, lohen the reaction is alkaline. Also in some forms of hepatic congestion.
379. Quinine Mixttires and Pills.
R. Quiuise Sulphatis, gr. 12 ; Acidi Nitrici Diluti, vel Acidi Phosphorici Diluti, vel Acidi Hydrochlorici Diluti, vel Acidi Sulphurici Aromatici, fl. drs. \k; Tincturae Lupuli, fl. drs. 6; Aquas, ad fl. oz. 8. Mix. Ooe-sixth part three times a day. Amongst other purposes, this mixture may be used to check the night sweats in phthisis.
R. Tincturae Quiniae, fl. drs. 14; Tincturae Zingiberis Fortioris, fl. drs. 2 ; Glycerini, fl. oz. 1. Mix. One teaspoonful in a wineglassful of water three times a day. In neuralgia, nervous irritability, weakness, etc.
R. Quinite Sulphatis, gr. 18; Extracti Lupuli, gr. 40. Make a mass, divide into twelve pills, and order one to be taken three times a day.
R. Quinise Sulphatis, gr. 4 ; Acidi Phosphorici Diluti, min. 20; Syrupi Aurantii, fl. drs. 4 ; Aquae, ad fl. oz. 4. Mix. One small tablespooful three times a day. In strumous ophthalmia and other cases of debility in children.
R. Quinise Sulphatis, gr. 64; Acidi Sulphurici Diluti, min. 10; Aquae, fi. drs. 4. Mix. From fifteen minims to half a drachm (gr. 4-8) may be carefully injected, into the subcutaneous connective tissue. Only a clear solution is to be used. Absorption of quinine merely suspended in fluid, is at least uncertain ; the alkaloid must be in solution. The injection may have to be repeated three, four, or more times before a cure is effected. In intermittent fever, etc.
The above for subcutaneous injection does not answer : the quinine will not dissolve. This is better — Quiniae Sulphatis Neutralis, gr. 30 ; Acidi Sulphurici Aromatici, min. 5 ; Aquas, fl. drs. 2. Mix.
380. Quinine and Steel.
R. Quinise Sulphatis, Ferri Sulphatis, aa gr. 12; Liquoris Strychnias, min. 30; Acidi Sulphurici Aromatici, fl. drs. 1^; Infusi Quassise, ad fl. oz. 8. Mix. One-sixth part three times a day. The black stools which are passed while any preparation of steel is being taken, are due to the com- bination of the metal loith part of the sulphur of the food^'orming sul- phuret of iron.
R. Quiniai Sulphatis, gr. 9 ; Acidi Hydrochlorici Diluti, fl. drm. 1 ; Tinc- turae Arnicae, min. 30-fl. drm. 1 ; Tincturse Ferri Perchloridi, fl. drs. H; Infusi Caryophylli, ad fl. oz. 8. Mix. One-sixth part three times a day. In general debility, diphtheria, erysipelas, etc.
358 APPENDIX OF FORMULA.
R. Qninise Sulphatis, gr. 12; Tiiictnrse Ferri Perchloridi, fl. drs. 2; Tincturse Nucis Vomicae, fl. drm. 1 ; Tincturse Lupuli, fl. drs. 6 ; Magnesise Sulphatis, oz. 1 ; Infusi Lupuli, ad fl. oz. 8. Mix. One-sixth part daily, three hours after breakfast. In habitual constipation tvith debility.
R. Quiniae Sulphatis, Ferri Sulphatis Exsiccatse, aa gr. 20; Extracti Hyoscyami, gr. 30. Make a mass, divide into twelve pills, and order one to be taken twice a day. In debility tvitli irritability of the nervous system.
R. Quinise Sulphatis. gr. 12 ; Ferri Redact!, gr. 30 ; Extracti Aconiti, gr. 12 ; Glycerini, sufficient to form a mass. Divide into twelve pills, and order one to be taken an hour after dinner and supper. In neuralgia, rheumatoid arthritis, painfid chronic affections with debility, etc.
R. Ferri et Quinise Citratis, gr. 30 ; Tincturse Chiratse, fl. drs. 1^ ; Aquae, ad fl. oz. 8. Mix. One-sixth part three times a day. An excellent tonic where there is exhaustion, ivith a weak and irritable storaach. If the strong bitter is objectionable, Tincture of Lemon Peel may be substituted for the Chirata.
381. Quinine, Steel, and Arsenic.
R. Tincturae Quiniae. fl. oz. 1 ; Liquoris Arsenicalis, min. 18; Ferri et AmmoniaB Citratis, gr. 30; Aquae Aurantii, ad fl. oz. 8. Mix. One-sixth part two or three times a day, after meals. In diseases of the skin, etc., with impoverished blood.
R. Quiniae Sulphatis, gr. 9; Acidi Phosphorici Diluti, Tincturae Ferri Perchloridi, aa fl. drs. 1^ ; Liquoris Arsenici Hydrochlorici, min. 1.5-40; Syrupi Zingiberis, fl. drs. 6 ; Aquae Cinnamomi, vel Infusi Quassias, ad fl. oz. 8. Mix. One-sixth part directly after breakfast, dinner, and supper. In many skin diseases, rheumatoid arthritis, carbuncidar inflammation, etc. See F. 52, 399.
382. Quinine and Iodide of Iron.
R. Tincturae Quiniae, fl. oz. 1; Syrupi Ferri lodidi, fl. drs. 3-6; Infusi Calumbae. ad fl. oz. 8. Mix. One-sixth part three times a day. In debility with a strumous taint, chronic rheumatism, tertiary syphilis, goitre, etc.
383. Quinine and Belladonna.
R. Quiniae Sulphatis, gr. 24; Extracti Belladonnae, gr. 4 ; CamphoriB, gr. 30; Confectionis Rosae Gallicje. sufficient to make a mass. Divide into twelve pills, silver them ; and order one to be taken twice or thrice daily, in conjunction with one teaspoouful of good vinegar mixed with a wine- glassful of sugared water. In some painful diseases [neuralgia, cancer, dysmenorrhoea, etc.), where a sedative and tonic are needed. See P. 44.
384. Quinine and Ipecacuanha.
R. Quinise Sulphatis, gr. 12 ; Pulveris Ipecacuanhae, gr. 12-24 ; Extracti Gentianas, gr. 24. Mix. Divide into twelve pills, and order one to be taken every day at dinner. An excellent remedy in cases of slow diges- tion. See F. 44.
385. Quinine and Rhuharh.
R. Quiniae Sulphatis, gr. 24; Pulveris Rhei, gr. 36; Extracti Lupuli, gr. 40. Mix. Divide into twenty-four pills, and order two to be taken night and morning.
TONICS. 359
38G. Quinine and Ammoma.
R. Tinctui\'B Quiniaj, fl. oz. 1 ; Glycerini, fl. drs. 6; SpiritCis Ammonife Aromatici, Spiritfis yEtberis, aa fl. dr.s. 3; Extract! Opii Liquidi, min. 30 ; luf'nsi Anrantii, vel Iiifusi Cinchonaj Flavte, ad fl. oz. 8. Mix. One-sixth part every six hours. In great exhaustio7i, ivitli loiv muttering delirium and restlessness.
387. Quinine and Nux Vomica.
R. QuinijE Sulphatis, gr. 18 ; Extracti Nucis Vomicae, gr. 3-6; Extract! Geiitiana;, gr. 3.5. Mix, and divide into twelve pills. One to be taken night and morning. In debility ivith constipation. See F. 175, 409.
388. Substitutes for Quinine.
R. Beberias Sulphatis, gr. 30; Acidi Sulphurici Aromatici. min. 40; Syrupi Aurantii, fl. oz. 1 ; Aquge Aurantii Floris, ad fl. oz. 8. Mix. One-sixth part three times a day. In neuralgic affections assuming a periodic character ; as loell as in intermittent and remittent fevers. Beheria does not produce cerebral disturbance and headache like quinine. This sulphate of an alhaloid is said to he an ingredient of Warburg's Fever Drops.
R. Salicini, gr. 60; Extracti Sarsa3 Liquidi, fl. drs. 6; Infusi Gentianas Compositi, ad fl. oz. 8. Mix. One-sixth part three times a day. During convalescence from acute disorders of the digestive organs. The anti- periodic properties of salicin render it useful in intermittents and some other fevers.
R. Salicini, gr. 120; Glycerini, fl. oz. 1; Tincturas Aurantii, ad fl. oz. 3. Mix. One teaspoonful in a wineglassful of water night and morning. Where the stomach is easily nauseated ayid cannot digest quinine, this formula will he useful.
389. Cod-Liver Oil
The oil most commonly used is of a pale straw color, the dose varying from a teaspoonful to a large tablespoonful twice or thrice daily. It should be taken immediately after meals ; floating it on milk, coffee, beef-tea, orange juice, orange wine, brandy and water, cherry brandy, etc. Chewing a piece of lemon peel or cinnamon, or a few cloves previously, will disguise the flavor. Sometimes it is preferred made into an emulsion ; which may be done by beating it up with an equal proportion of lime-water, or of milk, or with the yolk of an agg and some compound tincture of cardamoms. When the oil proves indigestible, giving rise to nausea or unpleasant eructations, the stomach can often be made to tolerate it by administering some pi^epa- ration of pepsine (F. 420) with each dose. Dr. De Jongh's oil is pure, and is prescribed by many practitioners.
Cod-liver oil may be impregnated with various drugs, — such as any of the essential oils, morphia, arsenic, iodine, mercury, quinine, zinc, iron, etc. Too large a quantity of the solution must not be made at a time, as the oil soon becomes rancid. Combined with ozone [an allotropic modification of oxygen — ax?i,oj = another + fportoj := manner of existence], it has been found to lessen considerably the frequency of the pulse in phthisis. The dose of ozonized oil, according to Dr. E. Symes Thompson, is from two to four drachms, two or three times a day. See F. 22, 32, 283, 390, and 418.
360 APPENDIX OF FORMULA.
390. Iodide of Iron and Cod- Liver Oil.
R. Syrupi Ferri lodidi, fl. drs. 4; Mucilag'inis Tragacantliae, fl. oz. 1 ; Olei Morrhnte. fl. oz. 4;^. Mix. One tablespoon ful twice or tlirice daily. In some forms of scrofula, phthisis, viild constitutional syphilis, etc.
R. Potassii lodidi, gr. 3-5; Glycerini, fl. drs. 2 ; Vini Ferri, fl. dr.s. 4; Olei Morrhuffi, fl. drs. 6. Mix, and make a draught to be taken twice a day. In chronic rheumatism, tertiary syphilis, strumous skin diseases, etc.
391. Steel and Cocoa-nut Oil.
R. Olei Oocos Nucis, fl. drs. 2; SpiritQs Ammonife Aromatic!, min. 30 ; Ferri et Aramonise Citratis, gr. 5 ; Aquaj MentlifB Piperitse, ad fl. oz. 1. Mix, and make a draught to be taken twice or thrice daily. Deserving of trial lohen cod-liver oil causes nausea.
392. Steel and Glycerine.
R. Tincturse Ferri Perchloridi. fl. drs. lg~2 ; Zinci Phosphatis, gr. 6; SpiritQs Chloroformi, fl. drs. 3 ; Glycerini, fl. oz. 1 ; Aquae, ad fl. oz. 8. Mix. One-sixth part three times a day. In some cases it is better to omit the glycerine frovi this mixture; administering cod-liver oil instead, after one or ttvo of the chief meals of the day.
R. Tincturae Ferri Perchloridi, fl. drs. 2-4 ; Glycerini, fl. drs. 4 ; Tincturee Cardamomi Compositas, fl. oz. 1 ; Aquae, ad fl. oz 8. Mix. One-eighth part every three or four hours. In diphtheria, erysipelas with albuminu- ria, etc.
R. Spiritds Ammonise Aromatici, fl. drs. 4; Ferri et Ammonise Citratis, gr. 40 ; Infusi Quassiae, fl. oz. &h; Glycerini, fl. oz. 1. Mix. One-sixth part three times a day. In general debility, loith a torpid state of the colon.
393. Steel and Digitalis.
R. Tincturae Ferri Perchloridi, min. 80; Infusi Digitalis, fl. oz. 2; Aquas Camphorae, ad fl. oz. 8. Mix and label, — " One-eighth part, with one table- spoonful of water, three times a day." In some forms of cardiac and renal dropsy, etc.
394. Steel and Pep sine.
R. Ferri Redacti, gr. 12-60; Pepsinae Porci. gr. 36; Zinci Phosphatis, gr. 18 ; Glycerini, sufficient to make a mass. Divide into twenty-four pills, silver them, and order two of them to be taken every day at dinner. In ancemia, etc., tvith weakness of the digestive organs.
R. Ferri et Ammonise Citratis, gr. 20; SpiritOs Vini Gallici, fl. oz. 1 : Yini Pepsinas. fl. drs. 4 ; Aquje. ad fl. oz. 6. Mix. One-half to be taken every day at dinner. See F. 420.
395. Steel and HemlocJc.
R. Pilulse Ferri Carbonatis, gr. 60 ; Extractii Conii, gr. 36-60. Mix, and divide into twenty-four pills. ^J'wo to be taken twice or thrice daily. In incipient phthisis, and in many diseases attended with cough and debility.
396. Steel Electuaries.
R. Ferri Peroxidi Hydrati, Mellis Depurati, aa oz. 2. Mix. One tea- spoonful twice a day. In chorea, etc.
TONICS. 361
R. Ferri Carbonatis Saccharaltu, gr. 120-240; Mollis, fl. oz. 3. Mix. One teaspoonful twice oi" thrice daily after meals. "Where there is no objec- lion to pills it will be better to prescribe from 5-10 grs. of the officinal PiLULA Ferki Carbonatis twice a day.
397. Steel and Hydrochloric Acid.
R. Tinctiirfe Ferri Perchloridi, fi. drs. 1^ ; Acidi Hj'droclilorici Dilnti, fl. drs. 2 ; SpiritCis Chloroformi, fl. drs. 3 ; Iiifusi Quassise, ad fl. oz. 8. Mix. One-sixth part three times a day. See F. 101.
398. Steel and Gentian.
R. Ferri Sulphatis Granulatte, Extracti Gentianse, aa gr. 30. Mix, di- vide into twelve pills, and order one to be taken three times a day. In chlorosis, etc.
399. Steel and Arsenic.
R. Vini Ferri, fl. oz. 4; Liquoris Arsenicalis, min. 20 ; Syrupi Zingiberis, fl. oz. 2. Mix. One-sixth part, with three tablespoonfiils of water, three times a day, immediately after meals. For cases of purpura. In redaced doses as a tonic and alterative in some of the skin diseases of children. See F. 52, 381, 402.
R. Syrupi Ferri Phosphatis, fl. oz. 2 ; Liqnoris SodfB Arseniatis. min. 30. Mix. One teaspoonful in a wineglassful of water directly after dinner and supper. In some forms of spleen disease, etc.
400. Steel and Gantharides.
R. TincturiE Cantharidis, fl. drs. \^; Glycerini, fl. oz. 1 ; Misturfe Ferr Compositae. ad M. oz. 8. Mix. One-sixth part three times a day. In de hiiity of the generative organs, some forms of incontinence of urine, etc
R. Tincturse Cantharidis, Tincture Ferri Perchloridi, aa fl. drm. 1 Tinctni-as Capsici, fl. drs. 1^; Syrupi Hemidesmi, fl. oz. 1 ; Aquae, ad fl. oz 8. Mix. One-sixth part three times a day.
401. Steel and Ammonia..
R. Ferri Tartarati, gr. 60; Spiritfls Ammonipe Aromatici, fl. drs. 3; Infusi Quassiae. ad fl. oz. 8. Mix. One-sixth part three times a day. In chlorosis, leuco7'rhoea from relaxation of vagincd mucous membrane, etc.
R. Ferri et Ammonise Citratis, gr. 40; Ammonise Carbonatis, gr. 30; Tincturse Zingiberis, fl. drs. 3 ; Aquae, ad fl. oz. 8. Mix. One-sixth part three times a day.
402. Steel and Chlorate of Potash.
R. Tincturae Ferri Perchloridi, fl. drs. \^] Potassae Chloratis, gr. 120; Liquoris Arsenicalis, min. 1.5 ; Aquae, ad fl. oz. 8. Mix. One-sixth part three or four times a day, in a wineglassful of water. In certain skin dis- eases, onychia, etc. Also in ancernia dependeiit on a syphilitic taint, in erysipelas about the fauces, and in tonsillitis, etc., omitting the solution of arsenic from the mixture.
403. Steel and Gitrate of Potash.
R. Ferri et Ammoniae Citratis, gr. 60 ; Spiritfis Ammonise Aromatici, fl. drs. 4; Potassae Bicarbonatis, gr. 120; Infusi Calumbae, ad fl. oz. 8. Mix, One-sixth part to be taken twice a day with one tablespoonful of lemon juice. As a tonic diLring convalescence from many acute diseases, espe- cially ivhere there is a tendency to nausea and dyspepsia.
362 APPENDIX OF FORMULAE.
404. Steel and Aloes.
R. Ferri Carbonatis Saccliaratse, (jr. 40; Infusi Antheniidis, fl oz. 8. Mix. One-sixth part twice a day. The followiiio- draught is also to be taken every other morning before breakfast : — R. Sodse Phosphatis, gr. 120 ; Extracti Rhei, gr. 10 ; Decocti Aloes Compositi, fl. drs. 4 ; Aquse Carui. fl. oz. 1. Mix. tisefulfor atonic gouty subject^!.
R. Ferri Eedactl, gr. 30; Pilulse Aloes et Myrrhas, gr. 24-40 ; Extracti Nucis Vomicae, gr. 4. Make a mass, divide into twelve pills, and order one to be taken three times a day. In anemia with constipation.
R. Misturae Ferri Compositse, Decocti Aloes Compositi, aa fl. oz. 4; Zinci Snlphatis, gr. 12. Mix. One-sixth part twice a day. In anoemia, hypochondriasis, general debility luith constipation, etc.
405. Phosphate of Iron.
R. Ferri Phosphatis, gr. 40; Acidi Phosphoric! Diluti, fl. drs. 1^ ; Syrnpi Aurantii Floris. fl. oz. 1; Mucilaginis Tragacanthge, ad fl. oz. 8. Mix. One-sixth part three times a day. In scrofula, cancer, loxu nervous vigor, etc.
R. Ferri Phosphatis, gr. 20; Pulveris Myrrhse, gr. 15; Sacchari Albi, gr. 30. Mix, and divide into six powders. One to be taken night and morning. In rickets, and all the strumous diseases of children.
A syrup of the phosphates of Iron,* Lime, Soda, and Potassa has been prepared by Mr. Parrish, of Philadelphia. It may be obtained from most London chemists; being known as " Chemical Food." The dose for a child ten years of age, is one teaspoonful in water after the two principal meals of the day. 'I'his measure contains one grain of phosphate of iron ; two and a half grains of phosphate of lime; and smaller portions of the alka- line phosphates. Chemical Food is a preparation of great value in all forms of strumous diseases, and general debility.
406. Steel and Manganese.
R. Ferri Phosphatis, gr. 120; Manganesii Phosphatis, gr. 90; Tincturae Calumbae, fl. oz. 1; Syrnpi Zingiberis, fl. oz. 2. Mix. One teaspoonful in a wineglassful of water three times a day. In chlorosis, scrofula, etc.
407. Acetate of Strychnia.
R. Strychnias Acetatis, gr. 1 ; Acidi Acetic!, min. 20 ; Alcoholis. fl. drs. 2; Aquae l»estillatae. fl. drs. 6. Mix. Ten drops (= to gr. -^^) to be taken in water three times a day. Recommended by Dr. Marshall Hall as a tonic in cases of nervous exhaustion.
R. Strj'chniae, gr. 1 ; Pulveris Zingiberis, gr. 40 ; Extract! Gentianae, gr. 60. Mix very thoroughly, divide into twenty pills, and order one to be taken night and morning. In partial p)aralysis, amaurosis, etc.,tuhen the acute symptoms have subsided.
408. Strychnia and Steel.
R. Ferri et Ammoniae Citratis, gr. 40; Liquoris Strychniae, min. 30 (= to gr. I); Infusi Quassiae, ad fl. oz. 8. Mix. One-eighth part twice a day. In chronic nervous affections with debility.
R. Ferri Redact!, gr. 40; Zinci Valerianatis, gr. 20; Strychniae, gr. 1; Glycerin!, sufficient to make a mass. Divide very carefully into twenty pills, silver them, and direct one to be taken three times a day, after food In hypochondriasis, great nervous depression, etc.
TONICS. 363
409. Zinc and Nux Vomica.
R. Zinci Sulpliatis, gi\ 24; Extract! Nncis Vomicas, gr. 6; Extract! Eliei, gr. 30. Make a mass, d!v!de !i)to twelve pills, and order one to be taken twice a day. In weahness of the muscular system, atony of intes- tinal avails, etc. See F. 177, 387.
410. Valerianate of Zinc.
R. Zinci Valerianatis, gr. 12-24 ; Extract! Belladonnse, gr. 3-6 ; Ex- tract! Gentianai, gr. 24. Make a mass, divide into twelve pills, and silver them. One to be taken three times a day. In some nervous disorders, in cases of hahitual constipation, and in spasmodic contraction of the sphincter ani.
R. Zinci Valerianatis, Zinc! Phosphatis, aa gr. 10 ; Extract! Rhe!, gr. 24. Make a mass, divide into 12 pills, and silver them. Order one to be taken three times a day. For epilepsy, neuralgia, hysteria, etc. The vcderianate of quinine, of soda, of ammonia, and of steel, may be em- ployed in the same manner. In some cases of neuralgia as many as twelve or twenty grains of valerianate of ammonia in infusion of calumba have been given every four hours.
411. Valerianate of Zinc and Quinine.
R. Zinc! Yalerianatis, gr. 12 ; Quinise Sulphatis, gr. 6 ; Pilulge Rhei Compositas, Extract! Anthemidis, aa gr. 20. Make a mass, divide into twelve pills, and silver them. One to be taken three times a day. In hys- teria, neuralgia, etc.
412. Vcderianate of Steel and Savin.
R. Ferr! Valerianatis. gr. 24 ; Ole! Sabinse, min. 24; Pilulse Assafoetidae Compositee, gr. 30. Make a mass, divide into twelve pills, and silver them. One to be taken three times a day. In ancemia, hysteria, and neuralgia, ivith amenorrhoea.
413. Sulphate of Zinc.
R. Zinci Sulphatis, gr. 24; Extract! Aconiti, gr. 12; Extract! Qnassise, gr. 24. Make a mass, divide into twelve pills, and order one to be taken three times a day. /n epilepsy with neuralgic pains, lumbago, pleuro- dynia, etc. Its efficacy is much increased by giving cod-liver oil at the same lime.
R. Zinci Sulphatis, gr. 12-24 ; Extract! Conii, gr. 36. Make a mass, divide into twelve pills, and order one to be taken three times a day. In the chronic bronchitis of old people as a tonic and sedative, etc.
■ 414. Phosphate of Zinc.
R. Zinci Phosphatis, gr. 20-40; Acid! Phosphoric! Diluti, fl. drs. 1^ ; Tinctura; Cinchonae Flavas, fl. drs. 6, vel Tincturse Ferr! Perchloridi, fl. drs. 1^; Aquoe Menthse Piperitae, ad fl. oz. 8. Mix. One-sixth part three times a day. In some affections of the nervous system loith debility.
R. Zinci Phosphatis, gr. 20; Extract! Nucis YomicjB, gr. 5; Extracti Gentianae, gr. 20. Mix. Divide into twenty pills, silver them, and order one to be taken twice a day.
415. Oxide of Zinc.
R. Zinci Oxidi, gr. 24-40; Extract! Anthemidis, gr. 30. Make a mass, divide into twelve pills, and order one to be taken twice a day. In chronic
364 APPENDIX OF FORMULA.
alcoholism [?), chorea, hysteria, etc. Dr. Golding Bird entertained an opinion that zinc has a specific influence on the nervous system, just as iron has on the blood. The dose may be gradually increased until tv)enty or even thirty grains of the zinc are taken in the day. It can sometimes be advantageously combined tvith opium.
416. Zinc, Bark, and Glycerine.
R. Zinci Sulphatis, gr. 12-20; Tiiictiirse Cinchonse Compositse. fl. oz. 1 ; Glycei-ini, fl. drs. 12 ; Aquae Mentlife Piperitae, ad fl. oz. 8. Mix. One- sixtli part three times a day. During convalescence from acide disease, especially where there is emccciation ivith great nervousness and consti- pation.
All . Phosphorus Pills.
R. Micpe Patiis, gr. 60; Aqutfi Destillatse, sufficient to make a mass. Then add — Pliosphori, gr. 1 ; mix tlioroughly, divide into twenty pills, and order one to be taken thrice daily. In extreme debility and mental depression. In various affections of the nervous system. After cholera, diphtheria, etc.
Phosphorus pills and phosphorus capsules, in which the phosphorus is defended from the rapid oxidation to which it is liable, are prepared by several houses, and may be obtained through most chemists. Of these the capsules or pearls, which contain g^^ of a grain of phosphorus dissolved in oil, are by far the best.
418. Phosphorus with Oil and Tincture of Phosphorus.
R. Phosphori. gr. 1 ; Olei MorrhujE, fl. oz. 6. Mix. One or two tea- spoonfuls three times a day, immediately after food. In tuberculosis, rickets, scrofula, etc.
R. Phosphori, gr. 1; Olei Amygdalas, fl. oz. 3. Mix. One teaspoonful in a wineglassful of barley water three times a day.
R. Phosphori, gr. 1; Alcohol, fl. dr. 5; Glycerin], fl. oz. 1J-; Spiritus Vini Rectificati, fl. drs. 2 ; Spirittts Menthae Piperitte, fl. dr. h
Dissolve the Phosphorus in the Alcohol by the aid of heat ; warm together the Glycerine and Spirit of Wine. Mix while hot, and add the Spirit of Peppermint on cooling; fl. dr. 1 contains gr. -^.j of phosphorus. Employed by Mr. J. Ashbdrton Thompson in the treatment of neuralgia.
419. Hypophosphite of Soda.
R. Sodae Hypophosphitis, 1)6/ Oalcis Hypophosphitis, gr. 30-90 ; Infusi Chiratae. fl. oz. 8. Mix. One-sixth part three times a day. la phthisis, tabes mesenterica, etc. In progressive locomotor ataxy the efficacy of this mixture may be increased by giving a pill containing Nitrate of Silver (F. .59) with each dose.
R. Soda; Hypophosphitis, gr 80-240; Spiritfls ^theris, fl. oz. 1; Tinc- turae Sumbulis, vel Tincturae Cinchonae Flavae, fl. oz. 2 ; Aquae, fl. oz. 3. Mix. One dessertspoonful in a large wineglassful of water three times a day. In epilepsy, hysteria, neuralgia, some forms of hypochondriasis, etc., this mode of administering phosphorus may be useful. The dose at first shoidd be moderate and then gradually increased. In very obsti- nate or severe cases of neuralgia, a cure may perhaps be effected by the hypophosphite of soda in forty or even sixty grain doses, repeated thrice daily, when the ordinary quantities have no effect. Where no apprecia- ble benefit ensues in five or six days, the remedy ivill probably prove useless however long it may be continued.
TONICS. 365
420. Preparations of Pep sine and Pancreatine.
The physician is sometimes hindered in the administration of tonics and cod-liver oil and animal food by the inability of the stomach to digest them. And this frequently happens where these restoratives are most needed, — iu cases of degeneration of tissue, iu lingering illness, and during convalescence from acute disease.
The food is subjected in the stomach to the action of the gastric juice ; a secretion consisting of water, probably of lactic and hydrochloric acids, and of an azotized substance having the nature of a ferment — pepsine. When from any cause the secretion of the gastric glands is deficient or arrested, recourse may be had to the use of artificial pepsine with great advantage. This substance is usually prepared from several rennet bags (the fourth stomach of the ruminants) by washing them and scraping off the mucous membrane. The latter is then reduced to a pulp, macerated in distilled water for twelve or twenty-four hours, and filtered. A sufficiency of acetate of lead is added to the liquor, the precipitate is collected, and a current of sulphuretted hydrogen passed through it. Then it is again fil- tered, evaporated at a low temperature, and the dry residue (pepsine) pow- dered.— The chief symptoms which call for the use of this agent, are — imperfect or slow digestion, with flatulence, acid eructations, nausea, low spirits, and lassitude ; diarrhoea, with portions of undigested food in the evacuations ; phthisis, cancer and other diseases attended with great de- bility; and affections of the stomach itself, — as gastric ulcer, malignant disease of the pylorus, etc. It is also beneficial in anaeniia and chlorosis, in habitual constipation, want of appetite, offensive breath, dilated stomach, morbidly fetid stools, and sometimes in the sickness of pregnancy.
Pepsine should be given alone, or it may be mixed with certain medi- cines without its properties becoming deteriorated. Thus, when severe pain follows the ingestion of food, the sixth of a grain of morphia can be added to each dose ; when there is pyrosis, fifteen grains of the white bis- muth ; when the peristaltic movements are sluggish, the twentieth or twenty-fifth part of a grain of strychnia ; and when there is ansemia, some preparation of steel — particularly the reduced iron, or the citrate of iron and quinia. It is a common occurrence for patients to be enabled to assimi- late ferruginous tonics and cod-liver oil by the aid of pepsine, who cannot do so without.
There are several preparations of this agent which may be used. In BouD. cult's Poudre Nutrimentive, as purchased from Mr. Squire, the pepsine is mixed with starch in such proportions, that one part of the pow- der so formed will have the power of digesting four parts of fibrin at a temperature of 98° Fahr. — Thus, fifteen grains of the powxler will probably cause the meat of a mutton chop to be digested in the stomach. This, then, is the ordinary dose ; and it should be taken at the commencement of the meal, either between two pieces of bread, or in a tablespoonful of luke- warm soup.
Morson's Pepsine Wine is obtained from the gastric juice of the calf's stomach. It is an agreeable, slightly acidulous wine; the dose being one teaspoonful in water. The Pepsine Lozenges prepared by the same chemist are convenient and agreeable.
BuLi^ociv and Reynolds' Pepsina Porci is procured, as its name implies, from the stomach of the pig. In a short series of experiments its action was found by the Author superior to that of most other kinds. The dose is from two to five grains, made into a pill with glycerine.
And lastly, there is the Rennet or Pepsine Wine of Dr. Ellis, of Dublin, the preparation of which may be thus described. Take the stomach of a calf as fresli as it can be obtained from the butcher ; cut off about three or
366 APPENDIX OF FORMULA.
four inches of the upper or cardiac extremity, which, containing few glandu- lar follicles, may be thrown away. Slit up the organ longitudinally ; and wipe it gently with a dry napkin, taking care to remove as little of the clean mucus as possible. Theu cut it into small pieces (the smaller the better), and put all into a common wine bottle. Fill up the bottle with good sound sherry, and let it remain corked for a fortnight ; at the end of this time it is fit for use. The dose is a teaspoonful in a wineglassful of water immediately after meals. Dr. Ellis also suggests this test for pep- sine : — Put a small cup containing milk in a vessel of hot water until the milk becomes blood-warm. Then add a teaspoonful of rennet wine; if it be genuine, the milk in two or three minutes will become as solid as blanc- mange.—See F. 389. 394.
The pancreatic juice has for its chief purpose the emulsification of the fatty constituents of food, and when there is difficulty in the digestion of fats, or when, from disease of the pancreas or obstruction of its duct, the pancreatic juice does not reach the duodenum, so that unchanged fat ap- pears in the stools, pancreatine has been given, or fatty matters already subjected to the action of this substance. The following emulsion of cod- liver oil and pancreatine is recommended by Dr. Richd. Mathieson : —
Pancreatini Saccharati, oz. 1; Aquae, oz. 4; Sacchari Albi, oz. 7; 01. Morrhuse, Ojss; 01. Gaultherise, min. 20; 01. Amygd. Amar. min. .5.
The pancreatine is rubbed with the sugar and water; the syrup then mixed with the oils. A little lime-water may be substituted for part of the water.
A pancreatic emulsion of solid fats is prepared by Messrs. Savory and
MOOEE.
XVIII. UTERINE THERAPEUTICS.
421. Ferruginous Emmenagogues.
'^.. Potassii lodidi, gr. 18-30 ; Ferri et Ammonise Citratis, gr. 40 ; Tinc- turse Nucis Vomicae, fl. drm. 1 ; Infusi Quassise, ad fl. oz. 8. Mix. One- sixth part three times a day. In amenorrhoea with a torpid circulation.
I^. Syrupi Ferri lodidi, Glycerini, aa fl. oz. 1 ; Olei Limonis, min. 10. Mix. One teaspoonful in a wineglassful of water three times a day. See F. 32.
^.. PilulsB Ferri Carbonatis, gr. 30 ; Pilulae Cambogite Compositge, gr. 15 ; Olei Sabina2, min. 12. Make a mass, divide into twelve pills, and order two to be taken twice a day. In amenorrhoea ivith ancemia and habitual constipation.
^.. Ferri Valeriauatis, gr. 18; Olei Sabinai, min. 24; Extract! Aloes Barbadensis, gr. 6 ; Pilute Assafoetidae Compositae, gr. 36. Mix tho- roughly, and divide into twelve pills. One to be taken three times a day. In amenorrhoea with hysteria. See F. 412.
I^. Tincturse Ferri Perchloridi, fl. drs. 1^ ; Potassse Chloratis, gr. 60. Tincturse Actese Racemosae, fl. drs. 4; Infusi Serpentariae, ad fl. oz. 8. Mix. One-sixth part three times a day. In debility, with imperfect menstruation, pains in the back, and an irritable condition of the buccal or gastric mucous membrane. See F. 320.
422. Stimulant Emmenagogues.
T^. Extracti Ergotaj Liquidi, fl. drs. 3; Tincturae Serpentariae, fl. drs. 6; Tincturae Nucis Vomicae, fl. drm. 1 ; Decocti Aloes Compositi, ad fl. oz. 8.
UTERINE THERAPEUTICS. 367
Wix. One-sixth part early every morning. In amenorrhoea dependent on simple atony of the uterine organs.
R. Potassii Bromidi, gr. 60; Tincturaj Cantliaridis, fl.drs. 1^ ; Tincturae Cinnamomi, fl. drs. 6 ; Aquis, ad fl. oz. 8. Mix. One-sixth part three times a day. In amenorrhoea with epilcptoid seizures.
R. Olei Rutse, niin. 15 ; Extracti Ergotfe Liquidi, fl. drs. 2 ; Mucilagiuis Tragacanthse, ad fl. oz. 8. Mix. One-sixth part three times a day.
R. Boracis, gr. 60 ; Tincturge Ergotae, fl. drs. 4 ; Aquse Cinnamomi, ad fl. oz. 8. Mix. One-sixth part three times a day.
R. Tincturf« Hollebori (Phar. Lond. 1851), fl. drs. 3 ; Syrupi Zingiberis, fl. drs. 6 ; Infnsi Sennse. ad fl. oz. 8. Mis. One-sixth part once or twice a day. In amenorrhoea loith torpid action of the hoivels.
R. Liquoris Strychnise, niin. 30; 'J'incturse Ferri Perchloridi, fl. drs. 1^; Tincturae Actese RacemosEe, fl. drs. 4; Int'usi Quassise, ad fl. oz. 8. Mix. One-sixth part three times a day.
R. Podophylli Resinse, gr. 6; Extracti Hyoscyami, gr. 24; Extracti Nucis Voniica3, gr. 4; Filulae Aloes et Myrrhse, gr. 30. Mix, and divide into twelve pills. One to be taken at bedtime for three or four nights in succession. Where the menstrual fiovj is scanty, and the liver sluggish.
423. Medicated Vaginal Pessaries.
R. Plumbi lodidi, gr. 80; Extracti Belladonnas, gr. 24-40; Extracti Conii, gr. 100 ; Olei Theobroraas, oz. 1-U ; Olei Olivae, fl. drs. 2. Mix; melt into a mass with gentle heat ; and pour it into a tube or roll of paper, about eight inches long and of the circumference of the little finger. Divide into eight pessaries, and order one to be introduced into the vagina every night or every other night. In chronic inflammatton and induration of the labia lUeri, in ovaritis, in pelvic cellulitis, and in chronic cystitis. For an account of the advantages of cacao butter (oil of theobroma) over other materials in making these pessaries the reader is referred to a paper by the Author in the Obstetrical Transactions, vol. iv. p. 205, London, 1863.
