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Full text of "An index of diseases, their symptoms and treatment : arranged in alphabetical order, for easy reference : including also a tabular synopsis of diseases, a very full appendix of formulae : arranged in twenty-one classes, directions for sick-room preparations, the use of mineral waters, climates for invalids, etc."

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http://www.archive.org/details/indexofdiseasest1882tann 



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. 



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^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. 
Resj ji rat ion 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 dil atatio n 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 a lien 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 ; paroxys ms of dy spnoea 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 ri ffht ven iricle 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^Mnur mur ca n 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 hear t. 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 o f 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, varyi ng fro m 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; ■^" 
h ypersem ia 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, a s a r ule, 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 ; dru ukenn gss 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, p hthisis , 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 la xge pea to a small po tato. 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 i mmatur e __tap eworms — 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 t apping . 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 pe ritoneal in vestment, 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. Di Latation 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. Ru pture 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'tTus cT^yorTrul ik 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 insert ed 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. — Inflam mat ion 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 blo od 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 j ust bey ond 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 pai nful sp asms 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. 
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 


. 


.. .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 u ric ac id ; sometimes blood, pus, or r op}^ m ucus. 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 (O xalat e 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 so lution of ca lculus (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 " 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 


. . 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 ski