R. Coniee, gr. 8; Gelatini, gr. 160; Glycerini, fl. drs. 2. Mix, divide into 8 pessaries. One to be introduced into the vagina every night. Useful in dysmenorrhoea and ovarian irritation with reflex disturb- ance.
R. Unguenti Hydrargyri, gr. 80-150 ; Olei Theobromse, oz. l-H; Olei Olivse, fl. drs. 2. Mix. Divide into eiglit pessaries. Where there is ten- derness of the cervix uteri, or of the ovaries, thirty grains of Extract of Belladonna or one hundred grains of Extract of Couium should be added to the mass.
R. lodoformi, gr. 80; Olei Theobromse, oz. 1; Glycerini, fl. drs. 2. Mix. Divide into eight pessaries. As a local anaesthetic in cancerous and other fainful iderine diseases. The smell of iodoform renders these pessaries very unpleasant to many patients.
R. Extracti Aloes Socotrinae, gr. 60; Olei Sabiuse, fl. drm. 1; Olei Theobromse, oz. 1 ; Olei Olivas, fl. drs. 2. Mix. Divide into eight pes- saries and order one to be introduced into the vagina every night. As an emmenagogue and purgative.
R. Plumbi Acetatis, gr. 20; Extracti Opii, gr. 24; Olei Theobromse, oz. 1 ; Glycerini, fl. drs. 2. Mix. Divide into eight pessaries, and order one to be used every night. In chronic leucorrhma, acute and follicular vaginitis, etc.
368 APPENDIX OF FORMULA.
R. Zinci Oxidi, vel Bismnthi Carbonatis, gr. 80 ; Extracti BelladoniifB, gr. 40 ; Olei Theobromge, oz 1; Olei Olivse, fl. drs. 2. Mix. Divide into eight pessaries. In the same coses as the preceding. Also in cancer of the cervix uteri, and in severe irritability of the bladder.
R. PotassEe Permanganatis, gr. 24 ; Extracti Aconiti, gr. 12; Extracti Opii, gr. 16; Olei TheobroriiEe, oz. 1-1^. Mix. Divide into eight pessa- ries, and order one to be used every night. In uterine diseases attended Vjith pain and offensive discharges. In cancer advanced to the .stage of tdceration the quantity of the permanganate should be reduced about one-third.
R. Potassii lodidi, gr. 40 ; Extracti Conii, gr. 120 ; Olei Theobromse, oz. 1 ; Olei OlivEe, fl. drs. 2. Mix. Divide into eight pessaries. One to be used every night. In induration of the labia uteri in strumous sub- jects.
R. Acidi Tannici, gr. 120 ; Pulveris Catechu, gr. 60; Olei 'Jlieobromse, oz. 2 ; Glycerini Acidi Carbolici, fl. drs. 3. Mix. Divide into eight pessa- ries, and order one to be used twice a week. In prolapsus titeri luith relaxation of the vaginal tissues, as toell as in uteriiie hemoi-rhage, in chronic metritis, and in menorrhagia.
424. Medicated Uterine Pessaries.
R. Acidi Tannici, Olei Theobromse, aa oz. ^. Mix. Divide into eight pe.ssaries, each having the diameter of an ordinary stick of nitrate of silver. In uterine hemorrhage, tvitli a patulous condition of the os ideri, one of these pessaries may be introduced up the canal of the uterus and left there. It soon dissolves and coats the lining membrane tuith the tannin.
R. Aluminis, gr. 80 ; Zinci Sulphatis, gr. 40 ; Olei Theobromae, oz. ^. Mix. Divide into eight pessaries, as in the preceding formula.
R. Ungueuti Hydrargyri, Olei Theobromse, aa gr. 200 ; Extracti Bella- donnse, gr. 20. Mix, and divide into eight pessaries as in the first of these formulse.
R. Extracti Aconiti, gr. 12; Extracti Opii, gr. 16 ; Extracti Hyos- cyami, gr. 100 ; Olei Theobromse, oz. 1^ ; Olei Olivse, fl. drs 3. Mix. Divide into eight pessaries, and order one to be used every night.
425. Vaginal Injections.
R. Extracti Hsematoxyli, oz. 1; Aliiminis, gr. 120; Aquae, fl. oz. 2. Mix, and label, — "To be added to one pint of cold water to form an in- jection."— Like other vaginal injections, this one is to be used with a vulcanized India-rubber syphon syringe, a pint or more of plain water being first thrown up. — In diseases attended ivith an offensive discharge. The patient should be cautioned that the fluid tvill dye linen, etc., soiled with it.
R. Zinci Sulphatis, Aluminis Exsiccatas. aa oz. 1 ; Acidi Tannici, oz. 2. Mix. Label, — " One teaspoonful to be mixed with a pint of tepid or cold water to form an Injection." In leucorrhoea, gonorrhoea, etc.
R. Zinci Chloridi, gr. 160; Aquse, fl. oz. 3. Mix. Label, — " One tea- spoonful to be mixed with a pint of cold water to form an Injection. To be used night and morning." In gonorrhoea.
R. Liquoris Plunibi Subacetatis, fl. oz. 6 ; Extracti Papaveris, oz. 2. Mix, and label, — "One large tablespoonful to be mixed with a pint of warm or tepid water to form an Injection." In cases of leucorrhoea, with
UTEEINE THERAPEUTICS. 369
mi irritable condition of the as uteri or vagina; as ivell as in rodent idcer of the uterus.
R. Extracti Fapaveris, oz. 1^ ; Tinctnrse Belladonnse, fl. drs. 4. Mix, and label, — " Two teaspoonfuls to be added to one pint of linseed tea, to foi-m an injection." — As a soothing remedy in cancer of the cervix %deri, ■ when there is but little tendency to hemorrhage.— It may he employed twice or thrice in the twenty-four hours.
426. Sponge Tents, etc.
For the purpose of dilating the mouth and cavity of the uterus, the female urethra, a strictured rectum, or a contracted orifice of the male prepuce, nothing can be better than the sponge tents introduced into obstetric practice by Sir James Simpson. These instruments are of a narrow conical form, and of various sizes. They are made by dipping a piece of sponge into water, and then compressing it around a central wire with whipcord. After drying, the cord is removed ; the surface of the tent being then coated with a mixture of lard and wax, while three or four inches of tape are fastened to its base. 'J'he tents which the Author has generally used have been made by Duncan and Flockhaet, of Edinburgh, and they are perfect. A metallic director, somewhat resembling the uterine sound, with a sharp point, is needed for their introduction up the uterine canal ; while their removal is accomplished by pulling the tape. A fresh tent must be introduced every twenty-four or forty-eight hours, until the tissues are sufficiently dilated to allow the finger to explore the cavity of the uterus.
Dr. Sloan, of Ayr, has suggested the use of the dried stem of the sea- tangle (Laminaria digitata) as a substitute for sponge. The stem of this common marine plant is cylindrical, soft, flexible, firm, and capable of being greatly reduced in size by drying. On subsec^uently being supplied with sufficient moisture it dilates to at least three or four times its size. The tangle tents produce equable dilatation, are in all respects very effi- cient, are cleanly, and ought to be cheap. They are more easily introduced into the uterus than the sponge tents, but they are also more liable to slip out again when the pressure of the finger is removed. In employing these tents it seems best to dip them in hot water just prior to introducing them; avoiding the use of oil, as it interferes with their absorbing power.
Tents may also be made of gentian and of elm bark ; but the Author has had no experience with these kinds, having been perfectly satisfied with the sponge and sea-tangle.
427. Gcdactojjhora and Gcdactophyga.
a. (xALACTOPHORA [PaXa = milk -f- ^£pw = to bear] , or Galactagogues [ra?ia -|- ayw> = to drive out], are remedies which increase the secretion of milk. Defective lactation is not common amongst healthy mothers, but with the weak and delicate it is very frequent. When it arises amongst the first class it is generally due to overfeeding; when amongst the second, auasmia is its cause. In either class, a torpid condition of the mammary gland may be its soui-ce.
Defective lactation from plethora will be best treated by purgatives, the most efficient being castor oil. All kinds of beer, wine, and spirits are to be prohibited. Animal food is to be allowed ; with vegetables, bread, tea, etc. A mixture of milk and soda water, in equal parts, forms an excellent drink in these cases. The patient is not to be weakened ; but she should be cautioned against the vulgar error, that a large quantity of food is ne- cessary, simply because she is nursing.
Defective lactation from ancemia is not uncommon. When the weakness 24
370 APPENDIX OF FORMULAE.
is not such as to forbid suckling, the health ought to be improved by animal food ; by a fair allowance of ale or porter or wine ; and by taking milk, or cocoa made with milk, instead of tea and coffee. A raw egg beaten up in a tumblerful of milk, once or twice a day, will do good. Then ammonia . and bark (F. 371) may be given, or some non-astringent ferruginous tonic (F. 403, 405) ; or cod-liver oil.
Defective lactation from torpor of the mamma is the most frequent variety. In these cases benefit will be derived from irritating the gland and nipple, — as by the careful nse of the breast pump ; by drawing out the nipple several times with the fingers, before the infant is applied ; by pass- ing an electric current through the gland, for fifteen or twenty minutes daily, for several days in succession ; or by the application of a hot carrot poultice, during some hours dailj'. The breasts are to be kept warm. Moderate sexual intercourse is also useful. — Beef and mutton, game and poultry, white fish, oysters, stewed eels, potatoes, parriips, lettuce, carrots, turnips, etc., will increase the secretion. There is no objection to stout, or to any other kind of malt liquor, provided the stomach can digest it; while from one to two pints of cow's milk should be allowed daily. With regard to drugs, perhaps the most afBcacious is a decoction of the leaves and stalks of the Ricinus community, or Castor oil plant. Dr. Routh recommends the administration of a strong decoction of this plant or of an extract ; the dose of the former being from one to two drachms daily in water, or of the latter five grains. The castor oil leaves may also be applied over the breasts, or an infusion of them can be used with lint and oiled silk. Amongst other remedies reputed to possess galactagogue properties must be mentioned, — J[qua Anethi or Dill water, and Oleum Anetln ; Aqua Anisi or Aniseed water, and Oleum Anisi; and particularly Aqua Foeniculi or Fennel icater, and Oleum Foiniculi. The dose of either of these waters is from two to four ounces, and of the oils about five minims on a lump of sugar, twice or thrice daily. — The value of such agents as the Malva Sylvestris or Marsh mallotv, of the Sa,ponar/'a vaccaria or coiv bas?l, of the juice or de- coction of Broom tops, and of the infusion of Althea root, is very doubtful.
Sore nipples may indirectly be the cause of defective lactation. Slight excoriations, as well as chaps and fissures, can generally be healed by the use of the dilute solution of subacetate of lead, or by the liniment of lime, or by an ointment of balsam of Peru, or by a lotion containing borax and glycerine, or by the glycerine of starch. Frequently drying the nipple with a soft rag, and then dusting it with spermaceti which has been finely powdered by the aid of a few drops of proof spirit, will be found exceed- ingly efiicacious. Where the fissures are deep, light cauterization with nitrate of silver often answers well ; or the painful spots may be painted with collodium, leaving the summit of the nipple free for the escape of the milk. A well-made shield, provided with an artificial nipple, will often en- able a woman to suckle when she would otherwise be unable to do so. The child's mouth must be looked to, so that if there are aphthaj they may be cured.
j3. Galactophyga [raxa = milk -|- (fsijyw = to shun] are the remedies employed to arrest the secretion of milk.
Extract of Belladonna is, I believe, the most certain agent of this kind. Reduced to the consistence of treacle, by the addition of a little glycerine or water, it should be freely painted over each breast, night and morning, the parts being also covered with wet lint and oiled silk, or with a cold bread and water poultice. At the same time, one-quarter or one-third of a grain of the extract, may be administered, twice or thrice daily, if a speedy effect be desirable. Sometimes it is advantageously given with quinine and camphor (F. 383).
Iodide of Potassium often succeeds, and is particularly useful if there
ELECTRO-THERAPEUTICS. 371
be any painful engorgement of the glands. Six or nine grains daily, in divided doses, should be administered. Occasionally it may he better to give about ten minims of the tincture of belladonna with each dose ; or the iodide can be combined with an active purgative salt, as the sulphate of magnesia (F. 31).
Colchicum has not succeeded well in the Author's hands when given alone. But combined with the sulphate of ihagnesia, in the proportion of twenty minims to sixty grains, administered two or three times a day, it has appeared serviceable.
Cam'plwr has been recommended. Three or four grains, with the same quantity of henbane, may be given in a couple of pills at bedtime; while frictions with the camphor liniment, or the compound camphor liniment, had better be employed twice or thrice daily.
Tobacco acts in a similar manner to belladonna. An ointment, made by boiling half an ounce of fresh tobacco in eight ounces of lard, is to be kept continually applied. Or this remedy may be employed in the form of a fomentation.
Sage tea is a popular remedy, which can certainly do no harm.
428. Aphrodisiacs and Anaphrodisiacs.
a. Aphrodisiacs [' Afpo^i^ia = venery] are medicines which excite or increase the sexual powers.
Many remedies have been supposed to act as sexual stimulants, but the majority of those which have been recommended merely have the property of exciting the imagination. This is especially the case with Husk, Cas- toreum, Ambergris ; extravagant substances which ladies may use as per- fumes if they please, but which should be abolished from the Materia Medica. The volatile sulphurated or allyle oils, obtained from alliaceous and cruci- ferous plants {Allium sativum, Allium ceva, Si7iapis nigra, Cochlearia Armoracia, etc.), have had some slight, repute. Indian hemp and Opium have been used ; but the latter, at least, generally exercises a contrary ef- fect to that desired. Cantharides, Turpentine, and Borax probably pos- sess no aphrodisiac powers, though popularly thought to do so. The only remedies which may truly be supposed to act as sexual stimulants are the various preparations of Iron, Strychnia and Nux Vomica, Quinine, and Phosphorus.
3. Anaphrodisiacs ('A, priv., -{- appo^iaia, venery) are generally believed to have the power of repressing the sexual feelings.
Nauseants ( Tartarated Antimony and Ipecacuanha), drastic purgatives ( Elaterium, Jalap, Calomel, etc.), Caviphor in large doses. Carbonate of Soda, Hemlock, Tobacco, and Alcoholic drinks probably possess anaphro- disiac properties.
XIX. ELECTRO-THERAPEUTICS.
Three forms of Electricity are used in medicine —
1. That of quantity: produced by chemical action and obtained directly from a battery, regulated by the number and size of the cells, and called the Continuous, Voltaic, or Galvanic current — often erroneously termed the constant current.
2. That of intensity : produced by induction either from a magnet or a galvanic current, by long coils of insulated wire, and called the Induced, Faradic, or Interrupted current, or Magneto-electricity.
3. That of highest intensity: produced by friction on an electro-negative substance, and called Static, Franklinic, or Frictional electricity."
372 APPENDIX OF FORMULA.
Galvanism, or the continuous current, is rarely applied without intermis- sion, which is usually obtained by the rhythmical removal of one of the conductors from the skin. The intensity of a single cell of any form or chemical arrangement is quite insufficient to overcome the bad conducting power of the liuman body ; therefore, when employing currents direct from the battery, many cells must be used, and as many as 50 or 60 should be contained in an apparatus intended for a variety of diseases.
The usual methods of applying electricity are direct and indirect localized electrization. In the former the rheophores, or current-bearers, are placed directly upon the organ, a muscle usually, to be Faradized or ~ Galvanized. (If the latter, one of the rheophores must be removed and replaced on the skin at regular intervals.) And in some cases it is well to moisten the sponges of the moist rheophores with salt and water; this solu- tion, being a better conductor than water alone, facilitates in a great degree ^ 'T.U- the passage of the current to the deeper parts.
(V' In indirect electrization, two points in the course of a nerve are selected
for the rheophores, and the current is thus made to affect the part supplied "" by the nerve.
A form of treatment called Genercd Electrization has been introduced by Drs. Beard and Rockwell (New York, 1871), on the principle that " Electrization, besides being a local stimulant, exercises an influence over > general and local nutrition entitling it to the liighest rank among constitu-
jf*^vA. ^ tional tonics." This is new ground for electrical practice. The American ^_.. practitioners generally appear to combine much rubbing and shampooing
of the surface with their Faradism and Voltaism. The method under con- sideration consists in placing the patient with his feet naked upon a sheet of copper connected with one pole, while the other pole is connected by a moistened sponge with the left hand of the operator, who passes his dis- engaged hand over the muscles of the patient, and sometimes over the whole body. (Tibbits.)
Great caution is necessary, more especially with the continuous current, in applying electricity to the spinal cord or brain ; and before electrizing any part of the body, it is well to place the electrodes on some analogous part of the operator's surface. Nevertheless, the effect of a current differs greatly, as there is idiosyncrasy with respect to this as to other remedial measures.
DucHENNE and others lay great stress upon Faradizing every bit of a muscle, either with a rheophore of large surface, or by carrying the sponge over its whole extent. The olivary conductors are useful for small muscles, as the interossei and facial muscles.
The differences in action of the continuous and induced currents are due to —
(1.) The higher tension of the induced current, which enables it to over- come great resistances, and reach deep muscles and nerves.
(2.) The greater cpiantity of the continuous current gives it more chemi- cal power; the Faradic current, as well as the continuous, decidedly affects nutrition by its action on the smaller arteries, and by inducing movements which produce tissue changes. (Duchexne.)
(3.) The direction of the continuous current is uniform, the induced cur- rent changes constantly, and
(4.) The continuous current flows in a I'egular stream as long as contact is maintained, the induced current lasts for a small fraction of a second. Partly due to this, probably, is the fact pointed out by M. Cyox, and more recently by Dr. Poore, that a continuous current passing through a group of healthy muscles enables them to make unusually strong and protracted action. {Practitioner, Jan. 1873.)
r**-- -^
ELECTRO-THERAPEUTICS. 373
Electricity in Diagnosis. — The main point on which the value of elec- tricity in determining the locality and nature of disease depends, is the behavior of muscles with the Faradic and Yoltaic currents.
The apparatus of each kind should be reliable in operation, and capable of having its strength easily controlled. Begin by placing the conductors of a moderately strong Faradic current on a muscle of the sound side, and decrease the strength until the point is reached at which contraction can only jnst be excited. The next step is to examine in the same manner the contractility of the diseased side. Next compare the results of Faradizing the healthy and diseased sides by passing the current through the nerve trunk supplying the muscle before examined. When the galvanic or con- __.-;■ tinuous current is used in this way, care must be taken in every trial to'^- "'^ ■ • place the positive conductor_nearest the centres, and to m^ke the interrup- f^f^tA'^ tions at the saime rate~in each case. -"""''
In hemiplegia, early in the disease, the Yoltaic and the Faradic contrac- tility will be found to be normal — if increased, there is central disease pro- gressing, as in inflammatory softening, and electric treatment is contra- indicated. As time goes on, the paralyzed muscles usually lose their cojitractility by degrees.
In paraplegia, due to disease of a segment of the cord only, which cuts off the part of the cord below the damaged poii>t from the brain, but leaves the paralyzed muscles in relation -with healthy cord, the condition of the paralyzed muscles will be similar to that found in hemiplegia; Voltaic and Faradic contractility will be normal till impaired by long disease, but there will in addition be excessive reflex action.
If the jjaraiylegia is due to disease of the entire portion of the cord corre- sponding to the paralyzed parts, we have the condition sometimes called Spinal Paralysis, in which there is lessened contractility. Voltaic and Faradic. 'Jliis condition is also present in muscles supplied by the nerves which arise from a diseased segment of the cord.
In peripheral paralysis, due to disease in the course of a nerve, cutting off the muscles from the nerve cells of the spinal cord, or to an affection of the peripheric extremities of the nerves, the muscles contract with the Vol- taic, but not so well, or not at all, with the Faradic current. The reason of this is, that the Faradic current excites the muscles indirectly through the peripheral extremities of the nerves, which are here affected ; while the Voltaic current acts directly on the muscular fibres.
In lead paralysis, the reaction with Faradism fails before the will has lost its control, but the Voltaic current acts with increased strength at this period, and the contractility remains after the voluntary power of moving the muscles is gone, and when atrophy has commenced.
lu infantile jyaralysis, due probably to an affection of the periphery of the^ n«pves7TIie loss of Faradic contractility is very sudden, and is usually complete in about four days (Barwell). A Voltaic current, of great sti'ength, will also fail, after the disease has lasted some time, to produce any effect; but it should be applied to the part affected a few times, and will usually restore the contractility. (See " Barwell's Lectures," Lancet, 1872-3.)
In rheuwatic and in hysterical paralysis contractility is usually normal, but in the latter the muscular sensation is nearly lost.
In progressive muscular atrophy, any muscular fibres which remain retain their electrical susceptibility; diminished electrical reaction follows, and denotes the gradual destruction of the muscles.
In the recognition o^ feigned disease, much assistance may be obtained from a powerful induction apparatus.
374 APPENDIX OF FORMULA.
DISEASES IN WHICH ELECTRICITY IS OF YALUE.
In cerebral disease Faradism is never to be used to the head. The Yol- taic current from 5-10 cells may be applied axially by placing one electrode on the lower part of the spine, and the other at the -back of the head ; or transversely, by placing one conductor on each temple, or one on the fore- head and the other on the occiput : and slow intermissions are to be made.
Melancliolia, with stupor and refusal of food, in two cases under the care of Dr. Williams, of Hayward's Heath Asylum, yielded at once to the use of a 40 celled Stohrer's battery, and after a few daily applications both patients recovered. The number of cells here employed must be considered as exceptional. [Lancet, 2.5th Jan. 1873.)
In softening, nervous exhaustion, and epilepsy the continuous current has been of use. In the latter disease, Dr. Althaus recommends the nega- tive conductor to be placed on the seat of the " aura," and the positive on the mastoid process.
In hemiplegia and paralysis of cerebral origin generally, no good can be done by muscular electrization soon after the attack, as a certain degree of irritability remains; and violent muscular tremors, to say the least, may result from Faradization.
When the proper time for treatment of the paralyzed muscles has arrived, Faradize the whole of the surface of the organs affected, passing one of the conductors over every part of the muscles : the application should last from 5-15 minutes and be repeated daily or every other day.
The end to be obtained by Faradization in hemiplegia, or other forms of
cerebral paralysis, is to maintain or restore the conductility of the nerves
and the contractility of the muscles of the paralyzed regions which are liable
to be impaired by prolonged disuse, so that as the nerve-centre recovers its
function a path may be open for the first feeble impulses it is capable of
issuing. When therefore, after a proper interval, the reaction of the muscles
to electrical stimulation, direct and indirect, is normal, and the paralysis
still persists, further electrical treatment will be useless, as the cause is to
be found in the character of the lesion of the nervous centre.
^ Dr. Tibbits says that four to six months should elapse before treatment
il of the muscles begins, and he gives some useful directions for managing
^ "late rigidity." The chief points are Yoltaism of the rigid muscles, and
Faradism of their opponents.
The nutrition of paralyzed parts may be improved, as well as contractility restored, through the action of the current on the muscular walls of the bloodvessels.
Diseases of the Spinal Cord. — Tumors, severe injuries, sclerosis or soften- ing of the cord, ai*e not likely to*be benefited by electrical treatment;- but paralysis resulting from slight meningitis, or myelitis, anaemia, or exhaustion, will probably derive benefit from a Voltaic (15-30 cells) current applied by electrodes placed over the nucha and lower part of the back. Begin with few cells and increase the number as may be indicated. The results of syphilitic disease are amenable to electricity when the morbid process has been arrested, and the exudation removed, by iodide of potassium. Electrical attention is to be directed to the peripheral expressions of disease.
Galvanizcdio7i of the cervical sympathetic, of which so much has been
said, is recommended by Meyer in irregularities of temperature, heat in the
skin of the head or face, coldness of extremities, etc., and in primary arterial
spasm, apoplectic paralysis, progressive muscular atrophy, and neuralgias
and spasms of the cerebro-spinal nerves, and he gives illustrative cases,
^_^. Benedikt also advocates this mode of treatment for intra-cranial diseases.
, . I J From ten to twenty cells are to be used. The electrodes are small sponges,
f^ffT^Jv^ the positive pressed deeply into the fossa under the ear, while the negative
ELECTRO-THERAPEUTICS. 375
is placed either on the sixth cervical spine, or over the sternal origin of the sterno-mastoid muscle. The application must be at once stopped if giddiness or sickness appears.
In hysterical paralysis, galvanize the spine, and Faradize the parts affected with a wire brush ; a sponge electrode being placed over the spinal- origin of their nervous supply.
Lead paralysis is treated by directly Faradizing the affected muscles, if they respond ; but if not, a strong Voltaic current should be used — say 40-60 cells — attacking every part of the muscles, and using slow intermissions. When the Faradic contractility returns — as is usually the case after a few applications of the battery current — Faradism and Voltaism are to be employed alternately. Medical treatment must be continued at the same time.
Peripheral paralysis, dependent on a wound of a nerve, will not be remedied until the nerve wound is healed. In paralysis dependent on rheumatism, cold, or pressure, the induced current must be employed.
The treatment of facial palsy should begin early if it is of local origin or from cold, and very often the continuous current will be needed to pro- duce muscular action. To produce an equable result, the treatment should be directed to each muscle affected, especially when using Faradism. (Tib- BTTs.) When the affection arises from locomotor ataxy, or cranial disease, Voltaism only should be employed.
Paralysis of the Ophthcdntic Muscles. — Put one conductor under the ear, or let the patient hold it in his hand, and let a small electrode, or the finger of the operator who holds the other conductor in his hand, rest as near the muscle as possible, beginning with a Faradic current.
Paralysis of the Laryngeal Muscles. — Three methods of electrical treat- ment are applicable to these affections : — 1. A gum elastic, metal-tipped conductor is to be passed down the pharynx, .touching the back of the larynx, the second electrode being a wire brush applied to the front of the neck over the cricoid cartilage. Faradism is to be employed. Or 2. A proper laryngeal rheophore is passed with the aid of the mirror into the larynx itself; the second electrode being a sponge on the front of the neck or else- where. 3. Electrization by sparks from a frictional machine has been of great use in emotional aphonia.
Lahio-glosso-laryngecd Paralysis. — The Faradic current should be ap- plied by means of one pole placed on the nape of the neck ; and the other to the inside of the lips, the tongue, and front of the neck.
Paralysis of the bladder requires Faradism by means of a peculiar elec- trode, consisting of a catheter, with a metal tip, the halves of which can be made to diverge after it is placed in the bladder ; otherwise an electrode, shaped like a catheter, with a metal point, must be used, the second being the rectal rheophore in the rectum. The bladder should be empty.
Constipation, when dependent on muscular inertia or disease of the spinal cord, may be relieved by a Faradic current, employed by means of a special conductor for the rectum, and a sponge applied to the abdomen or over the sacrum.
Impotency may arise from want of erectile power in the penis, in which case apply the Faradic current to the organ with a wire brush or sponge electrode. When the condition is due to deficiency of semen, apply Fara- dism by moist conductors to each side of each of the testes. Seminal emis- sions are in some cases restrained, or even checked, by applying the current from 10-15 cells to the veru montanum by one electrode, the second being placed on the perinseum, three times a week.
Progressive muscular cdrophy has been successfully treated in many cases by Meyer and Duchenne, by Faradizing the sets of muscles as they are attacked, and galvanizing the nerve trunks of the parts affected.
In locomotor ataxy, Faradization is employed for the diplopia, and ap-
376 APPENDIX OF FOEMULiE.
plied to the skin relieves the muscular pains. Benedikt and Onimus have galvanized the spine with benefit to some cases.
Chorea is best treated electrically by the continuous current : the positive conductor is placed over the muscles affected, the neji^ative to the nerve supplying them ; or the current may be passed from the affected parts to the upper part of the cord, the negative conductor being placed on the back of the neck.
Dr. Althaus recommends the alternate use of Faradism and Voltaism.
Writer's Cramp. — In this disease, as in torticollis and contraction of the splenius, it is advisable to Faradize muscles antagonistic to the affected ones. If there is tremor, "the positive charge" should be applied.
Shaking Palsy, in recent cases, is to be subjected to the positive charge.
Tetanus. — Apply a current from 8-10 Daniells, the negative pole being placed on the spine, the positive on the tetanic muscles.
Diseases of Women. — Amenorrhcea is often successfully treated by Faradizing, or still b"etter, galvanizing the uterus ; one electrode being placed on the abdomen, and the other, either a sponge holder on the lumbar spines, or a rectal rheophore passed up to the cervix uteri. The former is preferable, and according to Althaus just as good.
Menorrhagia is relieved by Faradization applied in the same mode, or passed from hip to hip, and from sacrum to pubis.
Uterine inertia. — The Faradic current may, in some cases, take the place of, or assist ergot of rye. A proper uterine rheophore is passed up to the cervix uteri, and a moist sponge is placed on the abdomen. A rheophore shaped like a long spoon, the bowl filled with soft sponge, and the handle made of insulating material, is very convenient for applying currents to the abdomen. Moisten the sponge with hoi water.
In a case of accidental hemorrhage in a flabby multipara, the Faradic current produced immediate expulsion of the child and placenta, shortly followed by a very large clot.
Faradism of the breasts will often increase or restore the secretion.
Relief op Pain. — Neuralgia often yields at once, sometimes permanently, to the Faradic current. Meyer applies it curatively as the " Electric Moxa," or a wire-brush electrode held in one spot, and a very strong current. Vol- taism is most successful in this disease, however, and is applied with the 'negative pole, a moist spong'e on the point of origin of the nerve affected, and another sponge electrode for the positive, placed on the painful spot, the time being determined by the amount of action on the skin, as it is undesirable to cause any soreness. Five to ten cells of a battery in good order will usually be enough for the face ; ten to thirty for other parts of the body. A little moral influence may be useful in the treatment, as neu- ralgic patients are given to variety, and often abandon a remedial measure if not at once successful, before it has had a fair trial.
Sciatica requires the application of a Voltaic current from 10-30 cells ; the negative on the lower dorsal spinous processes ; the positive on the lower part of the thigh or leg.
Sick headache. — A continuous current, beginning with 5 cells, is used, the electrodes being placed on the mastoid processes.
Rheumatic pains in the muscles are relieved by Faradizing the dry skin ■with a brush or dry plate.
Hysterical Anesthesia. — The best application is daily Faradization of the affected pai'ts with a wire brush, the strength of the current to be in- creased to the utmost bearable limit. And while increasing the power of a Faradic apparatus, it is well to keep the electrodes applied, always suppos- ing that the operator is acquainted with the energies of his instrument.
ELECTRO-THERAPEUTICS. 377
Deafness. — Electricity, in the form of a slowly interrupted Faradic cur- rent, has done much g'ood to old cases of nervous deafness. The meatus is filled with water, an electrode, insulated except at the tip, is passed in, and the other electrode is placed on the neck, 'i'he current must be weakened or discontinued if it cause giddiness.
Tinnitus Atirium. — This distressing affection has frequently been cured by both Voltaic and Faradic currents, one electrode being' placed in con- tact with the membrana tympani.
Asphyxia. — Use electrodes with button-like metal tips, covered with wash-leather or sponge, and a Faradic current sufficient to cause contrac- tion of the muscles of the ball of the thumb. Place one conductor on each side of the neck, outside the sternomastoid in its lower half, as in this place it will affect the phrenic nerve, the sternomastoid and the scaleni muscles ; let the pressure last the length of an inspiration, then assist expiration by pressure on the abdomen. The strength of the current at first failing to excite contraction, increase it to the full power of the apparatus, and, that failing, use Voltaism in the same manner. A double electrode Avonld be advantageous, conveying the current to the two sides of the neck from one pole of the instrument, while the other pole is applied to the epigasti'ium or seventh intercostal space.
Aortic Aneurisms have in some cases been successfully treated by a current from a few cells of medium size. Various methods have been recommended. Needles insulated to within a short distance of the point are passed into the sac; according to some experimenters they should be connected with both poles of the battery, according to others with the negative pole only, the positive rheophore being a wet sponge placed on the skin near the aneurism ; according to others again, the needle should be in relation with the positive pole. The object sought is the obliteration of the aneurism by the coagulation of the blood which takes place round the needle when the cun^eut is passing; the coagulum round the negative pole is large and loose, that round the positive small but more firm ; it is not yet definitely known which best answers the purpose required. The current must be passed for some hours. Great pain is often excited.
Vascular N^yi are treated Avith remarkable success by inserting needles into the tumor, which are connected with the negative pole of the battery, the positive being formed by a wet sponge. By some operators needles connected with both poles are inserted.
Hybatids of the Liver. — The current from ten cells was employed at Guy's Hospital, in some cases of hydatid cyst, and in eight instances proved very successful. Two needles from the negative pole were introduced into the tumor, and a moist conductor from the positive was applied to the skin of the abdomen. [Med. Cliir. Trans. London, 1871.)
For the practical use of electricity in medicine, see Tibbits' " Medical Electricity." (London, 1873.) For diagnosis, and for the application of the continuous current, see Meyer's " Electricity in Pract. Medicine," translated by Dr. Hammond. (New York, 1869.) For apparatus, see Duchenne's •' Localized Electrization," Part I., translated by Dr. 'I'ibbits, London. For a comprehensive treatise on the whole subject, see Dr. Althaus's " Medical Electricity." (New edition. London, 1874.)
378 APPENDIX OF FORMULA.
XX. CLIMATES FOR INVALIDS.
429. General Observations.
Notwithstanding the excellent writings of Sir James Clark, Edwin Lee, Granville, Borgess, Alexander Taylor. D. J. T. Francis, Scoresby-Jackson, and others, many invalids migrate every autumn to the South of France, Italy, Spain, etc., merely to find a grave. This hap- pens partly because cases of far-advanced disease are still sent abroad, when they ought to be kept at home ; partly, because a situation unfavor- able to the particular malady is selected, the laws of climate being ill understood; and, in some measure, because it is difficult to persuade the sick that simple change to another country is only one of the means by which they are to regain health. For although there can be no doubt that in change of air physicians have an efficient remedial agent, yet it is certain that this remedy, like all others, is not of indiscriminate application, but mnst be prescribed with judgment and discretion.
The diseases most likely to be cured or alleviated by the benign influence of change of climate are the following : — Pulmonary consumption ; chronic lai-yngeal and bronchial affections ; asthma ; disorders of the digestive organs, with the various forms of dyspepsia ; chronic gout and rheumatism ; functional derangements of the sexual organs ; affections of the kidneys ; obstinate neuralgia; and hypochondriasis. A change is beneficial to strumous delicate children ; is invaluable as a restorative during con- valescence from acute or prolonged disease ; and especially is it one of the chief resources of " preventive medicine." In incurable disease a visit to another part of the sufferer's country, or to some foreign station, will now and then serve to ward off complications, to give mental exhilaration, to promote appetite and digestion, and to be the source of tranquil nights.
There is no model climate : no country can boast of being perfect. Doubtless in some of the new towns about California remarkable climates are found. The luxuries on the Pacific side of North America are unknown to Europeans. Speaking of small towns near Placerville, Sir Wentworth Dilke says (Greater Britain. 156) that, except in the far interior or on the hills, " one even spring reigns unchangeably ; every fruit and vegetable of the world is perpetually in season." All that the physician's knowledge and tact will enable him to do is to select that situation which possesses the greatest advantages and the fewest drawbacks for the particular case he has in hand. Phthisis, for example, is prevalent and fatal in all coun- tries, though more so in some than others. Moreover, it must be remem- bered that, through the peculiar nature of zymotic (^d^ow = to ferment) diseases, towns usually healthy are apt to be periodically visited by epidemics ; and such places can only be avoided by consulting recent returns, or by instituting inquiries on the spot. In considering the sana- tive influence of any climate, our chief object must be to learn on how many days during the winter and spring months it may be expected that the invalid will be confined to the house by bad weather. If the number be at all large, he can just as well remain at home. To decide the point, the nature of the sick man's disease and constitutional strength must first be determined. Then as regards any given locality attention must be paid to its aspect, its drainage, and its elevation above the sea level ; to the temperature and its equability ; to the dryness or moisture of the soil and atmosphere, a degree of heat being often well borne when the air is dry, which is quite unbearable when it is moist ; and to the nature of the pre- valent winds. 'J'he amount of rain which descends in a season is not of such moment as the way in which it usually falls ; a region liable to sharp heavy showers being much more favorable for the invalid, than one where
CLIMATES FOR INVALIDS. 379
it drizzles — like a Scotch mist — for days together. Luxuriant vegetation, though agreeable to the souses, may merely mean high temperature com- bined with moisture ; conditions not favorable for the phthisical. So also the districts where marshy lands abound, or where occasional inundations occur, are notoriously unhealthy ; foi* the evaporation of the water lowers the temperature, while the decaying vegetable matter becomes the source of malaria.
'J'he beneficial effects of sea-air are due to its purity, to the equability of its temperature, to the iodine it contains, and to the constant presence of ozone. 'J'he latter — the most powerful oxidizing agent — is a stimulant to all the vital functions ; but if in excess, it causes great irritation, particu- larly of the organs of respiration. Ozone, found also in the air of moun- tainous and rural districts, has the property of decomposing iodide of potas- sium, uniting with the potassium and liberating the iodine, which latter body may be detected by starch. Hence, test-papers saturated with a solu- tion of iodide of potassium and starch are employed ; the iodine, when freed by the ozone, uniting with the starch and forming blue iodide of starch. (See F. 389.) — While sea-air by its invigorating and other properties has a certain amount of influence in preventing tuberculosis, it is by itself insuffi- cient to cure this disorder. Mountain-air is also pure, has an average low temperature, and contains a large proportion of ozone. There is a diminu- tion of atmospheric pressure, but more wind and moisture at high eleva- tions. Speaking generally, mountain air is tonic and bracing; it improves the appetite, lessens anaemia, and especially promotes a healthy action of the abdominal viscera.
Although a classification of climates can only be artificial, and merely useful as affording a rough view of their nature, yet those countries mostly resorted to by invalids may be arranged in four divisions, viz., the relaxing, sedative, exciting, and bracing.
1. In the relaxing climates (e. g. Pisa, Madeira, Torquay) there is au
elevated temperature with an excess of communicable humidity. They are unfitted for cases where we wish to restore diminished tone — to build up shattered constitutions ; as well as for subjects with a tendency to hemorrhage.
2. In the sedative climates (Rome, Pau, Venice) we find a freedom
from great dryness on the one hand, and from communicable hu- midity on the other. We should not select these where it is desirable to quicken a slow circulation, or where the secretions are too abun- dant.
3. In the exciting climates (Nice, Naples, Montpellier, Florence, Genoa,
etc.) there is an excess of dryness, a highly electric state of the air, an excess of ozone, and during the early months of the year keen irritating winds. Such climates are injurious where there is nervous and vascular excitement, a tendency to inflammation, or where functional repose is needed.
4. In the bracing climates (Southport, Brighton, Cannes, Mentone,
Malaga, Algiers, etc.) the winter temperature while comparatively high is not oppressive, the air contains a moderate proportion of ozone, there is a certain amount of dryness, and the winds are less irritating than in the exciting class. They are generally to be avoided where there is a very sensitive state of the system, a tend- ency to apoplexy from hyperaemia, and in many affections of the heart or large vessels. But, as a general rule, they are more suited to cases of pulmonary consumption, and to renal and hepatic dis- eases than either of the others.
It would be of little practical use to introduce an extended table giving an approximation to the death-rate of different countries. But it is inter-
380 APPENDIX OF FORMULA.
esting- to sliortly notice, tliat on an average of ten years (1851-60), the artinual mortality from all causes stands thus : —
-p Ti 1 1 1 iir 1 ( population in ) „„ „„„ „„. ( the deaths 1 to each 1000 For Ena-land and AV ales < *^ Voci i • > 20,066.224, ^ „„ > ...
° I 18ol being 3 ' ' j ;ire . . 20 ) persons living.
" London " ' 2,803,988, " 24
" Bristol " 66,027, " 27 "
" Birmingham ... " 212,621, " 27 "
" Manchester .... " 243,988, " 31
" Liverpool " 269,742, " 33 "
" Dover " 31,575, " 20
" Hastings " 26,631, " 18
" Eastbourne. ... " 10,721, " 17 "
" Brighton " 77,693, " 22 "
" Wortbina; " 18,921, " 18
" Isle of Wight. . . " 55,362, " 17
" Scarborough ... " 30,425, " 21
For Paris \ P^r'"*'?" '" \ 1,696,141,1 *^" *^*"=^''^^ l *° ^'°}'. I""*'
( 1862 numbering j ' ' ' ( are . . 28 ^ persons living.
" Berlin 1861 " 547,571, " 25
" Vienna 1861 " 612,000, " 49 "
" Turin 1868 " 179,635, " 26
" St. Petersburg . . 1858 " 520,131, " 41
" Moscow 1858 " 386,370, " 38 "
When the locality to which an invalid is to resort has been decided upon, he should, on leavinty home, be provided with a concise code of hiws in writing ; or he must be directed at once to consult a physician in practice at the town selected. His route had better be marked out for him ; ho should be cautioned as to the rate at which he is to travel ; rules must be laid down as to the regimen he is to adopt; while he ought to be reminded that warm clothing, especially flannel, will be required. Frequently it will be better to have cheerful apartments, with a southern aspect, secured beforehand ; so that at the end of his journey a few days' perfect rest may be enjoyed. The object of the tour ought to be clearly explained, while he is to be warned not to expect too much, especially at first. The physician, in sending his patient abroad, is merely placing him in the position most favorable to recovery, — but still where other remedies and general precau- tions will be indispensable. Foreign travel would be more agreeable to most men, could the plague of sightseeing be dispensed with. But for the sick man to visit picture galleries, museums, damp old ruins, cold churches, etc., is frequently to frustrate the only object he should have in view, viz., the restoration of his health. In giving directions as to diet it must be recollected that travelling is very exciting and wearying to the invalid ; that the organs of digestion almost alwaj's become more or less deranged ; and that many articles of food which are taken with advantage in England, disagree in warmer latitudes.
The best time for leaving England is between the end of September and the middle of October. The patient with pulmonary disease ought not to return until May. In many instances the Author has found it advanta- geous for the invalid intending to stay away from home for several months to carr}' with him a few pure drugs ; together with a brief account of their properties, doses, and modes of combination. Not that he is to be encour- aged to tamper with his health by playing the dangerous part of the amateur physician ; but good advice cannot alwaj^s be procured, or it may perhaps be had where only inferior drugs are obtainable for compounding the pre- scription. The medicines which are generally ordered are these : —
CLIMATES FOE INVALIDS.
381
Sulphate of Quinia, 1 oz.
Reduced Iron, 1 oz.
Liquid Extract of Yellow Cinchona,
4 fl. oz. Spirit of Ether, 6 fi. oz. Liquid Extract of Opium, 2 fl. oz. vSulphatc of Zinc (for emetics, lotions,
collyria, etc.), 3 oz. Chloroform, 2 fl. oz.
Bicarbonate of Soda, 4 oz. Compound Powder of Rhubarb, 6
oz. Aromatic Powder of Chalk and
Opium. 3 oz. Tincture of Arnica (for bruises, burns,
etc.), 2 fl. oz. Morphia and Ipecacuan Lozenges, ^
to 1 lb.
Scales and weights : an ounce and a minim measure : a small spatula : an enema syringe, the cheaper and more simple the better : with lint and strapping, will complete the medical equipment. In certain special cases it may be well to substitute for some of the above drugs— blue pill, iodide of potassium, colchicum, gallic acid, tincture of digitalis, pepsine prepared from the pig's stomach, and oil of peppermint. Two invaluable medicines — brandy and cod-liver oil — can be procured everywhere. An air-cushion often proves serviceable. ■•
La Poudre Insecticide is sold in France, and is a very efficacious remedy against fleas. One or two teaspoonfuls, sprinkled over the sheets, serve to destroy these foes to comfort and sleep. Persian powder, made with the leaves of a kind of groundsel, will have a similar effect ; and so will cam- phor, though in a less degree. Mosquito curtains may also be taken from England ; for mosquitos are a serious nuisance to all, but especially to the invalid, and they continue venomous in the south until the cold nights set it.
430. Middlesex.
London.— This city, the largest and most healthy in the world, is bounded by moderate hills ; has a soil of loam and gravel, with clay resting on a bed of chalk ; and is some fifty miles from the sea to the south and east. In 1861 the area of London was 123 square miles, — giving about 23,000 per- sons to a square mile of surface. The mean annual temperature is about 50° Fahr. : the average winter temperature being 38°, and that of the sum- mer 63°. The nights especially are warmer than in the environs. The annual rainfall is 21.6 inches, the average number of days, more or less wet, being 178. Formerly certain springs in the neighborhood of this city were used for medical purposes. Thus there were chalybeate springs at Hamp- stead and Sadler's Wells: aperient waters at the Beulali Spa, Kilburn, and Streatham. The aperient salt, as at Epsom, was sulphate of magnesia.
Delicate individuals are often better in London during the winter and spring, than in the country, owing to its greater warmth, and the greater steadiness of the temperatui-e from day to day. — Asthma is such a precari- ous disease, that it is impossible to say beforehand what particular climate will suit any special example of it. But it is certain that very many asth- matics are better and more free from attacks in a large city, than in the clearer atmosphere of the country. Sufferers from this affection can espe- cially apply to themselves the words of Bacon, — " The goodness of the air is better known by experience than by signs." Phthisical invalids will find Brompton or Chelsea the most sheltered spats of the metropolis ; but if they are benefited by a bracing air they must resort to Bayswater, or Highbury, or the upper part of Kentish Town or to Highgate.
Hampstead. — Many years ago, a mineral spring of repute in this village rendered it a fashionable watering-place. It is still a healthy suburb. From the heath, upwards of 200 acres in extent, there are many fine views. The air is pure and bracing, and well suited for children and convalescents.
382 APPENDIX OF FORMULJ^.
The low parts are damp, and should be avoided. — Like Greenwich, Richmond, Lewisham, Dulwich, Sydenham, etc., Hampstead often affords a convenient temporary residence for families driven from their towQ homes by the outbreak of some eruptive fever or other infectious disease.
431. Kent.
Margate. — The tonic and bracing air of this familiar locality renders it a very valuable temporary residence for many invalids. The atmosphere is extremely pure, the soil is dry and absorbent, and the water-supply good. Perhaps no place could be named which is more suitable for restoring the health of children and young people afflicted with any form of scrofula. In strumous diseases of the joints, the most marked improvement usually results from a few months' stay at this town. The bathing is good; though the flatness of the sands may be a disadvantage to the adult.
The mortality among the residents is very low. For a long series of years (1838 to 1862) the average annual death-rate has been only 16 per 1000 for this class. — The season lasts from the middle of Alay until the end of Sep- tember. Being open to the north and east, the air is very bleak during the late winter and early spring months.
Ramsgate. — Is much frequented in the summer, owing to its gaiety, facili- ties for sea-bathing, etc. It is an excellent residence for delicate children during the months of October and November, when the crowds of visitors have left. 1'he climate is warmer than that of Margate, and more bracing than that of the south-coast watering-places. — Broadstairs is situated in a pretty little bay about three miles from Ramsgate, and affords a very healthy and quiet sea-bathing place for children. The air is much less bracing than that of Margate.
Dover. — This sheltered town is generally full in the summer and autumn. ^ As a winter residence it is colder and more exposed to high winds than Hastings, but it is not therefore unsuitable for invalids who can bear a bracing air. In January the weather is often fine and invigorating, but decidedly cold. Tbe easterly winds which prevail during March are very trying. May and June are very agreeable months, as are August, Septem- ber, and October. The climate proves especially serviceable to those sub- jects of strumous affections, chronic bronchitis, dyspepsia, nervous debility, congestion of the liver, etc.
Folkestone. — The beautiful country in the neighborhood, and the fine tonic air of this town, render it a most agreeable residence from the end of May until the beginning of November. Sufferers from dyspepsia, nervous irritability, and over-work will derive most benefit from this climate. — Sandgate, about two miles to the east, offers a milder winter climate, with an exemption from fogs. The mean winter temperature is 41.76°. Con- sumptive and dyspeptic invalids, who find Brighton too bracing and Hastings too relaxing, may well winter at Sandgate, especially if they need quiet and seclusion.
432. Sussex.
Hastings and St. Leonards. — Situated about midway between Brighton and Dover, the climate of Hastings is very useful for invalids during the winter and spring months. Well sheltered from cold winds, with lofty cliffs and undulating downs, a beautiful and cultivated country, a dry and absorbent soil of clay overlaid with sand, a pure sea-air, and free from all sources of malaria, Hastings can be regai'ded as offering a healthy sedative climate during six or eight months of the year. The bathing also is good in the summer. — The mean annual temperature is 50° ; that of winter being 40°, of spring 44°, of summer 60°, and of autumn, 53°. The amount of rain
CLIMATES FOR INVALIDS. 383
in the year equals about 28.34 inches. South and southwesterly winds are most prevalent during the winter and spring, but unless high they cause very little discomfort. In the neighborhood are various springs impregnated with iron and carbonic acid, but they are not much used.
Hastings is suitable for cases of dyspepsia with loss of tone, chronic bronchitis, neuralgia, chronic rheumatism, gout, and scrofula. For the diseases of childhood it is a good locality. The author has not seen phthisi- cal subjects derive much benefit from it, however; and sometimes he has thought that it seemed to induce haBmoptysis. Dr. Mackness (" Hastings considered as a Resort for Invalids," London, 1842) has given a table of the causes of death during four years ; from which it appears that the total number was 865 ; of these 2.o4 being from chest affections, and of these latter 161 from consumption, — viz., 91 inhabitants, and 70 visitors.
Although Hastings and St. Leonards now form one town, yet the former is the warmer and more protected, and hence better suited for very delicate invalids. Such as find Brighton agree with them from October until the end of December, may often advantageously spend January and February at St. Leonards.
Eastbourne. — Filling, as it were, a chasm between two cliffs, one of which is Beachy Head, this watering-place is rapidly increasing in importance. It is visited in the summer for sea-bathing; but is a good residence for invalids requiring a bracing air from .September until the beginning of January. Cases of scrofula, consumption, hydrocephalus, and tabes mesen- terica often derive benefit here. It is also to be recommended in functional disorders of the heart and nervous system.
Brighton. — The climate is bracing and restorative, and is especially bene- ficial to invalids during the autumn and early months of winter. Although the town is sheltered on the north and northeast by the South downs, yet from the beginning of February until nearly the end of May cold north and easterly winds prevail, which prove very irritating even to the healthy. The annual fall of I'ain is 25.6 inches. ^J'he western is milder but more damp than the eastern cliff; but the tonic air of the latter agrees admirably where the circulation is torpid. The Old Steyne offers a climate intermediate between that of the western and eastern cliffs.
Diseases of a nervous hypochondriacal type are much relieved by the in- vigorating atmosphere of Brighton. Great good is also experienced when the vital powers are sluggish, when there is anasmia, or when disease of the kidneys exists. Strumous children and convalescents from acute disorders may also be sent to this part of the coast. It is unsuitable for individuals of an irritable or plethoric habit; for such as have a dry harsh skin, or any irritating cutaneous disorder; and for those who have a tendency to asthma^ inflammatory affections, haimorrhoids, etc.
Worthing.— Lying twelve miles west of Brighton and with an aspect almost due south, this town is fully exposed to the sun's rays. It is sheltered from the hot winds of summer and the cold of winter by the South down hills, which have an average height of 600 feet. Hence it is warm in winter until the middle of February, and cool in summer ; the air being neither too bracing nor too sedative. The mean temperature for the year is about 51°. The rainy days are fewer, and the quantity of rain that falls is less than at Ventnor or in the West of England. Occasionally the east and northeast winds render the air very bleak. During summer the fine sands afford excellent bathing.
Worthing can be recommended as a good residence for convalescents ; as well as for sufferers from lung diseases,, hooping cough, scrofula, chronic rheumatism, and renal affections.
384 APPENDIX OF FORMULiE.
433. Ham J) shire.
SouTHAMPTOx. — At the head of the Southampton Water, which stretches from the Solent and Spithead into the interior of Hampshire for some eleven miles, is the clean and handsome town of Southampton. The climate is said to be mild and humid, intermediate in character between that of Devonshire and Hastings. Though sheltered by the high grounds behind it, and by the New Forest, yet it is unsuited for most invalids, the temperature being variable. The efiQuvia from the river at low water are often very unpleasant.
A shoi't distance from Southampton Water is Netley. Here lias been built the Royal Victoria Hospital ; which is especially intended for the reception of invalid soldiers from foreign stations, and which has become the head-quarters of the Army Medical School. The site seems to have been well chosen ; while in most I'espects the arrangements of the building are excellent.
Bournemouth. — This favorite watering-place, situated within a fine bay, is about ten' miles from the western extremity of the Isle of Wight. It is well screened by hills and pine-woods from the north and northeast winds, but is exposed to the southwesterly gales. Owing to the nature of the soil, out-door exercise is practicable immediately after rain ; while there are great facilities for easy walking. The mean annual temperature is 51.00°; that of winter being 42.38, spring 49.11, summer 60.18, and autumn, 51.71.
It may be recommended as a quiet healthy resort, during the winter, for such invalids as are not affected by moderate variations of temperature, for those who are weak without having actual organic disease, and for persons returning from tropical countries. The climate is mild but not relaxing. During the spring and early summer months, thick fogs and cold easterly winds are rather prevalent. In summer there is good sea-bathing; but the heat, and clouds of fine sand which rise when there is any wind, render Bournemouth unpleasant to many at this season.
434. Isle of Wight.
Ryde. — The towns on the north side of the island — Ryde and Cowes — are more suitable for summer visitors requiring change of air and occupa- tion, than for invalids needing a dry atmosphere and repose. The air is mild. Although the attractions of both localities are great, yet in neither is the bathing good.
The Undercliff. — This is the best part of the island for a winter and spring residence. The Undercliff extends from the village of Bonchurch to Black Gang Chine, a distance of six miles along the southeast coast. The scenery is romantic, sea fogs are rare except towards the end of May and during June, and both soil and atmosphere ai'e dry ; while it is well pro- tected, by a I'ange of lofty chalk and sandstone hills, from the north, north- east, northwest, and west winds. It is raised some fifty or seventy feet above the level of the beach ; and may therefore be represented, in the words of Sir James Clark, " as a lofty natural terrace, backed by a mountainous wall on the north, and open on the south to the full influence of the sun from his rising to his going down, during that season at least when his influence is most wanted in a northern climate." — The mean annual tem- perature is 51.35° ; that of winter being 41.89, spring 49.66, summer 60.63, and autumn 53.58. The mean annual fall of rain is 23.48 inches ; whereas at Newport, in the centre of the island, it is 33.60. — The best season is from the beginning of November until the end of May : between August and October it is too relaxing and humid.
The Undercliff, of whiclp Ventnor is the chief town, may be resorted to by all those who need a genial and agreeable winter and spring climate. It allows the phthisical invalid to re-oxygenate his frame by almost daily exer-
CLIMATES FOR INVALIDS. 385
cise in the open air, at a season when he would be unable to do so at most other parts of England. The walks are fine and sheltered. The air is mild and yet of a bracing tonic character ; and hence it differs from that of Torquay, which is of a more moist and relaxing nature. Patients with laryn- geal and bronchial affections, hepatic and renal disease, atonic and nervous dyspepsia, and children with glandular swellings or strumous ulcers, do very well at this part of the island.
As a summer resort Sandown can be strongly recommended ; its beautiful bay and open sea, its fine sands, its good bathing, its dry sandy soil, its good drainage, and its pure and abundant water supply being so many strong recommendations. For some few cases of disease not requiring a mild climate, Sandown may prove serviceable in the winter. The air is bracing as compared with that of Ventnor and Shanklin. 'I'he invalid can readily change from one of these spots to the other if necessary.
435. Dorsetshire.
Poole. — Standing on a peninsula, this old-fashioned town is an agreeable place for such as have to be driven from books and business to quiet and idleness. Owing to geographical peculiarities in its position, the tides in Poole harbor ebb and flow twice in the twelve hours.
Weymouth. — This town, with the adjacent Melcombe Regis, is a favorite summer resort; the beautiful bay of the latter, with its fine sands, being well adapted for bathing. In the autumn and winter the temperature is equable; whilst the air is so pure that it is suitable for invalids from various diseases. Indeed, so healthy is the climate supposed to be, that Dr. Arbuth- NOT is reported to have jocosely said, — "A physician could neither live nor die at Weymouth." As it is the nearest English port to Guern^y, seventy miles distant, it forms a station of the mailboats.
436. Devonshire and Gornwall.
BuDLEiGH Salterton. — A quict retired village, nearly five miles to the east of Exmouth, in a small open valley on the sea-shore. For invalids who can climb the neighboring hills it offers a mild and protected winter residence.
Dawlish. — Resorted to in summer for bathing, Dawlish may be recom- mended as a winter resort for those needing a mild air. It is more humid than Torquay. Protected from northerly and southwesterly gales, it is still unfavorable in the spring, owing to the biting east wind which finds access to the picturesque valley on either side of which this small town is placed.
Exmouth. — The new portion of this town stands high, and is much ex- posed to wind from every quarter. The old part lies along the margin of the river and the base of Beacon Hill, and is damp ; though it has the ad- vantage of being protected from southwesterly and northerly gales. Invalids who require a bracing air may be benefited here ; but the cold variable weather in winter makes it unsuitable for those with pulmonary complaints.
Salcombe. — Well sheltered, this is said to be the warmest spot on the southwest coast. For such as seek a mild and equable winter temperature this small spot would be useful were it not for the want of convenient ground for exercise.
SiDMOUTH. — Recommended in summer and autumn for its bathing. Sid- moutb is also a good situation for invalids requiring a mild relaxing air during winter. 'I'he mean annual temperature is 50.2^ ; that of winter being 41.9, of spring 47.5, of summer 59.9, and of autumn 51.6. — The annual average rainfall is 27.9 inches, the average number of days on which rain falls in the year being 141. During the years 1865 and 1866 the 25
386 APPENDIX OF FORMULA.
returns show a much increased rainfall. The soil of the town is gravel on red sandstone ; the ground dries quickly after rain, so that the invalid can usually walk out on the Esplanade within half an hour of a heavy shower. The water supply is good.
Teignmouth. — The mean winter temperature is six degrees higher than that of London, while that of summer is five degrees lower. On account of its exposed position it is not suitable as a winter home for the sick.
Torquay. — The climate of this favorite locality, while mild and equable, is less humid than that of many other places on the southwest coast. It has a southern aspect, and is sheltered on all other sides by heights. Mean annual temperature 52.1°; the average for the winter being 44.0, spring 50.0, summer 61.2, and for the autumn 53.1. The average annual amount of rain is 35.20 inches, and it falls on about 175 days in the year. The season is from September to May ; and though it is not absolutely necessary for the invalid to leave during summer, yet it will be better for him to do so. November is generally very fine, being bright and sunny.
Torquay is useful in many cases of phthisis, chronic bronchitis, laryngeal affections, and rheumatism. In heart disease, when this organ is oppressed without much lowering of the vital powers; in inflammatory dyspepsia, with an over-irritable condition of the mucous membranes genei'ally ; and for in- valids returning from tropical climates, — this town may be recommended.
The climate has a soothing influence upon the organs of respiration ; but the effect upon the nervous, digestive, and muscular systems varies according to the situation which the invalid adopts for his residence. Dr. Radclyffe Hall recommends a feverish excitable consumptive patient to lodge in a sheltered part close to the sea, provided sea air does not disagree. When the feveristiness is less marked, and there is danger from a sinking of the powers of life, a situation part way up the hills suits better ; or the beautiful district of Meadfoot protected from the east and northeast by an extensive range of cliff, may be selected if close proximity to the sea be desirable. After a residence at the sea-level for a time, removal to the houses on the southern faces of the hills often proves useful.
Ilfracombe. — The fine and bold scenery of this town has attracted the attention of tourists during late years. Situated on the southern shore of the Bristol Channel, surrounded on three sides by the sea, Ilfracombe can be recommended to invalids who require a bracing air. The summers are comparatively cool; while the winters are warm and dry, but invigorating. Convalescents from tropical diseases often derive great good from wintering at Ilfracombe.
Exeter. — This fine old city, though standing upon elevated ground, is sheltered. Except during July and August (when it is close and relaxing) it offers an advantageous residence for invalids requiring a residence away from the sea. Its mean temperature in winter is 41 4°, spring 49.5, summer 62.0, and autumn 51.9. The avei-age number of days on which rain falls in the year is 162, the annual amount being 31.90 inches.
Other neighboring inland towns of Devonshire are agreeable and healthy :
KiNGSBRIDGE, ToTNES, NeWTON, AbBOT, TiVERTON, CrEDITON, CuLLOMPTON,
Ottery, Honiton, etc. Of the moor towns it need only be said the air is moist and misty. Dartmoor is bleak and chilly, the mornings and evenings even of summer being cold.
Penzance. — This seaport, on the northwest side of Mount's Bay in Corn- wall, is about ten miles from the Land's End. The climate is mild, but relaxing. It has a mean annual temperature of 51.8°; the mean for the winter being 44.0, for the spring 49.6, for the summer 60.2, and for the
CLIMATES FOR INVALIDS. 387
autumn 53.3. As a winter residence for invalids it possesses the twofold advantages of warmth, and great steadiness of temperature during the day • and night. The disadvantages are that it is much exposed to wind and storm, and that it is humid — the annual rainfall being 44.6 inches. It should be avoided in the spring.
Penzance may be useful in chronic bronchitis, in the earliest stage of consumption if there be a dry harsh cough with scanty evaporation, and in the case of aged invalids who derive benefit from a warm moist atmosphere. It is injurious in phthisis with relaxation of the mucous membranes and copious secretion, in cases of hemorrhage, in atonic dyspepsia, and in debility of a low nervous type.
Land's End. — The climate somewhat resembles that of South Devon, but as regards humidity and exposure to winds it is inferior to it. Invalids should not remain in this district during the winter and spring.
437. Gloucestershire and Worcestershire.
Bristol. — This city, situated chiefly in Gloucestershire, but partly in Somersetshire, has nothing to recommend it to an invalid. A few years since, a gentleman, who assured the Author that he always suffered either from gout or asthma, remarked that in Bristol he was generally afflicted with the former, but never with the latter ; though directly he left this spot his breathing became impeded. Of the two evils he preferred a smoky city with gout, to pure country air with asthma.
Clifton. — Clifton is built on the sides and summit of a precipitous lime- stone hill, about one mile west of Bristol. In former days invalids resorted to this spot on account of its hot well : now it is in repute for its mild winter climate. The mean temperature for the year is 51.26^; that for the winter being 39.91, spring 49.79, summer 63.87, and autumn 51.49. The annual rainfall is 32.56 inches; and the number of rainy days about 169. 1'he lower part of the town is much milder and more humid than the upper ; and hence while preferable during winter for many cases, is too relaxing in the summer. The loftier situations (such as York Crescent, with its southern aspect and sheltered sunny promenade) are beautifuly situated and well adapted for invalids during the summer and autumn months.
The Hot Well lies at the foot of St. Vincent's Rock. It yields an abundant supply of water at about 75° F., containing small quantities of magnesia and lime, with an unusual amount of carbonic acid gas. Owing to the latter, it might perhaps be advantageously taken in dyspepsia with irritability of the gastric mucous membrane ; but it is very rarely, if ever, employed medicinally.
Malvern. — Perhaps there are few more healthy and pleasant spots in the kingdom for a summer residence than this. Built on the declivity of the Malvern hills, situated eight miles S. S.W. of Worcester, the scenery is all that can delight the convalescent, or the man who is broken down from overwork. The air is pure and invigorating ; and is well adapted for bracing the system of such invalids as can bear an elevated site. Owing to the eastern aspect of the village, the strong winds of the winter and spring are severely felt.
There are two springs in the neighborhood, which may be frequented for amusement. But the waters of St. Anne's Well and of the Holy Well are only pure and soft; the very small quantities of muriate of lime, sulphate of soda, and carbonate of lime which they contain, being useless in a medical point of view.
388 APPENDIX OF FOKMULiE.
438. Lancashire and Yorkshire.
SouTHPORT. — Situated on the west coast of Lancashire, between the " mouths of the Mersey and the Ribble, this watering-place is eighteen miles from Liverpool and thirty-two from Manchester. The climate is bracing and sedative, the air dry but not irritating, fogs are very rare, and the atmosphere is light and pure. The temperature is variable, changes occur rapidly, while the mean for the year is 54°. The sea-bathing is good at low water, the shore sandy, the water clear and pure, and the bay so well sheltered that it is seldom too rough.
As a summer and autumnal residen-ce Southport is useful in laryngeal, bronchial, and pulmonary affections ; in tuberculosis ; in dyspepsia with constipation and flatulence ; in chronic rheumatism ; in some forms of paralysis ; and in nervous depression after long illness.
Grange in Cartmel. — At the head of Morecambe Bay, sheltered by the hills of the lake district of Cumberland and Westmoreland, it preserves an equable climate, more mild than would be expected so far north. It may be resorted to early in spring and in autumn as well as throughout the summer, and makes a good northern winter residence for invalids. The scenery in the immediate neighborhood is extremely pretty, and Winder- mere is within reach by a drive.
Scarborough. — Built on the slopes of a beautiful bay on the Yorkshire coast, in the form of an amphitheatre, this town is resorted to in the sum- mer for its sea-bathing. The season extends from June to October. It is suitable for nervous and hypochondriacal patients, for such as have been overworked and need change of scene and amusement, and for convalescents requiring a bracing air.
Close together at the Spa there are two mineral wells, — the North or chalybeate, and the South or saline spring. There is not much difference, however, between their waters; those of both being mildly aperient, alter- ative, and slightly tonic. 'J'heir temperature is about 49° ; and they yield nitrogen gas, carbonate of iron, chloride of sodium, sulphate of magnesia (most abundant in the South spring), sulphate of lime, and bicarbonate of lime. These waters may perhaps be useful in habitual constipation, dys- pepsia, torpidity of the liver, and scrofulous complaints.
Filey, seven or eight miles to the south of Scarborough, has many of the advantages of the latter, with the additional one for the invalid ol quiet and retirement — not to say dulness. To the north is the ridge of rocks known as " Filey Brig ;" while to the south are magnificent lofty cliffs, with Flamborough Head. The sands extend for some miles. At the top of the cliff, on the north side of the town, there is a saline chaly- beate spring.
Whitby. — The air of this seaport town is bracing and pure, the sands are extensive and afford good bathing, while there is a chalybeate spring which is thought well of for its mild tonic properties. The country round Whitby offers beautiful rides and walks. As at Filey, the season extends from the beginning of June until the end of September.
Eedcar. — This is still further north than Whitby, and enjoys locally the reputation of being the most bracing place on the Yorkshire coast. The surrounding country is beautiful.
439. Wales.
Llandcdno. — Situated in Caernarvonshire, in the most attractive part of North Wales, this watering-place has risen rapidly into favor during the
CLIMATES FOR INVALIDS. 389
Ittst few years. It is often called the Welsh Brighton. The town Hps between two bays — Conway and Llandudno. It is sheltered from the N.W. and E. by the Great and Little Orrae's Head, huge masses of limestone rock which rise precipitously from the sea for many hundred feet. In summer the invalid will find a residence on the flat facing Llandudno Bay most suitable. The beach is of sand ; the bathing is good. For winter, the houses under the cliffs are to be chosen, owing to their sheltered posi- tion. The winter climate is comparatively mild.
The geologist will find beautiful and delicate fossils on the Orme's Head (Encrinites of many species, Brachiopodous and Lamellibranchiate shells, as well as several species of Gasteropoda) ; while the botanist will be delighted with the many uncommon plants to be seen in the neighborhood. Only four miles distant is Conway, with its most picturesque Castle.
Pknmaenmawr — situated at the foot of the mountain of the same name on the north coast near the entrance of the Menai Straits — is more quiet than Llandudno, and is preferable to it on many accounts in summer. The bathing here is good, and there are numerous walks and drives in the neighborhood.
Barmouth, on the west coast, has a mild and sedative climate. The bathing is not good, on account of the flatness of the sands, but it affords some of the most charming walks and drives to be met with even in Wales.
Tenby. — This is the most fashionable bathing place in South Wales. Placed on the Pembrokeshire shore of Caermarthen Bay, the scenery of the neighboring country is attractive and beautiful. The sands are smooth and good. The season lasts from June until the end of October. Invalids, however, can often stay with advantage during the winter ; the atmosphere being then usually mild and spring-like, while accommodation can be obtained at moderate prices. There are not many days during the winter months when the invalid will be unable to take exercise in the open air.
The number and beauty of the Actiniae and other zoophytes to be found at Tenby have been made known to all lovers of natural history by Mr. Gosse. There are few places which can compare with it for the seaside naturalist. Moreover, the botanist, geologist, and antiquarian will all find occupation in their favorite studies.
440. Ireland.
Kingstown. — This is one of the best frequented sea-bathing places in Ireland. Situated about seven miles southeast of Dublin, on the southern shore of the bay, the harbor is said to be one of the most splendid artificial ports in the United Kingdom. There are good walks in the surrounding country.
The sharp and bracing air of Kingstown proves injurious, during the latter part of the winter and the early spring months, to patients with dis- ease of the lungs.
HoLYWOoD. — A small watering place much used by the residents of Bel- fast, from which city it is about five miles distant. The beach is sandy, and good for bathing. There are chalybeate springs in the vicinity.
QuEENSTOWN (Covc). — A town which consists of a series of terraces, built on the southern acclivity of Cove island, in Cork harbor. It is well shel- tered from northerly winds ; is exposed to the full influences of the sun ; and the winter climate is admirable, being mild and equable. The mean temperature for the year is 51.9°; that for the winter being 44.1, spring 50.1, summer 61.3, and autumn 52.0. The annual rainfall is 33.22 inches; and the average number of days on which there is wet being 131. The
390 APPENDIX OF FORMULA.
invalid should settle here about the end of October ; and he will scarcely have a day during the ensuing four or five months when he will be unable to take exercise in the open air. Owing to the way in which the houses are built, at a variety of elevations, the exact locality chosen must depend upon the patient's malady and strength.
All diseases needing a sedative and slightly humid atmosphere may de- rive benefit at Queenstown. Laryngeal, bronchial, and pulmonary com- plaints are especially relieved by a winter residence here ; and so also are dyspeptic, strumous, rheumatic, and cutaneous affections. It is admirably suited for delicate children ; and for convalescents from hooping cough, eruptive fevei's, etc. Functional disorders of the uterine system are often cured by it. In the summer there is excellent sea-bathing. — Passage and MoxKSTOWN are very healthy villages, situated on the river, about half-way between Queenstown and the city of Cork.
441, Scotland.
The climate of Scotland is remarkably equable throughout the year ; the summer heat and winter cold being mitigated by the ocean winds. The mean temperature for the year is about 47° ; that for the northern counties being higher than for the eastern. The prevailing winds are from a westerly quarter; blowing for more than two-thirds of the year from be- tween the southwest and northwest points. In spring and early summer cold east winds prevail. The atmosphere is moist, nearly 100 inches of rain falling annually in some of the mountainous parts ; though along the southern shores of the Firth of Forth the amount is under 30, at Glasgow about 29, and at Musselburgh not more than 24 inches.
The air of Edinbuegh, though neither genial nor mild, is yet salubrious; and is said to be favorable to longevity, as well as to the development of the mental and physical powers. The city extends northwards to the shores of the Firth of Forth ; Granton and the old fishing village of New- haven being only separated from the town by a pleasant walk. The ele- vated situation of the city renders it exposed to violent winds ; but the effect of these is favorable, at all events to the inhabitants of the Old Town, by driving away many impui-ities. As a place of education for youths needing a bracing climate Edinburgh has great advantages.
The old city of St. Andrews, situated on a rocky promontory some fifty feet above the level of the sea, has a wholesome genial climate. It should be avoided in the spring months, as it is then visited by a disagreeable chilly mist from the northeast ; but from July until the end of October the air is pleasant and salubrious. Sufferers from rheumatism, or invalids with weak lungs, had better not remain long in this city. The rate of mortality among the residents is somewhat high.
On the western coast there are several localities which seem to possess good winter climates for invalids. The island of Bute, in the Firth of Clyde, has many advantages ; the air being mild and equable, though rather humid. Its mean temperature for the year is 48.25°; that for winter being 39.62, spring 46.66, summer 58.06, and autumn 48.59. The annual rainfall is 38.62 inches ; there being more or less wet on about 150 days. Snow rarely falls in the winter, and there is a freedom from fogs. The island is protected from the east winds of spi'ing ; and there are great opportunities for outdoor exercise. The climate being rather sedative, invalids needing a strong bracing air must seek it elsewhere.
Hypochondi'iacs, sufferers from habitual constipation or sluggish action of the liver, and young men, with a predisposition to phthisis, are often much benefited by a summer or autumnal walk through the Highlands ; and cer-
CLIMATES FOR INVALIDS. 391
tainly for the overworked literary or professional laborer nothing can be more invigorating than such a tour. " I verily believe that I should die," said Walter Scott, " if I did not see the heather every year."
442. The Channel Islands.
All the Channel Islands are remarkable for their beautiful and varied scenery, for the temptations they offer to the zoologist and botanist, the mildness and humidity of their climates, the absence of great heat in summer and great cold in winter, and for the equability and duration of autumn. The east, northeast, and north winds which prevail in the spring, are disagreeable and injurious.
The climate of the Channel Islands is generally favorable in chronic disease, in asthma, in bronchial and intestinal disorders, and in affections of the urinary organs ; while it is also suitable for convalescents from acute inflammations of the organs of respiration. The old and the young also are benefited by it: to them the effect is tonic and regenerating. Invalids from India and Australia may winter in these islands with advantage. They ai'e unfavorable in chronic rheumatism, hepatic disorders, structural diseases of the uterus or ovaries, nervous dyspepsia, hypochondriasis, and in cases where there is a tendency to dropsy or hemorrhage. Pulmonary consumption appears to be as common and fatal among the inhabitants as in most other localities. — The most favorable time for a stay in either of the group is from August until the beginning of February. In some in- stances, a change for a time, from one island to another, is productive of good.
These islands may be reached by steamers from Southampton or Wey- mouth in less than twelve hours. Invalids, especially ladies and children, should choose their day of sailing so as to avoid a rough passage across the English Channel ; and so that they may not have to land in small boats. The packets can generally enter the harbor of St. Peter's Port in Guernsey, and that of St. Helier's in Jersey, except near low water on a receding tide.
Guernsey, the most westerly and exposed of the islands, has an average annual temperature of 51.50°; that for winter being 44.2, spring, 47.7, summer 59.9, and autumn 53.8. Sea fogs are rare, except in the early part of the day in spring and autumn. The air is relaxing. The mean annual rainfall is rather more than 35 inches, falling in heavy showers on about 164 days, and more often in night than day. Percolation takes place rapidly through the gravelly soil ; evaporation is also favored by the brisk wind and sunshine. The walks are too hilly for most invalids. Guernsey is thirty miles from Jersey.
Jersey is the largest of the group of islands, and the most important ; being about twelve miles long, with an average breadth of five miles. The surface of hill and dale is well wooded ; the coast is rocky and precipitous ; and it is exposed to the wind from every quarter. The mean yearly tem- perature is the same as for Guernsey ; during three quarters of the year the average being higher, while it is lower in the winter. Nevertheless the latter is mild, frost and snow being very rare. The daily range of the ther- mometer is small, though it is greater than in Guernsey. St. Helier's contains nearly half the population of the island ; but it is more foggy and humid, and therefore less suited for invalids than St. Aubin's, which lies three miles to the southwest of it. The sands are good for summer bathing.
The air of Alderney and Sark is usually said to be drier and more bracing than that of Guernsey ; while that of the latter is less relaxing than that of Jersey.
392 APPENDIX OF FORMULA.
443. South of France.
Pau. — This, the chief town of the department of the Basses Pyrenees, is about 125 miles south of Bordeaux and 56 miles east of Bayonne. It may be reached from London in 48 hours ; and the season lasts from the beginning of November until the end of May. The mean annual tempera- ture is about 56°. The average for September, October, and November is 56.4 ; that for December, January, and February 42.8 ; while for March, April, and May it is 54.0. The annual rainfall is about 43 inches, the rainy days numbering 119. Owing to the gravelly soil any quantity of moisture is rapidly absorbed. Dr. Playfair, quoted by Sir James Clark, sums up the nature of the climate, thus : — " Calmness, moderate cold, bright sun- shine of considerable power, a dry state of atmosphere and of the soil, the rains of short dviration. Against these must be placed, — changeableness, the fine weather being as short-lived as the bad, rapid variations of tempe- rature, within moderate limits. In autumn and spring there are heavy rains." The air in December, January, and February is dry, and out of the sun, cold ; but even in these months the rays of the latter are so power- ful that the pedestrian ought to protect his head with an umbrella. There are very few days on which the invalid will be unable to take exercise be- tween 12 and 3 o'clock. The evenings, however, are chilly, and the nights cold.
Pau is not influenced by the west-northwest wind, the Circms of the ancients ; nor by the north wind or Bise which produces a biting cold ; nor by the northwest wind or Mistral : in fact the climate is calm and soothing, high winds being rare. According to some physicians Pau is useful in cases with a scrofulous taint, in preventing generation of tubercle, and in checking softening of tubercle when formed. Dr. Taylor states, that the predisposition to disease favorably influenced by this town, may be sum- med up in one general principle — viz., wherever it depends upon increased nervous and arterial action, permanently produced, either by temperament or by some cause leading to more active disease.
The climate is sedative (not to say depressing), modifying nervous and vascular irritation ; and therefore beneficial in irritations of the mucous membranes of the air-passages or alimentary canal. — It is unsuitable where the powers of life are declining ; in chronic catarrh or bronchitis of old people, with loss of tone and excessive expectoration ; in chronic rheuma- tism or gout, with debility of digestive organs; in tendency to apoplexy from passive congestion ; in chlorosis ; and in disorders attended with con- gestion of the venous system and diminished nervous energy. In all these cases the climate of Mentone (from the commencement of November until the end of February) is the remedy. In short, Pau is to be chosen when there is " functional derangement of a tonic irritable type, which paves the way to organic mischief." Acting on persons in health the air lowers the tone ; makes the sanguine, phlegmatic ; and the choleric, melancholic.
Biarritz. — A fashionable sea-bathing village on the shores of the Bay of Biscay, some 5 miles southwest of Bayonne, and 65 miles from Pau. The roads between the two places are excellent, and communication by diligence or omnibus very easy. It can be reached from London in about 48 hours. The air is warm ; the temperature of the sea high ; and there is always a soft invigorating sea breeze. When benefit has been derived from a winter at Pau, it is often advisable for the patient to go to Biarritz for the summer ; returning to Pau for a second winter. The sandy gently- shelving beach is well adapted for bathing ; which is no slight luxury in water at a temperature of 75° Fahr.
According to Dr. Henry Bennet, the climate not only renders Biarritz a favorite summer and autumn watering-place, but puts it among the eligi-
CLIMATES FOR INVALIDS. 393
ble winter stations of the south. It is cheaper also in winter than summer, being- then almost deserted by fashionable visitors. In cases of severe dis- ease it is not equal to Pau, Ajaccio, or Mentone, the winter breezes from the Bay of Biscay being often very violent.
MoNTPEixiER. — The reputation which this city formerly enjoyed as a winter residence for consumptive patients has entirely gone. The climate is dry, irritating, and changeable ; and though the heat of the sun is great, yet the winter winds are cold and unbearable. Mean temperature of the year 59.5° ; winter 44.2, and summer 76. Phthisis is very prevalent amongst the native population. Invalids with relaxed mucous membranes and copious secretions, sometimes find advantage from spending the autumn here.
Marseilles. — This city, second only in importance to -Paris, offers no residence for the invalid. Pulmonai'y consumption annually 'destroys a large number of young women and men. Catarrhs, pleurisy, and pneumonia are common ; and so are cutaneous affections, diseases of the generative organs, and cancer.
Mean annual temperature 58.32°; winter 45.22, spring 55.91, summer 72.93, and autumn 59.21. Although these figures are high, yet the winter is sharp and cold, the winds being high and prevalent — especially the mistral (northwest). In spring, the variations in temperature are sudden and dan- gerous, and there is much rain. During summer the heat and dust and insects are intolerable.
Hyeres. — This little town is agreeably situated, about two miles from the shores of the Mediterranean, and an hour and a half's drive from Toulon. The climate is clear, pure, dry, and tolerably mild. The greater portion of the town is sheltered from north and east winds ; while it is open to the south, benefiting by the influence of the sun and sea-breezes. But it is exposed to the mistral, as there are no protecting hills on the northwest ; and this blows frequently during the first three months of the year. It has been thought one of the best localities in the South of France for the winter abode of invalids with pulmonary disease, as there is much fine weather, without great variations in temperature. The mornings and evenings, how- ever, are cold ; and hence, remembering too the prevalent winds, it should not be recommended. In summer the heat and dust prove very annoying. The best season is during April and May, or from the beginning of Septem- ber to the end of November.
Cannes. — An agreeable seaport, on the shore of a small bay, well pro- tected from cold winds. It has a climate more moist and sedative than Nice, and less so than Pau. The lower parts of the town should be avoided, as the drainage is bad. The overworked man of business, seeking fre.'-h air, genial sunshine, and a locality possessing a combination of fine sea and mountainous scenery, may advantageously winter here. Cases of nervous dyspepsia are particularly benefited, and so are some forms of phthisis.
In the summer Cannes is resorted to for sea-bathing, the extensive sands being well adapted for this purpose. Sand baths are sometimes used for the relief of rheumatic and paralytic affections of the limbs ; the patients being immersed up to the chest in sand warmed by the sun. Like mud baths they may serve to amuse the invalid, while he is breathing pure air and living by rule.
Nice. — The reputation long enjoyed by Nice for salubrity, has been found to have been greatly overrated. Protected towards the interior by the Maritime Alps and the Estrelles, cooled by the breezes of the Mediterranean, and with a mild dry climate, it would seem to be a favorable locality for phthisical patients. But notwithstanding these advantages the valley is exposed, during winter and spring, to cold irritating winds from the east
394 APPENDIX OF FORMULA.
and northeast; and the Nisands then suffer much from catarrh, ophthalmia, skin eruptions, pneumonia, and irritable gastric affections. — The mean tem- perature for the year is 59.01°; for winter 46.33. spring 5.5.92, summer 71.83, and autumn 61.52. The variations between the warmth of night and day, of sun and shade, are remarkable. The annual rainfall is about 26 inches ; most falling in October and November, leaving the other winter and spring months comparatively dry.
M. Carrteee has compared the valley in which Nice is situated to an open fan, the arch of which is formed by the mountains, and the point by the shore, where the Var discharges itself into the sea. But the mountainous semicircle is indented in parts, and down these interruptions the winds blow from certain points, and injuriously affect consumptives. — The mistral is " the scourge of the Mediterranean shores of France and Sardinia." It may continue one, three, seven or more days at a time ; in autumn and winter it blows frequently, and hence it is absurd for invalids requiring a mild temperature and calm atmosphere to winter at Nice. The southeast wind, or sirocco, so injurious on the continent of Italy, becomes changed into a mild beneficial breeze during its transit across the Mediterranean to Nice ; and hence it modifies winter cold, and summer heat and dryness. La Croix de Ifarbre, the suburb of Nice inhabited by the English, is most unfavorable for pulmonary invalids ; being exposed to the libeccio (a relax- ing southeast wind), and to the blighting influence of the mistral. The invalid if he will go to Nice should live at the foot of the heights, in one of the shady valleys open to the south. The brilliant sun entices him out of doors, and then the blighting piercing wind attacks him, and clings around him ; no furs, no heavy cloak, no flannel will keep out the cold. He ought not to venture into the open air too early in the day, nor should he remain there latter than one hour before sunset. The bills of mortality of the Nisands give one-seventh of the deaths as from phthisis. That "Nice is one of the last places to' which a foreigner laboring under tubercular phthisis should resort," is the opinion of Dr. Burgess. It is also unfavorable for nervous and susceptible invalids. The air may sometimes be beneficial in chronic rheumatism and gout ; in all uterine derangements connected with a relapsed and torpid state of the system ; for delicate children of a strumous habit; and for invalids returning from tropical climes. The stay should extend from the middle of October until the beginning or middle of January; for, although the season lasts until the end of April, yet the invalid will seldom derive benefit from prolonging his residence beyond January. The Author has been told that there are well-conducted Pensions both at Nice and Cannes, which are preferable to the hotels as being more quiet and homelike.
Villa Franca. — This little town, a short distance from Nice, has a climate somewhat warmer and drier, and is less exposed to the north and northwest winds. The vegetation is luxuriant and early.
Mentone. — Lately a small Italian town, but annexed to France in 1860, Mentone offers one of the most sheltered stations in the south of Europe. It is situated on the northern shore of the Mediterranean, at the foot of the Maritime Alps, and twelve or thirteen miles to the east of Nice on the road to Genoa. The bay, in the centre of which the town is placed, is completely protected from the north, northwest or mistral, and northeast winds by the mountains ; while owing to the absence of fogs, the paucity of rain, and the great power of the sun, the air is very pleasant during the winter months. The mean temperature is a little higher than that of Nice. The night temperature is also mild, and not subject to great variations ; so that many invalids are able to keep the air of their bedrooms pure by sleeping with the windows slightly open.
From the beginning of November until the end of April the climate is
CLIMATES FOR INVALIDS. 395
genial and bracing. The invalid must not remain during the summer. A residence here is very useful in phthisis, when the disease has not passed beyond the first stage ; and even when it has reached the second or third, provided the tubercular deposit be limited to a part of one lung. It is also beneficial in chronic cases gf consumption ; chronic bronchitis ; and chronic gout and rheumatism. Strumous children improve remarkably. Some who visit Mentone prefer the eastern bay, some the western ; but whichever be chosen, care must be taken to select rooms having a south aspect, and with the bedroom not on the ground floor. According to Dr. Henry Bennet pulmonary consumption is a rare malady among the native population ; the deaths from it being only 1 in 55, instead of 1 in 5 as in London and Paris. For the sake of those who are not overburdened with wealth, it may be as well to remember that Nice and Mentone are both extravagant places, while San Kemo is much cheaper, and the air is just as good during the winter. Moreover, twelve miles east of Mentone and seven miles west of San Remo lies Bordighera. It faces the south, in a fine bay protected from the due east and west winds by ranges of hills. The air is mild and exhila- rating. The walks are good, being well protected from dust and wind. The palm, olive, orange, and lemon all flourish on the hill, nearest the town. And lastly, the pleasure of staying at San Remo, or at Bordighera will be enhanced by reading a very charming tale — Doctor Antonio.
444. Corsica.
This island, one of the most important in the Mediterranean, has shores mostly low, while the centre is mountainous. Corsica is healthier than the Riviera, and its air is more genial. The olive is indigenous. The scenery is grand. Within a few hours' drive of Ajaccio are several villages in the hills {Orezza with chalybeate springs, Guagno with sulphur springs, etc.), where invalids might reside during the sunmier after having wintered in Ajaccio. This clean and cheerful little town, on the west coast, is said to be especially charming during the months of January and February. The gulf of Ajaccio offers an excellent harbor for yachts ; while it is protected from all winds but the southwest, by its semicircle of grand mountains in the distance. The sandy shore with beautiful rocks, is greatly to be pre- ferred to the shingly beach at Nice. The climate is as warm as that of Nice, and it is unexceptionally healthy. The air of Ajaccio is more sooth- ing (less stimulating) than that of Mentone, without being relaxing like that of Maderia. Napoleon Bonaparte was born at Ajaccio on 15th August, 1769.
Ajaccio is the only locality in Corsica that appears thoroughly eligible as a winter residence. The climate of Bastia is warm and agreeable ; but the town has a small tideless port, and is exposed both to southeast and northeast winds. Dr. Manfredi, the surgeon of the civil hospital at Bastia, states that nearly all surgical wounds heal at once by first intention, while purulent absorption is almost unknown. Intermittent fever prevails in parts of Corsica towards the end of summer or beginning of autumn. It may be reached from Marseilles by steamer in fourteen or sixteen hours, or from Nice in eight or nine hours, and is thus within about forty-eight hours of London.
445. Spain and Portugal.
Alicante. — Lying along the shores of a bright open bay in the Mediter- ranean, is this healthy town. It is sheltered on the north and northwest sides by a limestone rock some 700 feet high, is free from malaria, and has a mild dry air with comparative immunity from high winds. The mean
396 APPENDIX OF FORMULAE.
annual temperature is 63.7° that for winter being 52.1. The rainfall is very moderate. In summer the calm open sea, and sandy beach, afford good bathing. In winter, whatever may be the temperature of the morning air, the middle and after part of the day will generally be mild and calm.
As a winter residence it may be recommended- to such as need a dry and somewhat stimulating climate. It has been found useful in chronic bron- chitis, with excessive secretion ; as well as in atonic dyspepsia.
Barcelona. — This, the chief city of Catalonia and the second in import- ance of Spain, has a mild winter air. It is open to the sea on the south and southwest, and is partially protected from westerly and northerly winds by the hills at the back. The mean annual temperature is 63.14°, that of winter being 50.18, while there is rain on some 69 days in the year. In- valids requiring a rather stimulating and dry climate may reside here, but it cannot be strongly recommended. April and May are the most uncertain months.
Cadiz. — The semi-insular position of this commercial town, on the shores of the Atlantic, would seem to point it out as a suitable winter residence for those requiring sea air. The climate is soft, humid, and relaxing; the winters are mild and the summer temperate ; the weather is showery, espe- cially in winter and autumn, but the soil being porous, it soon dries ; and there are few days during winter on which exercise cannot be taken in the open air. The mean annual temperature is 62.7.5°; that for winter being 52.80. though very often at this season the thermometer, in the shade, will stand at above 60. Rain falls on about 100 days in the year ; but it gene- rally comes in showers, with intervals of sunshine.
This town may be recommended for some irritable affections of the chesty and in certain cases of heart disease. Women with any tendency to ovarian or uterine disorders should avoid Cadiz. The stranger will find it best to reside in the central portion of the town, — as on the suimy side of the square of General Mina or San Antonio, or in one of the lesser plazas. The wall (Muralla del Mar) which nearly surrounds the town has on its summit an agreeable walk.
Madrid. — The capital of Spain, situated nearly in the centre of the Peninsula, is perhaps an attractive city for the tourist; but the irritating and stimulating character of the climate renders it an unfavorable one for the English invalid. The mean annual temperature is 57° ; but the range is so great that Dr. Francis has observed a thermometer pointing to below freezing a little after sunrise, stand at 106 at 3 o'clock P. M. — The winters are raw and long, with hard frosts and piei'cing cold winds : in summer the heat is irritating and oppressive, so that even the Spaniards cannot stand it. — " The subtle air," saj's Ford in his Handbook, " which will not extin- guish a candle, puts out a man's life. ***** No wonder, accord- ing to Salas, that even the healthy of those born there live on physic."
Malaga. — Dr. Francis speaks very highly of Malaga, which, indeed, seems to be the El Dorado of cities ; for he asserts that there is no place in Spain, nor in the whole of Europe, as far as our present information goes, that possesses a climate at once so mild and equable, with so little variation from day to day. This seaport city is situated on the shores of a bay of the Mediterranean, 65 miles east-northeast from Gibraltar. The mean annual temperature is 66.11°, that of winter being 54.41 ; the heat of January corresponding with that of May in London. The air is neither too moist, nor too dry : and a lofty mountain range forms a protecting background to the winter winds. The annual rainfall is said to be only 16|- inches.
The longevity of the people is remarkable ; persons aged from 80 to 90 being seen going about the streets in full possession of all their faculties. Though the ratio of mortality is one in 37, yet it must be remembered that
CLIMATES FOR INVALIDS. 397
this is larger than it would otherwise be, not only from the excessive mortality in early life (42.3 per cent, during the first five years), owing to the mothers not nursing their infants, but likewise from the presence in the town of a large garrison and a crowded convict establishment. The principal drawback seems to be the terral, a cold 'harsh wind from the northwest, which occasionally blows during the winter with great force. It causes restlessness and oppression at the chest, where thei'e is any pul- monary affection. The air is also unfavorable in cases of disease of the nervous centres.
The invalid who requires a warm, dry, and gently tonic climate, with constant sunshine, may well visit Malaga for the winter. A residence here is especially useful when phthisis seems to threaten, or even when it is present in an early stage. He should live in the newer part of the town, where the soil is sandy, and through the centre of which runs the Alameda, a fine broad promenade bordered by cheerful well-ventilated houses. The Spanish custom of taking a siesta in the middle of the day ought to be adopted. There is regular steam communication with Liverpool, the voyage lasting seven or eight days.
Valencia. — This city, built upon the great plain of Valencia, is about three miles from the sea. It may be reached in seven days from England, by way of Marseilles. — The town is very clean, the climate unusually dry, though the water evaporated by the system of irrigation pursued impreg- nates the air with moisture ; there are no cold fogs ; the wind is soft and mild during winter, in summer refreshingly cool ; and the mean annual temperature is 63.5°, that of winter being 49.7. The cold is often appre- ciable in early morning and after sunset during winter, but it is warm by midday. 'J'he springtime is the best — from the middle of February till the beginning of May: autumn is to be avoided, owing to the miasmata from the rice plantations. — Consumption is not uncommon among the poor ; but then in no part of Spain does the laborer work harder, or subsist on a more meagi'e diet.
Useful for the overworked man of business, semi-invalids, and hypo- chondriacs, individuals with impaired health but no organic disease, gout and rheumatism, calculous affections, albuminuria, and nervous dyspepsia. There are several towns within easy reach of Valencia where the invalid may go for a short stay, — such as Alcira, Carcajente, Jativa, San Felipe, etc.
Seville. — The famous capital of Andalusia, and the city of Figaro, possesses a soft and tonic climate. It may be visited by the hypochon- driac, by convalescents ft-om lingering disease, etc. ; or the invalid who has wintered in Malaga might advantageously stay here during May. The best part of the year is from November to March. There is con- siderable rain in October, November, and April. Occasionally during the summer the sultry and irritating levante or east wind prevails, giving rise to fever, ophthalmia, mental irritability, and neuralgic affections.
Aranjdez. — Situated 24 miles south of Madrid, on the left bank of the Tagus. The season consists of April and May, during which months the climate is soft and most agreeable. The water of the town contains a little sulphate of soda, and hence it sometimes proves aperient if taken largely.
Lisbon. — The capital of Portugal has a dry and bracing climate ; though the changes from sunshine to rain, from heat to cold, are sudden and re- markable. Hence it is not to be recommended for pulmonary invalids; while, moreover, phthisis is very prevalent among the inhabitants.
The mean annual temperature is about 62.00° ; that for winter being 52.52, spring 59.66, summer 70.94, and autumn 62.48. The annual rain-
398 APPENDIX OF FOEMULiE.
fall is 23 inches, most wet days occurring in winter. The predominating winds are those from northeast to southeast, and to them is due the cold of winter.
Dr. Francis says that the best situation for an invalid who wishes to pass the winter in Lisbon is the upper part of the Yal de Pereiro, a con- tinuation of the valley in which the new part of the town and the public gardens lie. " Here, upon the southern slope of the hill, are a few villas in the midst of orange gardens, which are well sheltered, and afford choice views over the town and river. Those who prefer a country residence may select the neighborhood of Bemjica, a village on the Cintra road, about a league from Lisbon. This place is in high reputation, among the Portuguese physicians, for the purity of the air, and it is here they send their convalescents."
Cintra. — A summer residence of the court and wealthy inhabitants of Lisbon, from which it is only sixteen miles distant. Frequent bi'eezes, a humid soil, and an abundance of vegetation render the summer air cool and healthy. The winters are wet and cheerless.
446. Gibraltar.
This strongly fortified portion of the British possessions occupies a mountainous promontory near the southern extremity of Spain, at the entrance of the Mediterranean. The town is built on the western aspect of the rock. It is unsuitable as a residence for invalids. For though the average winter temperature is 57.93°, yet the prevalence of the southeast wind — the levante — renders the locality cold, raw, and very unpleasant. Snow and ice are very rare, but there is considerable rain. The annual rainfall is 43 inches.
447. Italy.
Lago Maggiore. — The largest of the lakes of Northern Italy. Along its shores are small towns resorted to by English invalids in summer. Baveno, Arona, and Sesto are the most frequented. But the climate, though clear and pure, is often marred by the violent thunder-storms which prevail in summer ; there are heavy dews at night, while the neighboring glaciers make it cold when the wind blows from that quarter. The air is injurious to phthisical invalids, but useful in general debility, in dyspepsia, and for such as need a cool tonic atmosphere.
Lake of Como. — Situated to the northeast of Milan, from which it is not far distant. The air is genial and mild, the temperature equable, and the heat not oppressive owing to the alternate play of the tivano or north wind during the night, and the breva or south wind in the day. For ordinary invalids in summer the best situations on the lake are Balhianino, Torno, and Bellagio ; but for the consumptive Varena is more suitable. Cade- nahhia and Tremezzine, on the shore near the middle of the lake, are very beautiful spots ; while, according to Dr. Burgess, Pliniana, the most noted spot along these classic shores, the supposed residence of Pliny, will not yield precedence to either in climate or situation. The cold in the winter is great, especially at the northern extremity of the lake. No part of Italy perhaps is so suitable for the consumptive in summer, as the Lake of Como. That dreaded disease called pellagra, a kind of leprosy, is not uncommonly seen here. From one-third to a fourth of the lunatics in the Lombardy Asylum are suffering from it, for it induces insanity ; while many cases of it, in early stages, are to be found in the hospitals.
CLIMATES FOR INVALIDS. 399
Milan. — This city, the capital of the Lombardo- Venetian kingdom until 18.59, when it was made over to Sardinia, is situated in a fertile plain between the Olona and Saveso Rivers, at an elevation of 394 feet above the Adri- atic. It is indifferently sheltered from the various winds, so that the climate is cold ; snow and rain are frequent during the winter ; while the sudden transitions from humidity to a dry harsh air, render it an unfavorable locality for any but the strong. It is frequented by consumptives going to, or re- turning from the south of Italy ; but the shorter their stay, the better. In 1831, official returns showed that amongst the Milanese alone, 20,000 indi- viduals were attacked by pellagra.
Brescia, Patia, Verona, and Mantua. — The principal towns of Lom- bardy, are all particularly unsuitable for invalids. Agues, fevers, and inflammations are very common. The cold in winter is intense ; the atmos- phere is saturated with moisture ; there are dense clouds and fogs ; there are large quantities of rain, in the form of a fine continuous drizzle; and cold winds are very prevalent, especially in the northeast.
Venice. — This city, the Queen of the Adriatic of the poets, is built on piles, in the midst of a lagoon or large marsh, two miles from the mainland of the Continent. It would seem to be slowly crumbling to decay. The climate is mild and equable ; the air being impregnated M'ith emanations of bromine and iodine. Consumption is prevalent among the inhabitants. Invalids are not attracted to Venice by the climate, however, but by its historical associations, and many sickly persons are to be found on the favor- ite promenade — the Piazza of St. Mark. The mean temperature of winter is about 39° F., of spring 54, summer 73, and autumn 55. Drizzling rain sometimes falls for days together. The result of seven years' observation gave a mean of 5f days of snow in winter. In Venice the dolce far niente practice is fully carried out ; the climate being favorable to indolence and voluptuous ease. Contrary to what might be expected, ague is unknown. The tranquillity which prevails over the city is not unfavorable. As the climate is sedative and lowering, it is not fit for those who are depressed by disease ; and except in the early stage, it is injurious to phthisical patients. It is suitable for such as have a tendency to inflammation, haemoptysis, etc. Invalids may remain here from the close of autumn to the end of spring ; but it is most agreeable in the latter season.
Genoa. — This town, at the head of the Gulf of Genoa, is one of the last places for a consumptive to pass any time at. The vicissitudes of tempera- ture are rapid, and extensive ; there are sudden gusts of wind ; while the biting coldness of the tramontana or north wind, alternating with the warmth and humidity of the sirocco or southeast, the two prevailing winds of Genoa, proves very trying. The best time for a visit to Genoa (not by a consump- tive) is about the autumn or beginning of summer. Pneumonia, haemoptysis, consumption, and catarrh are amongst the most frequent diseases of the inhabitants.
Florence. — Situated on the Arno, a few hours' ride from Pisa, this city may be an agreeable residence for the very strong. But certainly in no part of England could a mere unfavorable climate be found for consump- tives. It is built in a deep ravine, almost surrounded by the Apennines, and intersected by a squalid river. It is one of the stations on the western zone of Italy where it rains the most. Extreme cold in winter, great heat in summer, chilling northerly winds, occasional fogs, violent atmospheric and thermal variations, — these are its chief peculiarities in a sanitary point of view. The nervous excitability of Florentines is explained by the topog- raphy of the city. As the birthplace of Dante and Leonardo da Vinci and Machiavelli, etc., as the scene of Savonarola's preaching and martyrdom,
400 APPENDIX OF FORMULAE.
as well as for its churches and palaces and magaificent works of art, Florence offers many attractions to the tourist.
Pisa. — The dismal aspect of this deserted city surpasses that of any other in Italy. The dreary solitude of the streets causes gloom and melancholy ; while everything seems stricken with decay or death. It is often recom- mended for consumptive invalids ; but the climate is mainly indebted to tradition — being mild, humid, and relaxing. The sky is dull and often murky. Perhaps the high walls around Pisa assist in protecting portions of it from the cold winds, especially the Lung' Arno, or that quarter where the invalids reside. The mean temperatui-e of winter is about 45^, spring 59, summer 74, and autumn 63. The winter is colder than at Rome. The air is moist from the great prevalence of southerly and Mediterranean winds. The climate is very depressing — causing general lassitude while it enervates the faculties. Many foreign invalids die within a few weeks of their arrival. Haemoptysis frequently sets in where there is any tendency to phthisis.
Rome.— Situated on marshy ground at the foot of a range of low hills, about fourteen miles from the sea, and divided by the Tiber into two unequal portions,- Rome has not so much to recommend it to those really in search of health as many other places. The climate is mild, soft, and sedative ; but malarious effluvia, in a greater or less degree, are never absent. The best time in the year is October and the first ten days of November. The mean annual temperature is 60.49° ; that of winter being 46.75, spring ■58.25, summer 74.24, and autumn 62.75. Owing to its exposure to cold winds, the variations in temperature are great and sudden. Northerly winds are common in the morning and evening, though in the middle of the day the wind blows from the south. The tramontana is cold and searching ; but the prevalent wind is the sirocco from the southeast, which is hot, sometimes dry, and sometimes so moist as to render the streets slippery and damp. Under its influence the tissues relax, appetite fails, bowels become torpid, spirits flag, and the weakly get oppressed with lassitude and headache. If an invalid will go to Rome in the winter, let him spend as much time as he can in St. Peter's. No other public building can compare with this church as regards possessing a dry equable temperature all the year round. The mild genial air in its interior is so prized, that the sickly meet and prome- nade in St. Peter's when the weather will not permit of exercise in the open air.
Dr. Burgess entertains a very unfavorable opinion of the sanitary value of this city. And he points out that the popular feeling in favor of a mild and relaxing climate for consumption is altogether wrong, being based upon erroneous data, if not upon mere tradition. A cold climate, such as that of Norway or of Canada, and still air, are evidently more rational indications, if the formation of tubercle is the result of a relaxed state of the vital func- tions, involving impaired digestion, depraved nutrition, and degeneration of the blood. Nothing is more calculated to derange the digestive organs than the sedative influence of a malarious atmosphere. The mild climate allays bronchial irritation, at the expense of the general health and of disordered nutrition.
The most fitting localities in the city for the invalid with any bronchial irritation, chronic rheumatism, etc., are the north and wfest sides of the Piazza di Spagna, as having a southern exposure ; or he may choose one of the streets running east and west from, and near to, the Piazza, — the Strada de' Condotti, Strada della Croce, Strada Frattina, etc., the north sides of which gain the southern sun, and all of which are on sheltered ground. The south side of the Strada del Corso should be avoided, as the Tiber fre- quently overflows in winter, generating low fever, etc. The Piazza del Popolo is also subject to damp fogs. In most cases the second and third floors of a house are preferable to the first; since, owing to the narrowness
CLIMATES FOR INVALIDS. 401
of the streets, they are more exposed to the sun. The hig-her and more e.xposed ground of the Monte Pincio, Via Sistina, Piazza Barbarina. etc., is suitable for those with healthy chests, and who can bear a high wind. — The stay may extend from October till the end of May.
Naples. — The climate somewhat resembles that of Nice, but is variable and humid. Situated on the northern shore of the Bay of Naples, on the slopes of a range of hills, near the foot of Vesuvius, this city seems to offer all that is charming to the man in health, and everything that is pernicious to the invalid. The mean annual temperature is 60.26°; winter being 47.65, spring 57.56, summer 74.38, and autumn 61.46. Besides other winds, it is exposed to the sirocco or southeast, which is enervating to both body and mind ; as well as to the mistral or northwest, which brings raw piercing cold and damp. Catarrh, pneumonia, phthisis, rheumatism, ophthalmia, uterine disease, and cutaneous affections are common amongst the inhabitants. Eustace says, and apparently with reason, — " If a man be tired of the slow lingering process of consumption, let him repair to Naples ; and the denoue- ment will be much more rapid." Indeed, so fatal is the climate to invalids with pulmonary disease, especially during the winter, that the proverb, — " Vedi Napoli e poi mori," may be interpreted in a more literal sense than that intended.
Bai^ and Pozzuoli. — Situated in the vicinity of Naples, these towns are recommended by M. Carriere as winter residences for invalids already sojourning in the Neapolitan territory. The air is humid and mild, and little disturbed by violent winds. But the undrained swamps in the neigh- borhood of Baise, and the fatality of phthisis at Pozzuoli, ought to deter any invalid from leaving England for those stations of classic renown, how- ever anxious he might be to escape to them from Naples.
IscHiA. — The island of Ischia, in the Mediterranean, can be reached by steamer from Naples in about three hours; or the sea passage may be much shortened by driving from Naples to Miliscola, crossing over to the small island of Procida, only two miles and a half distant, and thence to Ischia, which is separated from Procida by a channel two miles in breadth. The circumference of Ischia is rather more than twenty miles. Nearly in the centre of the island is Monte Epomeo (the Mons Epomeus of the ancients), the highest point of which is 2574 feet above the level of the sea. Bishop Berkeley seems to have been delighted with a three or four months' residence at Ischia. Thus he speaks of the island as " an epitome of the whole earth ;" containing within a compass of eighteen miles a wonderful variety of hills and valleys, ragged rocks and fruitful plains, barren mountains and beautiful vineyards, cornfields and orchards, natural fountains and rivulets, etc., "all thrown together in a most romantic confusion." 'J'he air in the hottest season is refreshed by cool sea breezes. The hedgerows are of myrtle, with the aloe and prickly pear ; and there is an abundance of delicious fruit.
The baths of Ischia have been in repute for centuries. Strabo and Pliny were acquainted with the virtues of some of the waters. Their chief charac- teristics are the large quantities of chloride, sulphate and carbonate of soda which they contain ; combined with riiagnesia, lime, etc., and a large volume of carbonic acid gas. Their temperature is high : e. g. that of the Acqua del Tamburo is 210° Fahr., and that of Petrelles, on the south side of the Island, 205°.
The principal and most picturesque village on the island is Gasamicciola ; which is situated on high ground behind Lacco, is sheltered on the north- west and south sides by Monte Epomeo, and is in the neighborhood of the chief springs now in use. These springs rise in the Val Ombrasco, a ravine at the base of Monte Epomeo. The most celebrated spring is the Acqua di Gurgitello, which is used for bathing and drinking. It contains chloride 26
402 APPENDIX OF FORMULA.
of sodium, carbonate of soda, sulphuretted hydrogen, and nine cubic inches per cent, of free carbonic acid gas ; while the temperature of the M'ater is often as high as 170° Fahr. This spring is useful in cases of chronic gout and rheumatism, sciatica, scrofula, nervous irritability, etc.
Near the Gurgitello is the Acqua di Capovne, used for drinking only. The water, like that of Wiesbaden, has the taste of chicken broth: the temperature is 98° Fahr. Dr. A. Vaks Best tells the Author that the Italians praise this water for its good effects in renal, vesical, and uterine complaints.
Below Casamicciola is the pretty vilage of Lacco ; in which are the hot air and sand baths of Santa Restituta e Regina Isabella. The most cele- brated natural vapor bath in the island is the Stufa di S. Lorenzo ; the steam from which is discharged from cervices in the lava at a temperature of 13.5° Fahr. '
Independently of its remarkable mineral springs the climate of Ischia is delightful. The evenings are rather cold during the winter and spring months, but the air is genial throughout the day. The heat of summer is mitigated by the sea breezes, while the vines and orange trees afford a beautiful shade. A stay of some weeks on the island can be recommended in hepatic and splenic disorders, in the early stages of Bright's disease and other forms of renal mischief, as well as in gouty and rheumatic and neu- ralgic affections. Invalids from India might well be advised to recruit at Casamicciola.
448. The Ionian Islands.
This group of islands in the Mediterranean, off the west coast of Greecfe and Epirus, ceded to the Greeks by Great Britain in 1863, consists of Corfu, Cephalonia, Zante, Santa Maura, Ithaca, with many smaller islands. Their surfaces are mountainous and rugged, but in some of the larger islands there are fertile plains. They vary but little in climate ; the winters being stormy and wet with northerly winds, the springs warm, and the summers dry and hot. Intermittent and remittent fevers, dysentery and diarrhoea, phthisis and pneumonia are prevalent. As a tour for the hypo- chondriac a visit to these island may be recommended.
449. Malta.
Of an area not much exceeding that of the Isle of Wight, this island forms the chief station of the British fleet in the Mediterranean, and is daily called at by ships of all nations. The atmosphere is clear and bright, the annual rainfall about 1.5 inches, the air mild and bracing in winter, and the temperature equable, with a yearly average of about 64°. Heavy gales of wind are not very frequent, though the atmosphere is never en- tirely calm. The gregale or northeast wind is cold in winter, and often does damage in the harbor of Valetta ; while the sirocco or southeast pre- vails especially in August and September, is hot and humid, and produces lassitude with debility.
The Rev. James Sherman, who suffered from consumption, writing from Malta on the 16th January, 1861, said : — " A blazing sun shoots his rays into my room, and a delicious breeze makes it sufficiently cool. I look out on a sort of Regent Square — people traversing up and down in crowds — a beautiful "garden opposite my window, with hundreds of oranges on the tree — priests, beggars, and guides jostling one another in every direction — a side view of the ocean — a deep blue sky, without a cloud — and at night the stars looking so large, near, and brilliant, that I can scarcely believe I am
CLIMATES FOR INVALIDS. 403
only 4i days from the frost and snow of England. The climate seems most delicious, anttwcU adapted to invalids."
'J'he weather is most agreeable from the middle of October until the end of January. Asthma connected with chronic bronchitis, atonic dyspepsia, strumous glandular swellings, and deranged health from overworlv, — these are the cases which are most likely to be benefited by a stay in the cheerful bustling capital of Valetta.
450. Egypt.
One of the earliest civilized localities of the world, this country has long been divided into the provinces of Said or Upper Egypt, Vostani or Mid- dle Egypt, and Bahari or Lower Egypt. Upper and middle Egypt are more healthy than the Delta. There are only two seasons in Egypt, — the temperate from October to March, and the hot from March to October. At Cairo, the capital, the climate is healthy, little variable, and remarka- bly dry ; rain falling very rarely. The nights and early mornings during winter are cold, especially those of the last half of December and the first fortnight of January. The mean temperature of the year is 72.2°; that of winter being 58.5, and of summer 85.1. Taking the whole of Egj^pt the mean temperature in December, January, February, and March may be said to be about the same as thfkt of this country in June, July, and August. Be- tween April and June a hot wind sometimes blows from between the south and southeast. It is known as the " khamseen," because this word is the Arabic for fifty; and these winds are most prevalent during the fifty days preceding Whitsuntide. A khamseen may continue for two or three or more days ; the air is rendered hazy from the sand and dust suspended in it; while the thermometer, in a sheltered spot, will often reach 110°.
The invalid should leave England rather early in October, so choosing his time of sailing by one of the Peninsular and Oriental Company's steamers, as to be able to see the best spots on the south coasts of Spain and Portugal, Gibraltar, and Malta. This arrangement will usually be preferable to that of beginning the voyage at Marseilles. From Malta to Alexandria usually occupies only a few days : the traveller ought to arrive at the latter by the middle of November. Leaving this port as soon as " the Sights" are visited, he proceeds to Cairo by railway ; whence he begins to ascend the Nile, so as to reach 'J'hebes by the beginning of December. The climate of Thebes is all that the valetudinarian can desire ; and hence he may either remain there, or proceed southerly in the direction of Nubia. But, however far his trip may exteud,*he should be back in Cairo by the end of March ; whence he may arrange his home journey, by way of Greece and Constantinople, so as to be in England by about the latter part of June.
The necessity for travelling by, and living in boats after leaving Cairo, has of course certain advantages, and is somewhat expensive. But with a dry balmy atmosphere, and a sky bright and cloudless, the invalid may find much that is most agreeable and exhilarating in the even progi-ess of a Nile boat — a dahabeeh. 'i'he two chief annoyances to the traveller in Egypt are the dust, and " Baksheesh." The former may be mitigated by suitable clothing — mohair dresses for ladies, and flannel shirts with tweed suits for gentlemen ; while the latter must be avoided by not exhibiting too much liberality, and by bargaining beforehand with dragomen, guides, coachmen, boatmen, etc. 'J'he diet should be simple and unstimulating, but nourish- ing ; light Hungarian or Bordeaux or Khine wines are preferable to port and sherry and brandy. Bitter beer is often serviceable ; but stout and porter should be avoided. Purgatives ought to be taken as seldom as pos- sible. Cod-liver oil often disagrees ; while all the preparations of bark are more than ordinarily apt to produce headache and hepatic derangement. The climate may especially be recommended in the early stages of tubercu-
404 APPENDIX OF FORMULA.
losis, except in cases in which there is a dry irritable cough, in chronic bronchitis, in clergyman's sore throat, tertiary syphilis, some forms of asthma, gout aud rheumatism, renal diseases, dyspepsia, and affections of the nervous system.
451. Algiers.
The city of Algiers, the capital of an extensive country of northern Africa, bordering on the Mediterranean, has been much resorted to by invalids. It can be reached easily in seven or eight days from London ; by way of Folkestone, Paris, Lyons, Marseilles, and thence by steamer in forty-eight hours. About the end of October is the best time for the in- valid's arrival on the coast of Africa ; the great heat having then usually ceased, and the first rains having refreshed the lands, so that the country has the appearance of spring.
Speaking of this city, Dr. Mitchell says that with difficulty, if at all, will the European traveller find a spot on earth where natural beauties so combine with those of man's creation to please and interest him. One of the long sides of the oblong of which the " Place du Gouvernement" is formed is open to the sea ; commanding a view of the bay, the harbor, the peaks of the distant Atlas, and the verdure of the Sahel slopes. The " Place" itself is filled with a strange mixture of^all races ; the Arab, the Moor, the turbaned Jew of Africa, the Maltese fisherman, the Spanish fruitseller, the veiled women of Moslem, the picturesque Jewess, the pretty Spaniard, etc. etc. The invalid will find objects of interest without seek- ing them, and will be gratified and amused merely by wandering- in the open air. — The mean annual temperature is about 66.50° Fahr. The mean temperature for each season is — winter, 56.91 ; spring, 67.60 ; summer, • 77.73; and autumn, 63.80. The rainfall is 36 inches: rainy days, 96. Winter fogs are rare. Snow has fallen once in seven years. Compared with other points on the Mediterranean, Algiers has a warmer and a less varying climate than Marseilles, Nice, Genoa, and Naples ; while it more nearly approaches, but is still superior, to Malta, Corfu, and Gibraltar. — Dr. Mitchell quotes the opinions of M. Odrultz, which are to the follow- ing effect : — 1st, The climate of Algiers is opposed to the generation as well as to the evolution of tubercle in the lungs : 2d, This morbid produc- tion is observed but very exceptionally among the indigenous population : 3d, Europeans who do not bring the germ of the disease to Algiers almost never become phthisical : 4thj Those who do bring not only a predisposi- tion, but actually crude tubercle, in* greater or less quantity, in the lung, are often cured ; or, in the worst cases, the progress is extremely slow : 5th, When the tubercle has softened, the climate is no longer favorable, but the reverse.
The climate is also beneficial in laryngeal and bronchial affections ; in chronic heart disease ; in gout and rheumatism ; and in renal disorders. — Nervous complaints, paralysis, epilepsy, and convulsions are aggravated by it. Cerebral congestions, gastric and hepatic disturbances, and a plethoric condition of the uterine organs, appear to be common in Algiers.
Tangiers possesses a climate equal to that of Algiers, and is gradually becoming: available as a winter residence for invalids.
452. 77ie Azores — Madeira — Canaries.
The Azores or Western Isles. — This group of nine islands, belonging to Portugal, lies in the midst of the Atlantic Ocean. They are of volcanic origin, all possess similar features, and all have mild equable climates. The atmosphere is saturated with moisture. A winter trip to the Azores may be recommended where a soothing relaxing climate is needed. Hence
CLIMATES FOR INVALIDS. 405
it is beneficial in inflammatory dyspepsia, bronchial irritation with scanty secretion, and in the premonitory stage of consumption. Sir James Clark thinks that a change from the Azores to Madeira, and from thence to Teneriffe, would in many cases prove more beneficial than a residence during the whole winter in any one of these islands.
Madeira. — Of the group of Madeira Isles, the largest and most impor- tant is Madeira, about 120 miles in circumference. Funchal, its capital, has long enjoyed great reputation as a winter residence for the phthisical. It is almost certain that this reputation is now undeserved. Where the disease is advanced, and the irritable lungs are soothed by a humid heat, some of the distressing symptoms of phthisis are alleviated by a stay at Funchal ; but such relief does not stay the increase and degeneration of tubercle. 'Phe invalid who leaves this country about the middle of October, can reach Madeira in from ten to fourteen days ; where he will find himself in a tropical climate, with an unclouded sky, a glowing sun, a deep blue sea, a luxuriant and varied foliage, and beautiful hills which were covered with flourishing vineyards. Since the autumn of 1852, however, when the vine disease suddenly broke out, there has been a sad change ; the plants still being destroj'ed by the deadly fungus. — The return voyage should be undertaken about the beginning of June.
The climate of Madeira is mild, equable, and moist. There are occasional storms of wind and rain, and fires are often necessary in the mornings and evenings. The mean annual temperature is 64.9° ; that for winter being 60.6, spring 62.3, summer 69.5, and autumn 67.3. The annual rainfall is 29.23 inches; the days on which there is wet being about 70, whereas in London they number about 178. The most injurious wind is the hot parching leste, from the east-southeast ; which is often charged with a fine dust, very irritating to the air-passages.
The invalid who cannot bear a dry and irritating climate, but needs a mild and soft and relaxing atmosphere, will obtain it here. Laryngeal, bronchial, and pulmonary diseases are soothed; and benefit may be derived by a few patients threatened with consumption, provided their symptoms are marked by irritability and an excess of vascular action. Hypochon- driacal and rheumatic and neuralgic patients ought especially to avoid Madeira. Should the invalid wish to spend a second winter in Madeira before returning home, a voyage may be taken to Teneriffe in June, and the stay prolonged there until the end of October.
The Canary Islands. — This group (Fortunatse Insula) consists of seven principal islands, and several islets. The climate differs from that of the foregoing in being warmer, drier, and less relaxing. At Santa Cruz, the capital of Teneriffe (the only island possessing good accommodation for the valetudinarian), the mean annual temperature is 70.15°: that for winter being 64.85, spring 68.87, summer 76.68, and autumn 74.17. — Orotava and Laguna are sometimes preferred to Santa Cruz.
453. Oape of Good Hope — Natal.
The Cape op Good Hope. — The climate is mild and healthy but very dry. The seasons are the reverse of those in Europe ; December and January being the warmest, while June and July are the coldest mouths. The mean temperature for the winter months of 1858, at Cape Town, was 57° Fahr. The prevalent diseases appear to be rheumatism and dysentery. Invalids from India are often benefited by spending a season at the Cape or Natal.
Natal. — This British Colony lies on the southeastern border of Africa, about 800 miles from the Cape of Good Hope There may be said to be only
406 APPENDIX OF FORMULiE.
two seasons, — the summer from October to Marcli, and the winter from the beginning of April to the end of September. Even in the latter, during the coldest months of 1858, the temperature was occasionally 78° Fahr. in the neighborhood of Maritzburgh ; while in the hottest months it was occa- sionally below 60°. [The Colony of Natal. By Robert J. Mann, M.D., p. 48, London, 1860.) Notwithstanding its almost tropical position, and the frequent vicissitudes of temperatures, Natal is very healthy. Dr. Mann remarks that while 480 soldiers die yearly out of every 1000 stationed at Sierra Leone, 121 in 1000 at Jamaica, 78 in 1000 at the West Indies generally, 48 in 1000 in the Madras Presidency, 28 in 1000 at Bermuda, 27 in 1000 in the Mauritius, 25 in 1000 at St. Helena, 21 in 1000 at Gib- raltar, 16 in 1000 at Malta and Canada, and 14 in every 1000 in Nova Scotia and New Brunswick, — only 13 in 1000 die yearly in the westei'n districts of the Cape Colony, and only 9 in 1000 in the eastern district. During the Kafir war in 1835, not a single officer or man was invalided during the five months of active service. Newly arrived settlers in Natal remain for months under canvas, without the slightest injury.
454. Canada — New Brunswick — Nova Scotia — Neivfoundland.
Canada. — This British Colony of North America is divided by the Ottawa river into the provinces of Upper or West Canada (chief city Toronto) and Lower or East Canada (chief city Quebec). The climate is marked by extremes, the winters being excessively cold, while the summers are just as hot. The coldness of the winter is mitigated, however, by the dryness of the air and the absence of high winds; while the way in which, the Canadian protects himself with thick furs, and his house by well managed stoves, enables him to set the frost at defiance. A gentleman, resident in Canada for six years, told the Author that with the thermometer — 20° he never felt the cold so raw and unpleasant, as in London at the beginning of January, 1864. The climate is also much milder in Upper than Lower Canada ; but that of both provinces is healthy and conducive to longevity.
New Brunswick. — The climate of this portion of British North America resembles that of Canada ; the winters being very severe and the summers excessively hot. The winter, however, is mitigated by the length and fine- ness of the autumn,— the " Indian summer."
Nova Scotia. — This peninsula of North America, forming part of the British colonial territory, is separated from New Brunswick by an isthmus 14 miles across. The climate is remarkable for vicissitudes of temperature, prolonged falls of rain, and occasional fogs. The inhabitants, nevertheless, are said to enjoy a remarkable degree of health.
Newfoundland. — This island, lying off the coast of Labrador, is sepa- rated from the mainland by the Strait of Belleisle, which is 12 miles across. The surface of the island is mostly marshy, and the soil unfavorable to cultivation. The winters are less severe than in Upper Canada, but the summers are shorter. Dense fogs prevail along its banks, sometimes for the greater part of the summer. The annual mortality, however, scarcely ex- ceeds 12 per 1000 of the population, so that the climate must be favorable to the constitution.
455. West Indian Islands.
Invalids should not be sent to any of these islands ; for though they are not as unhealthy as was formerly supposed, yet severe fevers and inflamma- tory diseases are common and run a rapid course. Moreover, the returns
CLIMATES FOR INVALIDS. 407
show that nearly twice as many cases of consnmjition originate among our troops stationed here as at home. If a man in search of health will visit them, however, he must only do so between the months of December and April, after the heavy autumnal rains. Jamaica, the chief of the British possessions, is reputed the most healthy. The Bahamas are resorted to by American invalids. In the Bermudas and in Barbadoes dysentery, rheu- matism, and yellow fever are the prevailing diseases.
456. Hill and Marine Sanitaria in India.
The Indian hill stations offer a climate which is of great use to conva- lescents from fever, invalids from local cackexia, etc. ; and which exerts a powerful influence in maintaining the health and vigor of Europeans — espe- cially of such as have not been very long in India.
According to Dr. AV. J. Moore, of the Bombay Medical Service, the climate of the hill ranges differs from that of the plains in having a mean temperature some 10° to 15° cooler, in being above the influence of the hot winds, and in being more humid during the monsoon season. Various localities differ in minor points : in the Himalayas, a greater elevation will procure a colder, climate ; the fall of rain has sometimes been excessive at Mahableshivar, at Nt/nee Tal, etc. ; while at many of the hill stations sanitary laws are still too much disregarded, and too little care is taken to protect the system from the inclemencies of the weather.
The climate of the hill stations in the Himalayas, of Mount Aboo, of Ootocamund, Bangalore, etc., as well as of Matheran and Mahableshwar in Bombay, is of great service to the European whose health has deterio- rated from a residence on the Indian plains. The air invigorates both mind and body. But it is unsuitable where there is structural disease of any internal organ ; diarrhoea and dysentery being increased by it, while affec- tions of the brain and lungs and liver are much aggravated. Cholera, dysentery, and malarious fevers are less prevalent and fatal in the hill stations than in the plains below. Yet these affections are met with at high elevations ; as are also cases of hepatitis, tuberculosis, typhus, croup, diphtheria, smallpox, rheumatism, neuralgia, severe catarrh, and hill-diar- rhcea. It has been well suggested that European troops should be located more on the hills and less on the plains than is now the case ; not waiting until they are weakened by disease, climate, and service to be sent to these more temperate and less malarious regions.
Many of the diseases which are aggravated by the hill-stations of India, are much benefited by the greater purity and uniformity of the sea climates. 'I'he invalid who has been prostrated by the harsh parching winds of the interior, not only has his bodily sufferings greatly ameliorated by the moist fresh breeze from the sea, but the mere sight of the ocean raises his powers by giving him hope and confidence. It is necessary to select an open spot, with high cliffs and a rocky shore ; low, flat, sandy coasts being generally unhealthy in the tropics. The proximity of the island of Martaban to Madras and Calcutta, as well as its geological characteristics, have led Dr. Macpherson to recommend it as a marine sanitarium.
The weak-chested, and those persons of strumous habit predisposed to phthisis, are often greatly benefited by residence in India ; but where tubercle is deposited in the lungs, the climate seems to accelerate the pro- gress of the disease. Individuals of a phlegmatic temperament who have more or less difficulty in digesting their food, and who possess a languid circulation, often improve very much in this country.
408 APPENDIX OF FORMULA.
457. Australia — Tasmania — New Zealand.
Australia. — The immense extent of territory known as Australia, in the South Pacific Ocean, possesses a temperate climate which appears very- favorable to the European constitution. In speaking- of this antipodal region it is necessary to remember that the meteorological phenomena are generally the reverse of those experienced in this country. Thus the months of December, January, and February correspond to our summer, and have a mean temperature of about 80° ; while those of June, July, and August constitute the winter, the thermometer marking on an average 40° in an exposed situation.
In May, 1836, the number of settlers in the district of Victoria (formerly Port Philip), was 177. At the'end of a quarter of a century (April, 1861), the amount had increased to .540,322. The total area of Victoria (86,831 miles) is nearly as large as that of England, Scotland, and AVales united. Melbourne, the capital of Yictoria, is the most prosperous commercial city of the southern world. The mean annual temperature is 57°; extreme cold in winter, and excessive heat in summer (except nine or ten times in the season, under the influence of hot winds), being unknown. Although the annual rainfall is 26 inches (that for London being 21.6), yet the average number of wet days is much less than in Great Britain ; for in Melbourne the rain falls with great violence, but it only lasts a few hours, and then the sky clears. A continuance of cloudy weather is unknown. There is a genial sun; with a pure, dry, stimulating air.
Dr. S. Dougan Bird says [Australasian Climates, and their Influence in Pulmonary ^ Consumption, p. 41, London, 1863), that the main charac- teristics of the Victorian climate are these : — "It is a temperate warm climate, whose average summer heat is but two or three degrees above that of London ; while in winter it is warmer than Nice or Naples, and as warm as Valencia or Barcelona ; and actual cold is never felt at, or near, the sea level. The air is generally dry, always stimulating and ozoniferous ; but so tempered by the prevalence of ocean winds, that it is prevented from becom- ing irritating, like that of Nice or Provence. With this there is a very large proportion of sunny cheerful weather during the whole year. In no climate with which I am acquainted is there so much pleasant weather during the year as in Victoria — so many unclouded days when it is neither too hot nor too cold — and an invalid has, consequently, every temptation to be in the open air."
Tuberculosis (2. e., scrofula, phthisis, tabes mesenterica, and tubercular meningitis) is rare in Victoria, the mortality not being one-fourth of that in Great Britain from the same cause. Yet the population is composed of those who, hereditarily, from occujiation and mode of living (except that animal food is much cheaper), are as much predisposed to consumption as the inhabitants of London or Liverpool. It should be added that these statements have been controverted, and that phthisis has been shown to be more common than is here allowed, but there can be no doubt that the climate is exceptionally healthy.
At Sydney (the capital of New South Wales, East Australia) the mean annual temperature is about 65°. Heavy rains fall between June and Sep- tember. Disease is said to assume a milder form here than in European countries. Dysentery and pulmonary affections are, however, not uncommon. The winters are colder than at Moreton Bay, though this season is very salubrious and agreeable.
Moreton Bay (Queensland, East Australia) has a fine winter climate which proves very useful in advanced cases of phthisis, when combined with irritability of the system and a tendency to bronchial inflammation. The average temperature on the coast during the cold months is 62° or 63° ; the
MINERAL WATERS. 409
air being soft and sedative, and the weather brilliant and sunny. A few miles inland the ground rises, and the air is more dry and bracing.
In cases of consumption with copious expectoration, and in the chronic bronchitis of old people, Adelaide, the chief city of South Australia, may be chosen as a residence. The air is dry, warm, and tonic; the winter temperature averaging 53°.
The invalid leaving England for Australia will generally find the long uninterrupted voyage round the Cape of Good Hope, in a comfortable ship, much to be preferred to the more exciting and fatiguing "overland route," by way of Suez and Galle. The best time for leaving this country is from the middle of October to the end of November ; when the new home will be reached in about 90 days from Liverpool. Thus supposing the traveller to arrive about the end of January, he will find a pale-blue cloud- less sky, and the thermometer at 90° in the middle of the day without any unpleasant sense of heat. With a feeling of new life, general exhilaration, and a good appetite, he will experience a desire to be at work. 'I'he diffi- culty seems to be to persuade the phthisical that they are not cured ; and that the general rules of hygiene must be adopted, and all excesses avoided, to prevent the pulmonary mischief again starting into activity, or to escape hepatic congestion, or that he may obtain and retain health and vigor.
Tasmania. — The island (known as Van Piemen's Land, until the aban- donment of transportation in 1852) is separated from the southernmost point of Australia by Bass's Strait. The chief towns are Hohart Town in the south, and Launceston in the north ; the climate of both being salubrious and delightful, and highly conducive to longevity. The latter port is reached in twenty-four hours, by steamer from Melbourne, and is beneficial to such cases as are usually sent to Pau. The air is moist, sedative, and equable. In the winter months of June, July, and August, there is never great cold during the day. The mean annual temperature of Hobart Town is 52°. Tasmania is described as " the Garden of Australia."
New Zealand. — This group in the South Pacific Ocean consists of two principal (the North and Middle) and several smaller islands. The chief British settlements are Auckland, New Plymouth, or TarauTci, Haiukes Bay, and Wellington in the North Island ; with Nelson, Marlborough, Canterbury, and Otago in the Middle Island; 'J'he temperature of New Zealand is marked by its uniformity. The mean of the warmest month at Auckland is 68°, and of the coldest at Otago 42°. The climate, which in general terms may be described as mild and soft, appears to be favorable to the European constitution.
XXI. MINERAL WATERS.
458. General Observations.
Mineral Waters have been used in Medical practice since the days when .J^^scuLAPIUS was Worshipped throughout Greece, and when his temples were erected in healthy places, near wells which were believed to have healing powers. Like many other important remedies, their virtues have been regarded with singular scepticism at one time, and with blind credu- lity at another. The practitioner in the present day wisely attempts to keep the middle course ; neither over-estimating, nor unduly depreciating, the value of these agents in subduing disease.
A mineral water is merely a complicated medicine, containing various salts and gases blended together. The ingredients are generally derived from the soil or rocks through which the waters pass ; and they consist especially of chloride of sodium, sulphate and carbonate of soda, sulphate
410 APPENDIX OF FORMULA.
and carbonate of magnesia, some salt of iron, carbonate of iron, bromine and iodine, orp-auic matters (barfegine), and more or less of a free gas (sul- phuretted hydrogen, carbonic acid, nitrogen, or oxygen). The cause of the temperature of hot springs is a mystery ; and philosophers know not whether it is due to the internal heat of the globe, to electricity, to chemi- cal decomposition, or to volcanic agency. The heat is generally much under that of boiling water, and in .most springs it is found to have varied but little during a long succession of years. The only waters which have a temperature as high as 212° Fahr., are the geysers or hot springs of Iceland.
Mineral waters are administered internally and applied externally. They act chiefly by diluting and purifying the blood ; increasing the pro- cesses of secretion and excretion, so that morbid matters are eliminated from the system. They likewise stimulate the cutaneous and visceral cir- culation. It cannot be doubted that these efTects are in some measure due to the chemical composition and temperature of the waters ; though it is allowed on all hands that the beneficial influence is largely aided by the locality of the spring, the nature of the climate, the absence of business and care, the diet, and the general regimen.
Mineral waters are useful only in chronic disorders, where there is but little, if any, structural change; or in cases where disease is threatened. Hence the sufferers sent to the Spas are for the most part affected with skin affections, strumous and other rebellious ulcers, stiffness of joints and limbs from old sprains, etc. ; chronic, gout, rheumatism, sciatica, or neural- gia; gastric, hepatic, or renal disorders; sluggish action of the intestines, particularly of the colon and rectum; paralytic aff'ections, where all active disease has been subdued; hysteria or hypochondriasis; or with certain functional disorders of the uterine system. Nothing but mischief can arise where there is either acute disease, tuberculosis, cancer, fatty degeneration of any important structure, aneurism, or mischief about the heart or large vessels. Where there is any predisposition to cerebral, pulmonary, gastric, or intestinal hemorrhage all thermal mineral waters (especially in the form of baths) are contra-indicated. The young and the very aged, moreover, will derive little or no benefit : and in pregnancy the use of the springs, to say the least, demands great caution.
The time for residing at some of the Spas is from the beginning of May until about the close of September ; but at several of the foreign ones it is only from June until the end of August. At a few of the hot springs, invalids (chiefly the gouty) remain through the winter. The treatment, however, is not commonly to be prolonged beyond six or eight weeks ; and often three or four will suffice. 'I'he invalid should not be led to expect immediate relief. And he should be cautioned against the popular idea that the benefit derived will be in proportion to the quantity of water taken; while it may be as well to let him know that "critical eruptions" (psydracia thermalis), and " critical fluxes" are neither necessary nor ad- vantageous. As a rule, bathing and drinking ought not to be commenced on the same day ; and at first only a moderate quantity of the water should be taken, — two or three of the ordinary glasses before breakfast, and one or two in the evening. After a time, a glassful may also be taken before dinner. Very hot water is to be cooled, and very cold to be warmed, before drinking.
When the strength will permit of it, early rising (at about six o'clock) is to be recommended, so that the doses may be taken before breakfast. The contents of the tumbler are to be sipped slowly and methodically, not hastily swallowed like a nauseous draught; and an interval of 15 minutes, at least, should be allowed between each glass, which time may well be spent in a short walk. An hour after the last glass, a light breakfast is to be taken. Then, a gentle saunter, the bath, reading, writing letters, etc.,
MINERAL WATERS. 411
will agreeably occupy the hours till the early dinner ; at which fruit and raw vegetables had better be avoided, while a moderate quantity of light wine, or of mild bitter beer can be permitted. An excursion to the objects of interest in the neighborhood, perhaps one or two more glasses of water — never more than half the quantity taken in the morning. — a light supper at 8 o'clock, and bed two hours afterwards will complete the day's work.
Mineral waters are sometimes classified into the thermal or hot, and the cold springs. But a more useful division is into chalybeate, sulphurous, gaseous or acidulous, saline, iodo-bromated, and muriated lithia waters.
Class 1. Chalybeate or Ferruginous Waters. — A large number of waters contain small quantities of iron, but none are considered as belong- ing to this class unless the proportion of metal is considerable. The chief acidulous chalybeates (those which contain much carbonic acid gas) are the waters of Schwalbach, Spa, Pyrmont, Brlickenau, the Cambray well at Cheltenham, and Tunbridge Wells. The principal saline acidulous chaly- beates (such as, in addition to iron and carbonic acid, have a certain amount of sulphate and carbonate of soda, with chloride of sodium) are the springs of Franzensbad, Bocklet, Harrogate, etc. — Chalybeate waters are useful in anaemia, and in functional disorders of the generative organs.
Class 2. Sulphurous Waters. — They have the odor of rotten eggs, owing to their impregnation with sulphuretted hydrogen. The chief sulphurous thermals are those of Aix-la-Chapelle, Baden near Vienna, Aix-les-Bains, Bareges. Bagnferes de Luchon, St. Sauveur, Cauterets, Eaux-Bonnes, and Eaux-Chaudes : the higher the temperature, the more stimulating the effect of the water on the nervous and vascular and cutaneous system. Amongst the cold sulphurous springs may be mentioned Harrogate and Bocklet. — Sulphurous waters are recommended in cutaneous, hepatic, uterine, rheu- matic, gouty, neuralgic, and old constitutional syphilitic diseases. In chronic poisoning by mercury, lead, or copper, they help to eliminate the injurious mineral, 'fhe excretion of carbonic acid by the lungs and skin, as well as of urea and uric acid by the kidneys, is probably increased by these waters.
Class 3. Gaseous or Acidulous Waters. — The carbonic acid gas gives these waters a sharp acidulous taste, with a sparkling appearance. 'J'he most important are the thermal springs of Vichy, and the cold of Fachin- gen and Bilin. The refreshing and exhilarating waters of this class are recommended in dyspepsia, hepatic derangement, gout and rheumatism, etc.
Class 4. Saline Waters. — Those which are purgative and have sulphate of soda or sulphate of magnesia as their chief ingredients, are Epsom, Cheltenham, Leamington, Seidlitz, Fulna, Carlsbad, and Marienbad. They are useful in habitual constipation, torpidity of the liver, inactivity of the abdominal viscera generally, chronic rheumatism, sciatica, and perhaps in diabetes (Carlsbad especially). Those saline waters which have chloride of sodium as their characteristic ingredient, are Wiesbaden. Baden-Baden, Homburg, Kissingen, etc. They are employed in cases of scrofula, rheu- matism, dyspepsia from overwork, and irregularity .of the bowels. The sulphate or carbonate of lime, or both, predominate in the thermal waters of Bath and Buxton ; while the carbonate or bicarbonate of soda is the characteristic ingredient of the thermal springs at Ems, 'I'eplitz, etc.
Class 5. Iodo-bromated Waters. — The springs at Kreuznach are the most celebrated of this class ; while in England there is the Woodhall Spa. The waters are used in all forms of scrofula, in many chronic skin diseases, in uterine tumors, and in old-standing constitutional syphilis.
Class 6. Muriated Lithia Waters. — '^Phe springs of Baden-Baden have considerable reputation for the cure of gout and the uric acid diathesis, owing to the chloride of lithium which they contain.
412 APPENDIX OF FORMULA.
459. Tunhridge Wells, in Kent and Sussex.
This town is more visited on account of its dry bracing air, beautiful varied scenery, and fine walks, than for its chalybeate Spa. The water of the latter has a temperature of 50°, is feebly ferruginous to the taste, con- tains about a quarter of a grain of oxide of ii'on to the pint, and has just sufficient carbonic acid to hold the metal in solution. Freciuently, increased doses of steel are given with the water; or the sulphate of magnesia may be added, if an aperient be needed. The chief value of the spring is wit- nessed in cases of anaemia and chlorosis, debility inducing dyspepsia, and in general lassitude from a too sedentary mode of life.
460. Bath, in Somersetshire.
The thermal mineral springs, situated in the southern part of the town, near the Abbey church, are four in number. The temperature of the waters varies from 120° Fahr. to 104°. iSpeakiug generally the solid contents are about ten grains to the pint. The chief constituents are sidphate of lime, sidphate of soda, chloride of sodium, chloride of magnesiiLm, carbonate of lime, silicic acid, and a comparatively small portion of iron. The gases evolved consist of nitrogen in large quantity, with oxygen and carbonic acid.
The sparkling appearance of the waters at the springs, is due to the car- bonic acid they contain. The quantity generally drunk is from one-quarter to one pint before breakfast, and again in the afternoon. Taken quietly and leisurely the effect is usually to raise the temperature of the body, to quicken the circulation, to increase the appetite, and to promote the salivary and renal secretions. When headache, loss of appetite, thirst, nausea, men- tal depression, and a diminished flow of urine follow their use, they should either be discontinued or taken in very small doses.
The accommodation for bathing is excellent; there being good douche, shower, vapor, I'eclining, swimming, and chair baths. By the latter, worked with a crane, a helpless invalid is lowered into, and raised from the water. The bath is to be taken three or four times a week, not too near the meal times, and the patient should remain in it from ten to thirty minutes. The proper temperature is 96° to 98° Fahr.
'J'he spring and autumn are the best seasons for taking the baths and waters, though they may' be advantageously employed in the winter. And the diseases which are most benefited by them are subacute gout, chronic rheumatism, sciatica, neuralgia, lumbago, rheumatoid arthritis, contracted or rigid joints, dyspepsia, paralysis from rheumatism or metallic poisoning, leucorrhoea, chorea, anaemia, lepra, eczema, and psoriasis.
461. Cheltenham, in Gloucestershire.
Since the cure of George the Third by the waters of the Royal Old Wells, this Spa has been a fashionable resort. Situated 8 miles E. N. E. of Gloucester, Cheltenham offers an agreeable permanent residence, parti- cularly for valetudinarians from the East or West Indies. The climate in winter is mild and equable, but rather moist. The town is sheltered by tire Cotswold and other hills from the north and east winds. The season lasts from about the middle of April to the beginning of October.
The waters are chiefly taken internally. There are several cold springs, all of them powerfully saline except the Cambray chalybeate. The waters of the Royal Old Wells contain chiefly chloride of sodium, chloride of calcium, chloride of magnesium, and sidphate of soda. They are but slightly gaseous. Some of the wells of the Montpellier Spa have, in ad- dition to the foregoing, a little oxide of iron, and ioduretted magnesium saline salts. There is an unusual amount of silica in the Pittville saline ;
MINERAL AVATERS. 413
while Cambray spring is strongly chalybeate. The Montpellier baths have accommodation for warm and cold bathing, swimming, medicated air and va]3or douches, etc.
These springs enjoy considerable reputation for relieving the diseases engendered by a residence in tropical climates, and hence many old Indians with liver affections resort to them. They are also useful in gouty and rheumatic disorders, in the lithic acid diathesis, in plethoric and irritable systems, in skin diseases, in dyspepsia with torpidity of the bowels, as well as in some forms of amenorrhoea and chlorosis. The dose is usually from half a pint to one pint before breakfast; it is better to take the water pure, without the addition of any " solution" of the crystallized salts ; and it may be warmed if a more than ordinary aperient effect is needed. The spring to be recommended must depend upon whether a simply alterative, or an alterative and tonic remedy be indicated.
462. Purton and Melksham, in Wiltshire.
The healthy village of Purton in North Wilts, 4^ miles "VV.N.W. of Swindon, has a dry bracing air. The Spa is 2^ miles from the village, in a field known as Salt's Hole, where a pump-room has recently (18.o9) been erected for the accommodation of visitors. An analysis of the water shows that it is rich in sulphate of soda, sidphate of magnesia, sidphate of lime, carbonate of potash, and chloride of sodium. There are also small quantities of sulphate of potash, silica, iodide of sodium, and bromide of magnesium ; with traces of iron, phosphoric acid, and sulphuretted hydrogen. There is a large amount of free carbonic acid gas ; and the temperature is 58.50°.
The Purton sulphated and bromo-iodated saline water can be recommended where an alterative stimulant is needed. It seems to have been useful in strumous sores and enlarged glands, threatened consumption, stomach and liver disorders, gouty and rheumatic affections, obstinate skin diseases, as well as in functional derangements of the uterine system. The dose is from half a pint to a pint before breakfast, with half a pint in the evening.
The small town of Melksham lies 10 miles E.S.E. of Bath, in a fine open country. In its vicinity are baths and a pump-room erected over the chaly- beate and saline springs. The chief constituents of the waters are the salts of lime and magnesia, with smaller portions of soda and iron; and they are artiiically charged with gas for exportation. In strumous, rheumatic, and cutaneous diseases, the medicated vapor and douche baths may be employed simultaneously with the internal use of the waters.
463. Leajnington, in Warivichshire.
Being less protected by hills than Cheltenham, the town of Leamington, 2^ miles E. of Warwick, has a lower temperature. The climate, however, is genial and bracing, but humid ; while it is agreeable and healthy to the flagging invalid during the autumn and winter months.
The springs all lie near the banks of the Leam ; their principal salts being, — chloride of sodium, sidphate of soda, chloride of calcium, and chloride of magnesium. The chief gas is carbonic acid, with great quan- tities of nitrogen and oxygen. The most ancient and most used of the springs is the Old Well. The water at Goold's Spring and Baths con- tains more chloride of sodium, while Curtis's Well has more chloride of magnesium than the others. The Victoria Well and Pump-room possesses a weak sidphurous and a scdine chcdybeate spring ; and so does Lee's Well.
The temperature of Leamington waters is about 48"^ Fahr. ; and their action is aperient and alterative. They are suitable for the same class of cases as is sent to the Cheltenham springs ; but being more active they
414 APPENDIX OF FOEMULtE.
agree better with invalids of a torpid habit, than with those of a susceptible irritable temperament.
464. Buxton, in Derbyshire.
For invalids requiring mountain air Buxton may be recommended. Situated 31 miles W.N.W. of Derby, at an elevation of 900 feet, while some of the neighboring hills are 2000 feet above the sea, it enjoys a pure bracing air. Like all mountain districts the climate of Buxton is subject to sudden variations of temperature. The rainfall is rather great ; but owing to the absorbent nature of the soil the ground rapidly dries. The season is chiefly from June to October; the winds being sharp and cold late in the autumn, during winter, and early in the spring. Buxton is not to be selected where there is a tendency to internal hemorrhage.
The Buxton waters issue abundantly from several crevices in the limestone rock at a temperature of 82° Fahr. The chief saline salts in them are, carbonate of lime, carbonate of magnesia, chloride of sodium and calcium and potassium, with silica, carbonate of 'protoxide of iron, and traces oi fluoride of calcium and phosphctte of lime: though so small is the quantity, that in the whole, they only amount to 18.434 grains in the imperial gallon. In the same amount of water Dr. Playfair found (18.52) nitrogen gas 206 cubic inches, and carbonic acid gas 1.5.66 cubic inches. According to the most recent analysis by Dr. Sheridan Muspratt (1860) the quantity of nitrogen gas, at the moment of issue, is no less than 504 cubic inches per gallon. — As these waters, minus their gases, have only the composition of ordinary spring water, their stimulating eifects are generally attributed to the nitrogen. They are, however, chiefly used externally; the accommodation for plunge, swimming, and douche baths being excellent. ' The good which results from the latter is most marked in cases of gout and rheumatism, in severe sprains and old muscular contractions, as well as in cases where it is wished to stimulate the vascular or nervous or digestive systems.
A pleasant drive from Buxton is to the picturesque village of Matlock, built on the slope of a hill, at the base of which flows the Derwent. It is an agreeable summer residence, and its springs supply large tepid baths. The water, however, has no medicinal properties, though the guide books usually describe Matlock as a valuable Spa.
465. Woodhcdl, in Lincolnshire.
This strong saline spring arises in a plain 3 miles W.S.W. of Horncastle, and contains more iodine and bromine than any other English water. It has also 189 grains of chloride of sodium in the pint, with a little chloride of calcium and mag^iesium, bicarbonate of soda, and sulphate of soda. The temperature is 55^. The water is chiefly used externally in rheumatic and cutaneous affections, and in scrofula. Taken internally half a pint acts as a mild aperient.
466. Harrogate, in Yorkshire.
High and Low Harrogate, half a mile distant from each other, and 27 miles W. of York, are filled with visitors during the season, — from June until the middle of October, ^i'he air is pure and bracing, but somewhat humid. The soil is sandy, so that the walks are soon dry even after heavy rain. Low Harrogate is the most sheltered. The most elevated part of High Harrogate is 596 feet above the sea.
There are upwards of fifty different springs, some of which have been in repute since the end of the 17th century. The waters are all cold, being generally warmed artificially before they are drunk. Dr. Kennion divides the springs into four distinct groups: — (1) The strong sulphurous waters.
MINERAL WATERS. 415
(2) The mild sulphurous waters with alkaline impregnations. (3) The saline chalybeate waters. And (4) the pure chalybeate waters.
1. Strong Sulphurous Springs. — As types of this class may be men- tioned the old Sulphur Well in the Royal Pump Room, and the strong Montpelier Well in the Montpelier Gardens. They are both impregnated with Sulphuretted hydrogen gas (upwards of 25 cubic inches in the gallon); their chief salts being chlorides of sodium and calcium and potassium and viagnesium, sulphide of sodium and carbonate of lime, with traces of bromide of sodium, iodide of sodium, etc. 'I'he waters are alterative, aperient, stimulant, and diuretic : they are taken internally, and used as baths. The dose varies from half a pint to a pint and a half, in three or four divided quantities, before breakfast.
2. Mild Sulphurous Springs with Alkaline Impregnations. — The two most important are the mild Montpelier AVell, and the spring at the Vic- toria Gardens. They contain much less sidphuretted hydrogen, less chlo- ride of sodium, and less chloride of magnesium than those of the preceding group; but they have in addition carbonate of magnesia. They are ant- acid, alterative, diuretic and deobstruent ; and are used externally as well as internally.
3. Saline Chalybeate Waters. — One of these springs is in the Chelten- ham Pump Room, the other in the Montpelier Gardens. In addition to the salts already mentioned they contain carbonate of iron, so that they have tonic action superadded to their other properties.
4. Pure Chalybeate Waters. — The springs of the Tewit and St. John's Well, have almost the composition of pure water, with the addition of a small quantity of carbonate of iron.
Invalids with all forms of chronic disease visit Harrogate to drink the waters. But the cases most likely to derive benefit are the following : — Imperfect digestion in men too fond of good living, where the bowels and liver are inactive ; habitual constipation ; obesity ; indurations and chronic swellings of the glands, joints, etc. (the strong sulphur springs) : chronic skin diseases, such as eczema, lepra, impetigo, acne, pityriasis, lichen, etc. (the sulphur, beginning with the mild) : gouty and rheumatic affections (the strong sulphur) : threatened phthisis, especially in young women with dis- ordered menstruation (the mild sulphur, alternately with pure chalybeate) : strumous affections (the saline chalybeate) : and lupus, constitutional syphilis, chronic ulcers, etc. Very frequently great advantage is derived from the external use of the strong sulphur waters, combined with the internal •administration of the chalybeate.
467. Spa, in Belgium.
Situated near the frontier of Rhenish Prussia, in the beautiful valley of the Ardennes, at the foot of a steep mountain sheltering it from the north winds, is Spa. It possesses the only important mineral springs found in Belgium. The waters of the principal well — the Pouhon — have a tem- perature of 50° Fahr., and are largely charged with carbonic acid ; the chief solid constituents being the bicarbonate of soda, iron, lime, and magnesia. Spa is rather more than 1000 feet above the sea level.
The wells of the Sauvenifere, Groesbeck, Geronstfere, and the three Tonne- lets are situated at short distances from the town. Their waters are similar to those of the Pouhon, but the proportion of iron is smaller. The Ton- nelet springs are the most gaseous. 'J'he water of the last discovered spring, the Barisart, has a temperature of 52°, contains more carbonic acid than the Pouhon, and less iron. It sometimes proves useful where the Pouhon disagrees. This spring is much frequented.
These gaseous chalybeate waters are employed, to the extent of two or
416 APPENDIX OF FOEMUL^.
three pints daily, commencing with a couple of glasses before breakfast. They impart power, strengthen the digestion, and are valuable in such cachectic and other diseases as require a ferruginous tonic. The season is from the commencement of May until the end of September. During the early part of October the weather is often wet and cold.
Chaudfontaine, in the valley of the Vesdre, has a thermal mineral spring which is used for bathing by sufferers from chronic rheumatism, neuralgia, irritability of the nervous system, etc. The temperature of the water is 92° Fahr. The solid contents are scarcely more than two grains in the pint, and consist of chloride of sodium and carbonate of lime. The sur- rounding country is very pretty ; while there is much to be seen of great interest in the neighboring manufacturing town of Liege — five miles distant.
468. Bagneres de Bigorres, in the Pyrenees.
This celebrated watering-place (1850 feet above the sea) is situated at the foot of the Pyrenees, on the left bank of the Adour, about 35 miles to the southeast of Pau. The season commences in June and ends about the middle of October.
The springs in Bagnferes and its neighborhood are numerous, and may be divided into three classes :— 1. The Saline. The temperature of these waters varies from 124^ to 85^ Fahr. ; the chief chemical products found in them being carbonic acid, chlorides of magnesium and sodium, sulphates of lime and .soda, and magnesia, suhcarhonates of lime and magnesia and iron, an infinitesimal proportion of arsenic, with resinous and vegetable extractive matter, and silex. 2. The Ferruginous. There is only one spring of this kind, properly so called — la Fontaine Ferrugineuse. 3. The Sulphurous. Only one sulphurous spring has much reputation, — that of Labassfere ; and its waters contain a minute quantity of carbonic acid, hydrosulphuric acid, cidoride of sodium, hydrosulphcde of soda, subcar- honate of soda, vegeto-animcd matter, and silex.
The general efi'ect of the waters, taken internally and used as baths, is that of a stimulant to the mucous membranes, kidneys, lymphatic system, and skin. They are useful, more particularly, in diseases of the bones and articulations ; in chronic rheumatism, and allied disorders, as neuralgia, sciatica, etc., in atonic dyspepsia, from over mental work ; and in nervous affections, — hysteria, palpitations, hypochondriasis, gastrodynia, etc., espe- cially if there be biliary derangements. The Labassfere waters are beneficial in cases of excessive secretion from the mucous canals, in many skin diseases, and in some morbid states of the abdominal viscera, in anaemic conditions, valuable effects result from the employment of the ferruginous spring. — Patients who have been benefited by Pau during the winter may advanta- geously proceed to Bagnferes for the summer.
When the saline waters are taken for their alterative effects, the daily dose is small, — about a pint ; but if a purgative action is needed, from one to two quarts, in divided quantities, should be drunk daily.
469. Gaphern, in the Pyrenees.
Situated about ten miles from Bagnferes de Bigorres, the waters of Cap- bern are of a saline character, like most of those in that neighborhood. Their chief constituents are carbonic acid gas, siUphates of lime and magnesia, with carbonate of lime. One authority says that they also contain carbonate of lime, while another asserts that there is not a trace of it. They are deemed useful in congestions of internal organs, and are supposed to have warded off apoplectic seizures, when the cerebral circu- lation has been sluggish ; they stimulate the uterus and ovaries, and have been said to cure sterility : while many cases of chlorosis, leucorrhoea,
MINERAL WATERS. 417
clysmenorrhoea, etc., seem to have been benefited by them. The dose is from four to six tumblers, early in the morning, taking exercise between each glass. At the same time reclining or douche baths are employed.
470. Bareges, in the Pyrenees.
This village, on the Gave de Bastan, 47 miles from Pau, is about 4000 feet above the sea. — The season lasts from the beginning of June to the middle of September.
The well-known sulphurous and stimulating waters of Barfeges are of three kinds, as regards temperature : — viz., the hot source, the temperate, and the tepid. The principal baths are, the Bain de l'Entree, 107^ Fahr. ; Bain du Fond, 98° ; Bain de Polard, 101° ; and Bain de la Chapelle, 84°. The waters of all are limpid, have an oily nauseous flavor, and exhale an odor of rotten eggs. They contain nitrogen, sul- phuret of sodium, sidphate of soda, chloride of sodium, silica, lime, etc. On their surface is found a thin gelatinous kind of pellicle called harigine or glair ine, or zoogene ; which is probably of a vegetable character, is emollient and softening, and is supposed to have some peculiar power in curing chronic rheumatism.
These waters are beneficial in inveterate squamous, pustular, and papular skin affections ; in some forms of scrofula ; in chronic rheuma- tism, sciatica, lumbago, and stiffness of the muscles or tendons; in stru- mous and other indolent ill-conditioned ulcers ; and in irritation from the presence of carious or necrosed bone. For healing sinuses left by old gunshot wounds they are considered particularly efficacious. Pul- monary cases derive more benefit from Eaux-Bonnes and Cauterets. Moreover, the waters of Barfeges are not to be prescribed when there is any tendency to inflammatory disorders, or in heart disease, or for irri- table nervous temperaments. They are more powerful and stimulating than the waters of St. Sauveur.
The waters are taken internally, as well as employed in the form of baths, douches, lotions, and injections.
471. St. Sauveur, in the Pyrenees.
Situated on the Gave de Pau, in the valley of Laverdan, this watering- place (2500 feet above the sea) is 44 miles from Pau, 4 from Barfeges, and 1 from Luz. The still Alpine air is mild, and yet bracing. The season is from May until October.
The waters are milder than those of Barfeges, but have the same con- stituents. Their temperature varies from 135° to 80° Fahr. 'J'hey are useful for women and children, in the same disorders as are sent to Barfeges. Hysteria, neuralgia, hypochondriasis, leucorrhoea. and irregularities of the catamenial flow, are much benefited by them. When taken internally they have to be diluted, their greasy properties, from the excess of baregine,. being so great. They are mostly used as reclining and douche baths, vaginal injections, etc.
472. Bagneres de Luchon, in the Pyrenees.
This little town, in a magnificent valley surrounded by noble mountains, is 85 miles from Pau, and 2000 feet above the sea. The season lasts from; June to the beginning of October. The arrangements for drinking th& waters are all good.
There are upwards of 48 thermal sulphurous springs, the temperature of the waters varying from 152° to 62° P. Their chief constituents are sul- pharet of sodium, chloride of sodium, silicate of hme, and silica.; with traces of the sulphurets of iron and vianganese, iodide of sodium, sul- phate of potash and soda, and sulphite of soda, etc. The waters are 27
418 APPENDIX OF FORMULA.
efficacious in chronic skin diseases, in stiffness of limbs after dislocations and fractures, in old ulcers, chronic bronchitis, rheumatism, and neuralgia. Also in some cases of torpid digestion, auiEmia, hypochondriasis, hysteria, etc. Their effects are injurious when there is a tendency to plethora and nervous irritability. They are drunk, in doses of three or four glasses, pure or mixed with milk ; and are used as baths, injections, lotions, eye- washes, etc.
473. Cauterets, in the Pyrenees.
This celebrated watering-place, imbedded among the mountains, in the valley of Laverdan, 3200 feet above the level of the sea, and more sheltered than Bareges, is much frequented by Spanish invalids. July and August are the best months, but September is also good. 'I'here are some 32 sul- phuretted saline springs, the temperature of the warmest being 122° Fahr.
Some of the waters are very stimulating, causing headache and feverish- ness. They contain nitrogen, sulphur et of sodium, sulphate of soda, chloride of sodium, silica, etc. Glairine or baregine, a peculiar gelati- nous substance (see F. 470), is also present. They are not to be used where there is any tendency to inflammatory affections. The cases most benefited by drinking the waters are chronic derangements of digestive organs, chronic rheumatism and rheumatoid arthritis, chronic skin diseases, uterine congestions or irritations, bronchial catarrh, the early stages of phthisis, and strumous affections. The waters are often taken diluted with milk.
The baths are especially valuable in rheumatic affections, scrofula, and obstinate skin diseases.
474. JlJaux-Bo7i7ies, in the Pyrenees.
Eaux-Bonnes, a village in a sheltered valley at the foot of the Pic de Gers, is 22 miles from Pan. The air is remarkably pure and fresh. The altitude above the sea level is 2400 feet. The active mineral waters, of which the supply is scanty, have been deemed efficacious in the early stages of tubercular and other chronic diseases of the respiratory organs. They are likewise useful in scrofula generally, in chlorosis, in dyspepsia from want of tone, and in amenorrhoea. The springs are slightly alkaline, and contain chloride of sodium, sulphates of lime and soda, iodide of sodium, etc. Their temperature is about 90° Fahr. The sulphurous waters are mildly stimulating; and are taken internally, and less fre- quently applied in the form of baths. In the commencement only small doses (three ounces) should be taken, the quantity being gradually in- creased to three or four glasses of six ounces each. While undergoing treatment the patient is encouraged to live as much in the open air as his symptoms will permit. A residence of about a month, for one or two sea- sons (the season lasts from June to the middle of September), is generally deemed sufficient. Afterwards a trip to Biarritz, for the enjoyment of sea- bathing, may often be taken with advantage.
475. Eaux-Ghaudes.1 Pyrenees.
The position of this village, hemmed in by precipitous limestone cliffs, is wild and secluded. It lies about 26 miles from Pau, and 4 from Eaux-Bon- nes. The season lasts from the beginning of July until October.
Of the six springs some are used for baths, others as internal remedies. The hottest source is Le Clot (96°). ; while L'Esquirette has the largest amount of salts. The waters contain sulphuret of sodium, sidphate of lime, and silica. They deposit sulphuraire, a confervoid growth. The taste of the waters is disagreeable, the smell of rotten eggs being powerful.
MINERAL WATERS. 419
The waters (two to six glasses early in the morning) and baths are useful in rheumatism and sciatica, in neuralgia, in threatened pulmonary disease, in scrofula, and in atonic dyspepsia.
476. Ussat, in the Pyrenees.
The mineral baths of Ussat, in the Department of Ariege, are 70 miles from Toulouse, the inhabitants of which city value them highly. They contain about 11 grains of solids to the pint, — chiefly sulphates and carbon- ates of lime and magnesia, and chloride of sodium, with traces o^ arsenic. The waters belong to the acidulous thermal class ; are not at all unpleasant; are soothing to the nervous system ; and hence prove useful in hypochon- driasis, hysteria, chorea, paralysis agitans, neuralgia, cramp, muscular pains, dysmenorrhoea, irritable conditions of uterus, etc. Though sometimes taken internally, they are chiefly used as baths. The season lasts from June to October.
477. Vernet les J3ains, in the Eastern Pyrenees.
The little village of Vernet, 16 miles from Perpignan, is placed in a deep well-sheltered valley. The waters belong to the thermal sulphurous class, but are only feebly charged with solids — amongst others, with sulphuret of sodium.
Where a long course of weak sulphur waters is needed, these baths may be resorted to in the winter as well as in the summer months. Sunny walks may be had on most days in winter, the climate being mild and equable. 'J'he waters are taken internally, and employed as warm and vapor baths ; and this combination of drinking and bathing is thought efficacious in chronic chest afi'ections.
478. Panticosta, in Arragon.
This remarkable Spanish watering-place, 56 miles from Pau, is situated at a level of .5800 feet above the sea. It is romantically placed in one of the little green valleys of the Pyrenees ; being surrounded by the lofty granite mountains, except at one part through which flows the river Caldares. There are four springs; two being saline, one sulphurous and one ferrugi- nous. The chief source is the Fuente del Higado, which contains nitrogen in large quantity, with feeble proportions of stdphate of soda, chloride of sodium, carbonate of lime, chloride of magnesium, and silica. Its waters are agreeable, have a temperature of 81° F., and numerous gas bubbles (owing to its free nitrogen) escape with it.
The waters taken internally increase the secretions of the liver and kid- neys and skin ; produce a sedative effect on the system ; increase the appetite and general powers ; and in pulmonary cases, relieve the cough. They are particularly recommended in laryngeal phthisis, in hemorrhage from lungs or stomach, or uterus, and in chronic irritation of the bronchial or intestinal mucous membranes. Where there is softened tubercle, or much debility of system, they do harm. The best part of the season is from the beginning of July to the end of August.
479. Vichy., in Central France.
This important alkaline thermal bath is situated on the right bank of the Allier, in a large open valley, suri-ounded by hills covered with vineyards. The altitude is 780 feet. The air is temperate and pure. The season lasts from the middle of May until the same time in September.
420 APPENDIX OF FORMULA.
The springs used at Yicliy for drinking' and bathing- are nine in number; the waters of all being limpid, and having somewhat the taste of soda ■water. Bicarbonate of soda and carbonic acid gas form the predominat- ing ingredients ; but they also contain small quantities of the bicarhonates of potash and magnesia, with the arseniate of soda. There is also some baregine, most abundant at the Source de I'Hdpital. The proportion of chief chemical components, in the sources generally resorted to, is shown in the following table: —
Grs. Grs.
Grande Grille. 107.8° F. Bicarb, soda, 37.50 Garb, acid gas, < 6.97 to each
\ 16 oz.s.
Puits-Chomel 109.6° " 39.09 " 5.91 "
Fontaine de I'HOpital.. 89° " 38.ti0 " 8 21 "
Fontaine des Celestins. 58.6° " 39.19 " 8.04 "
Grand Puits Carre 110.5° " 37.57 " 6.71 "
Puits d'Hauterive 69° " 36.99 " 20.92 "
Wherever the use of strongly alkaline waters is indicated, those of Vichy will prove useful. They may be taken internally, or employed as baths ; or used in both ways at the same time. The diseases which derive most benefit are, — pulmonary catarrh, debility and irritability of the digestive organs ; chronic enlargement of the liver and spleen ; i;ric acid gravel and calculi; vesical catarrh; chronic gout and rheumatism; diabetes; and some cases of albuminuria. Obesity has been lessened by these waters ; and they might be employed with advantage where the blood contains an excess of fibrin. The dose is from half a pint to two pints daily; but they must not be continued too long, lest a super-alkaline condition of the blood be induced. The spring of the Grande Grille is in most repute, and is especially useful , in liver diseases ; while that of the Celestins is best for disorders of the urinary organs, as well as in the uric acid diathesis. The Hospital spring is in favor for chronic gastro-enteritis.
The Vichy waters are exported in considerable quantities, and it is sup- posed without their undergoing any deterioration.
Vals possesses several springs, all alkaline from the presence of bicar- bonate of soda, but slightly differing in the proportion of the saline con- stituents. The St. Jean is the weakest, and is useful chiefly in dyspepsia. The Precieuse and Desiree are more alkaline and slightly laxative; they are employed in gouty and renal affections. The Magdeleine and Rigo- LETTE contain a small proportion of iron, and are considered to be invigo- rating.
480. Mont D' Or, in Central France.
At this bath there are six thermal sources and one cold spring. The water of the latter, St. Marguerite, is acidulous from the carbonic acid it contains, has a temperature of 52° Fahr., and is an agreeable drink mixed with milk or wine. The thermal sources are Le Grand Bain (108*^), the Source of C^sar (113°), the Fountain Caeoline'(107°), the Bain Ray- mond (109°), the EiGNY (109°), and the Madeleine (114°). The ingredi- ents in the different waters only vary in quantity ; consisting of the car- bonates of soda and lime, chloride of sodium, sidphate of soda, with mere traces of iron and alumina. They all contain an excess of carbonic acid. The Madeleine spring is also strongly arsenical.
Besides drinking the waters, most invalids employ warm bathing. The effect is to increase the perspiration ; and at the end of a few days to pro- duce " the bath-fever" (lassitude, depression, constipation, etc.) which soon passes off. The invalids who will derive benefit from a visit to Mont D'Or ■ are such as have chronic pulmonary catarrh, some kinds of asthma, rheu- matism, and congestion of the liver. Mischief will result to persons of a languid circulation, and such as have a tendency to hemorrhage.
MINERAL WATERS. 421
The season is from the middle of July to the end of August; but the waters should not be used for more than a fortnight, on account of their exciting properties. The visitors who drink them take three or four glasses daily.
481. Keris, in Central France.
The thermal springs of N6ris are resorted to, from May until October, for the purpose of drinking the waters and bathing in them. There are four wells ; the temperature of the waters at their source being about 120° Fahr. They are insipid and oily ; containing only small proportions of carbonic acid, bicarbonate of soda, sulphate of soda, and chloride of sodium. Confervaj grow feebly in the basins. These waters are recom- mended in cases of nervous and hysterical excitement, in rheumatism, and prurigo.
482. St. Galmier, in Central France.
These waters, owing to their richness in carbonic acid gas, are agreeable whether taken pure or mixed with wine; while they have the property of hastening digestion, increasing the appetite, and augmenting absorption from the alimentary canal. The chief salts in them are the bicarbonates of lime and magnesia.
The St. Galmier waters are cold, and resemble Seltzer water. They are in common use at Lyons ; being deemed useful in gastric affections, and for preventing the formation of urinary calculi.
483. Aix-la-ChapeUe (^Anche)i), in Rhenish Prussia.
This town, in which Charlemagne was born, and in which he died in 814, about 43 miles W. S. W. of Cologne, is situated in a valley between the Rhine and Maas rivers, and is surrounded by well wooded hills. It is 450 feet above the sea level. There are eight principal springs, — six thermal and slightly sulphurous, and two cold chalybeate. Their therapeutical effects are due to the high temperature of the water (varying from 111° to 131° Fahr.) and the sidphur and chloride of sodium contained in it. The latter salt is found in the proportion of about twenty grains to the 16 ounces ; while the sulphuret of sodium varies from three-quarters to a quarter of a grain. Of the gaseous constituents the sulphuretted hydrogen is the most active, although it is only pi*esent in small quantity. The Elisenbrunnex is the principal drinking fountain ; its exceedingly unpleas- ant water being derived through subterranean pipes from the hottest and strongest of the sources — the Kaiserbad. Yery rarely the chalybeate springs are employed .as an " aftercure ;" but they have little power, one containing half, and tho others three-quarters of a grain of iron in the six- teen ounces, with some carbonic acid.
In doses of a few glasses these clear transparent waters do not produce much appreciable effect; their chief use being externally, — as vapor baths, douches, shampooing, etc. The baths have considerable reputation for curing scrofula, skin diseases (acne, psoriasis, and prurigo), hepatic and renal complaints, chronic gout and rheumatism, functional derangements of the uterine organs, rebellious ulcers, and the ill effects produced by the use of mercury or lead. In cases of long standing stiffness about the joints, as well as in sprains, the rubbing and kneading and stretching of the muscles and articulations which are employed prove very efScacious. The springs are to be avoided where there is any tendency to cerebral, pulmonary, gas- tric, or uterine hemorrhage. A course of the baths lasts from four to six weeks. The season begins early in June, and ends about the middle of September.
422 APPENDIX OP FORMULA.
At BoROETTE, or BuRTscHEiD, a suburb of Aix, there are several bath establishments. The thermal springs are divided into the sulphui'ous and non-sulphurous. The most important of the former is the Trintcquelle ; the water of which contains chloride of sodium, with sulphate and carbonate of soda, and has a temperature of 140° Fahr. The Kochhrunnen is the most used of the non-sulphurous springs. The waters of Borcette are re- commended for the same class of cases as is sent to Aix. The advantage of the former place over the latter is, that it affords a much cheaper residence.
484. Kreuznacli, in Rhenish Prussia.
The rather nauseous and bitter waters of this Spa have a considerable reputation for the cure of uterine diseases, as well as of most scrofulous affections. The chief waters are those of the Elizabeth BRUNNE>f, having a temperature of 54..')0° Fahr. They contain about 90 grains of solid con- stituents in 16 ounces: — chiefly, chloride of sodium (73), chloride of cal- cium (.13), chloride of magnesiuvi (4), bromide of magnesium {\), oxide of iron [\), with a trace oi iodide of magnesium, etc. The Karlshaller WATER has a temperature of 59°, and 75 grains of salts in the sixteen ounces : the Theodorshalle 70.25°, and 87 grains ; while for the chief well of MuNSTER the numbers are 81.50°, with from 64 to 76 grains.
In drinking the waters it is better to begin with small quantities, which may be drunk pure or mixed with hot milk. The baths are generally taken tepid ; " mother lye" (the brownish glutinous liquid left in the boiling pans, after the salt has been crystallized and removed) being added to the water, in proportions suitable to the requirements of each case. In uterine affec- tions, fomentations and vaginal injections are employed in addition to the bafhs".
The Kreuznach waters have proved valuable in congestions of the ute- rine organs ; as well as in chronic inflammatory affections of these parts, in hypertrophy and induration, in uterine displacements, and in derangements of the menstrual functions. Dr. Prieger, who has had very great expe- rience in the use of these waters, tells the Author that he has never seen a true fibroid tumor of the uterus absorbed through their influence ; but when such a growth is oedematous or congested, the waters relieve these complications. Hypertrophies of the mammary glands, cases of chronic skin disease, as well as scrofulous ulcers, are oft-times benefited by these waters.
The season extends from the end of April until the beginning of October. The stay which a patient should make may vary from six to eight weeks.
The springs of Nauheim, a village of Hessen-Cassel, resemble those of Kreuznach, except that they contain rather more chloride of sodium, only a trace of bromide of magnesium, and none of the iodide of magnesium. There is also an abundance of carbonic acid ; and the temperature of the four chief springs varies from 72° to 92° Fahr. The waters are drunk and used as baths ; while like those of Kreuznach, they are recommended for all strumous affections.
485. Neuenahr, in Rhenish Prussia.
This village, in the wild and picturesque valley of the Ahr, is easily reached from Cologne. Of the springs, the Victoria is the best. Mr. Miller, the late Professor of Surgery in the University of Edinburgh, says that it is the richest of all known brunnens in carbonic acid. It furnishes some 29,792 cubic feet of water daily ; an analysis of which has shown the presence of small quantities of bicarbonccte of soda, sidphcde of soda, chloride of sodium, bicarbonate of magnesia, bicarbonate of lime, prot- oxide of iron and alumina, silica, and free carbonic acid.
The waters are taken internally and applied externally. The dose is
MINERAL WATERS. 423
from two to five tumblerfuls, early in the morning ; with half the quantity in the evening. The temperature of the water is between 78° and 80° Fahr., and the taste is pungent and r)leasant, resembling — as an English valet said — " Seltzer water with the chill off." The best time for the bath is two or three hours after breakfast; the temperature of the water being about 88°, and the time for remaining in it twenty minutes. When the invalid is acclimatized, the douche may be used if needful.
The waters are tonic and anti-rheumatic ; acting especially on the mu- cous membranes and the glandular system. They are useful in simple dyspepsia, diminished secretion of bile, irritability of the bladder with excess of uric acid in the urine, chronic gout and rheumatism, asthma com- plicated with organic disease, chronic affections of the larynx or bronchi, eczema and prurigo, and chronic uterine maladies. — In a person apparently healthy, Dr. Weidgen found that the use of the waters was followed by these effects: — A sense of warmth in the stomach soon ^fter drinking; exhilaration ; increased flow of urine ; increased appetite ; and increased salivary and bronchial secretions. After a week the bowels were affected ; copious, soft, bilious evacuations being produced. The urine became neu- tral, but never alkaline.
486. Ems, Duchy of Nassau.
Ems, or Bad-Ems (as the Spa is called, to distinguish it from the old village or Dorf-Ems), lies on the right bank of the Lahn, enclosed in a narrow valley between high mountains, 15 miles N. of Wiesbaden. Ems is 290 feet above the sea level. The air is mild : the situation attractive. There are several springs. The waters are alkaline, saline, and gaseous ; while the temperature varies from 86° Fahr. to 133°. The chief con- stituents are carbonate of soda, chloride of sodium, and carbonate of magnesia ; with small quantities of carbonate of lime, iron, manganese, potash, and lithia. Their action is that of a mild alterative, diuretic, and laxative ; and they are believed to favorably influence all catarrhal aifec- tions of the mucous membranes.
The principal drinking springs are the Kraenchenbrunnen and the Kesselbrunnen. The waters of the former are clear, odorless, have a temperature of 80°, and leave a soapy taste owing to the soda they contain. According to Struve each 16 ounces contains l.i^ cubic inches of free car- bonic acid gas. The Kesselbrunnen or Kurbrunnen waters give out more carbonic acid, and are 118°. The dose is from one to six beakers, each holding about 4 oz. In many cases it is an improvement to add one-third part of goats' or asses' milk to the measure. ,
The waters are also employed externally, the baths being partly filled overnight to lower the temperature. The Bubenquelle (boy's spring), 117°, is used as a vaginal douche ; and is in repute for the cure of sterility due to uterine and vaginal leucorrhoea, or to inflammatory affections of the cervix uteri.
The waters generally are recommended in chronic bronchial and pulmo- nary affections, with irritable cough, but without profuse secretion, in the dyspepsia of such as have only a tendency to phthisis, as well as in eczema and prurigo. For the relief of the lithic acid diathesis they are valuable, but less so than those of Vichy. For drinking and bathing, French and German visitors usually resort to Ems in June. The best months are May, June, September, and October. Our own countrymen, however, seem to prefer July and August ; though the narrowness of the valley in which this bath is situated causes the air to be very oppressive and relaxing during these two months.
424 APPENDIX OF FORMULA.
The mineral springs of Fachingen, a village 9 miles B.N.E. of Nassau, on the Lahn, resemble those of Eras, the carbonate of soda and carhoiiic acid being present in rather larger proportions. The waters form an agreeable antacid drink in some forms of dyspepsia.
487. Selters, in Nassau.
This village, in a pleasant valley 37 miles N. of Wiesbaden, is every- where famous for its mineral springs ; an enormous quantity of Seltzer water being annually exported. Selters is 800 feet above the sea level.
The water has a temperature of 60^ Fahr., and contains much more than its volume of carbonic acid gas. It has about 32 grains of solids in the sixteen ounces: q\\\&^j chloride of sodium (18), and carbonate of soda (9), with minute quantities of sulphate of soda, lime, magnesia, and iron. Seltzer water stimulates the stomach ; and is a grateful, antacid, slightly alterative drink.
Apollinaris water, somewhat richer in saline ingredients but otherwise similar in all its properties to Seltzer water and very agreeable as a drink, has lately been most extensively used.
488. Schioalhach and Schlangenhad, in Nassaic.
ScHWALBAOH Or Langenscwalbach, 8 miles N. W. of Wiesbaden, con- sists of one long street, in the middle of Avhich. is the Kursaal. The climate is bracing ; the altitude is 900 feet. The gaseous chalybeate waters, with a temperature of 50° Fahr., owe their invigorating properties to carbonate of iron, which is held in solution by an excess of carbonic acid. They also contain a small amount of the bicarbonate of soda, magnesia, and lime. The chief springs are — the Weinbrunnen, near the Kursaal, which contains most iron, and is believed to counteract the evils arising from ex- cessive indulgence in wine ; the Paulinenbrunnen, the mildest, which was formerly used by invalids from tropical climates with torpid livers, but which appeared to be deserted in 1867 ; the RosenbrunnexV, only employed externally, the baths being heated by steam to 86° or 90° ; and the Stahl- brunnen, in the northern valley, which is the most exciting of the springs. The waters are drunk fasting, to the amount of one to three glasses, twice a day ; and they may be strongly recommended in cases of impaired strength where a ferruginous tonic is indicated, as well as in those examples of dys- pepsia and constipation which are due to a torpid and anaemic condition of the walls of the alimentary canal. The bath should be taken about two hours after breakfast, omitting its use every third or fourth day. The best time for a visit to Schwaibach is from the middle of June until the end of August. *
Rather more than two miles from Schwaibach, in a pleasant valley, with romantic environs, is Schlangenbad. I'he climate is pure and bracing; the height above the sea being 930 feet. As a Spa Schlangenbad is of in- significant value, owing to the small amount of solid constituents — only a few grains of carbonate of soda, lime, an"d magnesia, with common scdt — in the waters. Warm saline and mud baths are used by the visitors ; such amusements being in repute for softening and whitening (" satinizing") the skin, and for allaying nervous irritability. The season lasts from the be- ginning of June until September.
489. Wieshaden, in Nassau.
Wiesbaden, the capital of the Duchy of Nassau, lies on the southern slope of the Taunus mountains, 5 miles N. N. W. of Mayence. It is the most frequented of the watering places in Germany. The season extends from June until September, but it is very hot in July and August. Owing
MINERAL WATERS. 425
to tlie shelter afforded by the several peaks of the Taunns, the autumnal and winter climate is cjood.
There are some eighteen or twenty thermal springs, but only one is of much importance, 'i'his, the Kochbrunnen, rising nearly in the centre of the town, appears literally to resemble a boiling well. The temperature varies from 15(P to 160^ Fahr., volumes of vapor are emitted, and the ■water contains some 6.3 grains of solids in the sixteen ounces. The salts are chloride of sodium (52|-) ; with small quantities of potash, lime, iron, viagnesia. arseniate of lime, bromide of magnesium, etc. The carbonic acid gets is one-fifth of the bulk of the water. Sir Francis Head and Dr. Granville compare the taste to that of weak chicken broth slightly salted. Taken in a dose of three or four glasses, cooled, before breakfast, it has a slightly laxative and diuretic effect, and increases the appetite. As baths, at a temperature varying from 86° to 98°, about two hours after a light breakfast, the waters are somewhat soothing, while they increase the action of the skin and kidneys.
The cases in which these waters are likely to prove valuable, are chronic gout and rheumatism, hepatic congestion with haemorrhoids, and chronic skin diseases connected with abdominal plethora. They will be injurious in debility, in congestion of the uterine organs, or where there is a tendency to apoplexy or any other form of hemorrhage. The invalid may know that they disagree, when prostration, loss of appetite, constipation, irrita- bility, and palpitations are produced ; or when the doses give rise to a feel- ing of disgust, especially if they have been previously regarded as rather agreeable. The course ought not to extend beyond four or five weeks. The country in the neighborhood of Wiesbaden is charming.
490. Soden, in Nassau.
The waters of Soden, in the Taunus near Frankfort, are saline and gase- ous, issuing from twenty-three springs, scattered through the village. Their temperature varies from 64° to 74° Fahr.
The most important springs are, — the Milchbrunnen containing 23 grains of solids in the 16 ounces; 17 grains being chloride of sodium. 3 chloride of potassium, with 17 cubic inches of carbonic acid gas. The Warm- brunnen has 35 grains of solids, 26 of which are chloride of sodium ; the carbonic acid gas being 35 cubic inches. The Wilhelmsbrunnen has 117 grains of salts, 104 being chloride of sodium, with 48 cubic inches of gas. Whilst the Soolbrunnen has 129 grains, 114 of which consist of the same salt that predominates in the others, together with 14 cubic inches of gas. —Where alterative aperients are needed, these waters may perhaps be re- commended. They are deemed useful in pulmonary, strumous, gouty, and uterine affections.
One advantage possessed by Soden is the presence of the two ferruginous springs of Kronthal; so that the visitor, having employed the alteratives of the first Spa, may strengthen the system with the mild chalybeates of the Stahlquelle or Wilhelmsquelle. The climate of Kronthal is useful in chronic bronchial affections.
491. Ho7nhurg, in Nassau.
Homburg lies about nine miles northwest of Frankfort; being 660 feet above the sea level. The air is. invigorating and bracing during the months of June, July, and August ; but it is injurious to such as have delicate lungs, owing to the temperature being very variable. There are four cold (about 50° Fahr.) muriated mineral springs ; all rising near each other in the park or Kurgarten. The most frequented is the Elisabethquelle, containing about 110 grains of salts in the 16 ounces, and being- strongly charged with carbonic acid (48 cubic inches). The chief salts are chloride of sodium,
426 APPENDIX OF FOEMULJE.
(79), the chlorides of mugnesium and calcium (15) , and carbonate of lime (11) ; with small quantities of carbonate of magnesia, sidphate of soda, carbonate of iron, and silica. The Kaiserquelt.e has more chloride of sodium (117), more chloride of calcium, and a little more iron. The Stahlquelle has the same amount of common salt as the Elizabeth spring, but is more ferruginous than either of the others ; while the Ludwiosquelle is weak in almost all its constituents. The flavor of all the waters is re- freshing, saltish, somewhat bitter, and ferruginous.
Gout, dj'speptic and other derangements of the abdominal viscera, stru- mous enlargements of the external glands and mesentery, debility of the reproductive organs, constipation, obesity, and hypochondriasis are the diseases most likely to be benefited. From two to four tumblerfuls of the waters are to be taken fasting during three or four weeks. Though chiefly used internally, there are baths, douches, etc.
492. Baden-Baden, in Grand Duchy of Baden.
This renowned Spa, rather more than 600 feet above the sea, in one of the most delightful valleys of the Black Forest, about six miles from the Rhine, has 16 weak saline springs, the temperature of which varies from 117° to 161° Fahr. 'I'he chief spring, and the only one demanding notice, is the Ursprung ; which has a transparent, inodorous, saltish water. Its chemical constituents are merely about 23 grains to the 16 ounces, 18 grains being chloride of sodium. There are also 2^ grs. of sulphate of lime, about 1-10 of a grain of carbonate of iron, with less than half a cubic inch of carbonic acid. Recent analyses have shown the presence of lithia, in greater abundance than in any other springs.
Though their efficacy must be slight, these waters are often taken internally. Some drinkers add goat's milk to them, or whey, or aperient salts. But they are chiefly to be employed where simple hot baths are needed, while the invalid is enjoying beautiful scenery, in pure mild air. They may be recommended in chronic gout and rheumatism, dyspepsia from overwork, nervous affections, etc. The season lasts from the beginning of May until the 1st of October.
The waters of Wildbad. about thirty miles from Baden-Baden, and situated in the kingdom of Wiirtemburg, contain only 4 grains of salts in the 16 ounces, and have a temperature varying from 86° to 98° Fahr. Where hot baths and douches are needed in chronic paralysis, rheumatism, etc., a six weeks' sojourn at Wildbad may perhaps be recommended. The climate is very bleak from November until May ; and then in the four suc- ceeding fashionable months the heat is most oppressive. Wildbad is some 1320 feet above the sea.
493. Kissingen, in Bavaria.
Kissingen, one of the most fashionable watering places of Germany, is situated in a fertile valley, about 30 miles N. N. B. of Wlirtsburg. Its height above the sea level is some 800 feet. 'J'he tonic, laxative, and alte- rative waters are all cold (about 52° Fahr.). The most important spring is the Ragoczy, containing 65 grains of solids in the 16 ounces, according to LiEBiG, with 41 cubic inches of carbonic acid gas. The principal salts are chloride of sodium (45), carbonate of lime (8), sulphate of magnesia (4), chlorides of potassium and magnesium (5), with minute quantities of chlo- ride of lithium, bromide and iodide of sodium, and carbonate of iron. The waters of the Panderbrdnnen have rather a smaller amount of solids ;
MINERAL AVATERS. 427
while those of the Maxrrunnen and of the Theresiknbrunnen are very much weaker, and contain no iron.
The Ragoczy spring" is most used early in the morning, from three to six glasses being taken. In the evening the milder waters of the Pandur are preferred. The effect is to quicken the circulation, and to stimulate the secretions of the mucous membranes generally but especially those of the alimentary canal. Hence they are valuable in habitual constipation, con- gestion of the liver or kidneys, in dyspeptic eructations or flatulence, and in strumous enlargements of the glands. They may also do good in threat- ened tubercular diseases of the mesenteric glands. Gouty and calculous cases also derive benefit.
The baths are prepared from the waters of the wells just named, some of the "mother water" of the Soolensprudel being frequently added. This spring has a temperature of 62°; and contains 187 grains of solids in the 16 oz., upwards of 100 consisting of chloride of sodium. The astonishing fiux and reflux of the Sprudel, some eight or nine times a day, is one of the sights of the town.
About 4^ miles from Kissingen is the Spa of Booklet, in Bavaria, which contains several chalybeate and a weak sulphur spring. The temperature of the waters is about 52° ; while there is rather more than half a grain of carbonate of iron in the 16 oz., with .39 cubic inches of carbonic acid gas. They also contain a small amount of the sulpTiates of soda and magnesia, chloride of sodium, carbonate of lime, etc. Independently of the constant interchange of visitors between Kissingen and Bocklet, the baths of the latter (especially the " douche ascendante") have a considerable reputation for the cure of sterility, and for breaking off the tendency to habitual abor- tion. Bocklet is 620 feet above the sea.
Brijckenau, in Bavaria, is also only a few hours' drive from Kissingen. The waters contain scarcely any salts, but have about a quarter of a grain of iron in the 16 oz., with at least 35|^ cubic inches of carbonic acid gas. Their temperature is 49°. They are often employed by those who, after going through a course of the solvent waters of Kissingen, require a pure mild tonic.
The Adelheidsquelle is a well known salt water spring, found at the small village of Heilbrunn, in Bavaria. Prettily situated, not many miles from Munich, this village is said to be 2400 feet above the level of the Medi- terranean. The well affords a comparatively small supply of water, which has a temperature of .50° Fahr. It contains 47 grains of solids in the 16 ounces; upwards of 38 grains consisting of chloride of sodium, with 6 grains of carbonate of soda. There are also small quantities of iodide and bromide of sodium, silica, etc The alterative effect of these waters renders them useful in all kinds of scrofulous affections. The season is from the early part of May until the end of September. The accommodation for visitors is scanty.
494. Ga stein, in Austria.
A few hours' drive from Salzburg is the village of Gastein, in the most beautiful part of the Tyrol. It is one of the highest baths in Europe, being 3200 feet above the Mediterranean. The houses are grouped round the edge of the mountain torrent Ache, which here forms a splendid waterfall. The bracing alpine air is invigorating for such as have strong lungs, but the climate is often too raw and unsettled for the delicate invalid to depend upon it. Mean annual temperature 47° Fahr. July and August are the season months.
428 APPENDIX OF FORMULA.
There are six or eight very weak thermal springs, having the same chemical composition, but varying in temperature from 9,5° to 118°. In 16 oz. of water there are only 2.68 grs. of solids, sidphate of soda being the chief (1.51). The waters, after cooling to about 90°, are used as baths, and are said to stimulate the nervous system. It seems certain that the prema- turely old, the hypochondriac, the paralytic, and the sufferer from chronic rheumatism derive benefit.
The waters of Teplitz. in Bohemia, very much resemble those of Gastein, as regards temperature and chemical power. They contain only about 4.64 grains of solids in the 16 oz. ; the carbonates of soda and hvie, with sid- phate of soda^ being the chief ingredients. The baths are used in gouty and paralytic affections ; as well as in rheumatoid arthritis, chronic disease of the spine and large joints, and functional derangements of the uterine organs. The town lies in a fertile valley, 640 feet above the sea ; the envi- rons are remarkable for their beauty ; while the climate is healthy and genial.
495. Fried7'ichshall, in Saxe-Meiningen.
This place has long been noted for the manufacture of Glauber's salts and common salt. Of late years the purgative waters have acquired a high reputation, more especially for cases where it is necessary to promote excre- tion from the liver, kidneys, and bowels.
The bitter saline water of Friedrichshall is bright and clear, of a light yellowish tinge, free from smell, and possessing a salt bitter flavor. Accord- ing to Likbig's analysis (made in 1847) it contains about 194 grs. of solids in the 16 ounces, with 5.32 cubic inches of carbonic acid gas. The chief ingredients are chloride rf sodium (61), sidphate of soda (46), sulphate of magnesia, (39), chloride of magnesium (30), sidphate of lime (10), with small proportions of sulphate of potash, carbonate of magnesia, bromide of ma.gnesium, carbonate of lime, and silica. — The dose is from three ounces to a pint or a pint and a half, according to the aperient effect re- quired. Large quantities of this water are exported annually to different parts of Europe.
496. Carhhad, in Bohemia.
This town occupies the bottom of a narrow winding valley, on the banks of the Tiipel, 70 miles W. N. W. of Prague. The season extends from the beginning of June until the end of September; but the month of May is very quiet and pleasant and healthy, although the mornings are often cold. The " cure" generally occupies from five to six weeks. Carlsbad is 1200 feet above the sea.
There are several important springs, chiefly differing from each other only in temperature. The most important is the Sprudel ; the waters of which bound upwards for four or five feet, and then fall back in foam, while giving off clouds of vapor. The temperature is about 165° Fahr., and there are some 45 grs. of solids in the 16 oz. The principal salts are sulphate of soda (20), sulphate of potash (9), chloride of sodium (8), and carbonate of lime (2) ; with small quantities of carbonate of soda, carbonate of iron, phospjhate of alumina and silica. The carbonic acid gas is nearly 8 cubic inches. — 'I'he Schlossbrunnen contain only half the amount of sulphate of soda, double the quantity of carbonic acid gas, and have a temperature of 123°. The heat of the waters of the TheresienbrunnIsn is 131°, and as regards important ingredients may be said to resemble the Schlossbrunnen. The Marktbrunnen differ from the others principally in containing a little iodide and bromide of sodium. The temperature is 130°.
MINERAL WATERS. 429
The waters are chiefly taken internally, early in the morning and aofain in the evening. 'J'he dose varies from one or two glasses to ten or twelve; according to the stimulating and alterative and aperient effects on the digestive organs and abdominal viscera generally, which it is desirable to produce. The cases most benefited are, — liver and abdominal diseases, diabetes, gouty and rheumatic disorders, calculous affections, and hypochon- driasis with dyspepsia and constipation. The waters are also useful in rheumatoid arthritis, sciatica, and in jaundice from obstruction by gallstones. Old Indians, with enlarged livers, often derive remarkable relief. Baths of the cooled mineral water are now but seldom resorted to, though for one hundred and fifty years invalids only visited Carlsbad for the purpose of bathing. Sometimes the peat soil from the neighborhood, mixed with Sprudel water, is used as a poultice, etc.
497. Marienhad, in Bohemia.
Marienbad, in the territory of the abbey of Topi and the district of Eger in Bohemia, is about five hours' drive from Carlsbad. The air is pure and dry, but changes in temperature take place rapidly owing to the height of the village — 1912 feet above the level of the North Sea. The season lasts from the commencement of May until the end of September.
There are several cold (from 43° to 50° Fahr.) saline chalybeate springs; the chief constituent being sulphate of soda, with a moderate quantity of iron and carbonic acid. 'I'he waters when drawn are quite clear, but as the gas escapes they become turbid from the deposition of the carbonates. The Kreuzbkunn— the principal spring— has 69 grains of solids in the 16 oz., with 85- cubic inches of carbonic add ga^. The chief salts are sidphale of soda (38), chloride of sodium (13), carbonate of soda (9), and carboncde of magnesia (3); with small quantities of the carbonates of lime, lithia, iron, manganese, etc. The Ferdinandsbronn has nearly the same solid ingredients, but with nearly 14 cubic inches of carbonic acid gas. The Waldbrunn is much, weaker in sulphate of soda (7), and covimon salt (3), but its proportion of carbonic acid gas is 18f cubic inches. The waters of these brunnen are all used for drinking. 'J'he Carolinenbrunn has only 11 grs. of solids in the 16 oz., sidphate of soda being the chief; but there are 1.5^ cubic inches of carbonic acid gas. The Ambrosiusbrunn is still weaker (7 grs. in 16 oz.), with 13 inches of gas ; while the Marienbrunn has scarcely any salts (2 grs. in 16 oz.),. with 9 cubic inches of carbonic acid gas. 'I'he well of the Marienbrunn is used only for water and gas baths; but the Caroline and Ambrosius waters are employed internally as well as externally.
The effect of the Marienbad waters is laxative, alterative, and tonic, in proportion to the dose (from one to six tumblerfuls) ; while they increase tlie action of the liver and kidneys, and promote appetite. Hence they are particularly valuable in chronic disorders of the abdominal viscera. The mud baths and poultices are made with the Marienbad water mixed with a black mineral pulverulent substance, brought from a neighboring peat bed. They stimulate the skin, heal chronic ulcers, and disperse glandular swellings. The gas baths [carbonic acid with a small amount of sidphuretted hydrogen) soothe muscular and neuralgic pains, remove torpor of tbe female sexual organs, and generally tranquillize the nervous system.
The bitter saline waters of Pijllna, in Bohemia, are very nauseous and indigestible, while they possess no advantages over the ordinary prepara- tions sold by the chemist. Their chief ingredients are sidphate of mag- nesia (96 grains in the 16 oz.), sulphate of potash (82), sulphate of soda (12), chloride of magnesium (16), carboncde of magnesia (6), with sul- phate of lime, carboncde of lime, and bromide of magnesium. Piillna water is largely exported.
430 APPENDIX OF FOEMUL^.
498. Eger, in Bohemia.
This frontier town stands on the right bank of the Eger, 92 miles W. of Prague. In the district, some three miles off, is the Spa of Franzexsbad. The tonic solvent waters of this spring have a refreshing acidulous taste, a temperature of 52° F., with 42 grains of solids in the 16 oz. The chief of these are sidjjhate of soda (24), chloride of sodium (9), atid carbonate of soda (6) ; together with the carhoncdes of magnesia, lime, iron, Hthia, manganese, and strontia, and 40 cubic inches of carbonic acid gas.
The waters of the Franzensbad and other wells are taken internally and employed as baths. They strengthen the nervous system, improve indi- gestion, stimulate the circulation, relieve bronchial affections, and act powerfully on the uterine organs. Mud and gas baths are especially in favor. The boggy earth is sifted free from foreign matters, and converted into black mud ; which is heated to 100°, and which contains sulphate of soda, iron, lime, alumina, and ulmic acid. In this mineralized mud the body is immersed for fifteen minutes, when the patient transfers himself to a plain water bath to remove the dirt. The treatment is said not to be disagreeable ; and it may perhaps prove beneficial in chronic skin diseases, indolent ulcerations, old rheumatic affections, gouty deposits, and in pa- ralysis without active disease of the nervous centres. The gas baths are considered as specifics for the cure of scrofulous ulcers.
499. Aix-les-Bains, in Savoy.
This beautiful and sheltered town, 788 feet above the sea, may be reached by railway from Paris in about fifteen hours. The climate is mild but yet bracing, and is especially adapted to invalids from April until October. There are two chief springs ; but as they are only slightly mineralized, the effects which they produce must chiefly be due to their temperature, — about 116^ Fahr. The Sulphur Spring contains but little more than 3 grains of salt in the 16 oz., with a small quantity of carbonic acid and sulphuretted hydrogen gas. The Alum Sfrtng, so called on the lucus a non lucendo principle, since it contains no alum appreciable to the seiises, has the same composition minus the sulphuretted hydrogen.
'J'he waters are chiefly used externally, and especially in the form of douches. They are valuable in chronic rheumatism, sciatica, rigidity of tendons or muscles after sprains and contusions, chronic skin affections, diseases of the bones, nervous disorders, etc.
500. Baths of Switzerland.
Leuk or LouECHE, on the Rhone, stands a little to the left of the high road passing through the Valais to the Simplon, and is nearly 4500 feet above the sea. There are twenty-three thermal mineral springs, varying in temperatui'e from 9.5° to 124° Fahr. 'I'he latter is the heat of the St. . Laurent or Lorenzquelle. All the waters have the same composition, the solid constituents being about 15 grs. in the 16 oz. The chief salt is the sulphate of lime (nearly 13), with small quantities of the sidphates of magnesia, and soda, etc. It is the custom to bathe in common ; there being four public piscinte, each about a yard deep, and each capable of accommodating some forty bathers, with their small floating tables. On the first day the patient remains an hour in the water, clothed in a long flannel gown ; the duration being daily increased till it extends to four or five hours in the morning, and for a shorter period again in the afternoon. About the twelfth day, an erythematous rash called the poussee appears over the body, with prickling sensations of heat, and febrile symptoms ; its
MINERAL WATERS. 431
disappearance being followed by desquamation of the cuticle. The dura- tion of the bath is then gradually diminished by half an hour daily, until the cure is complete in some twenty-five or thirty days from the commence- ment. This peculiar practice is recommended in cases of scrofula, enlarge- ments of the liver or spleen, chronic gout and rheumatism, obstinate eczema and psoriasis, old wounds and ulcers, calculous affections, etc. The season is from May until October.
Pfeffers, in the Canton of St. Gallen in the Grisons, is in a wild and sombre dell. It is 2115 feet above the sea. The feeble thermal water is conducted down the romantic glen of the Tamina by wooden tubes, to the hotel and bathing-house at Ragatz, in the valley of the Rhine. The salts in the waters are scarcely equal to 2 grains in the 16 oz. ; the chief being the sulphates of soda and lime, with chloride of sodium and carbonate of lime. The temperature is nearly 100° Fahr. The bath is used twice a day, for about half an hour each time ; and is useful in calming nervous irritability, and in relieving neuralgia, hysteria, etc. The waters are also used for drinking, — from four to eight tumblerfuls. The invalid should be advised to reside at Ragatz rather than at Pfeffers, which generally has a cheerless and sunless aspect. When, however, the fall of snow during the preceding winter has been less than usual, the supply from the hot spring is so diminished in quantity, that sufficient water cannot be conveyed to Ragatz. The season lasts from the beginning of June until the end of September.
Tarasp, on the right shore of the Inn in the Grisons, has cold gaseous springs somewhat resembling those of Marienbad. There are numerous wells, having their source in a rocky hollow some 4300 feet above the sea. The chief are the Grosse Quelle and the Kleine Quelle, their composition being similar, and their temperature 45° Fahr. Their salts (95 grs. in the 16 oz.) consist of chloride of sodium (29), carbonate of soda (27), sidphate of soda (16), and carbonate of lime (12), with small quantities of the car- bonates of magnesia and iron, iodide of sodium, sidphate of potash, etc. The carbonic acid gets is 32 cubic inches. These aperient and resolvent waters are useful in plethora of the abdominal viscera, and in incipient phthisis.
St. Moritz, Upper Engadin, Grisons, lies 5863 feet above the sea, in a valley surrounded by high mountains, close to large glaciers. This height will be better appreciated by remembering that Ben Nevis, in Inverness- shire, is 4380 feet high, and Snowdon, in Caernarvonshire, 3571. The village of St. Moritz is about a mile and a half from the baths ; the w^aters of which are strongly chalybeate, with a large amount of free carbonic acid. They are taken internally and used as baths. The air is cold and bracing and stimulating ; there are sudden changes of wind. In July, at night, the thermometer is often as low as 31° Fahr. The average temperature during January and February is 14°. The mean barometric pressure at the Kur- haus is 24 inches (on the English coast it is 30). The removal of one-fifth of the atmospheric pressure gives lightness and elasticity to the physical and mental feelings. The air is suitable to such as have a sluggish circula- tion and uuexcitable nervous system. In the early stage of phthisis benefit has accrued from a residence in the neighborhood of St. Moritz, even during winter. When accommodation cannot be got at St. Moritz, it may usually be obtained at one of the villages in the valley — at Samaden, Pontresina, or Silva-Plana. The Bernina Hotel, at Samaden, is open all the year round. Dr. Berry, at St. Moritz, receives patients. Dr. W. Bayes has strongly recommended [Medical Times and Gazette, p. 400, London, 3d October, 1868) St. Moritz as a winter residence for cases where steady cold and extreme tenuity of air are indicated.
432 APPENDIX OF FORMULA.
Baden, a few miles from Zurich, on the left bank of the Limmat, has several thermal g'aseous springs. The temperature of the waters ranges from 117° to 122° Fahr., and the salts are in the proportion of 34 grs. to the 16 oz. The principal are, chloride of sodrum (13), sidphate of lime (10), smaller quantities of the carbonates of lime and of magnesia and of strontia, sulphate of soda, and the chlorides of potassium and magnesium, etc. There are 22 cubic inches of carbonic acid gas, 125 of nitrogen, and an o&OY of 'sidphuretted hydrogen. The action of these waters is chiefly diuretic and constipating. They are recommended in gouty and rheumatic diseases, in chronic diarrhoea with congestion of the bowels, and in incipient phthisis. They are used internally, and externally as baths and douches. The climate of Baden being mild, invalids often remain throughout the ■winter.
BiRMKNSDORF has bitter purgative waters resembling those of Piillna. They are cold (46° Fahr.), have only traces of carbonic acid gas, and their solid constituents slightly exceed 5 grs. in the 16 oz. They are used princi- pally for exportation.
ScHiNZNACH, in the canton of Aargau, in a valley through which flows the Aar, five miles from Baden, is well known for its saline sulphurous thermal spring. The temperature of the waters is about 94° Fahr., the solid constituents being nearly 15 gi's. in the 16 oz., with 1^ cubic inches of carbonic acid gas, and rather less of sidphuretted hydrogen. The chief salts are, chloride of sodium (5), sidphate of lime (4), sulphate of magnesia (2), carbonate of lime (1), sidphate of soda (1), with minute quantities of carbonate of mcignesia, alumina, and silicic acid. The invalids both drink and bathe ; the baths being used for twenty minutes at first, and afterwards for a longer time if necessary. The pouss^e is milder but appears more quickly than at Leuk. The waters have a reputation for relieving strumous and rheumatic affections, for curing skin diseases, and for healing callous spongy ulcers. The season lasts from the middle of May to the end of September. The climate is mild. Schinznach lies 1060 feet above the sea level.
WiLDEGG, close to Schinzuach, has been gaining repute for some few years as an iodated and bromated spa. The spring rises through an artesian well. The supply of water is scanty. The analysis of Dr. Laue shows the solid contents in 16 ounces to be 110 grains. The chief are, chloride of sodium (80), chloride of magnesium (12), sulphate of lime (14), with iodide of sodium, bromide of sodium, chloride of strontium, etc. There are nearly 2i cubic inches of carbonic acid gets. These waters are recommended in strumous diseases, and in chronic glandular swellings.
THE END,
REVISED CATALOGUE. See Reduction in Prices. The Physicians' Visiting List for 1878 now Ready.
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6
ATTHILL (lombe), M. D.,
Fellow and Examiner in Midwifery, King and Queen's College of Physicians, Dublin.
CLINICAL LECTURES ON DISEASES PECULIAR TO WO- MEN. Second Edition, Revised and Enlarged, with Six Lithographic Plates and other Illustrations on Wood. Price . . . * 2.00
The value and popularity of this book is proved by the rapid sale of the first edition, whicli was exhausted in less than a year from the time of its publication. It appears t» possess three great merits : First, It treats of the diseases very common to females. Second, It treats of them in a thoroughly clinical and 23ractical manner. Third, It is concise, orig- inal, and illustrated by numerous cases from the author's own experience. His style is clear and the volume is the result of the author's large and accurate clinical observation recorded in a remarkable, perspicuous, and terse manner, and is conspicuous for the best qualities of 81 practical guide to the student and practitioner. — British Medical Journal.
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ALTHAUS (JULIUS), M.D.,
Physician to the infirmary of Epilepsy and Paralysis.
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In this work both the scientific and practical aspects of the subject are ably, concisely, and thoroughly treated. It is much the best work treating of the remedial effects of electricity in the English language. — New York Medical Record.
ARNOTT (henry), F.R.C.S. CANCER: its Varieties, their Histology and Diagnosis. With Five Lithographic Plates and Twenty-two Wood Engravings. Price $2.25
AGNEW (d. hayes), M.D.,
Professor of Surgery in the University of Pennsylvania.
THE LACERATIONS OF THE FEMALE PERINEUM. AND
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STIMULANTS AND NARCOTICS. Their Mutual Relations, with Special Researches on the Action of Alcohol, Ether, and Chloroform on the Vital Organism. Octavo. ..... ^3.00
ANDERSON (m'call), M.D.,
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ECZEMA. The Pathology and Treatment of the various Eczema- tous Affections or Eruptions of the Skin. The Tl^ird Revised and En- larged Edition. Octavo. Price ... . . . . ^2.75
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8
BEALE (LIONEL s.), M.D.
DISEASE GERMS: AND ON THE TREATMENT OF DIS- EASES CAUSED BY THEM.
Part L— SUPPOSED NATURE OF DISEASE GERMS. Pabt II. — real nature OF DISEASE GERMS. Part III.— THE DESTRUCTION OF DISEASE GERMS.
Second Edition, much enlarged, with Twenty-eight full-page Plates, containing 117 Illustrations, many of them colored. Demy Octavo. Price *4.oo
This new edition, besides including the contents revised and enlarged of the two former editions published by Dr. Beale on Disease Germs, has an entirely new part added on " The Destruction of Disease Germs."
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BIOPLASM. A Contribution to the Physiology of Life, or an Intro- duction to the Study of Physiology and Medicine, for Students. With Numerous Illustrations. Price ...... ^3.00
This volume is intended as a Text-Book for Students of Physiology, explaining the nature of some of the most important changes which are characteristic of and peculiar to living beings.
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BENNETT (j. henry), M. D.
NUTRITION IN HEALTH AND DISEASE. A Contribution to Hygiene and to Clinical Medicine. Second Edition, Revised and En- larged. Octavo. Cloth. Price $2.50.
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CONSTIPATED BOWELS ; the Various Causes and the Different Means of Cure. Third Edition. Price . . . . ^i.oo
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This edition contains upwards of 200 pages of additional matter, and, in consequence of recent advances in Psychological Medicine, several chapters have heen rewritten, bringing the Classification, Pathology, and Treatment of Insanity up to the present time.
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MEDICAL JURISPRUDENCE OF INSANITY. Second Edition,
very much Enlarged. With References to the Scotch and American Decisions, etc., etc. Octavo. Price . . . . . ^5.00
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MATERIA MEDICA, FOR THE USE OF STUDENTS. With
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This new and thoroughly revised edition of Professor Biddle's worli has incorporated in it all the improvements as adopted by the New United States Pharmacopoeia just issued. It is designed to present the leading facts and principles usually comprised under tliis head as set forth by the standard authorities, and to fill a vacuum which seems to exist in the want of an elementary work on the subject. The larger worlis usually recommended as text-books in our Medical schools are too voluminous for convenient use. This will be found to contain, in a condensed form, all that is most valuable, and will supply students with a reliable guide to the course of lectures on Materia Medica as delivered at the various Medical schools ia the United States.
BALFOUR~7g~w.), M. D.,
Physician to the Royal Infirmary, Edinburgh j Lecturer on Clinical Medicine, &c,
CLINICAL LECTURES ON DISEASES OF THE HEART AND AORTA. With Illustrations. Octavo. Price . . -u . *4.oo
BYFORD (\^71^), A.M., M.D.,
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PRACTICE OF MEDICINE AND SURGERY. Applied to the Diseases and Accidents incident to Women. Second Edition, Revised and Enlarged. Octavo. Price, cloth, ^5.00; sheep . . ^6.00
SAME AUTHOR.
ON THE CHRONIC INFLAMMATION AND DISPLACEMENT
OF THE UNIMPREGNATED UTERUS. A New, Enlarged, and
Thoroughly Revised Edition, with Numerous Illustrations. 8vo. * 2.50
Dr. Byford writes the exact present state of medical knowledge on the subjects presented;
and does this so clearly, so concisely, so truthfully, and so completely, that his book on the
uterus will always meet the approval of the profession, and be everywhere regarded as a
popular standard work. — Buffalo Medical and Surgical Journal,
10
BLACK (d. CAMPBELL), M. D., L. R, C. S. Edinburgh, Member of the Genera! Council of the University of Glasgow, &c., &,c.
THE FUNCTIONAL DISEASES OF THE RENAL, URINARY,
and Reproductive Organs, with a General View of Urinar}' Pathology,
Price * 2.00
The style of the author is clear, easy, and agreeable, . . . his work is a valuable contri- bution to medical science, and beinsf penned in that disposition of unprejudiced philosophical inquiry which should always guide a true physician, admirably embodies the spmt of ita opening CLUotation from Professor Huxley. — P'hilada. Med. Times.
BY SAME AUTHOR. LECTURES ON BRIGHT'S DISEASE OF THE KIDNEYS.
Delivered at the Royal Infirmary of Glasgow. With 20 Illustrations, engraved on Wood. One volume, octavo, in Cloth. Price . * 1.50
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This work includes full botanical descriptions, and an account of the properties and uses of the principal plants employed in medicine, especial attention being paid to those which are officinal in the British and United States Pliarraacopceias. The plants whicli supply food and substances required by the sick and convalescent will be also included. Each spe- cies will be illustrated by a colored plate drawn from nature.
BEASLEY (henry).
THE BOOK OF PRESCRIPTIONS. Containing over 3000 Prescriptions, collected from the Practice of the most Eminent Physi- cians and Surgeons — English, French, and American; comprising also a Compendious History of the Materia Medica, Lists of the Doses of all Officinal and Established Preparations, and an Index of Diseases and their Remedies. Fifth Edition, Revised and Enlarged. Price ^2.50
BY SAME AUTHOR.
THE POCKET FORMULARY: A Synopsis of the British and Foreign Pharmacopoeias. Tenth Revised Edition. Price . *2.5o
THE DRUGGIST'S GENERAL RECEIPT BOOK and VETERI- NARY FORMULARY. Seventh Edition. Price. *2.5o
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HAND-BOOK OF PRACTICAL RECEIPTS. For the Chemist,
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BRAUNE— BELLAMY.
AN ATLAS OF TOPOGRAPHICAL ANATOMY. After Plane Sections of Frozen Bodies, containing Thirty-four Full-page Photo- graphic Plates and numerous other Illustrations on Wood. By Wilhelm Braune, Professor of Anatomy in the University of Leipzig. Trans- lated and Edited by Edward Bellamy, F. R. C. S., Senior Assistant Sur- geon to, and Lecturer on Anatomy and Teacher of Operative Surgery at, the Charing Cross Hospital, London. A large quarto volume. Price in cloth, ^12.00; half morocco, . . . . . ^14.00
11 ^
COHEN (i. soLis), M.D.
Lecturer on Laryngoscopy and Diseases of the Throat and Chest in Jefferson Medical College.
ON INHALATION. ITS THERAPEUTICS AND PRACTICE.
Including a Description of tlie Apparatus employed, &c. With Cases and Illustrations. A New Enlarged Edition. Price . . $2.75
SAME AUTHOR. CROUP. In its Relations to Tracheotomy. Price . . ^i.oo
CARSON (JOSEPH), M.D.,
Professor of iVlateria Medica and Pharmacy in the University,
A HISTORY OF THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF PENNSYLVANIA, from its Foundation in 1765: with Sketches of Deceased Professors, &c. . . . . * 2.00
CHARTERIsT^^THEw), M. D.,
IVIember of Hospital Staff and Professor in University of Glasgow.
STUDENTS' TEXT-BOOK OF THE PRACTICE OF MEDI- CINE. With Illustrations. In the Press. This book will form one volume of the Students' Guide Series, or Text- Books, now in course of publication.
CARPENTER (w. b.), M.D., F.R.S.
THE MICROSCOPE AND ITS REVELATIONS. The Fifth
London Edition, Revised and Enlarged, with more than 500 Illustra- tions. . ^5-5°
SAME AUTHOR. PRINCIPLES OF HUMAN PHYSIOLOGY. The Eighth Revised and Enlarged Edition. With nearly 400 Illustrations on Steel and Wood. Edited by Mr. Henry Power. 1200 pages. Octavo. *5-5o
CHAVASSE (p. henry), F.R.C.S.,
Author of Advice to a Wife, Advice to a Mother, &.c.
APHORISMS ON THE MENTAL CULTURE AND TRAIN- ING OF A CHILD, and on various other subjects relating to Health and Happiness. Addressed to Parents. Price . . . * i.oo
Dr. Chavasse's works have been very favorably received and had a large circulation, the value of his advice to WIVES and MOTHEP^S having thus been very generally recognized. This book is a sequel or companion to them, and it will be found both valuable and important to all who have the care of families, and who want to bring uptlieir children to become useful men and women. It is full of fresh thoughts and graceful illustrations.
CLARKE (w.fairlie), M.D.,
Assistant Surgeon to Charing Cross Hospital.
CLARKE'S TREATISE ON DISEASES OF THE TONGUE.
With Lithographic and Wood-cut Illustrations. Octavo. Price $5.00 It contains The Anatomy and Physiology of the Tongue, Importance of its Minute Exam- ination, Its Congenital Defects, Atrophy, Hypertrophy, Parasitic Diseases, Inflammation, Syphilis and its effects, Various Tumors to which it is subject, Accidents, Injuries, &c., &c.
COOPER (s.).
A DICTIONARY OF PRACTICAL SURGERY AND ENCY- CLOPEDIA OF SURGICAL SCIENCE. New Edition, brought down to the present time. By Samuel A. Lane, F.R.C.S., assisted by other eminent Surgeons. In two vols., of over 1000 pages each. ^15.00
12
CLAY (CHARLES), M. D.
Fellow of the London Obstetrical Society, die.
THE COMPLETE HAND-BOOK OF OBSTETRIC SURGERY,
or, Short Rules of Practice in Every Emergency, from the Simplest to the most Formidable Operations in the Practice of Surgery. First American from the Third London Edition. With numerous Illustra- tions. In one volume. * 2.00
CHAMBERS (thomas k.), M. D.,
LECTURES, CHIEFLY CLINICAL. Illustrative of a Restorative System of Medicine.
CORMACK (sir john ^^^^K. B., F. R. S. E., M. D.
Edinburgh and Paris, Fellow Royal College of Physicians, Physician to the Hertford British Hospital, Paris, &c.
CLINICAL STUDIES, Illustrated by Cases observed in Hospital and Private Practice. With Illustrative Plates. 2 Volumes. Octavo. * 5.00
COBBOLD (t. spencer), M.D., F.R.S. WORMS: a Series of Lectures delivered at the Middlesex Hospital on Practical Helminthology. Post Octavo. . . . . ^2.00
CLEAVELAND (c. h.), M.D.,
Member of the American Medical Association, &.c,
A PRONOUNCING MEDICAL LEXICON. Containing the Cor- rect Pronunciation and Definition of Terms used in Medicine and the Collateral Sciences. Improved Edition, Cloth, *i.oo; Tucks, * 1.25 This work is not only a Lexicon of all the words in common use in Medicine, but it is also a Pronouncing Dictionary, a feature of great value to Medical Students. To the Dis- penser it will prove an excellent aid, and also to the Pharmaceutical Student. It has received strong commendation both from the Medical Press and from the profession.
COLES (oakley), D.D.S.
Dental Surgeon to the Hospital for Diseases of the Throat, &c.
A MANUAL OF DENTAL MECHANICS. Containing much
information of a Practical Nature for Practitioners and Students.
INCLUDING The Preparation of the Mouth for Artificial Teeth, on Taking Impressions, Various Modes of Applying Heat in the Laboratory, Casting in Plaster of Paris and Metal, Precious Metals used in Dentistry, Making Gold Plates, Various Forms of Porcelain used in Mechanical Dentistry, Pivot Teeth, Choosing and Adjusting Mineral Teeth, the Vulcanite Base, the Celluloid Base, Treatment of Deformities of the Mouth, Receipts for Making Gold Plate and Solder, etc., etc.- With 140 Illustrations. Price . . . . . . * 2.00
SAME AUTHOR. ON DEFORMITIES OF THE MOUTH, CONGENITAL AND ACQUIRED, with their Mechanical Treatment. Second Edition, Re- vised and Enlarged. With Illustrations. Price, . . . ^^2.50
CURLING (T.B.), F.R.S.
Consulting Surgeon to London Hospital, &c,
OBSERVATIONS ON DISEASES OF THE RECTUM. With
Illustrations. Fourth Edition, Revised and Enlarged. Octavo. Cloth. Price ........... ^2.75
13
CLARK (f. le gros), F. R. S.,
Senior Surgeon to St. Thomas's Hospital.
OUTLINES OF SURGERY AND SURGICAL PATHOLOGY, .
including the Diagnosis and Treatment of Obscure and Urgent Cases, and the Surgical Anatomy of some Important Structures and Regions. Assisted by W. W. Wagstaffe, F. R. C. S., Resident Assistant-Surgeon of, and Joint Lecturer on Anatomy at, St. Thomas's Hospital. Second Edition, Revised and Enlarged. Price .... *3.oo
• COTTLE (e. wyndham), M. A., F. R. C. S., &c.
THE HAIR IN HEALTH AND DISEASE. Partly from Notes by the late George Nayler, F. R. C. S., Surgeon to the Hospital for Diseases of the Skin, &c. iSmo. Cloth. Price . . $o-75
COOLEY (a. J.).
CYCLOPEDIA OF PRACTICAL RECEIPTS. Containing Pro- cesses and Collateral Information in the Arts, Manufactures, Profes- sions, and Trades, including Medicine, Pharmacy, and Domestic Economy; designed as a General Book of Reference for the Manufac- turer, Tradesman, Amateur, and Heads of Families. The Fifth Edi- tion, Revised and partly Rewritten by Richard V. Tuson, F. C.S., &c. Over I GOO royal-octavo pages, double columns. With Illustrations. Price . . . . . . . . . . . *io.oo
Every part of this edition has been subjected to a thorough and complete revision by the editor, assisted by other scientific gentlemen. In the cliemical portion of the book, every subject of practical importance has been retained, corrected, and added to; to the name of every substance of established composition a formula has been attached; while to the Phar- maceutist its value has been greatly increased by the additions which have been made from the British, Indian, and United States PharmacojDceias.
CAZEAUX (p.), M. D.,
Adjunct Professor of the Faculty of lyiedicine, Paris, etc,
A THEORETICAL AND PRACTICAL TREATISE ON MIDWIFERY,
including the Diseases of Pregnancy and Parturition. Translated from the Seventh French Edition, Revised, Greatly Enlarged, and Improved, by S. Tarnier, Clinical Chief of the Lying-in Hospital, Paris, etc., with numerous Lithographic and other Illustrations. Price, in Cloth, *6.ooj in Leather ........ * 7.00
M. Cazeaux's Great Work on Obstetrics has become classical in its character, and almost an Encycloptedia in its fulness. Written expressly for the use of students of medicine, its teachings are plain and explicit, presenting a condensed summary of the leading i>rinciples established by tlie masters of the obstetric art, and such clear, practical directions for the management of the pregnant, parturient, and ))uerperal states, as have been sanctioned by the most authoritative practitioners, and confirmed by the author's own experience.
DOBELL (HORACE), M. D.,
Senior PInysician to the Hospital,
WINTER COUGH (CATARRH, BRONCHITIS, EMPHYSEMA, ASTHMA). Lectures Delivered at the Royal Hospital for Diseases of the Chest. The Third Enlarged Edition, with Colored Plates. Octavo. Price . . . . . . . . . • * 3.00
This work has been thoroughly revised. Two new Lectures have been added — viz.. Lecture IV., " On the Natural Course of Neglected Winter Cough, and on the Interdepen- dence of Winter Cough with other Diseases ; " Lecture IX., " On Change of Climate in Winter Cough." Also additional matter on Post-nasal Catarrh, Ear-Cough, Artificial Respiration as a means of Treatment, Laryngoscopy, New Methods and Instruments in Treating of Emphy^ sema, a good Index, and Colored Plates, with appended Diagnostic Physical signs.
14 DIXON (jAMEs), F.R.C.S.
Surgeon to the Royal London Ophtha'mic Hospital, &.c,
A GUIDE TO THE PRACTICAL STUDY OF DISEASES OF
THE EYE, with an Outline of their Medical and Operative Treatment,
with Test Types and Illustrations. Third Edition, thoroughly Revised,
and a great portion Rewritten. Price * 2.00
Mr. Dixon's book is essentially a practical one, written by an observant author, who brings to his special subject asouud knowledge of general Medicine and Surgery. — Dublin Quarterly.
DILLNBERGER (dr. emil).
A HANDY-BOOK OF THE TREATMENT OF WOMEN AND
CHILDREN'S DISEASES, according to the Vienna Medical School. Part I. The Diseases of Women. Part II. The Diseases of Children. Translated from the Second German Edition, by P. Nicol, M. D. Price . . . . . . . . . . . * 1.50
Many practitioners will be glad to possess this little manual, which gives a large mass of practical hints on the treatment of diseases which ])robal)ly make u]^ the larger half of every-day practice. The translation is well made, and explanations of reference to German medicinal preparations are given with proper fulness. — The Practitioner.
DUNGLISON (RICHARD j.), M. D.
THE PRACTITIONER'S REFERENCE BOOK. Containing
Therapeutic and Practical Hints, Dietetic Rules and Precepts, and
other General Information Useful to the Physician, Pharmacist, and
Student. Octavo. Cloth. Price ^3- 5°
DUCHENNE (dr. g. b.).
LOCALIZED ELECTRIZATION AND ITS APPLICATION TO PATHOLOGY AND THERAPEUTICS. Translated by Her- bert TiBBiTS, M.D. With Ninety-two Illustrations. Price . $3.00 Duchenne's great work is not only a well-nigh exhaustive treatise on the medical uses of Electricity, but it is also an elaborate exposition of the different diseases in which Electric- ity has proved to be of value as a therapeutic and diagnostic agent.
Part II., illustrated by chfomo-lithographs and numerous wood-cuts, is preparing.
DURKEE (silas), M.D.,
Fellow of the Massachusetts Medical Society, &c.
GONORRHCEA AND SYPHILIS. The Fifth Edition, Revised
and Enlarged, with Portraits and Eight Colored Illustrations. Octavo.
Price . . . . . . . . . . • *3-5o
Dr. Durkee's work impresses the reader in favor of the author by its general tone, the thorough honesty everywhere evinced, the skill with which the book is arranged, the man- ner in which the facts are cited, the clever way in which the avithor's experience is brought in, the lucidity of the reasoning, and the care with which the therapeutics of venereal com- plaints ai'e treated. — Lancet.
DRUITT (ROBERT), F.R.C.S. THE SURGEON'S VADE-MECUM. A Manual of Modern Sur- gery. The Tenth Revised and Enlarged Edition, with 350 Illustra- tions ^5.00
15 DALBY (w. B.), F. R. C. S.,
Aural Surgeon to St. George's Hospital.
LECTURES ON THE DISEASES AND INJURIES OF THE EAR. Delivered at St, George's Hospital. With Illustrations. Price . . . . . . . . . . . ^1.50
We cordially recommend this admirable volume by Mr. Dalby as a trustworthy guide in the treatment of tiie art'ections of the ear. The book is moderate in price, beautifully illus- trated by wood-cuts, and got up in the best style. — Glasgow Medical Journal.
DAY (WILLIAM henry), M. D.,
Physician to the Samaritan Hospital for Women and Children, &c.
HEADACHES, THEIR NATURE, CAUSES, AND TREAT- MENT. i2mo. Cloth. Price ^2.00
DUNGLISON (robley), M. D.,
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ELLIS (EDWARD), M. D., Physician to the Victoria Hospital for Sick Children, &c.
A PRACTICAL MANUAL OF THE DISEASES OF CHIL- DREN, with a Formulary. Third Enlarged Edition, Revised and Improved. One volume.
The AUTHOR, in issuing this new edition of his bonk, says : "I have very carefully revised each chapter, addhig several new sections, and making considerable additions where the subjects seemed to require fuller treatment, without, however, sacrificing conciseness or ijnduly increasing the bulk of the volume."
ELAM (CHARLES), M.D., F.R.C.P. ON CEREBRIA AND OTHER DISEASES OF THE BRAIN.
Octavo.
52.50
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THE HEART AND ITS DISEASES, AND THEIR TREAT- MENT. With Illustrations. Octavo. Price . . . ^5.00
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Physician to the Department for Skin Diseases in University College Hospital.
ATLAS OF SKIN DISEASES. Consisting of a Series of Colored Illustrations, in Monthly Parts, together with Descriptive Text and Notes upon Treatment ; each Part containing Four Plates, reproduced by Chromo-Lithography from the work of Willan & Bateman, or taken from Original Sources. Now Complete in 18 Parts. Price, per Part, ^2.00 ; or in one large Folio volume, bound in cloth. Price . . ,136.00
16
FENNER (c. s.), M. D., &c.
VISION: ITS OPTICAL DEFECTS, and the Adaptation of Spec- tacles ; embracing Physical Optics, Physiological Optics, Errors of Re- fraction and Defects of Accommodation, or Optical Defects of the Eye. With 74 Illustrations. Selections from the Test Types of Jaeger and Snellen, etc. Octavo. Price ...... ^3.50
FOSTER (BALTHAZAR), M.D.,
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HOW TO TEACH CHEMISTRY, being the substance of Six Lectures to Science Teachers. Reported, with the Author's sanction, by G. George Chaloner, F. C. S., &c. With Illustrations . ;^i.25
FENWICK (SAMUEL), M.D., F.R.C.R
THE MORBID STATES OF THE STOMACH AND DUO- DENUM, AND THEIR RELATIONS TO THE DISEASES OF OTHER ORGANS. With Ten Plates ^5.00
FLINT (AUSTIN), M.D.,
Professor of the Principlps and Practice of Medicine, &.C., Bellevue Hospital College, New York,
CLINICAL REPORTS ON CONTINUED FEVER. Based on an Analysis of One Hundred and Sixty-four Cases, with Remarks on the Management of Continued Fever; the Identity of Typhus and Typhoid Fever; Diagnosis, &c., &c. Octavo. Price . . ;g2.oo
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DISEASES OF THE BLADDER, PROSTATE GLAND, AND URETHRA, including a Practical View of Urinary Diseases, Deposits, and Calculi. Fourth Edition, Revised and Enlarged. With New Il- lustrations. Now Ready. Price . . . . . • *3-5o
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GODFREY (benjamin), M.D., F.R.A.S. THE DISEASES OF HAIR: a Popular Treatise upon the Affec- tions of the Hair System $^-5°
GROSS (SAMUEL D.), M.D., Professor of Surgery in the Jefferson Medical College, Philadelphia, &c.
AMERICAN MEDICAL BIOGRAPHY OF THE NINETEENTH CENTURY. With a Portrait of Benjamin Rush, M.D. Octavo. I3.50
17 GREENHOW (e. headlam), M.D.,
Fellow of the Royal Colleije of Physicians, &c.
ON CHRONIC BRONCHITIS. Especially as Connected with Gout, Emphysema, and Diseases of the Heart. Price . . . * 1.50 Of all worlds yet written on Chronic Bronchitis, this is undonbtedly the best. The style is clear and to tlie point, and the principles of pathology ajid treatment eminently correct and practical. It is a positive addition to our medical literature. — Journal Psychological Medicine.
BY SAME AUTHOR.
ADDISON'S DISEASE. Being the Cronian Lectures for 1875. Delivered before the Royal College of Physicians. Revised, and Illus- trated by numerous Cases and 5 full-page Colored Engravings. One volume, octavo. Price . . . . . . . , * 3.00
HARLEY (GEORGE), M. D., F. R. C. P.,
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THE URINE AND ITS DERANGEMENTS: With the Applica- tion of Physiological Chemistr}^ to the Diagnosis and Treatm.ent of Constitutional as well as Local Diseases. New Revised and Enlarged Edition preparing. With Engravings.
We have here a valuable addition to the library of the practising physician; not only for the information which it contains, bijt also for the suggestive way in which many of the subjects are treated, as well as for the fact that it contains the ideas of one who thoroughly believes in the future capabilities of Therapeutics based on Physiological facts, and in the important service to be rendered by Chemistry to Physiological investigation.
American Journal of the Medical /Science:
HEATH (CHRISTOPHER), F. R. C. S.,
Surgeon to University College Hospital and Holme Professor of Clinical Surgery in University C(rflege, OPERATIVE SURGERY. Elegantly Illustrated by 20 Large Col- ored Plates, Imperial Quarto Size, each Plate containing several Fig- ures, drawn from Nature by M. Leveille, of Paris, and Colored by hand under his direction. Complete in Five Quarterly Parts. Price, per Part, ^2.50; or in one volume, handsomely bound in cloth. Price ^14.00
HEWITT (graily), M. D.,
Physician to the British Lying-in Hospital, and Lecturer on Diseases of Women and Children, &.c,
THE DIAGNOSIS, PATHOLOGY, AND TREATMENT OF DISEASES OF WOMEN, including the Diagnosis of Pregnancy. Founded on a Course of Lectures delivered at St. Mary's Hospital Medical School.- The Third Edition, Revised and Enlarged, with new Illustrations. Octavo. Price in Cloth . . . * 4.00
" Leather . . ^ . ' * 5.00 This new edition of Dr. Hewitt's book has been so much modified, that it may be considered substantially a new book ; very much of the matter has been entirely rewritten, and the whole work has been rearranged in such a manner as to present a most decided improvement over previous editions. Dr. Hewitt is the leading clinical teacher on Diseases of Women in London, and the characteristic attention paid to Diagnosis by him has given his work great popularity there. It may unquestionably be considered the miost valuable guide to correct Diagnosis to be found in the English language. „
18 HILLIER (THOMAS), M.D.,
Physician to the Hospital for Sick Children, &c,
A CLINICAL TR EATISE ON THE DISEASES OF CHILDREN.
Octavo. Price . . . . . . , . . * 2.00
We have said enoiigh to indicate and illustrate the excellence of Dr. Hillier's volume. It is eminently the kind of book needed by all medical men who wish to cultivate clinical accuracy and sound practice. — London Lancet.
HOLDEN (luther), F.R.C.S.
HUMAN OSTEOLOGY, comprising a Description of the Bones
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HOLDEN'S MANUAL OF DISSECTIONS. Price . ^5.00 HARRIS (cHAPiN A.), M. D., D. D. S.
Late President of and Professor of the Principles and Practice of Dental Surgery in the Baltimore College, &c.
THE PRINCIPLES AND PRACTICE OF DENTISTRY. Tenth Revised Edition. In great part rewritten, rearranged, and with many new and important Illustrations. Including — i. Dental Anatomy and Physiology. 2. Dental Pathology and Therapeutics. 3. Dental Sur- gery. 4. Dental Mechanics. Edited by P. H. Austen, M.D., Pro- fessor of Dental Science and Mechanism in the Baltimore College of Dental Surgery. With nearly 400 Illustrations, including many new ones made especially for this edition. Royal octavo. Price, in cloth, ^6.50; in leather ........ ;^7.5o
This new edition of Dr. Harris's work has been thoroughly revised in all its parts — more so than any previous edition. So great have been the advances in many branches of dentistry, . that it was found necessary to rewrite the articles or subjects, and this has been done in the most eflScient manner by Professor Austen, for many years an associate and friend of Dr. Harris, assisted by Professor Gorgas and Thomas S. Latimer, M. D. The publishers feel assured that it will now be found the most complete text-book for the student and guide for the practitioner in the English language.
SAME AUTHOR. A DICTIONARY OF MEDICAL TERMINOLOGY, DENTAL SURGERY, AND THE COLLATERAL SCIENCES. Fourth Edition, Carefully Revised and Enlarged, by Ferdinand J. S. Gorgas, M. D., D.D.S., Professor of Dental Surgery in the Baltimore College, &c., &c. Royal octavo. Price, in cloth, ^6.50; in leather . . $1-S°
The many advances in Dental Science rendered it necessary that this edition should be thoroughly revised, which has been done in the most satisfactory manner by Professor Gorgas, Dr. Harris's successor in the Baltimore Dental College, he having added nearly three thou- sand new words, besides making many additions and corrections. The doses of tlie more prominent medicinal agents have also been added, and in every way the book has been greatly improved, and its value enhanced as a work of reference.
HANDY (WASHINGTON R.), M.D. Late Professor of Anatomy, &.c., in the Baltimore Collegei
A TEXT-BOOK OF ANATOMY, AND GUIDE TO DISSEC- TIONS. For the Use of Students of Medicine and Dental Surgery. With 312 Illustrations. Octavo. Price ... . . *3.oo
Dr. Handy's work was prepared with special reference to the wants of the Student and
Practitioner of Dental Surgery. Directing particular attention to thp Mouth, it shows step
by step the important Anatomical and Physiological relations which it has with each and
all the organs and functions of the general system.
19
HARDWICH AND DAWSON.
HARDWICH'S MANUAL OF PHOTOGRAPHIC CHEMISTRY, With Engravings. Eighth Edition. Edited and Rearranged by G. Dawson, Lecturer on Photography, &c., &c. i2mo. . . ^2.00
The object of the Editor has been to give practical instruction in this fascinating art, and to lead the novice from iirst princijiles to tlie higher branches, impressing him with the value of care and exactness in every operation.
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ON THE ACTION OF MEDICINES IN THE SYSTEM. Sixth American from the Fourth London Edition. Revised and Enlarged. Octavo. Price ......... ^3.00
Dr. Headland's work gives the only scientific and satisfactory view of the action of medi- cine; and this not in the way of idle speculation, but by demonstration and experiments, and inferences almost as indisputable as demonstrations. It is truly a great scientific work in a small compass, and deserves to be the hand-book of every lover of the Profession. It has received the approbation of the Sledical Press, both in this country and in Europe, and is pronounced by them to be the most original and practically useful work that has been issued for many years.
HILLES (m. w.),
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HEATH (Christopher), F.R.C.S.,
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INJURIES AND DISEASES OF THE JAWS. The Jacksonian
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HAYDEN (THOMAS), M. D.,
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THE DISEASES OF THE HP:ART AND AORTA. With 81 Illustrations. In tvi^o volumes, Octavo, of over 1200 pages. Price, * 6.00
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THE ART OF PROLONGING LIFE. Edited by Erasmus Wil- son, M. D., F. R.S., &c. i2mo. Cloth *i.oo
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20 . HEWSON (addinell,) M. D.
Attending Surgeon Pennsylvania Hospital, &.c.
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HODGE ON FCETICIDE, OR CRIMINAL ABORTION.
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A TREATISE ON GOUT, RHEUMATISM, AND THE ALLIED AFFECTIONS. Crown octavo. ^4.25
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ON THE OPERATIVE SURGERY OF THE FOOT AND
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DEFECTS OF SIGHT AND HEARING. Their Nature, Causes, Prevention, &c. Second Edition. Price . . . ^ *i,oo
JONES, SIEVEKING, and PAYNE.
A MANUAL OF PATHOLOGICAL ANATOMY. By C. Hand- field Jones, M. D., F. R. S., Physician to St. Mary's Hospital; and Edward H. Sieveking, M.D., F.R.C.P., Physician to St. Mary's Hos- pital. A New and Enlarged Edition. Edited by J. F. Payne, M.B., F.R.C.P., Assistant Physician and Lecturer on Morbid Anatomy at St. Thomas's Hospital. With Numerous Illustrations. . ' . ^6.00
21 KIRBY (e. a.), M. D., M. R. C. S. Eng.,
Late Physician to the City Dispensary,
ON THE ADMINISTRATION AND VALUE OF PHOSPHO- RUS, as a Remedy for Loss of Nerve Power, Neuralgia, Hysteria, etc. With Formulae for Combinations with Iron, etc.
LAWSON (GEORGE), F.R.C.S.,
Surgeon to the Royal London Ophthalmic Hospital,
DISEASES AND INJURIES OF THE EYE, THEIR MEDICAL AND SURGICAL TREATMENT. Containing a Formulary, Test Types, and Numerous Illustrations. Price . . . . *2.oo
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LEBER & ROTTENSTEIN (drs.).
DENTAL CARIES AND ITS CAUSES. An Investigation into the Influence of Fungi in the destruction of the Teeth, translated by Thomas H. Chandler, D.M.D , Professor of Mechanical Dentistry in the Dental School of Harvard University. With Illustrations. Octavo, Price . . . . . . . . . . . * 1.25
This work is now considered the best and most elaborate work on Dental Caries. It is everywhere quoted and relied upon as authority by the profession, who have seen it in the Oi-iginal, and by authors writing on the subject.
LEGG (j. wickham), M. D.
Member of the Royal College of Physicians, &.c,
A GUIDE TO THE EXAMINATION OF THE URINE. For
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LEARED (ARTHUR), M.D., F.R.C.P.
IMPERFECT DIGESTION: ITS CAUSES AND TREATMENT.
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CHEMIA COARTATA ; or, The Key to Modern Chemistry. With Numerous Tables, Tests, &c., &c. Price, . . . . ^2.25
LIVEING (EDWARD), M. D.
ON MEGRIM, SICK- HEADACHE, AND SOME ALLIED DISORDERS. With Colored Plate. Octavo . . . ^6.00
22
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Professor at the Fr.-Wilh. University) and Surgeon-in-Chief of the Syphilitic Wards and Skin Diseases of
^ the Charity Hospital, Berlin.
THE TREATMENT OF SYPHILIS by Subcutaneous Sublimate Injections. With a Lithographic Plate illustrating the Mode and Proper Place of administering the Injections, and of the Syringe used for the purpose. Translated by Carl Prgegler, M.D., late Surgeon in the Prussian Service, and E. H. Gale, M.D., late Surgeon in the United States Army. Price . . . . . . . . * 1.50
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. LIZARS (JOHN), M. D.
Late Professor of Surgery in the Royal College of Surgeons, Edinburgh,
THE USE AND ABUSE OF TOBACCO. From the Eighth Edinburgh Edition. i2mo. Price, in flexible cloth, . *o.c;o
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MACNAMARA (c).
Surgeon to the Ophthalmic Hospital, and Professor of Ophthalmic Medicine in the Medical College, Calcutta.
MANUAE OF THE DISEASES OF THE EYE. The Third Edition, carefully Revised; with Additions, and numerous Colored Plates, Diagrams of the Eye, many Illustrations on Wood, Snelleit's Test Types, &c., &c. Price . . . . -. . . * 4.00
"This work wiien first published took its place in medical literature as the most complete, condensed, and well-arranged manual on oi^hthaimic surgery in the English language. Arranged especially for medical students, it became, however, the work of reference for the busy practitioner, who could obtain nearly all that was best worth knowing on this subject, tersely stated, and easily found by the aid of tlie excellent marginal notes on the contents of the paragraphs." — Fhiladelphia lledical Times.
MACKENZIE (morell), M. D.
Physician to the Hospital for Diseases of the Throat, London, &c.
GROWTHS IN THE EARYNX. Their History, Causes, Symp- toms, Diagnosis, Pathology, Prognosis, and Treatment. With Reports and Analysis of One Hundred Consecutive Cases treated by the Author ; and a Tabular Statement of every published case treated since the in- vention of the Laryngoscope. With numerous Colored and other Illustrations. Octavo. Price . . . . . . * 2.50
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care and expense.
OTHER V^^ORKS BY SAME AUTHOR.
THE LARYNGOSCOPE IN DISEASES OF THE THROAT.
With an Appendix on Rhinoscopy, and an Essay on Hoarseness and Loss of Voice. With Additions by J. SoLis Cohen, and Numerous Illustrations on Wood and Stone. Price ....
PHARMACOPCEIA OF THE HOSPITAE for Diseases of the Throat; with One Hundred and Fifty Formulae for Gargles, &c., &c. Price ^1.25
23
MEIGS AND PEPPER.
A PRACTICAL TREATISE ON THE DISEASES OF CHIL- DREN. By J. Forsyth Meigs, M.D., Fellow of the College of Physi- cians of Philadelphia, &c., Sic, and William Pepper, M.D., Physician ' to the Philadelphia Hospital, &c. Sixth Edition, thoroughly Revised and greatly Enlarged, forming a Royal Octavo Volume of over looo pages. Price, bound in cloth, ^6.00; leather . . . I7.00
It is tlie most complete work on the subject in o.ur language. It contains at once the re- sults of personal, aud the experience of others. Its quotations from the most recent author- ities, at home and abroad, are ample, and we think tlie authors deserve congratulations for having produced a book unequalled for the use of the student and indispensable as a work of reference for the practitioner. — American Medical Journal.
MURPHY (JOHN G.), M.D.
A REVIEW OF CHEMISTRY FOR STUDENTS. Adapted to the Courses as Taught in the Principal Medical Schools in the United States. . . . . . . . . . . ^1.25
MENDENHALL (george), M.D.,
Professor of Obstetrics in the Medical College of Ohio, &c.
MEDICAL STUDENT'S VADE MECUM. A Compendium of Anatomy, Physiology, Chejuistry, the Practice of Medicine, Surgery, Obstetrics, Diseases of the Skin, Materia Medica, Pharmacy, Poisons, &c., &c. Eleventh Edition, Revised and Enlarged, with 224 Illustra- tions. In cloth .........* 2.00
MAXSON (EDWIN R.), M.D.,
Formerly Lecturer on the Practice of Medicine in the Geneva Medical College, &c.
THE PRACTICE OF MEDICINE *3.oo
MARSHALL (john), F.R.S.,
Professor of Surgery, University College, London.
PHYSIOLOGICAL DIAGRAMS. Life-size, and Beautifully Col- ored. An Entirely New Edition, Revised and Improved, illustrating the whole Human Body, each Map printed on a single sheet of paper, seven feet long and three feet nine inches broad.
No. 1. The Skeleton and Ligaments. No. 7. The Brain and Nerves.
No. 2. The Muscles, Joints, and Animal Me- No. 8. The Organs of the Senses and Organs chanics. of the Voice. Plate 1.
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No. 4. The Organs of Circulation. Textures. Plate 1.
No. 5. The Lymphatics or. Absorbents. No. 11. The Microscopic Structure of the
No. 6. The Digestive Organs. Textures. Plate 2.
Price of the Set, Eleven Maps, in Sheets, ..... I50.00 " " " " handsomely Mounted on
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MADDEN (t. m.), M.D.
Author of " Climatology and the Use of Mineral Waters."
THE HEALTH RESORTS OF EUROPE AND AFRICA for the
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24 MAUNDER (c. f.), F. R. C. S.
Surgeon to the London Hospital; formerly Demonstrator of Anatomy at Guy's Hospital.
OPERATIVE SURGERY. Second Edition, with One Hundred and Sixty-four Engravings on Wood. Price . . . ^2.50
BY SAME AUTHOR.
SURGERY OF THE ARTERIES, including Aneurisms, Wounds, PIsemorrhages, Twenty-seven Cases of Ligatures, Antiseptic, etc. With 18 Illustrations. Price . . . . . . . . *i.5o
MAYNE (r. g.), M. D., and MAYNE (j.), M. D.
MEDICAL VOCABULARY: An Explanation of all Names, Synonyms, Terms, and Phrases used in Medicine and the Relative Branches of Medical Science, giving their correct Derivation, Meaning, Application, and Pronunciation. Intended especially as a book of reference for Physicians and Students. Fourth Edition, Revised and Enlarged. Post Svo. 450 pages. Price .... ^3-oo
MARTIN (joHNH.).
Author of Microscopic Objects, &c.
A MANUAL OF MICROSCOPIC MOUNTING. With Notes on the Collection and Examination of Objects, and upwards of One Hun- dred Illustrations on Stone and Wood, drawn by the Author. Price ........... ^^.00
MEADOWS (ALFRED), M.D.
Ptiysician to the Hospital for Women, and to the General Lying-in Hospital, &c.
MANUAL OF MIDWIFERY. A New Text-Book. Including the Signs and Symptoms of Pregnancy, Obstetric Operations, Diseases of the Puerperal State, &c., &c. Second American from the Third Lon- don Edition. Revised and Enlarged. With 145 -Illustrations. * 3.00
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MILLER (jAMEs), F. R. C. S.
Professor of Surgery University of Edinburgh.
ALCOHOL, ITS PLACE AND POWER. From the Nineteenth
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This work was prepared by Professor Miller at the special request of the Scottish Temper- ance League, who were anxious to have a work of high authority, presenting the medical view of the subject that could be freely disseminated among all classes.
MILLER AND LIZARS.
ALCOHOL: Its Place and Power. By James Miller, F.R.S.E., late Professor of Surgery in the University of Edinburgh, &c. — THE USE AND ABUSE OF TOBACCO. By John Lizars, late Professor to the Royal College of Surgeons, &c. The Two Essays in One Volume. i2mo. ^i.oo
25
MARSDEN (ALEXANDER), M.D.
A NEW AND SUCCESSFUL MODE OF TREATING CERTAIN FORMS OF CANCER. Second Edition, Colored Plates. . ^3.50
MACDONALD (j. d.), M. D.,
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A GUIDE TO THE MICROSCOPICAL EXAMINATION OF DRINKING WATER. With Twenty Full-page Lithographic Plates, References, Tables, etc., etc. Octavo. Price . . . ^3.00
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26
PARKES (EDWARD A.), M. D., Professor of Military Hygiene in tlie Army Medical Sdiool, &c.
A MANUAL OF PRACTICAL HYGIENE. The Fourth Revised and Enlarged Edition, for Medical Officers of the Army, Civil Medical Officers, Boards of Health, &c., &c. With many Illustrations. One Volume Octavo. Price ....... ^6.00
This work, previously unrivalled as a text-book for medical officers of the army, is now equally unrivalled as a text-book for civil medical officers. The fi.i"st book treats in succes- sive chapters of water, air, ventilation, examination of air, food, quality, choice, and cooking of food, beverages, and condiments ; soil, habitations, removal of excreta, warming of houses, exercise, clothing, chmate, meteorology, individual hygienic management, disposal of the dead, the prevention of some common diseases, disinfection, and statistics. The second book is devoted to the service of the soldier, but is hardlj' less instructive to the civil officer of health. It is, in short, a comprehensive and trustworthy text-book of hygiene for the scientific or general reader. — London Lancet.
POWER (henry), M. B., F. R .C. S.,
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27 PARSONS (CHARLES), M. D.,
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28 RINDI^LEISCH (dr. edward).
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11
29 RADCLIFFE (charles bland), M.D.,
Fellow of the Royal Cclkge of Physicians of London, &c.
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RICHARDSON (joseph), D.D.S.
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THE STUDENT'S GUIDE TO THE PRACTICE OF MID- WIFERY. With 95 Illustrations. Price . . . . * 2.00
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30
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31
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LECTURES ON THE EFFICIENT TRAINING OF NURSES' FOR HOSPITAL AND PRIVATE* WORK. With Illustrations. 121110. Cloth. Price ,,...... ^2.25
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32 SWERINGEN (hiram v.).
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PHARMACEUTICAL LEXICON. A Dictionary of Pharmaceu- tical Science. Containing.a concise explanation of the various subjects and terms of Pharmacy, with appropriate selections from the collateral sciences. Formulae for officinal, empirical, and dietetic preparations; selections from the prescriptions of the most eminent physicians of Europe and America; an alphabetical list of diseases and their defini- tions; an account of the various modes in use for the preservation of dead bodies for interment or dissection; tables of signs and abbrevia- tions, weights and measures, doses, antidotes to poisons, &c., &c. Designed as a guide for the Pharmaceutist, Druggist, Physician, &c. Royal Octavo. Price in cloth , . . . . . *3.oo " leather . . . . . . * 4.00
SEWILL (h. e.), M. R. C. S., Eng., L. D. S.,
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THE STUDENT'S GUIDE TO DENTAL ANATOMY AND SURGERY. With 77 Illustrations. Price . . . . *i.5o
SHEPPARD (edgar), M. D.
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SAVAGE (henry), M. D., F. R. C. S.
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Physician to the East London Hospital for Diseases of Children, &c.
CLINICAL STUDIES OF DISEASES OF THE LUNGS IN CHILDREN. Price ^2.50
33
TANNER (THOMAS hawkes), M.D., F.R.C.P,, &c.
THE PRACTICE OF MEDICINE. SL^th American from the last London Edition. Revised, much Enlarged, and thoroughly brought up to the present time. With a complete Section on the Diseases Peculiar to Women, an extensive Appendix of Formulae for Medicines, Baths, &c., &c. Royal Octavo, over iioo pages. Price, in cloth, ^6.00; leather . ... . . . . . . . ^7.00
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SAME AUTHOR.
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TAFT (JONATHAN), D.D. S., •' Professor of Operative Dentistry in the Ohio College, &c.
A PRACTICAL TREATISE ON OPERATIVE DENTISTRY.
Third Edition, thoroughly Revised, with Additions, and fully brought up to the Present State of the Science. Containing over 100 Illustra- tions. Octavo. Price, in cloth, I4. 25. In leather, . . ^5-oo Professor Taft has done good service in thus embodying, in a separate volume, a compre- bensive view of operative dentistry. This gentleman's position as a teacber must have ren- dered him familiar with the most recent views which are entertained in America on this matter, while his extensive experience and well-earned reputation in practice must have rendered him a competent judge of their merits. We willingly commend Professor Taft's able and useful work to the profession. — London Dental Review,
3
34 TROUSSEAU (a.),
Professor of Clinical JVledicine to the Faculty of Medicine, Paris, &c.
LECTURES ON CLINICAL MEDICINE. Delivered at the HStel Dieu, Paris. Translated from the Third Revised and Enlarged Edition by P. Victor Bazire, M.D., London and Paris; and John Rose Cor- MACK, M.D., Edinburgh, F.R.S., &c. With a full Index, Table of Con- tents, &c. Complete in Two volumes, royal octavo, bound in cloth. Price* 8.00; in Leather . . ... . . . * 10.00
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TILT (edward John), M.D.
THE CHANGE OF LIFE IN HEALTH AND DISEASE. A
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TOYNBEE (j.), F.R.S.
ON DISEASES OF THE EAR. Their Nature, Diagnosis, and'
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35 THOROWGOOD (j. c), M. D.
Physician to the City of London Hospital for Diseases of the Chest, and to the West London Hospital, &c.
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TOMES (JOHN), F. R. S.
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A SYSTEM OF DENTAL SURGERY. The Second Revi.sed and
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This book has been for some time out of print in this country. The material progress made in the science of Dental Surgery since its first publication has rendered large additions and many revisions necessary to the New Edition : in order to bring it fully up to the time ; this has been done without increasing the size of the book more than possible. Many improve- ments, however, will be found added to the Text, and some Sixty new illustrations are in- corporated in the volume.
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/ A MANUAL OF DENTAL ANATOMY, HUMAN AND COM- PARATIVE. With 179 Illustrations. Now Ready. Price . $3.50
TRANSACTIONS OF THE COLLEGE OF PHYSICIANS
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